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Video: Farzad Mostashari on patient engagement, ‘physician ACOs’

As I alluded to earlier, I was leaving the press room one afternoon at HIMSS14, and there I see former national health IT coordinator Dr. Farzad Mostashari hanging around Gregg Masters and Dr. Pat Salber of Health Innovation Media. It turns out, Masters and Salber had just pulled Mostashari aside to do an interview on video, but they didn’t have anyone to interview him on camera, so they asked me right there on the spot to be the interviewer. Here is the result.

Mostashari, now a visiting fellow at the Engelberg Center for Health Care Reform at the Brookings Institute in Washington, discussed how the years of searching for a business model to coordinate care and engage patients is finally starting to pay off. Always the champion of the little guy in healthcare, Mostashari also brought up the notion of physician-led ACOs, or, as he called it, the “Davids going up against the Goliaths.”

 

I had pretty much no preparation for this interview. It probably shows. I still think it worked out well.

Here’s a link to Salber’s post about the interview because I don’t want to steal page views. :)

March 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.

Podcast: HIMSS CEO Steve Lieber, 2014 edition

It’s time for my annual podcast interview with HIMSS President and CEO Steve Lieber, this time from the Orange County Convention Center in Orlando, Fla., on the day before the official opening of the 2014 HIMSS Conference, rather than in his Chicago office a week or so in advance.

Lieber reiterated HIMSS’ position that the federal government should extend the attestation period for Meaningful Use Stage 2 by one year. I wasn’t there, but today at the CIO Forum, one of the preconference educational symposia, ONC Chief Medical Officer Jacob Reider, M.D., hinted that there will be an announcement on Stage 2 flexibility, possibly Thursday morning at a joint ONC-CMS town hall. That session will feature CMS Administrator Marilyn Tavenner and new national health IT coordinator Karen DeSalvo, M.D. I’ve never heard either of them speak, and now I’m excited to be covering that session.

We also discussed other aspects of healthcare reform, trends in health IT and expectations for HIMSS14. Of note, on Monday morning, HIMSS and two other organizations will announce a new initiative on “personal connected health.”

Near the end, I reference the podcast I did last week with Dr. Ray Dorsey about remote care for Parkinson’s patients. For easy reference, here’s the link.

This is, I believe, the seventh consecutive year I have done a podcast with Lieber at or just before the annual HIMSS conference. Another interview that has become somewhat of a tradition won’t happen this time, as Athenahealth CEO Jonathan Bush is not making the trip to Orlando this year.

 

Podcast details: Interview with HIMSS President and CEO Steve Lieber, Feb. 23, 2014, at HIMSS14 in Orlando, Fla. MP3, stereo, 128 kbps, 36.2 MB. Running time 39:35.

0:40 “It’s time to execute.”
1:40 Challenges for small hospitals and small practices
3:10 New ONC EHR certification proposal and continued questions about Meaningful Use Stage 2
5:00 Prioritizing with multiple healthcare reform initiatives underway, including proposed SGR repeal
6:30 Surviving ICD-10 transition
7:35 HIMSS’ position on MU2 timelines
9:05 Remember “macro objective” of Meaningful Use
10:00 Letter to HHS from organizations not including HIMSS calling for what he says are “very vague” changes to MU2 criteria
11:40 Things in MU2 causing providers fits
13:05 Fewer EHR vendors certified for 2014, but more HIMSS exhibitors
15:00 What this means for providers who bought products certified to 2011 standards
17:20 Progress on Meaningful Use so far
21:00 Looking toward Stage 3
22:42 What healthcare.gov struggles might mean for health IT
25:35 Other aspects of the Affordable Care Act being lost in the public debate
27:10 Political considerations related to health IT
29:40 Patient engagement and new HIMSS exhibitors
32:20 Why healthcare spending and provider shortage forecasts don’t account for efficiency gains made from technology and innovation
35:10 Demographic challenges for healthcare
35:45 Shift from hospitals to ambulatory and home care and consolidation of provider organizations

February 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.

Patients raise their voices at CES

I’m about to escape the frigid winter blast in Chicago, a.k.a., Chiberia, for the relative warmth of Las Vegas (it will be below 40 degrees Fahrenheit at night, so it’s not exactly tropical there either) and the Digital Health Summit at International CES. On Wednesday afternoon at 4:10 p.m. PST, I will be moderating a panel called “Loudmouth Patients: Making Noise and Making Change.” Panelists will include: well-known empowered patient — and pain in Medtronic’s behindHugo Campos; Donna Cryer, CEO of the Global Liver Institute (and a liver transplant recipient herself); and Greg Matthews, group director of  interactive and social media at WCG.

