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How Do We Build Health 2.0 Into the Delivery System?

Apr 9, 2009• 11

By JOHN HALAMKA

The Health 2.0 Meets Ix conference, will take place April 22 and 23 in Boston, Massachusetts. As part of the lead-up to the conference, which will focus on the interplay between the Health 2.0 and Information Therapy (Ix) movements, the THCB, the Health Affairs Blog and other participating blogs will feature a series of posts discussing ideas that will be featured at the conference.

The post below by John Halamka is the second in this series. The first post in the series described the background and main themes of the Health 2.0 and Ix movements. In his post, Halamka offers a vision on how best to build Health 2.0 into the health care delivery system; he will participate in a debate on this topic in Boston. Halamka also recently contributed to a Health Affairs online package on implementing the health information technology provisions of the recently passed economic stimulus legislation. The package was published in conjunction with the Health Affairs March-April issue on health IT.

Over the past few months, I’ve seen a convergence of emerging ideas that suggest a new path forward for decision support and information therapy. I believe we need Decision Support Service Providers (DSSP), offering remotely hosted, low cost knowledge services to support the increasing need for evidence-based clinical decision making.

Beth Israel Deaconess has traditionally bought and built its applications. Our decision support strategy will also be a combination of building and buying. However, it’s important to note that creating and maintaining your own decision support rules requires significant staff resources, governance, accountability, and consistency. Our Pharmacy and Therapeutics Committee recently examined all the issues involved in maintaining our own decision support rules and it’s an extensive amount of work. We use First Data Bank as a foundation for medication safety rules. We use Anvita Health to provide radiology ordering guidelines based on American College of Radiology rules. Our internal committees and pharmacy create and maintain guidelines, protocols, dosing limits, and various alerts/reminders. We have 2 full time RNs just to maintain our chemotherapy protocols.

Op-Ed: No Need for Alarm Over Need for Foreign Nurses

Apr 9, 2009• 22

By MICK WHITLEY

Recent news coverage (“Amid Nation’s Recession,
More Than 200,000 Nursing Jobs Go Unfilled,” Reuters, March 8th) validly
and vividly calls attention to a nursing shortage in the U.S. healthcare system that
“threatens the quality of patient care even as tens of thousands of
people are turned away from nursing schools, according to experts.”

That article adds, “The shortage has drawn the
attention of President Barack Obama. During a White House meeting on Thursday
to promote his promised healthcare system overhaul, Obama expressed alarm over
the notion that the United States
might have to import trained foreign nurses because so many U.S. nursing jobs are
unfilled.”

Importing internationally-trained nurses is no cause for
alarm. The fact is, at least in the short term, the U.S.does have to
import these nurses, and plenty more of them, if we are to meet our rapidly
growing healthcare needs. Don’t understand why? Consider the
following:

Kaiser Permanente CEO George Halvorson on reform and life after IT

Apr 8, 2009• 22

By Matthew Holt

George Halvorson is the CEO of Kaiser Permanente, and the driving force behind both the HealthConnect EMR implementation and a national player in the health reform debate. I got to talk to him at HIMSS where he’d just finished giving the Monday keynote. We discussed KP HealthConnect, and the impact it’s having internally (good), why KP is making such a high-profile fuss about it (no, they’re not planning on expanding nationally or internationally), what AHIP and the insurers might face in the future (a choice between Canada and Switzerland), whether chronic care management can work without integration (he says yes), and whether the big guys will cast the smaller insurers adrift. You’ll have to watch for that answer.

Psilos Seeks $450 Million Health Care Fund, Defying Crunch

Apr 7, 2009• 5

By TIM MULLANEY

April 7 (Bloomberg) — Psilos Group, a New York venture-
capital firm focused on health-care technology and services,
plans to raise a $450 million fund, its largest ever, an
investor in Psilos’s most recent fund said.

The firm told some investors of its plans to gauge their
interest in a new fund, said Tom Reilly, managing member at
Fernwood Investment Management LLC in Quincy, Massachusetts. He
and his clients have invested with Psilos before.

Psilos’s investments include companies that drive
information technology into health care, an area promoted by
President Barack Obama, Chief Executive Officer Al Waxman said.
Its fundraising may also benefit from a wave of health-care
mergers, as companies seek combinations to contain costs amid
increasing pressure for lower medical expenses, said D. Brooks
Zug, senior managing director at HarbourVest Partners.

“The one area in private equity that has done really well
recently is health care,” said Zug, whose Boston-based firm
invests in venture funds on behalf of institutions. “It’s the
one area with a merger market that’s active. And you’ve got
Obama’s health plan. Those are two reasons to think it might be
a place to put some of your money.”

Glen Tullman, CEO of Allscripts

Apr 7, 2009

By Matthew Holt

Glen Tullman, Allscripts CEO is one of the more charismatic, opinionated and politically connected players in health IT. I grabbed a few minutes with him at HIMSS 09 on how he’s positioned Allscripts to be a survivor in the coming consolidation, why he likes CCHIT (he’s a happy cat!), if SaaS (and AthenaHealth) is a real threat, and whether his buddy Barrack Obama (for whom he was on the original fundraising committe) is going to whisk him off to DC any time soon….

Advances in Online Care and Telehealth

Apr 6, 2009• 12

By DAVID C. KIBBE

At a recent symposium on Online Care in Hawaii , two Family Physicians and a primary care Internist participated in a panel in which they described their experiences with Online Care and Telehealth.

