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Telehealth right here right now

A very smart doctor told me, "there’s been a realization that the exam room is wherever the patient is."

That simple, elegant and insightful remark was offered by Dr. Jay Sanders, one of the godfathers of telehealth. I quote him here from my report published this week by the California Health Care Foundation. It’s called Right Here Right Now: Ten Telehealth Pioneers Make It Work.

This report is coupled with another by Forrester, Delivering Care Anytime, Anywhere: Telehealth Alters the Medical Ecosystem. My colleagues at Forrester, Carlton Doty and Katie Thompson, have assembled a very current look into the state of telehealth and drivers for the future.

Forrester defines "telehealth" as, "The use of telecommunications and information technologies in any area of health care, including medical intervention, prevention, care management, education, administrative tasks, and even health advocacy….It is a broader term than ‘telemedicine.’"

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Happenings in HIT

Cleveland Clinic launched its pilot partnership with Microsoft HealthVault to provide personal health records for 150,000 patients.

CMS selected four companies to pilot its personal health record program: Google, HealthTrio, NoMoreClipboard, and Passport MD. Beginning in January, Medicare beneficiaries will have their claims data automatically added to their PHRs.

Google launched Flu Tracker, a program to help CDC track disease outbreaks in real time by looking for regional trends in search terms.

MedSphere announced a $9.7 million contract with the federal Indian Health Service (IHS) to develop the agency’s EHR system.

Intel unveiled its new telehealth home monitoring technology. According to Health Data Management, "The home computers can be linked to medical devices, including blood pressure
monitors, glucose meters and pulse oximeters, to transmit encrypted data to a
secure server via the Internet. They also can display patient reminders, offer
access to educational content, and accommodate e-mail between caregivers and
patients."

Analysts say deCODE Genetics is headed for bankruptcy.

Winners & Losers in HIT

I was recently asked to predict IT Winners and Losers in 2009. Rather than name individual companies, I’d like to highlight categories.

Winners1.  Electronic Health Record vendors, especially web-based applications – The Obama administration has promised  $50 billion for interoperable EHRs.

2.
Software as a Service providers – SaaS providers offer lower cost of
ownership and faster implementation than traditional software
installation approaches.

3. Open Source – I’m embracing Open
source operating systems, databases, and applications as long as they
can provide the reliability and supportability that I need.

4.
Green IT – Winners will be innovative techniques to adjust power draw,
such as idle drive management, cpu voltage adjustments, and high
efficiency power supplies.

5. Cloud Computing offerings – These
are remote infrastructure utilities such as storage and high
performance computing. Friday’s Cool Technology of the Week will
describe a new technology called Cloud Optimized Storage.

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Shreeve brothers named winners of Linux Freedom Award

I am deeply honored and profoundly grateful to be recognized, along with my brother Steve Shreeve, as the 2008 winner of the Linux Medical News Freedom Award. While this is a niche award in a niche space, it is highly symbolic in recognizing individuals who are “crying in the wilderness” regarding the promise and potential of open source within health care.

The award comes with the bitter irony of course, in the history and
historicity of the events which have led to it being awarded. On the
positive side, Medsphere was
born as a revolutionary force within the Health Care information
technology world. The company was founded on the premise that open
source could have a similar impact within health care as it has had in
other major industries of lower costs, improving quality, and
delivering more value. The open source approach has a particular
kinship with health care, as the notions of price sensitivity, peer
review, open collaboration, and transparency are desirable attributes.
I have discussed this at length before in many forums, and I see that Medsphere is still using our same slides to describe this connection.

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Maxing out on health reform

Senate Finance Committee Chairman Max Baucus’ unveiling of a health reform proposal yesterday fed speculation about the possibility of Democrats tackling health reform from the get-go of the new Administration.

The Montana Democrat’s proposal is detailed in an 97-page "call to action" document. In his letter of introduction, Baucus says the plan is not a legislative proposal but his vision for policy reforms and the political process.

Baucus says the plan will require an initial investment, but doesn’t name how much. There are no cost figures in the plan, but the Senator writes, "It is my intention that
after ten years the U.S. will spend no more on health care than is
currently projected, but we will spend those resources more
efficiently, and will provide better-quality coverage to all Americans."

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Baucus to unveil reform proposal with individual mandate

The Wall Street Journal reports that the Senate Finance Committee Chairman Max
Baucus (D-Mont) will unveil today his plan to overhaul the U.S. health care system.

Laura Meckler, of The Journal, reports the plan is very similar to the one Obama touted on the campaign trail with one major exception: Baucus wants to require all individuals to buy health insurance.

Given this, one could probably more accurately say the plan resembles Sen. Hillary Clinton’s plan. Where is Clinton in these discussions? Time has an update on the health care reform veteran.

Here’s what Jonathan Cohn has to say about Clinton’s involvement: "Exactly what role Clinton can play remains unclear, since she doesn’t
have the committee seniority to assert herself the way, say, Baucus or
Kennedy does. But she remains one of the most visible and, on health
care, one of the most trusted policymakers in Washington. If she wants
to say something, she’ll be heard. And that’s a good thing."

For background on the Senate’s health plans, see Jonathan Cohn’s article in the New Republic.

Will Democrats muck up any chance for health reform?


&amp;amp;lt;a href=&amp;amp;quot;http://www.buzzdash.com/index.php?page=buzzbite&amp;amp;amp;BB_id=130601&amp;amp;quot;&amp;amp;gt;Will Democrats muck up health reform by infighting and power plays?&amp;amp;lt;/a&amp;amp;gt; | &amp;amp;lt;a href=&amp;amp;quot;http://www.buzzdash.com&amp;amp;quot;&amp;amp;gt;BuzzDash polls&amp;amp;lt;/a&amp;amp;gt;</center>

Will layoffs take us closer to single-payer?

Only a few months ago, Goldman Sachs was touted as an incredible
bastion of strength in the face of the credit crunch. Sure some other
institutions might have been suffering, but Goldman was savvy enough to
earn record profits in 2007. The average bonus was a whopping $600,000 per employee.
Then very suddenly Goldman and pretty much the whole industry
collapsed. The federal government has stepped in, and a partial
nationalization of the financial industry is underway. That’s not the
free market, it’s socialism.

While actual socialism was being carried out by the Republican
Administration in Washington, out on the campaign trail, McCain and
Palin were bashing Obama for allegedly socialistic policy proposals,
namely rolling back the Bush tax cuts for high earners. Obviously the
voters didn’t buy it.

Thanks to the credit crisis, companies and non-profits are starting
to lay people off. My inbox is filling up with messages from people
who’ve been given the sack and are searching for their next gig. Today
I received such a notice from a close friend at Goldman Sachs itself.

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Getting value from medical devices

The buyers of medical devices aren’t very good shoppers. They lack the kind of information about technologies that would help them make value-based purchasing decisions, according to James Robinson in the most recent issue of Health Affairs.

This issue is so important because medical technology is the No. 1 factor driving up health spending in the U.S., according to the Center for Studying Health System Change in their recent report, High and Rising Health Care Costs: Demystifying U.S. Health Care Spending.

What are medical devices? They’re the hardware used by surgeons and clinicians in curing, cobbling together, stabilizing, and managing patients’ medical challenges. They cover orthopedics, interventional cardiology, cardiovascular surgery, and neurosurgery. The technologies represented here are collectively known as “physician preference items.” They can account for one-third of overall hospital supply costs and are growing as a percent of total costs according to the Financial Leadership Council of the Advisory Board. They have an FDA-designed life cycle, as shown in the figure.

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