WASHINGTON—As co-chair of the State Alliance for e-Health, Tennessee Gov. Phil Bredesen has been heavily involved in the health IT policy debate. He’s also frustrated with the slow progress of technology adoption that’s holding back gains in quality and efficiency (read “cost savings” from a governor’s perspective). And Monday at the World Health Care Congress, he was not afraid to share his thoughts, as this short audio clip demonstrates.
WASHINGTON—Live from the World Health Care Congress, here’s an interview with Dr. Bill Bria, chief medical information officer of Shriners Hospitals for Children and president of the Association of Medical Directors of Information Systems. We talk about the increasing importance of CMIOs as hospitals align their IT strategies with overall institutional goals, including quality improvement, and we discuss the similar growth of AMDIS. Bria also plugs the annual AMDIS Physician-Computer Connection, which is OK with me since I’ve been shameless in plugging my article in Red Herring.
At long last, I have a copy of my story from the April 23 issue of Red Herring. I’ll post a PDF version later for easy downloading and printing, but for now, here’s the text.
Google, then Gargle
America’s sorry performance on personal health records could soon change.
By Neil Versel
With names like GlobalPatientRecord, NoMoreClipboard, HealthKey, and HealthCard, the U.S. marketplace for electronic personal health records, so-called PHRs, is getting crowded. And yet the public has barely noticed that the era of people tracking their own medical history has arrived.
Dr. David Kibbe, a former director of the Center for Health Information Technology of the American Academy of Family Physicians, estimates that perhaps 10 percent of adults in the United States will have access to PHRs by the end of 2007, though only 2 percent will actually be using the records.
Now senior advisor to the academy, he expects that figure to double in 2008.
Those numbers won’t blow anyone away, but today’s sleepy calm could change once a few tech heavyweights enter the PHR arena. Steve Aylward, Microsoft’s U.S. general manager for healthcare, says, “It’s not an if, it’s when we’ll do that and how we’ll play.”
Google also is preparing its much-anticipated entry into the healthcare arena.
Internet scuttlebutt suggests that a simplified PHR called Google Scrapbook could surface sometime this year, perhaps as an outgrowth of Google Co-op.
Naturally, Googleplex mouthpieces are on lockdown, but Vice President Adam Bosworth dropped some hints in a speech to a Washington, D.C., audience in December.
In describing how his mother died of cancer, Mr. Bosworth said, “For lack of an easy way to find the right specialist and for lack of comprehensive medical information about her that could have been shared between her doctors and caregivers, she ended up being sicker than she should have been and dying sooner than she should have.”
The solution, according to Mr. Bosworth, is for sick people to have a “health URL” for caregivers to share information and discuss treatment options. “This isn’t rocket science. It is Online Web Applications 101,” he said.
Indeed, a three-year-old Watertown, Massachusetts-based company called MedCommons already offers health URLs, secure web pages summarizing basic health status, including diagnoses, medication lists, and allergies, all under the control of patients. “It’s a patient-centered view of the world,” says Chief Science Officer Dr. Adrian Gropper.
AOL co-founder Steve Case is also putting his time and bankroll behind Revolution Health, a company that is offering free online “personal health homes” to the public.
“It’s really a dynamic and interactive concept,” Dr. Kibbe says of the URL system. It moves the focus from software to the control of information, says Dr. Kibbe, a contributor to Google Co-op for Health. A health URL would provide access to basic health data, as well as relevant documents, images, and video, he says. “All of those things might be useful in taking more control of your health and healthcare.”
A Measure of Control
An oft-stated problem in healthcare is that records are scattered and otherwise unavailable when doctors and patients need them most. Personal health records are meant to address the situation by centralizing health information and giving consumers a measure of control, with the goal of cutting out some of the administrative waste and improving the quality of care.
That is the idea behind Dossia, a project bankrolled by some of the nation’s largest employers, including Intel, Wal-Mart Stores, Applied Materials, and Pitney Bowes. Announced in December and scheduled to debut in the second half of the year, Dossia is a nonprofit effort to provide “lifelong” PHRs to employees of each participating company, records that people will be allowed to take with them even if they change jobs or retire.
