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Some truths about health IT and innovation

This morning at the annual SAS Health Analytics Executive Conference in Cary, N.C., former national health IT coordinator Dr. Farzad Mostashari dubbed Dr. Eric Topol “the high priest of personalized medicine.”

That reminded me of an e-mail I received a couple weeks ago, suggesting that someone should start a blog called, “What’s Eric Saying?” As this correspondent explained it, all you need to do is read Topol’s Twitter stream to know where health IT and the practice of medicine are headed. I checked it out. It’s true.

Some examples:

 

 

 

And that’s just since Monday.

Meanwhile, Mostashari added some truisms himself this morning. “Med speed is slow. Tech speed is fast,” he said, apparently paraphrasing current TEDMED owner Jay Walker. Then, speaking as a physician, Mostashari said, “Most of what determines our outcomes isn’t what happens in our office.” Which is kind of what Topol has been trying to get across for several years.

If only the financial incentives would encourage care outside the office, we might be getting somewhere. It’s starting to happen, but, as it says above, med speed is slow.

May 14, 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.

Still no consensus on digital/mobile/connected health

A while back — three months, to be exact — I asked readers if they had a preferred term to describe “the application of new, personalized technologies to healthcare.” I gave you the choice of digital health, connected health, wireless health, mobile health and telehealth, and surmised that the results would not be conclusive. On that part, I was right:

digital health poll resultsHowever, I was surprised that connected health, a relatively underutilized term, did so well and that telehealth got but one vote. Wireless health certainly has kind of become passé, but I was surprised nobody picked it at all.

In any case, these results, however unscientific they may be, are representative of the fact that it is so hard to reach consensus on anything in health IT. They also are symbolic of the silos that still exist in newer technologies.

May 6, 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.

IBM acquiring Epic or Cerner? I dunno

The “unconfirmed rumor of a huge acquisition” that HIStalk (a.k.a. the National Inquirer of health IT) tweeted about on Wednesday apparently is that IBM was going to acquire Epic Systems. Mr. HIStalk on Thursday expressed some reservations.

 

 

So am I. The announcement was supposed to happen Friday morning, which is right now (10 am EDT as I write this). IBM is in the Eastern time zone and Epic is in the Central time zone; for that matter, Cerner also is on Central time, and when you think “huge” in health IT, really only Epic and Cerner come to mind. If there were to be an announcement not involving anyone on the west coast, it probably would have happened already.

In any case, I’m told that IBM has been rather quiet with analysts of late. I actually haven’t been able to find the ages of Epic honchos Judy Faulkner and Carl Dvorak, but they’ve been at this for some 35 years. Cerner CEO Neal Patterson is 65 and has an ownership interest in the Sporting KC soccer team. He’s also been in the health IT business for 35 years.You’d think any or all of the three have to be thinking of retirement, or, in Patterson’s case, moving on to the hobby of running a pro sports franchise. Except that Faulkner seems to love what she does.

Cerner’s stock price has dipped a bit in the last couple of months, but it has risen by 259 percent in the past five years, according to Yahoo! Finance. It still seems as if the health IT business has plenty of room to grow, especially among the biggest players, who promise to be the biggest beneficiaries of consolidation on the lower end of the market.

Until I hear something more substantive, I am not buying the IBM-Epic rumor. IBM-Cerner seems a tad more likely, but I still need to hear more.

May 2, 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.

Docs, stop whining, start e-prescribing

The whining is getting old.

Per Surescripts, in 2012, the latest year for which statistics are available, about 69 percent of physicians nationwide used e-prescribing technology in one way or another, and 44 percent of all prescriptions written nationwide were routed electronically. (That report came out in early May 2013, so expect some new numbers soon.) Both are up substantially from the previous year, probably due in no small part to the Meaningful Use EHR incentive program, which does require a minimal level of e-prescribing.

But what about the holdouts? A recent article in the journal Perspectives in Health Information Management found that cost remains the No. 1 reason why physicians still haven’t ditched the paper prescription pad in favor of electronic prescribing.

“While e-prescribing offers many benefits, not all providers have been excited about implementing e-prescribing systems. A major barrier, reported by more than 80 percent of primary care physicians, has been lack of financial support. New technology requires training and information technology support for installation and upkeep. A practice must take these costs into account when deciding whether to implement an e-prescribing system and also when choosing a stand-alone system or one that is integrated into an EHR system. According to the Health Resources and Services Administration, in a 2007 study the total cost of implementing an e-prescribing system was found to be $42,332, with annual costs after implementation of about $14,725 per year, for a practice of 10 full-time equivalent psychiatrists,” the authors reported.

