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Keep wasting your money, Silicon Valley venture capitalists

Silicon Valley is at it again.

Last week, digital health accelerator Rock Health unveiled its new offices, and from the news coverage, it seems as if it’s creating an image as much as incubating startup companies.

According to Xconomy, “a big crowd of investors, executives, and other life science industry insiders took time away from JP Morgan to attend the grand opening of Rock Health’s stylish new headquarters in the Mission Bay neighborhood of San Francisco.” And stylish it is.

“Rock Health’s kitchen and community gathering space includes a Cirque-du-Soleil-style swing,” Xconomy reported. Because, you know, incubating companies that will fix a broken $2.8 trillion industry with their “solutions” requires a little avant-garde spectacle à la Québécoise — or perhaps Las Vegas. Having been at the Digital Health Summit at International CES in Sin City myself a week earlier, I was happy to see more focus on substance than style in the meeting room, if not in the exhibit hall.

© Bruce Damonte/Studios Architecture

I bet that swing cost a lot of money. So did the design, since Xconomy saw fit to identify the architecture firm. (For that matter, so did I, but only to give proper credit for the photo.) In an industry where a third or more of spending is wasteful — completely irrelevant to care and probably preventable — according to a 2012 report in Health Affairs, are such frills really necessary? I’m certainly not blaming Rock Health here. It’s the investors who are throwing away their money.

In opening the center, Rock Health reportedly dubbed Mission Bay the ‘United States’ New Digital Health Hub.’” That’s a bold statement. There certainly is a lot of potential there, but, as the person who identified San Diego as “a leader in mobile healthcare” back in January 2010, I still see more substance and tangible results in Southern California than in Northern California. For that matter, the Boston area could make a strong case, as could New York City. Smaller but healthy communities have popped up in places like Madison, Wis. That’s fine, competition is good.

However, I’ve seen more failures in Silicon Valley than anywhere else. But does that stop Silicon Valley’s No. 1 media cheerleader, TechCrunch, from declaring, “VC’s Investing To Heal U.S. Healthcare”? No, it does not.

No flame-out has been as spectacular as that overhyped vaporware known as Google Health. Google is back at it again with its VC arm, but this time the Internet giant seems to have a direction and a clue. Maybe.

As TechCrunch reported, “Google Ventures is addressing the nation’s healthcare dilemma with investments in companies like the physicians’ office and network One Medical Group, which raised a later stage $30 million last March. At the opposite end of the spectrum in December 2013 Google invested in the $3 million seed financing of Doctor on Demand, which sells a service enabling users to video chat with doctors.”

Google appears to be scrapping the torturous direct-to-consumer route in favor of going where the money actually is, from third-party payers and from providers, newly incented under the Patient Protection and Affordable Care Act and private reform efforts to work more efficiently and better coordinate care.

On the other hand, it’s been less than two weeks since Stephen Colbert made fun of Doctor on Demand. (Health 2.0 boss Matthew Holt commented on that post that it was “Kind of unfair that Doctor on Demand get the publicity when American Well and a [scad] of others have been doing this at scale for years.” He was right, but, hey, Google.)

Google Venture General Partner Dr. Krishna Yeshwant told TechCrunch the real motive behind all the VC money flooding into healthcare. “As an entity it is where we’re spending 17 percent to 18 percent of GDP, so any one segment is tens of billions of dollars,” Yeshwant is quoted as saying. “Increasingly you’re seeing IT investors who have a fine sense of disruptive opportunities enter the market.” In other words, it’s all about the Benjamins.

But do they understand that healthcare doesn’t work like any other industry? I’m not so sure. And I haven’t even addressed the bigger questions of privacy, data stewardship, interoperability and workflow.

As you prepare your hate mail for me, check out this site, “What the F*** Is My Wearable Strategy?” (NSFW). Refresh the page for more hilarity, but be forewarned: some of the ideas may hit close to home.

You’re welcome.

January 20, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

CMS proposes MU2 extension, MU3 start date of 2017

Less than three weeks ago, I reported from the American Medical Informatics Association Annual Symposium in Washington that officials from the Office of the National Coordinator for Healthcare Information Technology were publicly saying it was unlikely there would be a delay to Stage 2 of Meaningful Use.

In October, noting that the federal rule-making process can be arduous, former national health IT coordinator Dr. Farzad Mostashari said, “I think folks should assume that the timelines stick.” He was speaking to the College of Healthcare Information Management Executives a week after leaving government service.

