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EMRs, Checklists and Meeting Atul

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By JONATHAN BUSHJonathan Bush

Recently, I got to shake hands with and also have lunch with doctor-writer extraordinaire Atul Gawande! He was nearly everything I had made him out to be. He wore a snappy blue blazer, a jumble of ID tags, and round specs befitting a prominent Harvard academic doc … only he wore them in a manner that suggested a man of action. Am I gushing? Sorry. I’ll stop … except to say that he had the chicken salad on white, which sat largely untouched as he drove through the conversation.

One of the greatest storytellers in the history of health care, Atul has discovered something very important about the way we deliver complex procedures … a series of checklists that bring down costs and improve outcomes … and yet adoption of his findings is incredibly low! He is seriously considering raising money to fund—NOT to continue his research and writing—but to literally fund a team of Maoist-like activists to cajole the ranks of docs and hospitals into adopting these bloody checklists!! These checklists are real bluebirds. Nobody loses their job from the adoption of these things. Except for a few embarrassing ‘re-operations to fix terrible mistakes, nobody loses any money either. So what gives?

Atul told me the story of penicillin adoption … I was stunned at how long it took for this miracle drug to be mainstreamed. I remember from my OB-GYN days the number of docs who were still doing continuous fetal monitoring during labor, twenty years and five studies after it was shown to be counter-indicated … and episiotomies, and circumcisions (ouch)!

How frustrating.

These are good people. I have met literally tens of thousands of docs and can count the truly questionable people on one hand. So what is it?

There is no market mechanism for the solution. That’s what.

If a payer came to me and gave me Atul’s checklist and said they’d pay even 5% more for a surgery done according to his checklist, I’d build it into an EMR and flick it in within a week! It’s a no-brainer for me and it’s good money for the doc! Ya know what that would be an example of? That would be MEANINGFUL use of an EMR.

God Bless you, Atul. I’m in for a donation … but not for the Maoists. You go find the truth and we’ll go make a market for it.

PS … Atul signed my copy of his book!

Jonathan Bush co-founded athenahealth, a leading provider of internet-based business services to physicians since 1997. Prior to joining athenahealth, he served as an EMT for the City of New Orleans, was trained as a medic in the U.S. Army, and worked as a management consultant with Booz Allen & Hamilton. He obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an M.B.A. from Harvard Business School.

MinuteClinic’s hour may be at hand

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By DAVID WILLIAMS Picture 18

Mark Perry draws an interesting inference from two news stories: a WSJ article that suggests consumers are using less health care and another that reports a big jump in MinuteClinic volumes.

Consumers aren’t necessarily consuming less health care like the WSJ suggests; rather, they are shifting their  demand for health care away from expensive, conventional physician offices with limited hours to affordable and convenient retail clinics.  Especially when consumers are spending their own out-of-pocket money for health care and they have a choice, they prefer market-driven, consumer-driven options like affordable, convenient retail clinics over conventional physician offices.

I think Perry is on to something. It’s hard to get people out of their established habits. They have a relationship with their own doctor, they accept the long wait for appointments and even treat it as a proxy for high quality (if my doc is so busy he must be great), and just suck it up when it comes to co-pay’s and deductibles. They want access to high tech exams and the latest drugs.

But all these things change over time. MinuteClinic and its ilk are well-positioned to take advantage of these trends in the long run. To take them in turn:

  • Relationships aren’t what they once were. Your doctor may or may not remember you. If you have something routine (or even if not) you may be shunted off to see a “physician extender, ” such as a nurse practitioner. At least when you go to MinuteClinic that’s who you expect to see
  • Wait times for appointment can be lengthy. Under health reform they are likely to get worse, especially since open access scheduling is slow to catch on
  • We’ve now reached the breaking point for co-pay’s and deductibles. Even insured people are nervous about going in for treatment and want to save money. They realize it’s only going to get worse
  • High tech exams (like MRIs) and drugs have lost some of their allure. Cost is part of it, but the continued news stories of safety problems with drugs are taking a toll, too. I think Americans are finally realizing that when it comes to health care less is often moreContinue reading…

Should We Fear Genetic Testing?

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By THOMAS GOETZ
Thomas Goetz

Though the prospect of learning about our DNA might seem wrapped in mystery and intrigue, genetic information is not so different from any other metrics we know about ourselves: Our age, our weight, our blood pressure. With a little scrutiny, any of these numbers can tell us something about our health and ourselves. It’s the same with a genetic scan – it gives us some perspective on our health, though far from the complete picture. It is, in other words, a place to start thinking about how we’re living our lives.

It’s important to remember, though, that genetics is a very new science, and that getting a scan today is the equivalent of buying the first generation iPod – it’s a work in progress, and will get much better as time goes on. There’s a lot that science doesn’t know yet about the exact influence of DNA on our health, and the journey is part of the ride. But it’s a rare opportunity, unprecedented, perhaps, in history, that the general public might be granted unfettered access to experience science as it happens. It’s not something that everyone will be comfortable with, but we shouldn’t underestimate how profound this opportunity is.Continue reading…

HIT Trends Summary for July 2010

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By MICHAEL LAKE

Whirlsandtwirls This is a summary of the HIT Trends Report for June 2010. You can get the current issue here.