Yes, but the paper also says this: “E-prescribing improves the efficiency of the prescribing process. Though the actual entering of a new prescription takes about 20 seconds longer per patient than writing a prescription, this time is offset by the time saved because of the fact that less clarification is needed for electronic prescriptions. Prescribers spent more time on the computer, on average an extra 6 minutes per prescriber per day or an increase of 20 seconds per patient when seeing 20 patients per day. If implemented correctly, e-prescribing should cause little disruption in the workflow of ambulatory care settings.”

In other words, those resisting the switch are being penny-wise and pound-foolish.

Besides, e-prescribing systems don’t have to cost that much. In fact, they don’t have to cost anything. Allscripts offers a free, standalone e-prescribing system online, while PracticeFusion, DrChrono and Kareo have e-prescribing modules in their free EHRs. A startup named ScriptPad has an e-prescribing app for Apple iOS that’s free to prescribers; transaction fees get billed to pharmacies. I can’t vouch for the efficacy of any of this software, but cost doesn’t have to be an issue.

I think the real problem here is intransigence. Some doctors simply don’t want to get with the times, and the only losers are patients.

April 24, 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.

Athenahealth-EHRA news significant only that it shakes up the status quo

By now, you’ve likely heard the news that Athenahealth has decided to quit the HIMSS EHR Association. As Athenahealth’s Dan Haley put it in a blog post: “At the end of the day, athenahealth left the EHRA because we never really belonged there in the first place. The EHRA was founded in 2004 by a group of EHR software vendors. Today, a decade into the age of cloud technology, the EHRA is still dominated and governed by a group of EHR software vendors.”

Athenahealth long has billed itself as a services company, not a software vendor, going so far as to hold a jazz funeral for the “death of software” at HIMSS13 in New Orleans. Athenahealth didn’t join the EHRA until 2011 anyway. It sounded like a bad fit.

I contacted Athenahealth, and was told that the company remains “fully committed” to the CommonWell Health Alliance, a coalition of health IT companies — also including Allscripts, Cerner, CPSI, Greenway Health, McKesson and Sunquest Information Systems — that came together for the stated purpose of “developing, deploying and promoting interoperability for the common good.” (There’s also the unstated purpose of fighting the dominance of Epic Systems.)

Athenahealth is staying on the interoperability path, but as is befitting the corporate culture, is going rogue when it comes to EHRs. It’s not the first time. It won’t be the last time, because it’s not like most of the other vendors/service providers, if for no other reason than CEO Jonathan Bush doesn’t fit the buttoned-down model of an executive. For that matter, neither did his co-founder, Todd Park, whom I often called an “anti-bureaucrat” during his time with the federal government. Park’s brother, Ed, is COO of Athenahealth, and also has unconventional tendencies.

I can relate to this mentality in a way. I quit the Association of Health Care Journalists years ago because it didn’t feel like a good fit for me. That group tried to include health IT in its programming, but it really was an organization for consumer and scientific reporters, not those of us in the business and trade press. Eight years later, I still don’t think the national media are doing such a great job covering health policy or explaining the nuances of this complicated industry. And, as I’ve said many times before about healthcare, the status quo is unacceptable.

 

April 23, 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.

Despite scandal, TMIT is still operating

You’ve no doubt hear about the kickback scandal involving CareFusion and Charles R. Denham, MD, founder of the Texas Medical Institute of Technology (TMIT). I wrote a piece about it in the context of Meaningful Use for Healthcare IT News this month, since Denham co-chaired the steering committee of the National Quality Forum’s Safe Practices for Better Healthcare program during the time CareFusion allegedly paid Denham $11.6 million to promote its products.

CMS, of course, has, to date, based Meaningful Use quality measures on NQF recommendations.

Denham has become a pariah of sorts in patient-safety circles since the U.S. Department of Justice announced a $40.1 million settlement with CareFusion in January. Yet, believe it or not, TMIT is still in business. The organization’s Web site is functional; in fact, the “about” page prominently features a video with Denham. And the TMIT Twitter account is activem, promoting a webinar as recently as yesterday.