Today, we find out that they knew something we didn’t. The Centers for Medicare and Medicaid Services proposed extending Stage 2 to 2016 and delaying the start of Stage 3 to 2017.

Per ONC:

Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2. The goal of this change is two-fold: first, to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2; and second, to utilize data from Stage 2 participation to inform policy decisions for Stage 3.

The phased approach to program participation helps providers move from creating information in Stage 1, to exchanging health information in Stage 2, to focusing on improved outcomes in Stage 3. This approach has allowed us to support an aggressive yet smart transition for providers.

 

The delay to Stage 3 was likely. As I exclusively reported in June, ONC’s deputy national coordinator for programs and policy, Judy Murphy, dropped a strong hint that Stage 3 would not start until 2017, saying, “2016 would be a problem.” By pushing back the start of the third stage, we would automatically get an extension to Stage 2, making it a three-year program instead of two.

The start of Stage 2 already had been pushed back a year from the original plan of 2013. From my reading, what CMS is proposing today is not another delay to the beginning of Stage 2. Hospitals that have begun their attestation periods since Oct. 1 may continue and physicians are allowed to start Jan. 1.

CMS said to expect proposed Stage 3 regulations, as well as proposed ONC EHR certification rules for Stage 3, in the fall of 2014.

What strikes me as odd is that this announcement came late on a Friday afternoon. There is no time stamp on the ONC blog post, but CMS’ Travis Broome tweeted this at 4:05 pm EST:

Late Friday is typically when government agencies take steps they don’t want plastered all over the news. I don’t see anything here that is surprising or controversial, and it could be argued that ONC didn’t mislead people with earlier statements because the start dates for Stage 2 are not changing. Did I miss something?

UPDATE: CMS held a webcast about this that started at 1 p.m. EST. That’s still Friday afternoon, but not so late that it looks like they’re trying to bury the news.

 

December 6, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Videocast with ATA: Mobile health predictions for 2014

A couple of weeks ago while I was in Washington for the U.S. News & World Report Hospital of Tomorrow conference, I stopped by the headquarters of the American Telemedicine Association to record a videocast with ATA CEO Jonathan Linkous. We discussed some of my predictions for 2014 in the fields of mobile health and telehealth:

  1. Imperative to cut costs will drive demand.
  2. More mental health services will be delivered remotely.
  3. Clarity from the FDA means more diagnostic apps and smartphone add-on devices.
  4. Patient engagement in Stage 2 Meaningful Use might finally make untethered PHRs and consumer-facing apps viable.
  5. Home monitoring and video chats will help prevent hospital readmissions.
  6. State licensing issues persist but some states are looking to adapt their rules to facilitate telemedicine.

I’m going to try to embed the video here. If not, here’s the ATA’s link.

 

November 15, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

The ‘Hospital of Tomorrow’

WASHINGTON—I’ve just finished 2 1/2 days of helping US News and World Report cover its inaugural Hospital of Tomorrow conference. My assignment was to sit in on four of the breakout sessions, take notes, then write up a summary as quickly as possible, ostensibly for the benefit of attendees who had to pick from four options during each time slot and might have missed something they were interested in. Of course, it’s posted on a public site, so you didn’t have to be there to read the stories.

Here’s what I cranked out from Tuesday and Wednesday:

Session 202: A Close-Up Look at EHRs — ‘Taking a Close Look at Electronic Health Records”

Session 303: The Future of Academic Medical Centers — “Academic Medical Centers ‘Must Become More Nimble’”

Session 305: Preventing and Coping With Infections — “How Hospitals Can Better Prevent and Cope With Infections”

Session 401: Provider and Patient Engagement — “Hospitals Grapple With Patient Engagement”

The one on infection control was particularly interesting, in large part due to the panel, which included HCA Chief Medical Officer and former head of the Veterans Health Administration Jonathan Perlin, M.D., Johns Hopkins quality guru Peter Pronovost, M.D., and Denise Murphy, R.N., vice president for quality and patient safety at Main Line Health in suburban Philadelphia.

The session on patient engagement was kind of a follow-on to my first US News feature in September.

If you want to read more about the whole conference, including US News’ live blog, visit usnews.com/hospitaloftomorrow

November 7, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: MMRGlobal’s Bob Lorsch addresses the ‘patent troll’ issue

Two weeks ago, I picked apart a terribly misleading, ideologically steeped Fox News story that wrongly linked the initial failure of the healthcare.gov Affordable Care Act insurance exchange to the Meaningful Use EHR incentive program. Among my many criticisms was the reporter’s apparent confusion between an actual EHR and My Medical Records, the untethered PHR offered by MMRGlobal.