E-prescribing. Two surveys re-confirm that while e-prescribing adoption is rapidly increasing, utilization continues to lag, particularly with advanced features. HIMSS released a survey about industry support for a DEA rule of allowing for e-prescribing of controlled substances. In this study, 40% say their organizations use e-prescribing, but half of these report doing so in a limited way. The Center for Study of Health System Change confirms these numbers with their study reporting only half of e-scripts users send them electronically and only a quarter regularly use routing and formulary checking and interaction checking together. Barriers include alert fatigue and suspicions about the accuracy of formularies. There are a number of cross-stakeholder groups working on these utilization issues. They are critical.

EHR. Hospital outreach to affiliated practices is a model that makes a lot of sense now. This month HP announced a comprehensive services offering in this area that competes with similar services from its rival Dell. Services include marketing support to educate community physicians, financing mapped to expected incentives, packaged hardware and implementation services and a menu of solutions from its VAR and ISV channel. I believe that hospital-centric marketing may have also had a role in the acquisition of Picis by Ingenix. Picis automates ICUs, ORs and EDs in hospitals with gives Ingenix some acute care assets to combine with its CareTracker EMR. The ED solution could help with medication reconciliation. The rich clinical data sets are attractive targets for Ingenix analysis. And it’s a strong growth segment.

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Job Post: THCB Editorial

THCB is looking for talented interns to assist with editorial, research and web production tasks as our web site undergoes a major expansion. Perfect for a grad or med student with an interest in journalism, public policy, and/or the business of health care.  Work out of a great home office location in the Princeton area or remotely, convenient to both Princeton University and UMDNJ. Reasonable train ride from midtown Manhattan. Production and research opportunities may also be available in our San Francisco offices for qualified candidates.

Editorial candidates should have an in depth familiarity with at least one area of the healthcare or tech industries and strong writing and editing skills.  Web production candidates should know their way around content management systems like Typepad (our current platform) and WordPress, our CMS in the not-too-distant-future.  Basic photoshop / fireworks / gimp or comparable image editing software required.Continue reading…

Public Is More Savvy than Harris Polltakers

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By JOHN C. GOODMAN, PhD

Are the nation’s polltakers part of a surreptitious plot to convince us that what’s good for us is bad and what’s bad is good? A new Harris poll is the third in the space of a week claiming that the public (or some subset of it) is badly misinformed about the Patient Protection and Affordable Care Act. This follows on the heels of similar polls commissioned by Kaiser and the National Council on Aging (which I have criticized at my blog).

Yet the people responding to these polls appear to have a much better understanding than those asking the questions. Consider this tidbit from Harris:

Eighty-two percent think the bill will result in rationing of health care or that it might (it won’t).

Really? Well, what would a reasonable person expect to happen if (a) 32 million newly insured people try to double their consumption of health care, (b) 70 million or so additional people are moved into much more generous insurance than they have today, (c) most of the remaining 200 million people are promised preventive services without the deductibles and copays they face today and (d) almost nothing is done to increase the supply of providers?

Do you think health services are going to magically emerge from thin air? Or is it more reasonable to anticipate significant rationing?

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“I Like (Political) Science and I Want to Help People”

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By BOB WACHTER, MD

I thought I was an oddball in college. I’ve only recently learned that I was avant-garde.

Right before beginning college in 1975, I decided I wanted to be a doctor. Being the first-born son – with decent SATs – of an upwardly mobile Long Island Jewish family, I had relatively little choice in the matter. Notwithstanding this predestiny, I felt confident that medicine was a good fit for my interests and skills.

But on my med school interviews four years later, I stumbled when the time came to answer the ubiquitous, “Why do you want to be a doctor?” question. The correct (but hackneyed) response, of course, is “I like science and I want to help people.” You’ll be comforted to know that I had no problem with the helping people part. It was the science thing that threw me for a loop.

It wasn’t that I didn’t like science, mind you. I found biology interesting, and organic chem was kind of cool, in the same way that Scrabble is. But I barely tolerated Chem 101, and disliked physics.Continue reading…

Docs and Insurers Posture on Report Cards, But Is Silence the Real Goal?

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By MICHAEL L. MILLENSON
 

Millenson  Report cards are back in the news.

The Washington Post (via Kaiser Health News) is warning about the difficulty of rating individual physicians. Meanwhile, spokesmen for the insurance industry and the doctor industry (a/k/a the American Medical Association) are content with huffing and puffing about the perfidy of any report card that’s about them.

 In late July, for instance, the AMA sent letters to more than 40 health insurance companies requesting they investigate the reliability of their physician rating programs in the wake of RAND studies casting doubt on how low-cost and high-cost doctors are classified and on some quality rankings. That work was partly funded by the AMA and the Massachusetts Medical Society, which is also suing the Massachusetts Group Insurance Commission (GIC) over its physician ranking effort.
 

I'd have more sympathy for the docs except for the fact that the GIC effort has actually been one of the most intensive in the country to take into account quality as well as cost. Moreover, GIC executive director Dolores Mitchell has been a fierce pro-consumer advocate, not a role typically filled by your local medical society. (One local profile called her a “change agent” who “doesn’t take any guff.) And despite the complaints, there has been very little effort by the AMA or most other medical societies to work with insurers to provide the kind of timely clinical data (as opposed to claims data) that would make report cards more useful to patients.  The search for the perfect is too often a deliberate tactic to delay the implementation of the good.

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