Above the Fold
What is a Patient?
By ROB LAMBERTS, MD
What is a patient? What do they do? What’s their role in the doctor’s office? Are they chassis on a conveyor belt? Are they puzzles for doctors to solve? Are they diseases? Are they demographics? Are they a repository for applied science?
Or are they consumers? Are they paying customers? Are they the ones in charge? Are they employing physicians for their own needs?
It depends. It depends on the situation. It depends on perspective.
Some physicians are very offended when the “consumer” and “customer” labels are applied to patients. They see this as the industrialization of healthcare. We are no longer professionals, we are made into “providers” – a sort of smart vending-machine made out of flesh.
Reckless REC Wrecking
The Health Information Technology Extension Program, created and funded by ONC, has completed funding for all 62 Regional Extension Centers (REC), with a grand total of well over half a billion dollars and, predictably, criticism of the program was immediately forthcoming. The RECs are supposedly an impediment to free EHR markets and doomed to failure from the start, which may seem a bit contradictory if you think about it. Anyway, before making further statements and assertions regarding the “recklessness” of the RECs, or the impeding “train wreck” they represent, it may be beneficiary to take a closer look at the program.
Overview
The HIT Extension Program consists of 62 RECs, at least one for each State and territory, and one national Research Center (RC). The stated goal of the program is “to provide outreach and support services to at least 100,000 priority primary care providers within two years”. The individual RECs are supposed to conduct outreach and education campaigns in their respective States and inform physicians on the latest HIT developments and available programs and incentives. The RECs are also chartered to offer support and guidance to physicians selecting and implementing EHRs, particularly Primary Care docs in small practices and in underserved areas. These are the doctors that were left out by the regular market process because they were hard to reach, too expensive to implement and too poor to bother with. While the individual RECs are locally oriented, with feet on the ground in each State and each County, the RC is basically a National forum for RECs to share information and exchange lessons learned.
Funding
Other than a small amount of seed money, RECs are not handed out all those hundreds of millions of dollars of grant funds. RECs are paid for performance. For each physician they touch and manage to recruit, the RECs are paid about $1500. If and when the provider implements an EHR, the RECs receive another equal payment. The last third of the money is handed to the REC if, and only if, the provider achieves Meaningful Use. This arrangement is only in effect for two years. All those who believe that RECs are bound to fail should be reassured by the fact that in that dire case most of the allocated funds will remain with ONC. The RECs are expected to use the ONC seed money and find a way to become sustainable businesses after ONC ceases to support them financially.
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Seeds of Destruction
By
I never used to talk much with hospital CEOs. After all, if you’re running a hospital, improving the revenues of the physician practice by 6%, when the physician revenues only make up 10% of your overall revenues, doesn’t really make it to the scheduling screen.
Now it seems that hospital CEOs are the only new people I meet. In fact, I recently had dinner with over 100 of them at a meeting of the Leadership Institute in Washington, D.C. I gave the breakfast speech the next morning…it was awkward.
You see, I’m dying to be liked by these people—all people really—but these are health system/hospital CEOs and CMOs, many of whom are currently thinking about adding hundreds or even thousands of doctors to their payrolls. For a guy who does business services for doctors, who better to be friends with?! And yet, the only thing I could think to say to them was that they were sowing the seeds of their own destruction! I try to be smooth and cool when I get up in front of these groups, but somehow, when the microphone turns on, I can’t keep what’s on my mind from pouring out of my mouth!
I’m not exactly sure how I said it then, but let me try to say it like a grown-up now.Continue reading…
A more palatable path to rationing
By DAVID WILLIAMS
Rationing is a very dirty word in America, evoking grim images of wartime Great Britain and –in the health care context– withholding of needed care from patients based on cost. But cut back on costs we must, and with magical thinking about the deficit becoming every more popular, we’ll have to find other ways to convince folks to do it.
Patient safety is a promising guise under which to achieve cutbacks, especially in costly areas where the dangers are real. The new radiation protection bill signed into law in California yesterday is a great example. From AuntMinnie (Calif. governor signs medical radiation bill into law):
The bill requires that radiation dose be recorded on the scanned image and in a patient’s health records, and that radiation overdoses be reported to patients, treating physicians, and the state Department of Public Health (DPH).
The law is clearly focused on overdoses, but once patients realize how much radiation they’re being exposed to –especially by repeated CT scans– many will start cutting back on what they request or accept. Over time, perhaps this attitude will spread to other areas of medicine such as surgical procedures and prescription drugs, where the risks are not always recognized today.
The federal government has done a great job whipping people into a sustained frenzy about airport security. All the time I hear people say they’ll put up with whatever hassles it takes at the airport in the name of security, and it almost seems the greater the hassle, the more satisfied people are to be subjected to it. I don’t admire this approach in airport security, but if the same zeal were devoted to patient safety (with the idea of reducing health care costs) I think it could succeed.
David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma, biotech, and medical devices. Formerly with BCG and LEK. He blogs regularly at Health Business Blog, where this post first appeared.
“What is… Wegener’s Granulomatosis?”
By
A terrific article in The New York Times Magazine this summer described the decade-long effort on the part of IBM artificial intelligence researchers to build a computer that can beat humans in the game of “Jeopardy!” Since I’m not a computer scientist, their pursuit struck me at first as, well, trivial. But as I read the story, I came to understand that the advance may herald the birth of truly usable artificial intelligence for clinical decision-making.
And that is a big deal.
I’ve lamented, including in an article in this month’s Health Affairs, on the curious omission of diagnostic errors from the patient safety radar screen. Part of the problem is that diagnostic errors are awfully hard to fix. The best we’ve been able to do is improve information flow to try to prevent handoff errors, and teach ourselves to perform meta-cognition: that is, we can think about our own thinking, so that we are aware of common pitfalls and catch them before we pull our diagnostic trigger.