In that post, I said, “I haven’t seen a whole lot of evidence that MMRGlobal isn’t much more than a patent troll.”

Bob Lorsch, CEO of that company, posted in the comments that I should put my money where my mouth is and interview him. (I had interviewed Lorsch before, but never wrote a story because of my longstanding policy of not paying attention to untethered PHRs since none that I know of has gained any market traction, despite years of hype.)

As this podcast demonstrates, I took Lorsch up on his offer. It was at times contentious, in part because I challenged many of his statements in the Fox story and to me, and in part because he challenged some of mine.

He asked me a pointed question, whether I still thought he was a patent troll. Based on the fact that MMR actually earned patents on a product it actively markets and didn’t just purchase someone else’s patents for the point of suing others, it’s hard to conclude that he is a patent troll.

Investopedia defines patent troll as:

A derogatory term used to describe people or companies that misuse patents as a business strategy. A patent troll obtains the patents being sold at auctions by bankrupt companies attempting to liquidate their assets, or by doing just enough research to prove they had the idea first. They can then launch lawsuits against infringing companies, or simply hold the patent without planning to practise the idea in an attempt to keep other companies productivity at a standstill.

By that definition, MMR is not. I still don’t think an untethered PHR is a good business model, a belief supported by the fact that publicly traded MMR is a penny stock, currently trading at less than 3 cents per share. I have said that patient engagement, called for on a small scale by Meaningful Use Stage 2 rules, could change the landscape for PHRs—with a better chance in pediatrics than for adult populations—but it certainly will take a few years.

I stand by my original statement that the Fox News story did health IT a huge disservice by latching onto one problem and trying to tie it to an unrelated issue simply because it fits an ideological narrative. As for MMR, well, take a listen and then judge for yourself. It’s a long podcast, but I went through the trouble of breaking it down by discussion point so you can skip around as necessary.

Podcast details: Interview with Bob Lorsch, CEO of MMRGlobal, recorded Oct. 18, 2013. MP3, mono, 128 bps, 49.5 MB, running time 54:07

2:03        About My Medical Records
3:26        Why he believes his product is better than traditional EHRs
5:00        My skepticism of untethered PHRs
6:28        Lorsch’s interview with HIStalk from February
6:40        MMR’s user base
8:00        Why he thinks MMR could facilitate health information exchange
9:40        Health information exchanges vs. health insurance exchanges
10:15     Patient-centered HIE as an alternative to multiple patient portals
12:20     Physician trust of patient-supplied data, and other workflow issues
15:05     Emergency use case
15:50     How MMR is different from other PHRs
16:32     “Last mile” of connectivity
18:17     His assertion in Fox story that patients lose control of health information and privacy under ACA, despite HIPAA
24:15     MMR carries cyber liability insurance
25:00     Scope of MMR’s patents
26:45     “Likely” infringement of patents
27:45     Lawsuits and licensing
29:30     Patent troll?
31:10     Negotiations with WebMD and others
33:00     MMR’s reputation
35:00     “We build and sell what we have intellectual property rights to.”
36:25     Other vendors ignoring patients?
36:50     Standardization in health IT
38:38     MMR’s low stock price
39:20     Patient engagement boosting PHR use?
42:00     Interest from WellPoint
42:48     Payers building trust with PHRs
44:18     Other features of MMR’s PHR
46:45     Segmentation of sensitive parts of medical records
49:08     Putting me on the spot
50:35     His objective in asserting patent rights
51:15     MMR’s issue with Walgreens
52:25     Revenue sharing vs. licensing

October 31, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Top 10 things wrong with Fox News smear job on EHRs

Today, FoxNews.com published a hit job on health IT and EHRs in the guise of another hit job on Obamacare. I found out about it courtesy of this tweet:

First off, it’s clear that Mostashari feels unshackled from having to watch his words now that he’s no longer national health IT coordinator. Secondly, he’s right. This story contains so many errors and misleading statements that it’s almost funny. Let’s count down the top 10.

10. “Under a George W. Bush-era executive order, all Americans should have access to their medical records by the end of 2014, part of a concept referred to as e-health. President Obama then made electronic medical records (EMRs) central to the success of the Affordable Care Act”

When Bush issued the executive order in 2004 that created the Office of the National Coordinator for Health Information Technology, he set as a goal interoperable EMRs for “most” Americans. The “all” part came after Barack Obama took office in 2009.

