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10/21/2009

Shutting Down Social Media? Not Here.

By PAUL LEVY

Paul Levy is the President and CEO of Beth Israel Deconess Medical Center in Boston. He blogs about his experiences at Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive and where this post first appeared.

The following email message was broadcast last week in a Boston hospital. Of course, you can guess my view of this: Any form of communication (even conversations in the elevator!) can violate important privacy rules, but limiting people's access to social media in the workplace will mainly inhibit the growth of community and discourage useful information sharing. It also creates a generational gap, in that Facebook, in particular, is often the medium of choice for people of a certain age. I often get many useful suggestions from staff in their 20's and 30's who tend not to use email. Finally, consider the cost of building and using tools that attempt to "track utilization and monitor content." Not worth the effort, I say.

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10/12/2009

Nursing a Health 2.0 Hangover

By J.D. KLEINKE

J.D. Kleinke

So it’s the morning after the big Health 2.0 bash and the hangover is awful. My head is awash with flashing screens of medical alerts, rainbow-colored demos of virtual patients flitting from one personal health app to the next, and a blur of snappy, almost sneering answers to the same old questions about user adoption, ROI, and business models. I just spent two days getting high on health care’s highest high-concept, I can’t log into my own health plan’s portal to look up a simple eligibility thing, and it’s dull, gray cloudy morning in San Francisco.

Whither the 2.0 revolution you’ve been reading about all week? Was the blueprint unfurled before the cognoscenti by Matt Holt and the NorCal health care keiretsu? Was there an exhibitor booth handing out the magic bullets, along with the usual pens and mugs? Um - no.

Perhaps it’s my own perennial impatience with health care’s miserable status quo; perhaps it’s a sign of the inevitable coming of age for the 2.0 community, or space, or ecosystem, or whatever the corporate concept jockeys are calling a market this year. But at the risk of offending Matt and my other good friends in the keiretsu, this year’s conference felt for the first time oddly normative, almost reminiscent of other conferences like HIMSS and the World Health Congress, where Big New Health Care Ideas run headlong into The Great and Powerful Health Care Inertia Machine.

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Why Standards Matter 2: Health IT Enters a New Era of Regulatory Control

By DAVID C. KIBBE and BRIAN KLEPPER

David KibbeThe recent history of electronic medical records in ambulatory care, or what we now call EHR (electronic health record) technology, can be divided roughly into three phases. Phase I, which lasted approximately 20 years, from about 1980 to the early 2000's, was an era of exploration and early adaptation of computers to outpatient medicine. It coincided with the availability of PCs that were cheap enough to be owned by many doctors, and with the increased capacity of off-the-shelf software programs, mainly spreadsheet and database management systems such as Lotus, Excel, Access, and Microsoft's SQL, to lend themselves to computerized capture of health data and information.

Phase II coincided roughly with the American Academy of Family Physician's (AAFP's) commitment to health IT as a core competency of the organization, and with its support/promotion of the early commercial vendors in the Partners for Patients program, a national educational campaign inaugurated in 2002 which involved joint venturing with vendors that included Practice Partners, MedicaLogic, eClinicalWorks, and eMDs, among others. Several other physician membership organizations joined this effort to popularize EMRs, or crafted their own education programs for their members based on the AAFP's model. The most popular Phase II products were, and still are for the most part, client-server software applications that run on local networks and PCs within the four walls of a practice, and tend to use very similar programming development tools, back-end databases, and support for peripherals such as printers. The industry grew, albeit sluggishly, from roughly 2002-present in an unregulated environment, with increasing support from quasi-official industry groups like HIMSS and CCHIT, and with the blessing of many professional organizations, including the AAFP, ACP, AOA, and the AAP. Best estimates are that the numbers of physicians using EHR technology from a commercial vendor roughly tripled during this period, from about 5% of physicians to about 15%. The Bush administration gave moral support to the industry, but did not provide funding or payment incentives, and mostly left the industry to itself to sort out the rules, including certification. The industry is now entering a new phase, one we predict will significantly depart from the previous two eras.

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The Long Tail of the EMR

By Margalit Gur-Arie

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In the fall of 2008 I had the opportunity to do some research on the, then dormant, EMR marketplace. The results came as no surprise. Most physicians did not have an EMR and were not interested in adopting an EMR due to cost and usability barriers.

Much has changed in one short year. Spurred by ARRA and its HITECH portion, there is a renewed interest for technology in the physician community. Some of it came from the promise of stimulus funds and some stems from the perceived inevitability of the need to have technology in one's office. There is no feverish anticipation of the great things an EMR will bring to a medical practice. Instead, there seems to be a somber resignation to the upcoming demise of a trusted friend: the paper chart.

On the other side of the market, vendors are gearing up for 2010. Since stimulus funds are supposed to begin flowing in 2011, the coming year is crucial to most vendors. There is a palpable sense of urgency for capturing market share before it is too late, and all physicians have made their choices. After all, once a physician buys and uses an EMR, changing vendors is not an easy proposition. Transferring clinical data from one EMR to another is practically impossible and the costs of change are high.

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10/10/2009

Interview with Jon Bush

10/07/2009

The Health 2.0 Accelerator is really gunning it...

