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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.

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.

Another PHR venture (yawn) brings in some big names

I normally shy away from stories about the crowded and, to this point, spectacularly unsuccessful field of untethered personal health records, but one got my attention this week because of the names it’s just attracted.

Box, a cloud-storage company that offers something similar to Dropbox or Google Drive, has hired former White House CTO Aneesh Chopra and former Allscripts CEO Glen Tullman to, according to VentureBeat, “help the company push into the notoriously tricky health care vertical.” That’s an understatement. (Full disclosure: I serve on the advisory board of Health eVillages with Tullman, but I’m not in regular contact.)

Those hires bring instant credibility, though not necessarily success, and shows, as I’ve said before, that untethered PHRs might stand a chance once providers start addressing the patient-engagement requirements of Meaningful Use Stage 2. Emphasis on “might.” To date, nobody has found a way to get more than a small handful of patients to control their own medical data via PHRs.

Chopra — who once was managing director of the Advisory Board Co. and led open-data  efforts as secretary of technology in Virginia prior to joining the Obama administration — and Tullman know the health IT business better than most, but I still cast a skeptical eye on any PHR company until they prove to me they can capture a market. None ever has.

Good luck, gentlemen. You will need it.

 

March 19, 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.

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.

Follow-up from ATA Fall Forum

Last week, I joined Steve Dean of Falls Church, Va.-based Inova Health System’s Inova Telemedicine Program on stage at the American Telemedicine Association’s Fall Forum in Toronto for what turned out to be a very well-received session on mobile apps and devices finding their way into clinical workflows. It was either a Letterman-style top 10, or, as Dean described it, a Siskel and Ebert-style discussion and review of 10 popular and/or interesting apps.

In one example, Dean noted that Aetna’s iTriage consumer app had been downloaded more than 9.5 million times. One audience member questioned the relevance of that number, suggesting that many people download an app, try it once and decide not to use it again. She asked if we had any actual usership statistics. I said I would contact Aetna and find out, then post the answer here on this blog.

An Aetna spokeswoman didn’t have data on the number of iTriage users, but told me that iTriage has nearly 60 million user sessions per year. (For what it’s worth, the app also passed 10 million downloads last week, she added.)

Here are our slides from that presentation. We alternated, with Dean presenting AirStrip OB, AliveCor, Asthmapolis (which changed its name last week to Propeller Health), iTriage and Welldoc. I opened discussion on DrawMD, mym3, Walgreens, Fitbit and various apps from the VA and CMS. Download ATA Fall 2013 v3.pdf

I realize context might be missing from just looking at these slides, but the ATA tells me video will soon be available online through the ATA Learning Center. (For now, access is restricted to ATA members, but the site promises non-member access “soon.”)

 

September 18, 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.

‘Blue Button Plus is totally disruptive’

AURORA, Colo.—”Blue Button Plus is totally disruptive,” Frost & Sullivan health IT analyst Nancy Fabozzi just told me at the Healthcare Unbound conference. Why? Because the enhanced Blue Button Plus format can eliminate the need for healthcare providers to invest in patient portals in order to meet Meaningful Use Stage 2.

I tend to agree. The Stage 2 rules don’t require a portal, just the ability to transmit records securely from provider to patient. Providers, whether they be hospitals, clinics or even small physician practices, can just put a Blue Button widget on their Web site and give patients easy access to their medical records, transferred securely by the Direct protocol, itself a disruptive force for health information exchange.

Longtime readers might recall that I had dissed Blue Button in the past. More than once, in fact. That’s because the original Blue Button format was plain, unstructured text when it was an experiment at the VA. My opinion changed this week, when I realized that Blue Button Plus adds structure such as the Continuity of Care Document, and third-party vendors like Humetrix, make of the iBlueButton mobile app, provide additional context.

I don’t think this will kill the portal business because portals provide additional services such as secure messaging, appointment scheduling, refill requests and online bill payment. But it will make a lot of providers think twice about springing for an advanced portal when Blue Button Plus will fill the Meaningful Use need so easily.

July 12, 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.

Health Wonk Review: money talks, but IT helps

The latest edition of Health Wonk Review is hot off the digital presses, with Joe Paduda taking hosting duties on his Managed Care Matters blog. And managed care does matter in this trip around the health blogosphere, with most of the attention on healthcare costs and insurance coverage.

On the quality front, which is my primary interest these days, there is some interesting discussion about  whether the new Medicare hospital readmissions policy truly will produce better care or will prod some into providing the minimum level of service to readmitted patients.