9. Though Obama did reiterate the 2014 goal and up the stakes by saying “all Americans,” nobody realistically thought it could happen. After all, the HITECH Act, which created Meaningful Use, didn’t pass until March 2009 and Meaningful Use didn’t even start until 2011. Before the HITECH Act, ONC barely had any funding anyway. For five years, Congress failed to pass much in the way of health IT legislation, even though a federal EHR incentive program had bipartisan support, symbolized by an unlikely alliance between Newt Gingrich and Hillary Clinton.

8. “Doctors, practitioners and hospitals, though, have been enriching themselves with the incentives to install electronic medical records systems that are either not inter-operable or highly limited in their crossover with other providers.”

Meaningful Use was never intended for enrichment, or even to cover the full cost of an EHR system.

7. While systems mostly are not interoperable yet, that wasn’t the intent of Stage 1 of Meaningful Use. Stage 1 was meant to get systems installed. Stage 2, which has barely started for the early adopters among hospitals and won’t start for 2 1/2 months for physicians, is about interoperability. That’s where the savings and efficiencies are supposed to come from.

6. We’re years away from knowing whether Meaningful Use program did its job, though I don’t fault members of Congress such as Sen. John Thune (R-S.D.) for putting pressure on the administration to demand more for the big taxpayer outlay.

5. “‘The electronic medical records system has been funded to hospitals at more than $1 billion per month. Apparently little or none of that money went to the enrollment process which is where the bottle neck for signing up to ObamaCare’s insurance exchanges appears to be,’ Robert Lorsch, a Los Angeles-based IT entrepreneur and chief executive of online medical records provider MMRGlobal, told Fox News.”

The money wasn’t supposed to go to the insurance enrollment process. The Meaningful Use incentive program was from the HITECH Act, part of the 2009 American Recovery and Reinvestment Act. The Patient Protection and Affordable Care Act, a.k.a. Obamacare, came a year later. Again, someone is confusing insurance and care. They are not the same thing.

4. “Lorsch, at MMRGlobal, offered the U.S. government what it describes as a user-friendly personal health record system for one dollar per month per family – a fraction of what it has cost the taxpayer so far.”

MMRGlobal’s product is an untethered personal health record. No untethered PHR anywhere is “user-friendly,” which is why adoption has been anemic. Without data from organizational EHRs, PHRs are worthless. Besides, the direct-to-consumer approach in healthcare has failed over and over, since people are used to having someone else — usually an insurance company — pick up the tab.

3. For that matter, MMRGlobal is a bad example to use as an alternative to EHRs. (The Fox story is correct in saying that other vendors do have close ties to the Obama administration, though the former Cerner executive’s name is Nancy-Ann DeParle, not “Nance.”) I could be wrong, but I haven’t seen a whole lot of evidence that MMRGlobal isn’t much more than a patent troll.

2. “But this process could have been easier if a nine-year, government-backed effort to set up a system of electronic medical records had gotten off the ground. Instead of setting up their medical ID for the first time, would-be customers would have their records already on file.”

Actually, as I wrote in a story just published in Healthcare IT News, we could have had national patient identifiers 15 years ago, as called for by the 1996 HIPAA statute. But Congress voted in 1998 not to fund implementation of a national patient ID and President Bill Clinton signed that into law. Since then, interoperability and patient matching have been mighty struggles.

1. “‘Plus, unlike under ObamaCare, the patient would be in control of their health information and, most importantly, their privacy,’ Lorsch said.”

Where in Obamacare does the patient lose control of health information? Less than a month ago, I was in Washington listening to HHS Office for Civil Rights Director Leon Rodriguez say, ““There is a clear right [in the HIPAA privacy rule] not only of patient access, but patient control over everything in their records.” This may come as news to some people, but patients own and control the information. They might not know it, but the language is pretty clear.

Already, the Fox story has been reposted in a number of blogs shared all over the Internet, so it’s being accepted as fact in some quarters. If you want the truth, you sometimes have to do the work yourself.

October 15, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Transcript from Leslie Saxon’s appearance on CNN’s ‘The Next List’

LOS ANGELES—Yesterday, I covered the seventh annual Body Computing Conference at the University of Southern California, hosted by Dr. Leslie Saxon, chief of cardiovascular medicine at USC’s Keck School of Medicine. That got me thinking: Whatever happened to the video from Saxon’s appearance on CNN’s “The Next List” back in March?