 


Perry Bechtle, D.O., is a neuroanesthesiologist at Mayo Clinic in Jacksonville, Fla., and a former U.S. Navy flight surgeon. I want to believe that his credentials are impeccable, but it’s hard to take TMIT seriously these days in the absence of a major house-cleaning. Interestingly, the last academic article Denham wrote before the scandal broke was in the December 2013 issue of the Journal of Patient Safety. It’s entitled, “Safe Use of Electronic Health Records and Health Information Technology Systems: Trust But Verify,” and co-authors include heavyweights such as David Classen, M.D., and David Bates, M.D.

How are we supposed to trust an organization that itself was wrapped up in such a serious breach of trust?

April 18, 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.

Podcast: Owen Tripp, CEO of Grand Rounds

Yesterday, Grand Rounds, a San Francisco-based startup that makes an “outcomes management platform” for large employer groups, introduced Office Visits, an online service that helps consumers find “quality” physicians close to home. I’ve long been skeptical of any claims of healthcare quality or any listing of “best” physicians or hospitals, so I invited Grand Rounds co-founder and CEO Owen Tripp on for a podcast to explain what his company is doing.

He told me that a proprietary algorithm helps Grand Rounds “recommend with confidence” the top physicians among the 520,000 medical specialists the company graded nationwide, based on numerous publicly available data sources and some self-reporting. Of those more than half a million specialists, only about 30,000 meet the company’s criteria for recommendation, which shows, at the very least, that Grand Rounds is highly selective.

Based on this interview, I think the product has a lot of potential. It’s nice to see ratings based on outcomes data and not squishy criteria like “he is a great doctor,” as parodied in The Onion this week (“Physician Shoots Off A Few Adderall Prescriptions To Improve Yelp Rating”).

At about 18:30, the conversation reminds me of another recent podcast, with University of Rochester neurologist Dr. Ray Dorsey. It turns out that Dorsey is among the 1,000 or so medical advisors to Grand Rounds.

Podcast details: Interview with Owen Tripp, co-founder and CEO of Grand Rounds. MP3, stereo, 128 kbps, 23.8 MB, running time 26:04.

1:00 “Safety” vs. good outcomes
2:20 “Downright terrifying” facts about choosing doctors
4:15 Story behind Grand Rounds
5:30 Algorithm for measuring physician quality that he says has shown about a 40 percent lower rate of mortality on common cardiac procedures
7:10 Data sources, including some self-reporting
8:35 Care coordination services Grand Rounds provides for patients
9:50 Why the direct-to-consumer market is so difficult in healthcare
12:00 Care teams
14:00 Availability and scope of service
16:15 When patients should travel for care and when they should not
18:15 Elements of telemedicine
19:35 Importance of asynchronous communication
21:45 Target market and why he sees the $200 fee as a bargain for patients
23:35 Managing patient records and other data
24:35 Company goals

April 9, 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.

Digital health at the Mid-America Healthcare Venture Forum

In case you haven’t seen the official announcements or caught my tweets, later this month I will be moderating a panel at the Mid-America Healthcare Venture Forum, an event being put on by MedCity News, April 22-23 at the J.W. Marriott hotel in Chicago.

The panel is called “Opportunities (and Challenges) in Digital Health. Per the official description: “Digital health — and its business models — are coming of age. Promising young companies are integrating into healthcare and, in some cases, beginning to find exit partners. But that’s also meant new scrutiny from everyone from investors to the FDA. Learn about the challenges, opportunities and promising new markets in digital health.”

Panelists include: Amy Len, director of Chicago-based accelerator Healthbox; Julie Kling, director of mobile health at Verizon Wireless; and Jack Young, who heads the Qualcomm Life Fund for Qualcomm Ventures. I’ll just be there to keep order, and, of course, to cast my usual, skeptical eye on the field and continue to wonder why investors are throwing so much money at me-too fitness trackers and countless direct-to-consumer products that don’t stand a chance in an industry where nearly everything is paid for by third parties. Or at least that’s my thought at the moment, until we have our conference call next week. :)

The session is scheduled for Wednesday, April 23, at 8:55 a.m. CDT. The hotel is located at 151 W. Adams St. in the heart of the Financial District. Years ago, I worked about two blocks west of there, so I know it’s about 40-45 minutes away from me by public transit, and I’m not a morning person. This could get  interesting. (If any MedCity people are reading this, I’m kidding. I’ll be there on time. Hopefully.)

