November 25th, 2009

U.S. health IT money going to community colleges

Posted by Dana Blankenhorn @ 8:58 am

Categories: General, Government, Hospital IT, Medical IT, Medical Office IT, Medical Records, Physician Information, U.S.

Tags: Information Technology, Health Care, Training, Workforce Management, Vertical Industries, Training And Certification, Benefits, Healthcare, Human Resources, Dana Blankenhorn

National Coordinator for Health Information Technology (NCHIT) David Blumenthal has launched his own blog, where he announced this week $80 million in grants for health IT training, mainly to community colleges.

The money was authorized as part of the Obama stimulus, specifically the $19.2 billion HITECH Act.

Administrators can apply for a total of $70 million in community college grants, which would go into programs aiming to train health IT professionals. The hope is that 10,500 people can be trained annually in the use of health IT systems through the program.

These are not programming jobs. Among the “exciting job opportunities” the money hopes to create are:

• Practice workflow and information management redesign specialists;
• Clinician/practitioner consultants;
• Implementation support specialists;
• Implementation managers;
• Technical/software support staff;
• Trainers

This follows common medical practice, where a hospital or medical practice has a number of people trained at different levels of depth to perform different roles.

In addition to the training money, there’s $10 million available to create the training materials for these programs.

It will be interesting to find out just what is going to be taught, given the wide differences among all the various EHR systems now on the market.

Will Community Colleges align themselves with specific vendors in order to stretch their dollars, thereby giving those products market advantages? Or will the curriculum be more general, based on technical standards and legal requirements?

Stay tuned to Blumenthal’s blog for more. We’ve put it on our blogroll.

November 24th, 2009

What open source can teach medical practice

Posted by Dana Blankenhorn @ 7:34 am

Categories: Consumer Information, Ethics, General, IT Management, Internet, Medical Office IT, Medical Records, Networking, Open Source, Research

Tags: Gender And Diversity, E-health, Open Source, Human Resources, Healthcare, Dana Blankenhorn

It is frustrating whenever personal medical questions become political questions.

This happens all the time. Example A, ripped from the headlines, is the kerfluffle over mammograms.

Women, doctors and politicians who hate having to go through the procedure are now screaming bloody murder over the non-existent “threat” to halt access to it.

Let’s go back to where this started. It was a population study, done on behalf of the U.S. Preventive Services Task Force,  which concluded that the risk of unnecessary treatment exceeds the risk of death from annual screenings for the disease.

It was a science paper, and it was complicated, couched in the words scientists use to describe their work with precision.

Every profession has its version of this language. Engineers do, lawyers do, even software developers do. Learning the language gives a journalist entree into these professional worlds, but it’s not an exercise most of us will, or should, go through.

Thus this study, like so many, was filtered through the lens of journalism. A flood of words failed to answer the questions women wanted answered

• What are the chances I will die from a late diagnosis?
• What are the chances I will suffer from over-diagnosis and over-treatment?

Calculate the threat to me so I can make a rational choice.

This is where technology comes into play. An Electronic Health Record (EHRs) can show you your own history, we can take your family history, we can analyze your genetic history, and we can estimate based on that.

If, that is, we have access to the larger pool of data. That’s our baseline. It’s what we need to compare your own data to before we can give you the answer you seek.

In scientific studies like this one we don’t have access. The data is locked away somewhere. Mass adoption of EHRs is going to unleash a firehose of data, and the question should occur, very soon, what to do with it.

I’m not talking here about your record. I’m talking about the gross data, this warehouse of numbers describing everyone’s condition, what is being done for us, and what the results are.

An open source attitude toward that data, within the realm of science and throughout the medical community, can help patients gain access to the benefits of that data and answer the question they ask — what should I do?

Unfortunately medicine, health IT, and medical data all suffer from a proprietary attitude born of paranoia, the fear that you may be identified in this data mountain, that your needle will appear in this haystack, and that giving everyone access to data means giving them access to you.

A database, stripped of personal information, consisting of millions of records, is safe for use by software code. The data, and the code, are what we need to provide real answers.

We are collecting the data. We need to unlock it. We are writing the code. We need to share it.

This is what open source can teach the practice of medicine.

November 23rd, 2009

The medical home is reform without objections, so far

Posted by Dana Blankenhorn @ 10:13 am

Categories: Aging, Ethics, Finance, General, Government, Home Health Care, Hospital IT, IT Management, Internet, Medical IT, Medical Office IT, Medical Records, Wellness

Tags: Team, Patient, Health Care, Home, Doctors, Team Management, Management, Dana Blankenhorn

There is one type of health reform that, so far, has received little publicity and no political objections.

It’s called the medical home. (Picture from the American Academy of Family Physicians.)

Physicians have been talking up the concept since the 1960s, and at its heart it is pretty simple. Charge for wellness and create a team, headed by a physician, that can deliver it.

When people like Larry Green, who heads the American Board of Family Medicine, talk about moving toward a “blended payment” model he’s advocating for this team approach to care.

Many doctors’ groups support the medical home, but getting from here to there is not easy. Doctors are basically being asked to create a new business, with a new set of employees, and to do this they need start-up capital.

The AAFP magazine Family Practice Management published an article last month with 10 suggested steps for getting that capital.