Much of the impetus for Dossia came from Intel Chairman Craig Barrett, who thinks businesses should expect better results for the billions of dollars they spend on employee health insurance, and the best way to do that is through information technology. “The people with the purchasing power have to provide the incentives because, frankly, I don’t think the [healthcare] industry is capable of modifying itself,” Mr. Barrett said in a speech last September.
According to Dr. Kibbe, “That’s exactly the kind of national dialogue we need to be having about healthcare.” But reform needs to involve consumers, be patient-centric, and focus on preventive care, he says. “It is unlikely to come from those incumbent interests—disruption will come from outside the healthcare system.”
Omid Moghadam, director of PHR programs at Intel, says that the chip maker looked at many of the 200 or so PHR options out in the marketplace, but nearly all were “tethered” to a single vendor, health system, insurer, or employer—and information was all over the place. “You have to go through nine or 10 different sources and you can’t take it with you when you change jobs,” he says.
“Fragmentation is what we realized is the big problem,” Mr. Moghadam adds. “What that requires is for the individuals to gather and enter all the information themselves.”
Users of Dossia PHRs will have the option of keying in their own information, but the system also will aggregate data from billing claims, pharmacy records, and, where they exist, electronic medical records. (Perhaps a quarter of all U.S. hospitals keep patient records electronically, and even fewer independent doctor’s offices do, according to most estimates.)
“There is enough electronic data to make a pretty good record,” Mr. Moghadam says. “The combination of claims and pharmacy data will get you about 80 percent there.”
Health insurers are thinking along the same lines, working through national associations to develop a standard for a “payer-based” PHR, a standard that may or may not be compatible with the one Dossia is creating. Some of the larger insurers, including Cigna, Aetna, and Blue Cross and Blue Shield, offer a form of PHR through their web portals.
Predictably, many are skeptical about the notion of insurance companies building clinical records from billing claims. “There has to be a Chinese wall between the record and the health plan,” asserts W. Ob Soonthornsima, CIO of Blue Cross and Blue Shield of Louisiana.
“I don’t think people realize how much data the insurers have,” says Dr. William A. Yasnoff, a former senior federal health IT official who now consults on the interoperability of health information. “Do patients trust the insurance companies to
have this information?”
Trust is a big deal in the PHR arena. “Doctors are not that interested in claims data. They are interested in clinical data,” says Dr. R. Daniel Claud III, an emergency physician at Chicago’s Northwestern Memorial Hospital. But today, much more electronic information exists on the payer side than anywhere else in healthcare.
Dr. Claud also runs HealthCapable, a small firm that just introduced an ATM-like system called HealthCard in Illinois after running a test in Colorado last year. A swipe of the card in a standard magnetic-stripe reader “unlocks” secure patient information stored online—currently limited to medication lists—when the holder shows up at a doctor’s office or hospital. The provider then can update the information when the patient leaves.
Whether on a card, CD-ROM, USB drive, secure web site, or even a piece of paper, the advantage of a consumer-controlled PHR is that it is more portable than one tied to a specific health plan, job, or hospital system.
The sponsors of Dossia are promising that all records created on that platform will be fully portable when employees leave. Louisiana Blue Cross and Blue Shield, for example, is developing a claims-derived PHR that people will be allowed to keep—for a fee—if they switch insurers. “We want to advocate the ownership of the record,” Mr. Soonthornsima says. “We want it to be portable.”
Red Herring 04.23.07
This just in from the Department of Health and Human Services: Dr. Robert Kolodner has been named coordinator of the Office of the National Coordinator for Health Information Technology, effective immediately. He had been interim coordinator since Sept. 20.
This really should come as no surprise to anyone in the industry. At last month’s Health IT Summit in Washington, there was a lot of talk that Kolodner would serve out the remainder of President Bush’s term, until January 2009, in which case the “interim” boss would be on the job longer than the only previous permanent coordinator, Dr. David Brailer. Today’s announcement at least does away with that bit of incongruity.
Now that everyone has had a turn trashing Practice Fusion for its apparent attempt to use Google‘s name to promote itself, I’m thinking that perhaps there is a future for an advertising-supported EMR.