(Frankly, hospitals have been overtreating for years. If a minimal level of service gets the job done for the patient, that’s a good thing. And the policy is supposed to cause hospitals to do the right thing in the first place, knowing that they will lose out later if they don’t. I’m all for that.)

My post on consumer ignorance of telemedicine is in there, as is a good one from Vince Kuraitis and Leslie Kelly Hall about the duty providers have to share information with patients. EHRs and wearable sensors also make this edition of HWR. Not bad from an IT perspective.

May 10, 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.

Breaking down ignorance about telehealth

AUSTIN, Texas — I’m at my very first American Telemedicine Association annual conference, which starts later this afternoon. This morning, I gave a short presentation to the ATA’s Industry Council, made up of technology vendors, about trends in the telehealth industry.

My slides are here: ATA 2013 presentation.

I want to draw your attention in particular to slide 9, which is a letter to the editor of the Kearney (Neb.) Hub newspaper. Honestly, it’s one of the most ignorant, poorly argued pieces of garbage I’ve seen in a long time, and I can’t believe the editor actually accepted it and published it with such a weak argument. (Really, there’s “no scientific way to diagnose a patient with a mental illness,” but it’s OK to make a diagnosis in person?) Unfortunately, I can believe that someone would be so misinformed about telehealth and healthcare in general (“doctors are being paid millions to visit with patients for five minutes …”).

Thankfully, a commenter took the author, Kearney resident Kristyn Drahota, to task. I took her to task this morning, too. I hope you will join me in helping to combat such ignorance about telehealth.

 

May 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: HIMSS CEO Steve Lieber: 2013 edition

Once again, as has become custom, I sat down with HIMSS CEO Steve Lieber at the organization’s Chicago headquarters the week before the annual HIMSS conference to discuss the conference as well as important trends and issues in the health IT industry. I did the interview Monday.

Here it is late Friday and I’m finally getting around to posting the interview, but it’s still in plenty of time for you to listen before you get on your flight to New Orleans for HIMSS13, which starts Monday but which really gets going with pre-conference activities on Sunday. At the very least, you have time to download the podcast and listen on the plane or even in the car on the way to the airport. As a bonus, the audio quality is better than usual.

Podcast details: Interview with HIMSS CEO Steve Lieber about HIMSS13 and the state of health IT. Recorded Feb. 25, 2013, at HIMSS HQ in Chicago. MP3, stereo, 128 kbps, 46.0 MB. Running time: 50:17.

1:00        Industry growth and industry consolidation
2:50        mHIMSS
3:45        Why Dr. Eric Topol is keynoting
6:00        New Orleans as a HIMSS venue
6:50        Changes at HIMSS13, including integration of HIT X.0 into the main conference
8:55        Focus on the patient experience
9:35        Global Health Forum and other “conferences within a conference”
13:00     Criticisms of meaningful use, EHRs and health IT in general
17:00     Progress in the last five years
20:45     Healthcare reform, including payment reform
22:30     Why private payers haven’t demanded EHR usage since meaningful use came along
23:50     Payers and data
26:28     Potential for delay of 2015 penalties for not meeting meaningful use
29:15     Benefits of EHRs
30:40     Progress on interoperability between EHRs and medical devices
32:52     Efficiency gains from health IT
35:27     Home-based monitoring in the framework of accountable care
36:55     Consumerism in healthcare
39:40     Accelerating pace of change
41:10     Entrepreneurs, free markets and the economics of healthcare
43:25     Informed, empowered patients and consumer outreach
46:30     Fundamental change in care delivery

March 1, 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.

Automation is good. Robocalls are bad.

I just got a robocall from my primary care physician’s office asking first if this was actually me — not that anyone would actually lie — and then if I had received a flu vaccine this season. Well, the practice itself administered the vaccine last month, so they should have known that the answer was yes. I did say yes to the interactive voice-response system and also provided the month, as asked.

I realize it is good to make sure that patients get the  recommended preventive care and that it may be impossible for staff in a small practice to call every last patient, but robocalls are awfully impersonal. If the system had actually been connected to the practice’s EHR, I wouldn’t have needed to get the call in the first place. Or maybe someone forgot to enter the vaccination into the record? In either case, the process is imperfect.

Yes, it’s a small deal, but how many imperfect processes are there in medicine? Little things have a way of adding up.

December 11, 2012 I Written By

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