Our session follows a keynote from James Rogers, chairman of Mayo Clinic Ventures. After the panel is a break, then breakout sessions featuring presentations to investors from startups in digital health, medical devices and pharma/biotech. I hope I don’t prematurely burst anyone’s bubble with too much of a reality check. But, in honor of this week being the 25th anniversary of the release of the great Gen X satire, “Heathers,” I offer this quote from the movie: “Heather told me she teaches people ‘real life.’ She said, real life sucks losers dry.”

Wait, was that too cynical?Let me just say that the panel just got another thing to talk about today, as the FDA, FCC and ONC just released their proposed health IT regulatory strategy, as called for by the Food and Drug Administration Safety and Innovation Act (FDASIA). To nobody’s surprise, they recommend a “risk-based framework” to regulation of health IT and digital health. Now to figure out if there are any details people should be concerned about…

In the meantime, you can register for the conference here.

April 3, 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.

About those Obamacare numbers and the ICD-10 delay

While I’ve been busy writing a couple of stories on different topics, you’ve probably heard two pieces of news that will affect healthcare providers nationwide: the close of the first open enrollment period for Patient Protection and Affordable Care Act insurance exchanges and the Congressional “fix” (read “Band-Aid”) to the Medicare sustainable growth rate that statutorily delays the ICD-10 compliance deadline for another year, until October 2015.

The White House yesterday reported that 7.1 million people had signed up for health insurance through healthcare.gov or state-run exchanges, barely exceeding the Congressional Budget Office’s projection of 7 million. Independent tracking site ACAsignups.net says it’s more like 7.08 million, but still just above the goal. That site also tallies the following sign-ups as a result of the ACA:

  • 6.37 million – 12.45 million in private “qualified health plans” (plans that meet ACA standards) via private exchanges, insurance agents or direct purchases from insurers, including deductions for the estimated 3.7 million whose “noncompliant” policies were canceled;
  • 4.71 million – 6.49 million through Medicaid/Children’s Health Insurance Program expansions;
  • 2.5 million – 3.1 million “sub-26ers,” young adults whom the ACA allows to stay on their parents’ health insurance until age 26; and
  • 1.8 million “woodworkers,” those who came out of the woodwork because they did not know before the Obamacare enrollment push that they were eligible for Medicaid or CHIP.

ACAsignups.net places the total range at 14.6 million – 22.1 million as of March 31, not counting the healthcare.gov numbers, though my math puts it at 15.38 million – 22.06 million. Add in the healthcare.gov sign-ups and you get about 22.5 million to nearly 29 million newly insured people. However — and this is a big however — we do not know how many of the beneficiaries are newly insured and how many were replacing previous coverage.

Personally, I bought a high-deductible, ACA-qualified health plan through an independent agent to replace a rather restrictive high-deductible plan that was grandfathered in, and should save about $70-$80 a month on premiums starting in May. The new insurer rejected me several years ago due to a pre-existing condition; the ACA assures that I can’t be denied for that reason anymore. I imagine there are millions in the same boat as I am.

The U.S. Census Bureau placed the number of uninsured for 2012 at about 48 million, or 15.7 percent of the population. (The same year, 198.8 million had private insurance.) Until we see new figures for uninsured Americans, we will still just have “gross” statistics, not a net figure to show if the insurance part of the ACA is working.

By the way, the ACA is about much more than insurance coverage, despite what the national media have focused on. I encourage you to read up on this before you say Obamacare is saving or ruining our country.

Now, as for the temporary SGR fix, the ICD-10 delay kind of came out of nowhere last week when it got slipped into the House version of the legislation, but the Senate adopted the same language — reportedly without debating ICD-10 at all — and President Obama today signed it into law. I’ve said before that ICD-10 and other transactional elements of healthcare stopped mattering to me as I watched my dad being mistreated in a hospital due to broken clinical processes in his last month of life. I still think this way. However, this sneaky move shows that the AMA, AHA and other groups more intent of protecting the status quo than fixing healthcare still have enormous sway in Washington.

It makes me wonder whether lobbyists haven’t already started pushing hard for Congress to delay the Medicare penalties for not achieving Meaningful Use that are due to kick in next year. Actually, I don’t wonder. I’m sure it’s happening.

All delaying real reform of a broken industry does is prolong the agony, and ensure that millions more people will be affected by errors and neglect in institutions that are supposed to “do no harm.” The status quo is not acceptable.

