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Confessions of a Physician EMR Champion

Nov 1, 2008• 103

By DAVID KIBBE, MD

Starting this month and continuing for the next year or so, I’ll be presenting a standard talk to physician audiences entitled “Confessions of a Physician EMR Champion,” subtitled “A Conversation with American Physicians About How to Save Medicine in the Age of Information.”

The broad message is that, to be successful, the adoption of health IT by physicians, nurses, and staff must extend communication and health data exchange beyond the narrow confines inside the four walls of their practice. Health IT needs to empower all providers to act as effective members of a team which includes the patient, medical home, specialists, and ancillary service providers such as pharmacists and lab technicians.

My “confession” is that for several years I led a team effort by the American Academy of Family Physicians, its state chapters, and its members, to promote adoption of electronic medical records, or EMR software systems. Between 2003 and 2007, the percentage of the AAFP’s active membership of 60,000 doctors who utilize an EMR from a commercial vendor in their practices jumped from about 10 percent to almost 50 percent. The overwhelming majority of the doctors in these practices consider this a good thing, and would never go back to paper systems. The accumulated knowledge and experience about EMRs among the AAFP’s membership is unparalleled.Continue reading…

Perhaps Obama will have to do rather more than he says he will

Oct 31, 2008• 8

By Matthew Holt

I feel like Mrs Miggins in my favorite comedy show, Blackadder. It’s the scene when Blackadder says “The hustings are down, the candidates have spoken and after the madness of a general election, we can return to normal” and Mrs Wiggins says “Has there been an election? I’ve never heard about it?” (Yes that is a much younger version of Dr House playing the Prince Regent).

Anyway I’ve had my head so far up the Health 2.0 rear that until this week I haven’t really paid too much attention to the election. In all honesty (speaking as a Democrat who could never conceive of a Republican win in the current circumstances) I’ve been trundling along expecting an Obama win with the same set of Democrats running Congress but not with the vicious efficacy that Tom Delay & friends showed in getting their bills passed in 2001–2004. So I haven’t been expecting that much change in the healthcare system.

But if you do believe something is going to happen, over at the HuffPo Susan Blumenthal, whom I saw earlier this week, nudges me towards her side by side comparison of the U.S. Presidential Candidates’ Health Care Plans.

On the other hand, and I’ll be writing more about this before the election, if the recession is bad enough—and this morning’s numbers suggest that it could be—what Obama is proposing may be torn up and we might do something much more radical. It sounds crazy, but then again a year ago you wouldn’t have thought that the US taxpayer was going to own the biggest insurance company and most of the banks. After that actually IS socialism according to Lenin’s “owning the commanding heights of the economy” definition, no matter how much Sarah Palin rails against it. And socialism in health care makes rather more sense than socialism in banking, or autos.

So if there are 90 million uninsured and 15% unemployed, perhaps a Federal rescue package for health care is on its way—we just haven’t seen it poke its head out of the water yet. And if it does, it will likely be much more radical than the gentle proposal Obama is starting with, which the conventional wisdom says is a non-starter anyway.

Can Health Plans Explain Why They Aren’t Re-Empowering Primary Care?

Oct 30, 2008• 31

By Brian Klepper & David Kibbe

Sometimes a whisper is more powerful than a shout. Here’s a cartoon from Modern Medicine that shows a Medical Home counseling session between a primary care physician (PCP), a specialist and the health plan. The PCP looks forlorn, while the specialist and the insurer have their backs turned, fuming. It is perfectly true.

Along with changing the way we pay for all health care and creating far greater pricing and performance transparency, we need to turn around the primary care crisis if we hope to substantively improve quality and cost.

Health Wonk Review Is Up!

Oct 30, 2008

Over at Health Blawg, David Harlow has a special and particularly entertaining "Samhain" edition of Health Wonk Review. Pull out your costumes and head on over for some treats!

Pitfalls of VIP Syndrome

Oct 30, 2008• 2

By Sarah Arnquist

Slate has an article today by two doctors discussing VIP syndrome in health care and how it can lead to worse care for the rich and powerful, such as Sen. Ted Kennedy, who following a diagnosis of cancer convened his own tumor board.

The authors lay out the pitfalls of VIP syndrome here:

VIP syndrome affects not only treatment but also testing decisions. If
Joe the Plumber requests a CT scan he doesn’t need, doctors simply say,
"No, Mr. Plumber." But Joe Biden can get any CT he wants. Some health
care programs
for corporate executives even involve routine full-body CT scans as
screening tests as part of the "chairman’s physical." The problem is
that these expensive and detailed tests may actually increase the risk
of cancer from radiation exposure
and have never really been shown to improve anyone’s health. And if
there is an incidental finding, as there often is, more tests might be
ordered, which may lead to unnecessary biopsies. And doctors perform
heroic procedures on VIPs not just when there is clear benefit but when there is any question of benefit.

Bob Wachter wrote a few months ago about VIP Syndrome, noting there is a sizable medical literature documenting this shift in practice for the rich and powerful.

Wachter writes, "Every hospital I know keeps some sort of a VIP list, a tripwire to
alert the organization of the arrival of a dignitary or billionaire.
Even when there isn’t a formal list, you can be sure that a single call
to the CEO’s office is more than enough to lift the velvet rope. That’s
a simple fact of life, and to me, not worthy of a big fuss. Unless,
of course, they’re getting better care than Joe and Jane Average. But
are they? Believe it or not, I really doubt it."

Something interesting that both articles point out is that the top researcher or surgeon often directs the care or operates on the VIPs. Often, these top doctors haven’t been in the OR for a long time.