Given my propensity for letting things pile up, I just read the Feb. 15 commentary by Michael Millenson in HHN Most Wired OnLine. Millenson, who’s been covering health IT a lot longer than I have, suggests with tongue only slightly in cheek that the profit motive will lead to all kinds of corporate sponsorships of healthcare technologies and even facilities.
What’s cool about this article is that it was published a full month before the Practice Fusion story broke. Could it be that advertising really is the future of medicine?
And speaking of advertising, I’m going to use this space to promote myself once again. Don’t forget to check newsstands next week for the April 23 issue of Red Herring for my look at personal health records. Naturally, I’ll post a link to the online version when it’s available.
Last year, when I complained about not being able to sell a story to any national publications outside the insular world of healthcare, at least one commenter called me on my sour grapes.
Today, I am proud to say I can stop complaining because I have learned that I will have a story on personal health records published in the April 23 issue of Red Herring. That issue hits newsstands next week.
Persistence pays off.
Watch the hit counter at the bottom of the right-hand column. Watch it carefully as it approaches and hopefully passes 20,000 since I began tracking traffic in September 2004. Thank you for your continued readership.
And now for a reality check. The HIStalk blog had 186,445 hits in March alone. While I count visits more than hits (a.k.a. total page views) still I can only aspire to provide a fraction of the entertainment value as Mr. HIStalk—or for that matter, a fraction of the entertainment value of those fun-loving hipsters at the Agency for Healthcare Research and Quality, who have gone all YouTube on us.
Yes, AHRQ and the Ad Council have teamed up to produce the following public-service announcement aimed at encouraging patients to seek information from their healthcare providers as part of a campaign called “Questions are the Answer.”
This is the 30-second version. A 60-second spot is at http://www.ahrq.gov/questionsaretheanswer/level2col_1.asp?nav=2colNav00&content=09_0_videos.
AHRQ also is working on a pilot with PBS related to patient safety. The first episode will focus on health IT, according to Jon White, M.D., health IT portfolio manager of AHRQ’s Center for Primary Care, Prevention, and Clinical Partnerships. I’ll try to track down some more details.
Meanwhile, on the publishing front, Atul Gawande, M.D., seems to be doing something useful with his $500,000 “genius grant.” The follow-up to his 2002 best-seller “Complications: A Surgeon’s Notes on an Imperfect Science,” hits bookstores April 10. Read the introduction to “Better: A Surgeon’s Notes on Performance” here.
And finally—stealing a phrase from FierceHealthIT since editor Anne Zieger asked me to link to them—said publication has come out with its list of 10 Top Health IT Innovators for 2007. Anne would like readers to chime in on the selections.
Viva la shameless self-promotion!
I think this might be the same site that Matthew Holt of The Health Care Blog fame (infamy?) contributed to last year, when organizers and session moderators put the kibosh on any attempt by audience questions to ask the obvious question of then-CEO of UnitedHealth Group Dr. Bill McGuire, the same day the Wall Street Journal reported on some alleged misdeeds involving a mere $1.6 billion in stock options. Still, it was cool to see live blogging of an event. (Personally, I chuckled when someone asked me via e-mail before last year’s HIMSS conference if I would be “blogging from the show floor.” Read my memorable rant from February about how much time I might have to do something like that.)
Anyway, the next U.S. version of the World Health Care Congress is scheduled for April 22-24 in Washington, and I suspect someone will blog that event as well. Matthew, care to chime in? And anyone care to remind me to book my trip soon?
You can bet that finding a viable business model for regional health information organizations will be a hot topic at that event and others coming up this spring and summer. On that note, the Healthcare IT Transition Group, publisher of the HIT Transition Weblog, is looking for opinions for its second-annual survey of RHIO finance. The deadline to opine is April 20.
And to my fellow bloggers, a team from the School of Medicine of the University of Rijeka in Croatia is taking a survey of health and medical blogs that may be fodder for a scientific paper. I’m leaning against participating because I want to maintain my objectivity as a journalist, but does the mere act of blogging compromise that anyway?
How did a Croatian medical school find the names of American bloggers? The invite came from Ivor Kovic, a student at Rijeka, who also happens to be a contributor to MedGadget, an online journal about medical technology. So there you have it, another example of the Internet making the world smaller.