 

April 2, 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.

eHealth Initiative ’2020 Roadmap’ panel needs consumers

This press release showed up my inbox on Tuesday:

eHealth Initiative Launches 2020 Roadmap Process

Framework to Change the Future of Nation’s Healthcare System

March 25, 2014, Washington, D.C. – The eHealth Initiative (eHI) announced the launch of the eHealth Initiative 2020 Roadmap, a public-private collaboration that will help guide the  transformation of the nation’s healthcare system by 2020. With the help and support of a  wide array of leading healthcare associations, organizations, and federal agencies, 2020 Roadmap will propose key policy recommendations to implement at a federal level and actions for the private sector to help transform healthcare.

“Health reform calls for transformation to a value-based interoperable system, but there is no direction on how to transition from our current work processes and systems. Clinicians, payers and providers are in dire need of leadership to help transform delivery systems and control cost,” said Jennifer Covich Bordenick, Chief Executive Officer of the eHealth Initiative. “The goal of our new initiative is to craft a multi-stakeholder solution that coordinates the efforts of both the public and private sector so that we can make this transition successfully.”

The 2020 Roadmap will be developed over the next six months through a series of surveys, webinars, executive roundtables, and events with key constituencies; the outcome will be a consensus on how to shape the future of our healthcare system.  Individuals are welcome to complete surveys, participate in upcoming events, and provide general feedback. A new survey is currently being fielded to gather information from the industry.

The 2020 Roadmap will focus on recommendations that:

•        Identify a sustainable glide path for meaningful use;

•        Promote interoperable systems;

•        Transform care delivery; and

•        Balance innovation and privacy.

Several advisors representing different stakeholders are leading the 2020 Roadmap activities, including:

·         John Glaser, PhD, Chief Executive Officer, Health Services, Siemens (representing vendors)

·         Sam Ho, MD, Executive Vice President and Chief Medical Officer, UnitedHealthcare, Chair eHI Board of Directors, (representing payers)

·         Christopher Ross, MD, Chief Information Officer, Mayo Clinic (representing providers)

·         Susan Turney, MD, Chief Executive Officer, Medical Group Management Association (representing clinicians)

·         Micky Tripathi, PhD, President and Chief Executive Officer, Massachusetts eHealth Collaborative (representing information exchanges)

·         Joseph Touey, Senior Vice President, North American Pharmaceuticals, Information Technology, GlaxoSmithKline (representing pharmaceutical manufacturers)

“The impressive caliber of individuals leading our effort reflects the importance of the 2020 Roadmap,” said Jennifer Covich Bordenick. “We invite all organizations to participate in this important process and bring the best thinking to the table.”

Visit the 2020 Roadmap webpage for more information at http://www.ehidc.org/2020-roadmapMore information about the eHealth Initiative is available online at www.ehidc.org.

###

About the eHealth Initiative: The eHealth Initiative (eHI) is a Washington D.C.-based, independent, non-profit organization whose mission is to drive improvements in the quality, safety, and efficiency of healthcare through information and information technology. eHI is the only national organization that represents all of the stakeholders in the healthcare industry. Working with its membership, eHI advocates for the use of health IT that is practical, sustainable and addresses stakeholder needs, particularly those of patients. www.ehidc.org .

What immediately jumped out at me was the list of advisors. I’m familiar with most of the names, and I am sure all are qualified to provide valuable input on how to promote interoperability and improve our nation’s broken healthcare infrastructure. But the notes on representation raise an important question: How come nobody is representing consumers?

It’s after hours as I read the press release and I post this commentary, but I’ve e-mailed the press contact to see if the eHealth Initiative has a good answer. I will report back as soon as I hear anything. In the meantime, consumer and patient advocacy groups should take Bordenick up on her offer to participate.

UPDATE, March 27, 11 am CDT: I’ve just received this response directly from Bordenick:

Please know that the news release just highlighted just a few of the individuals and groups that will be involved.  We absolutely welcome the representation and involvement of patient and advocacy groups, and any stakeholder groups who want to participate— that is one of the reasons we put the announcement out, and asked people to fill in contact info in the survey. We are at the very start of this process, so now is definitely the time to get engaged. We currently work with National Partnership for Women and Families, Center Democracy & Technology, American Cancer Society, and have just started work with Smart Patients, and many others. We expect all of these groups to continue working with us, and many others to join in the process.

So there you have it. As I said in the original post, consumers and patient advocacy groups should take Bordenick up on the offer. It sounds like she would appreciate it.

March 26, 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.