I’m giving just a short intro since the session is only 30 minutes long, though I do intend to give a condensed version of the story of how I had to raise my voice in support of my dad, who was rendered unable to speak by a rare disease as he was dying — and being badly mistreated — in an ill-equipped and poorly run hospital less than two years ago.

Hopefully soon we can all speak up to our healthcare providers without being blacklisted like Seinfeld’s Elaine back in the 1990s (h/t Brian Ahier).

Speaking of patients getting a look at their medical records, I’m also working on a story for U.S, News & World Report about the pros and cons of the OpenNotes project. Stay tuned for that one hopefully later this month.

January 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.

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.

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.

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.

More on Blue Button Plus and MU2

My last post, based on comments from Frost & Sullivan health IT analyst Nancy Fabozzi at last week’s Healthcare Unbound conference, has generated a bit of controversy. Fabozzi said that “Blue Button Plus is totally disruptive,” possibly eliminating the need for some providers to get full-fledged patient portals in order to meet Meaningful Use Stage 2 standards.

In the comments under that post, David Smith of HealthInsight.org, a health improvement consortium in three Western states, correctly pointed out that MU2 requires not just that providers give 50 percent of patients electronic access to their records, but also that 5 percent of patients actually view, download and/or transmit information back to their doctors or hospitals. I also got an e-mail from a GE Healthcare executive reminding me that of the view/download requirement as well as the fact that EHR technology had to be certified by an ONC-approved certification and testing body.

The viewing and downloading certainly can be accomplished with Blue Button Plus apps or widgets. In fact, ONC’s Lygeia Ricciardi has said Blue Button Plus could be part of the Stage 3 rules.

Transmitting would seem to necessitate a portal since HIPAA demands — and patients should expect — security when sending protected health information over the Internet. Standard e-mail doesn’t cut it, but e-mail following Direct Project protocols does. MU2 already sanctions Direct Project for health information exchange between healthcare entities. There is no reason why it can’t work for individuals as well, as Dr. Deborah Peel’s Patient Privacy Rights Foundation is trying to facilitate.

This might be a bit unwieldy, asking each patient to set up a Direct e-mail address, but remember, providers only need 5 percent to do so in Stage 2. I see it as perfectly feasible that some small physician practices could bypass the portal and just make do with freely available resources like Blue Button Plus — though Blue Button Plus app developers likely will charge fees — and open-source Direct standards.

UPDATE, July 18, 12:40 a.m. CDT:

HHS itself says Blue Button Plus meets MU2 standards.

From http://www.hhs.gov/digitalstrategy/open-data/introducing-blue-button-plus.html:

Blue Button Plus is a blueprint for the structured and secure transmission of personal health data. It meets and builds on the view, download, and transmit requirements in Meaningful Use Stage 2 for certified EHR technology in the following ways —

Structure: The recommended standard for clinical health data is the HL7 Consolidated Clinical Document Architecture or Consolidated CDA. The C-CDA is a XML-based standard that specifies the encoding, structure, and semantics of a clinical document. Blue Button Plus adopts the requirements for sections and fields from Meaningful Use Stage 2.

Transmit: In alignment with Meaningful Use Stage 2 standards, Blue Button Plus uses Direct protocols to securely transport health information from providers to third party applications. Direct uses SMTP, S/MIME, and X.509 certificates to achieve security, privacy, data integrity, and authentication of sender and receiver.

It sounds to me like compliance is just a matter of making sure that a Blue Button Plus app is certified as an EHR module.

July 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.

Video: My interview with Hands On Telehealth

I recently was a guest on a vodcast with Nirav Desai, founder and CEO of telehealth consulting firm Hands On Telehealth, whom I met because I moderated a panel he was on at the American Telemedicine Association‘s annual conference in May. In a Skype interview that went up late Friday, we chatted for 45 minutes about telehealth, the broader  health IT landscape and how it all fits into U.S. healthcare reform.

I’m unable to embed the video on this page, so please visit the Hands On Telehealth page to watch the interview. (That’s a screen grab below.) The page contains a detailed description of the interview, much as I like to have for my own podcasts. Perhaps next time I’ll spend more time looking directly at the camera. :)

Hands On Telehealth screen grab

July 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.