These solutions are fine, but they go only so far. In the age of Google, you’d think we’d be on the cusp of developing a computer that is a better diagnostician than the average doctor. Unfortunately, computer scientists have thought we were close to this same breakthrough for the past 40 years and both they and practicing clinicians have always come away disappointed. Before getting to the Jeopardy-playing computer, I’ll start by recounting the generally sad history of artificial intelligence (AI) in medicine, some of it drawn from our chapter on diagnostic errors in Internal Bleeding:
HIT Trends Summary for September 2010
This is a summary of the HIT Trends Report for September 2010. You can get the current issue or subscribe here.
Look beyond the EHR to healthcare transformation. A big idea that continues to emerge this month is to think beyond the EHR and Stage 1 meaningful use incentives toward future stages and healthcare transformation. Last month, in this column, we reported on a McKinsey analysis arguing that hospitals need to take the long view toward EHR and look for ROI beyond the meaningful use incentives. This month we learn from a CHiME survey that hospital CIOs are optimistic about earning federal incentives, although KLAS reports that many express that they are not getting their money’s worth from current IT investments. Epic users seem to be the major exception.
The answer according to Daniel Marino, CEO at Health Directions, is to seek an ROI through deeper connections with physicians and patients. These ideas are confirmed as well by a Deloitte report out this month that looks at HIT and patient-centered medical homes and by John Glaser’s outline of an HIT roadmap for accountable care organizations. CIOs are also asking to be included in the work of the regional extension centers (RECs) through a CHiME network. This seems like a good idea as we learn from an eHI report that progress at RECs has been slow.
Mobile health will be a growing part of the solution. PricewaterhouseCoopers (PwC) and Deloitte each released reports on how mobile health is increasing in importance. The PwC report predicts a $8B-$43B mobile health market with the key being provider payment reform. It proposes three emerging business models supporting transformation: operational-clinical, consumer and infrastructure. The applications include provider-patient communications from simple texting to virtual online visits. There is some evidence that consumers will pay for getting detailed clinical information to providers for review. The Deloitte report focuses on mobile personal health records (mPHR) and sees potential applications in obesity, post-acute, home care and diabetes. An innovative partnership between Roche and InterComponentWare underscores these issues with a marriage of Roche’s mobile Accu-Chek software and ICWs secure application infrastructure creating communications solutions for diabetes.
Health Innovation Week Press Conference, TODAY 11.15
Tomorrow we’re doing an early kick-off for Health Innovation Week, San Francisco. We’re having a public kick-off and press conference at the same place as this picture was taken. My guess is that we won’t get quite the passion, controversy or size of crowd that surrounded the Goodlett steps outside San Francisco City Hall at the height of the gay marriage month. But that’s where we’re going to be at 11.15 am Friday, Oct 1. Please come join us.
PLACE AND TIME: Goodlett Steps (Polk Street side of), San Francisco City Hall
11.15 am-11.45am, October 1, 2010
Health Innovation Weekis a series of some 20 events in San Francisco between October 2-10 — these are events with over 2,000 attendees from all across the US and the world. San Francisco is a center of innovation in health technology, and Health 2.0.
Mayor Gavin Newsom has proclaimed October 2-10 Health Innovation Week in San Francisco.
Some of the leaders of the Health 2.0 movement will make brief remarks about Health Innovation Week and the importance of health care technology innovation to the health care system and the San Francisco Bay Area. Speakers include:
- Jordan Shlain MD, CEO of Current Medical Group and Commissioner for the Health Service System City & County of San Francisco
- Matthew Holt & Indu Subaiya, Co-Founders of the Health 2.0 Conference, the largest event during Health Innovation week. Health 2.0 takes place on October 7-8.
Health 2.0 Reveals the Winners of the 2010 Developer Challenge
The time has come to announce the six winners of the 2010 Health 2.0 Developer Challenge. They will be showcased at the Health 2.0 Developer Challenge session at the Health 2.0 San Francisco Conference, October 7-8, 2010.
Drum Roll Please!
- Accelerating Wireless Health Adoption through a Standardized Social Network Platform, sponsored by West Wireless Health Institute, chose team Videntity. The challenge asked developers to save health care cost through creation of an application that will integrate sensor-derived data with social networks to construct a personalized wireless health ecosystem.
- Project HealthDesign Developer Challenge, sponsored by Robert Wood Johnson Foundation Pioneer Portfolio and California HealthCare Foundation, chose team Pain Care @Ringful Health. The challenge asked developers to build apps for the web, smartphones or tablets that are built to run on a commercially available PHR service that can securely store the data.
- The Health Factor – Using the County Health Rankings to Make Smart Decisions, sponsored by Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute, chose team Acsys Healthcare. The challenge was an invitation for teams to create tools to integrate the Rankings data into smart phones, tablets or Web platforms that people already use to inform their decisions. The Ranking data provides people with a snapshot of a community’s health.
- Real-Time Patient-Driven Data Challenge, sponsored by Practice Fusion, chose team Critsys from Critical Systems. The challenge asked teams to be a visionary in the frontier of patient-driven health data, by giving medical providers the tools they need to track their patients’ health when they’re not in the exam room.
- Move Your App! Developer Challenge, sponsored by Catch and HopeLabs, chose team Happy Feet from Stanford University. This challlenge asked developers to build an app to encourage people to get in motion. How can movement be just as easy and fun as checking-in or updating a status?
The Blue Button Challenge, sponsored by Markle Foundation and the Robert Wood Johnson Foundation, will announce their winner at the Health 2.0 Conference on October 7-8, 2010. This challenge asked to develop a web-based tool that uses sample data from CMS or VA to help patients stay healthy and manage their care.