McCain’s health plan likely going down with him

Oct 29, 2008• 7

By Robert Laszewski

John McCain would reform the American health care system by providing big tax incentives for it to transition from being employer-based to one built on a system of individual responsibility. He would do this by eliminating the longtime personal tax exemption on employer-provided health insurance and replacing it with a $2,500 individual, and $5,000 family, tax credit for those who have health insurance.

It’s too bad this idea will likely recede from the national health policy debate whether John McCain wins or loses the presidency. Even if he wins, the Democratic majorities in Congress will be so large there is little chance we will be able to move away from the traditional employer health insurance base in the next few years. All you have to do is look at the way Obama and all of the Democratic candidates for the Senate and House have railed against McCain’s plans to "tax your health benefits" to see how Democrats have willingly painted themselves into a political corner that makes this idea a non-starter in the new Congress.

As I have said before on this blog, I have been largely disappointed in the McCain health plan. He started out with a bold new approach but never closed the loop on so many key elements in his plan. For example, he leaves those with pre-existing conditions to the fate of state-based risk pools–a place no one would ever vote themselves into.

Safeway uses incentives and transparency to improve employee health

Oct 29, 2008• 13

By Scott Shreeve Scott_shreeve

In this interview on “The Business Case for Health 2.0,” Ken Shachmut,
Senior VP Strategic Initiatives, Health Initiatives, and Health
Re-engineering at Safeway, shares is thoughts on some of the highly
impressive results that the company has obtained by introducing market-based
health plans.

SS: Ken, thanks for making time today. Tell me a little about your background?

KS: I have been active as an executive and
management consultant for over 30 years. I graduated from Princeton in
Engineering and later obtained my MBA from Stanford. In consulting, I
worked first with McKinsey & Company,
later at Booz Allen Hamilton, and for awhile independently. I had done
some consulting for Safeway. I later joined Safeway and have been there
the last 15 years in various capacities.

Due to my consulting background and analytical focus, I am
frequently asked to look at new challenges and opportunities for the
organization. As health care costs continued to rise, we started
looking at ways that we could engage our employees or work with the
unions to control costs. The process has been highly successful, and we
now have broad participation in “market-based health care” (MBHC) plans
– starting with our non-union population and evolving into our union
plans currently. In consequence, our employees are now much more
actively involved in their health care and are making better choices
that improve their health. As a result of our learning and success, we
have helped to create the Coalition to Advance Health Care Reform
(CAHR) which is led by our CEO Steve Burd. CAHR now has over 60
companies as members.

The inconvenient truth

Oct 29, 2008• 12

By Sarah Arnquist

The Los Angeles Times ran a great series last week called "Shedding Risk" in which it detailed through compelling human stories the erosion of the health insurance market. It’s definitely worth finding the time to read.

Matthew has talked about this eroding model for a while, including in a speech about three inconvenient truths that he gave to health plan executives in March.

Here are four key paragraphs from the first article in The Times‘ series to give you a sense of the articles:

At the heart of the problem is the clash between the cost of medical care and insurers’ need to turn a profit.Today, four publicly traded corporations — WellPoint Inc., UnitedHealth Group, Aetna Inc. and Cigna Corp. — dominate the market, covering more than 85 million people, or almost half of all Americans with private insurance.On Wall Street, they showcase their efforts to hold down expenses and maximize shareholder returns by excluding customers likely to need expensive care, including those with chronic diseases such as asthma and diabetes. The companies lobby governments to take over responsibility for their sickest customers so they can reserve the healthiest (and most profitable) for themselves.Meanwhile, insurance premiums are becoming a heavier burden on employers, many of which say that rising healthcare costs cut into their ability to compete and, in some cases, to survive.

Here are Matthew’s three inconvenient truths to the insurance execs:

e-Patient Dave tells his story

Oct 28, 2008• 7

By Matthew Holt

In the Connected Health conference at Partners I sat in on a great session in which e-Patient Dave (Dave deBronkart) and his physician, Danny Sands described his use of listservs, the Internet, email and BIMDC’s PatientSite and other tools in his (successful!) battle with renal cancer—after being told median survival was 24 weeks. I won’t tell the whole story as they’re trying to get it published in an authoritative journal—so that physicians will pay attention and promote this use of technology by patients.

Danny Sands says most patients with his condition feel incredibly alone. but "Dave told me he didn’t think he was isolated. He felt
connected.”

Dave said, “Reading and connecting online makes me a better patient. But it doesn’t make me an oncologist.” But doing all these things via ACOR and the use of CaringBridge and PatientSite did, he believe, increase his hope & outlook, and helped make his treatment successful.

A remarkable story and one that we’ll tell more about later.

(Note: I made a minor edit as my original note got garbled between my ears and my fingers!)

The latest on technology-enabled DM

Oct 28, 2008

By Matthew Holt

I sat in on another session at Connected Health about A Progress Report on Medicare’s CMHCB (Care Management for High Cost Beneficiaries) Pilot. This is the medical group alternative to Medicare Health Support operated via providers not health plans. Some quick notes…

Suneel Rataan from Health Hero: We know that we can make DM work using the Health Buddy and supporting nurses in the VA. But could they make it work in a community setting under Medicare Fee for Service. We know how badly Medicare Health Support has gone, what about this one (CMHCB)? “We can’t talk about the results but our program has not been terminated!” (Actually they have applied for an extension & expansion of the project).

Couple of others, one from Montefiore in the Bronx another from Partners—the Partners one has a variety of practices and the problem is that they need to have the consistent program across those.