– Ron Dixon, MD is the Director of Massachusetts General Hospital’s Virtual Practice Project. He talked about his practice using videoconferencing for patient visits, and discussed results of his research on e-visits, which includes the largest randomized comparative trial to date of videoconferenced medical visits versus face-to-face visits.

– Peggy Latare, MD is Chief of Family Medicine at the Hawaii Kaiser Permanente Medical Group, and the physician lead charged with the implementation of KP HealthConnect in the Hawaii region. For over two years she has used Kaiser’s online tools on a daily basis for communicating with and caring for her patients.

– Dr. Michele Shimizu, a native Hawaiian, is a family physician in private practice on the Big Island, and uses the American Well platform for Online Care to maintain relationships with her former patients on Oahu, despite being separated by more than 100 miles of Pacific Ocean, and to treat new patients as well. She uses the web-based Telehealth system made available through HMSA, the Blue Cross Blue Shield of Hawaii , on average three times a day, mostly in the evenings.

It’s, err, gulp, HIMSS time

Apr 6, 2009• 2

By Matthew Holt

Yes, the annual cavalcade of boat-show sized booths and late night partying—interspersed with frequently mind-numbing presentations that most people skip— is on. In Chicago in a snowstorm! I touched down on Sunday midday and managed to compound the craziness in HIMSS by starting in London (thanks to American Airlines for the free upgrade this time!), but I did make it to bed before midnight. And yes, there was 3 inches of snow/slush in Chicago and I did throw snowballs.
Before I got in there appears to have been a rather odd session on Health 2.0 (at least judging by this report, it seems it was all about hospital marketing and excessive use of FaceBook which I don't think is the whole point).

Dennis Quaid Overlooks Too Much

Apr 6, 2009• 3

By Michael Millenson

Anyone who cares about patient safety has to be grateful to Dennis Quaid
for the way he and his wife Kimberly reacted to the near-death from a
medication error of their twin baby girls. Using his celebrity and his
contacts as an award-winning actor, Quaid launched a crusade to stop
similar errors from ever happening again. He has appeared on 60 minutes , testified before Congress and, Sunday, came to HIMSS to tell his story once again.

At HIMSS, Quaid was amusing (“I am not a doctor [and] I have never
played a doctor on television or in the movies”) and moving, as he
detailed how two massive heparin overdoses turned his newborn twins’
blood to the consistency of water and left them bleeding inside and
out. He was also generous and humble, repeatedly thanking the HIMSS
membership for the work they did in developing the technology that can
prevent inevitable human error from causing harm.

Andy Slavitt, Ingenix

Apr 6, 2009• 8

By Matthew Holt

So we're going to start with one of the more controversial people I'm meeting at HIMSS, Andy Slavitt the CEO of the newly discovered and reviled by the Senate Ingnix. As you may recall, despite the fact that (not entirely to Andy's pleasure) I called them arms dealers, I was not entirely unsympathetic to what Ingenix was up to in the recent mess. So I talked to Andy about that, about what Ingenix actually does and whether it made sense for a health plan to own a big informatics company (his short answer…they don't!) An interesting interview you can see immediately below.

Op-Ed: Let’s Pay Nurses Minimum Wage!!

Apr 5, 2009• 114

By ANGRY AMERICAN

Every morning I wake up and thank God that we still have some Republicans in Congress. Representative John Shadegg (R) from Arizona, is one of those blessings. He has introduced a bill in Congress called the Nursing Reform Act of 2009. The bill calls for increasing work visas for foreign nurses (and their spouses). When passed, it will eliminate the nursing shortage!

This bill is great on so many levels. For one, everyone knows that healthcare is costing us an arm and a leg (pun intended). The biggest causes are obviously nurses and nursing unions. Nurses are way overpaid, but unfortunately the healthcare corporations have not been able to break the nursing unions because of the shortage of nurses. By bringing in lots of foreigners, they can flood the market with labor, break the unions, and get nursing salaries down to where they belong — somewhere around what retail pays. If only there weren’t that law capping the number of foreign nurses we allow in the country… As a side benefit, the bill allows for nurses’ spouses to get unrestricted work visas as well, so it will help bring down salaries in all sorts of other industries as well!

The true brilliance of this bill (thank you Mr. Shadegg!) is in the way it is written. It doesn’t bring them all in at once. It starts out with 50,000 new visas the first year, which is a low enough number that people will “buy it” and the bill can get passed. Supporters of the bill have had to go to great lengths to say that nursing salaries will be unchanged, which of course will be true at first. However, the genius in the bill (evil grin) is that the number of allowable visas automatically goes up 20% per year, so it will be 60,000 visas in year two, 72,000 visas in year three, 86,400 visas by year four, 103,680 by year five, and a whopping 124,416 by year six! The bill states that “According to the Department of Labor, the current national nursing shortage exceeds 126,000.” Therefore, the nursing shortage will be solved in about six short years, and healthcare companies can get back to earning the kind of money they deserve! Incidentally, this is just the approach that was so successful in cutting the salaries earned by information technology workers about 10 years ago. Corporate profits were getting impacted by high IT costs, so our brilliant Congress increased the number of H1-B visas, and companies were able to hire cheap workers from India and other places. Thank you, Congress! Later, many of these foreign workers returned to their homelands and brought the work with them. Now, corporate America doesn’t have to pay high salaries, and they don’t even have to look at the foreigners anymore — they can just write a little check to India. Bravo! Fortunately, information technology salaries have never rebounded to the levels where they were.