By Matthew Holt

The Health 2.0 Accelerator was a glimmer in the eye of Commerce.net’s Marty Tenenbaum late in 2007. But under the dedicated leadership of Julie Murchinson and Aaron Apodaca, something quite remarkable is happening. The Accelerator is an industry consortium, mostly made up of very small Health 2.0 companies who are just getting started in their own young lives. But working together they’re integrating data and services in a way that’s going to make consumers’ use of online health tools very different from the patchwork we see today.

And the effort is getting attention. Today Kaiser Permanente announced that it was joining the Accelerator, moving alongside Sage and Catholic Healthcare West as corporate members. And in the wings is a major health care data player, who’s going to be adding their seal of approval next week.

What’s happening here is the evolution of an ecosystem—an ecosystem where innovation on the web and in mobile Health 2.0 is now finding ways to present itself to consumers and healthcare organizations in new ways.

I don’t want to let the cat out of the bag completely, but I think that anyone who’s interested in seeing the evolution of Health 2.0 and the evolution of health care consumer technology will be fascinated by what around a dozen Health 2.0 Accelerator members are going to show—together—at the tools panel at the Health 2.0 Conference next week.

In the meanwhile kudos to Julie and Aaron, to Erick & Linda von Schweber from PHARMASurveyor who’ve been founding board members and have driven the technical process, to the folks from Sage who were great early supporters and to the more than 100 people and companies who’ve been supporting the Accelerator.

They’ve all made a real difference. And it’s just beginning.

E-Health - It All Depends on How It's Used

By MERRILL GOOZNER

Technology isn’t a quick fix. Just ask General Motors. In the 1980s, the auto giant spent $50 billion to automate and computerize its plants in an effort to compete with Toyota. Today, GM is emerging from bankruptcy while Toyota still leads in producing high quality, fuel-efficient vehicles.

What happened? “The Japanese have a great way of describing the error that General Motors made,” said Thomas Kochan, co-director of the Institute for Work and Employment Research at the Massachusetts Institute of Technology Sloan School of Management. “It’s workers who give wisdom to these machines.”

Will the Obama administration’s $20 billion push to flood the nation’s physician offices and hospitals with electronic medical records (EMRs) suffer a similar fate? The July/August cover story in the Washington Monthly by Phillip Longman pointed to one possible stumbling block on the road to widespread diffusion of EMRs – self-interested software firms pushing proprietary systems that can’t talk to each other.

But there may be an even greater danger. The people who actually deliver care will fail to achieve the potential health benefits of having every patient’s EMR at their fingertips.

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09/30/2009

The Doctor Is In and Logged On.

By RAHUL PARIKH

ParikhWow. I've just taken care of three patients in 12 minutes, and I didn't do it by "churning" them through my office as if it's some sort of factory assembly line. Rather, those patients (their parents, more specifically -- I'm a pediatrician), e-mailed me over a secure network with questions and descriptions of signs and symptoms.

One mother attached a digital photo of a rash on her 3-month-old daughter's face; it turned out be nothing more serious than baby acne (it'll go away in a month or so). Another mom had noticed that her son was missing one of his pre-kindergarten immunizations (she had pulled up his shot records online) and requested that I order it. And the father of a 5-month-old boy told me that his son has been constipated off and on for the last month. I e-mailed him a questionnaire so I could determine whether the family should try something at home or bring the child to the office.

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09/14/2009

“Meaningful Use” Criteria as a Unifying Force

By Vince Kuraitis, David C. Kibbe & STEVE ADAMS

Vince-20kuraitis09-smallOver the past several years, many diverse initiatives have arisen offering partial solutions to systemic problems in the U.S. health care non-system. 

We see Meaningful Use Criteria recommended by the HIT Policy Committee as a unifying force for these previously disparate initiatives. These initiatives have included:

  • Patient Centered Medical Homes (PCMHs)
  • Regional Health Information Organizations (RHIOs)/Health Information Exchanges (HIEs)
  • Payer Disease/Care Management Programs
  • Personal Health Record Platforms — Google Health, Microsoft HealthVault, Dossia, health banks, more to come
  • State/Regional Chronic Care Programs (e.g., Colorado, Pennsylvania, Improving Performance in Practice)
  • Accountable Care Organizations — the newest model being proposed as part of national reform efforts

Today

While there are some commonalities and overlap, to-date these initiatives have mostly arisen in isolation and are highly fragmented — they’re all over the map. Here’s a graphic representation of the fragmentation that exists today:

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Can Social Media Save Healthcare Reform?

By Daniel Palestrant

Daniel Palestrant Speaking at Fortune’s Brainstorm Technology Conference last month, longtime healthcare reform advocate, Howard Dean pointed out that the "dirty secret" of social media is that it can put a whole lot of politicians out of business because it allows the truth to bubble up. For the sake of healthcare reform, let’s hope he is right.

True healthcare reform has no chance of occurring with the current political topography. As the general public tries to make sense of the 1,000+ page version of the bill and President Obama distances himself from Howard Dean’s raison d’etre, the public option, two things are becoming increasingly clear:

1. There is very little actual healthcare reform going on.

2 The insurance companies look like they will win, no matter what, especially if you believe the cover of the most recent Business Week "The Health Insurers Have Already Won".

At Sermo.com we seem to be seeing Governor Dean’s prediction come true.

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