I’m pretty sure CNN never actually posted the full video anywhere online, though the network did share a short teaser clip a couple days before the show, hosted by CNN Chief Medical Correspondent Dr. Sanjay Gupta, first aired. However, I did find a full, albeit unverified, transcript of the episode on CNN’s Web site if you care to imagine what the pictures might look like.

Several of the people who were on the show also appeared at USC yesterday, including AliveCor’s Dr. Dave Albert, Zephyr Technologies CEO Brian Russell, Misfit Wearables CEO Sonny Vu and product designer Stuart Karten, as, of course, did Saxon and her Oscar-winning film producer-brother, Ed. I’ll have more coverage Monday in MobiHealthNews.

In the meantime, here’s Friday’s news about AliveCor earning FDA 510(k) clearance for the universal, Android-compatible version of its smartphone ECG, the newly dubbed AliveCor Heart Monitor. I’ll see you next week at CHIME’s Fall CIO Forum in Scottsdale, Ariz.

October 5, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: A quick chat with Farzad Mostashari

Friday is the last day on the job for departing national health IT coordinator Dr. Farzad Mostashari, who is stepping down after four years with the Office of the National Coordinator for Health Information Technology, including the last two years as head of ONC.

I was in Washington two weeks ago and stopped by the HHS headquarters for ONC’s Consumer Health IT Summit, the opening event of National Health IT Week, and got a few minutes with Mostashari. (I suppose that was good timing, because I imagine the government shutdown that took effect this week would have canceled the summit and even prevented me from entering the Humphrey Building.) I had the recorder rolling for a brief chat, which lasted less than 15 minutes before Mostashari’s handlers ushered him out to his next appointment. But I did get something.

The interview actually goes on a bit longer than what’s on this track, moving on to a discussion about Food and Drug Administration guidance on mobile medical apps. (You can read about that in this story I wrote for MobiHealthNews.) As it turned out, the FDA issued its final recommendations Sept. 23, which also happened to be the same day new HIPAA regulations—modifications called for in the HITECH Act—took effect.

I might get another chance to talk to Mostashari at the College of Healthcare Information Management Executives Fall CIO Forum at the end of next week, after he officially leaves government service and is allowed to discuss his future plans and perhaps be more candid about his tenure; CHIME has confirmed to me that he will keep his speaking slot. For now, enjoy this short interview.

Podcast details: Interview with outgoing national health IT coordinator Dr. Farzad Mostashari, Sept. 16, 2013. MP3, stereo, 128 kbps, 7.1 MB. Running time 7:44.
0:00 Why he’s leaving
1:20 Different “tribes” of health IT
2:25 Balancing competing interests and the pace of change
4:30 Difficulty of culture change
5:35 Patient control of data and confusion about HIPAA

 

October 2, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

At the very least, expect Muntz to be acting national coodinator

I don’t have any inside knowledge about whom the White House might be considering to replace Dr. Farzad Mostashari when he steps down from his post as national health IT coordinator on Oct. 5, but I get the sense Principal Deputy National Coordinator David Muntz will at least be acting head of the Office of the National Coordinator for Health Information Technology. What makes me think this?

Here is the lineup for tomorrow’s press conference at the U.S. Capitol marking National Health IT Week:

  • Sen. Sheldon Whitehouse (D-R.I.)
  • Rep. Mike Honda (D-Calif.)
  • ONC Principal Deputy National Coordinator David Muntz
  • Former Wyoming Gov. Jim Geringer
  • Incoming Director of the Department of Health for the District of Columbia Dr. Joxel Garcia

Mostashari isn’t speaking. Muntz is. The transition is underway.

By the way, I had a chance to interview Mostashari yesterday. Stay tuned for details.

September 17, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Patient engagement: Check me out in ‘US News’

I’ve just had my first story published in a major national magazine, or at least the online version of one, namely US News and World Report. It’s about patient engagement strategies for hospitals and medical practices in the context of EHRs, for the magazine’s “Hospital of Tomorrow” feature, and I’m getting good feedback so far. Needless to say, I’m pretty excited. Check it out here.

Also, I’ll be presenting on Tuesday at 11:30 a.m. EDT at the American Telemedicine Association’s Fall Forum in the non-American (but very North American) city of Toronto. It’s there because this year’s ATA president is Dr. Ed Brown, president of the Ontario Telemedicine Network, right there in the T.O.  Steve Dean of Falls Church, Va.-based Inova Health System’s Inova Telemedicine Program and I will be counting down a top 10 of mobile apps we deem to be prominent, successful or highly useful. (The description in the online program is wrong as of this writing.)

September 7, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.