These start with using existing medical codes to generate more revenue from each patient visit, hiring more nurses and medical assistants, then using these people to increase the number of patients you “see” each day. Wash, rinse, repeat.

If this sounds like gaming the system to generate revenue, it reads like this to me, too. But this revenue has a purpose. The article suggests that capital go into an Electronic Health Record (EHR) system, a “patient portal” through which customers access health data, and links to other helpful electronic resources.

One idea of the $19.2 billion HITECH stimulus cash is that it helps doctors pay for these computer resources so they don’t need to game the system to get the money. But they still have to build scaled businesses.

Only after doctors have their office and systems right should they focus on high-cost patients, the article continues. A lot of alligators need to be slain before you drain this swamp.

From the patient point of view, you’re going to be given a lot more control over your care, you’re going to have a lot more appointments with people other than the doctor, but you’re going to get more face time with people trained to help you.

It’s that face time that can end disputes like the present one over pap smears and other tests. You will have people you can discuss these issues with, people who have access to your medical records, people who will have the time to listen to you as well as talk.

Now that you know the good news, here is the bad news:

1. The financial success of a medical home is based on nagging. You get the data, you get access to the people, but money is only saved when you take the advice.
2. It takes money and business transformation to get from here to there. Running a team takes money and organization. Either doctors become businessmen or go to work for people who are. Either they buy and build systems they need or they associate with others who have them.

A health policy based on the medical home is going to be a lot more intrusive than the present fee-for-service model. The team will know if you smoke, how much you drink, what you eat, even what you’re likely to die of, based on a whole lot of data.

If the medical home is to save money, and lives, that team will need power to enforce what’s good for you. It could come from an adjusted insurance rating, based on your observed lifestyle, with the higher fee going to your medical home.

Or the medical home needs the power to force you out for non-compliance.

The medical home, in the end, offers the promise of lower costs and personal attention, in exchange for your willingness to be bound by your doctor’s advice on what’s good for you.

Do you still like the medical home?

November 18th, 2009

Practice Fusion in PHR game

Posted by Dana Blankenhorn @ 11:36 am

Categories: Consumer Information, General, Home Health Care, Internet, Medical IT, Medical Office IT, Wellness

Tags: Game, Electronic Health Record, Personal Health Record, PracticeFusion, E-health, Healthcare, Dana Blankenhorn

Practice Fusion is a well-known SaaS vendor of electronic health record (EHR) software to doctors and hospitals, working inside the Salesforce.com cloud.

(Shown is part of the new product’s medications screen, from PracticeFusion.)

Their base product is ad-supported, so while larger vendors are hustling hospitals for multi-million dollar contracts, Practice Fusion is able to get small practices online for zero dollars. Priceless.

So it is natural Practice Fusion would get into the Personal Health Record (PHR) game.

The difference between an EHR and a PHR is that, while the EHR belongs to the doctor or hospital who creates it, the PHR belongs to you. Also, while disclosure of EHR data is subject to HIPAA rules, you control what is released from your PHR, and to whom.

So PracticeFusion is highlighting Salesforce’s annual Dreamforce conference this week with the announcement of PatientFusion.

It’s a PHR built and delivered on the same platform as the EHR offering. Multiplying the number of doctors using its service by their rough patient counts PracticeFusion says it is offering this service to 1 million people at launch.

Any PracticeFusion practice, which may be paying nothing for its service, can thus offer a PHR to their patients, who also pay nothing.  This is not as large a benefit as what Microsoft HealthVault and Google Health offer, but wait, there’s more.

Since the EHR and PHR are in the same cloud, populating your PHR, and managing the permissions needed to keep the data flowing, is easy. Security is also simplified, since once you order your EHR a bunch of data isn’t flowing between systems, but within a single cloud.

When PracticeFusion’s PR shop pitched this to me, they compared it with Kaiser Permanente’s EPIC-based system, myHealth Manager. One can argue that’s unfair, since Kaiser spent billions to build a scaled EHR-PHR system early in this decade, while PracticeFusion has been growing its smaller SaaS operation organically.

But if the feature sets are nearly identical, and the delivery mechanisms are similar, how different are they? Time will tell. As more people get PHRs we’re going to get into a feature war, with all vendors looking to connect a range of devices and analysis to their offerings.

Should be fun.

November 18th, 2009

Why electronic health records have far to go

Posted by Dana Blankenhorn @ 7:30 am

Categories: Finance, General, Government, Hospital IT, IT Management, Internet, Medical IT, Medical Office IT, Medical Records, Physician Information, U.S.

Tags: Electronic Health Record, Training, Health Internet, Moore, E-health, Healthcare, Dana Blankenhorn

It’s easy to seize on word that electronic health records (EHR) are not yet saving money and call everything the Obama Administration is doing in health care bogus.

That would be unfair to the technology.

Ashish Jha of the Harvard School of Public Health offered the report this week as a scene-setter for the school’s Public Health and Technology (PHAT) conference, whose speakers’ list is a who’s who of EHR advocates. (Picture from Dr. Ashish Jah’s home page at Harvard.)

Rather than being a hit piece at the current Administration’s aims, the report focuses on the best practices of groups like Kaiser Permanente and the Cleveland Clinic, which have spent years adapting their work to the technology. Do these things and you can make things work, as proven in areas like heart care, he writes.

Rather than focusing on paying for the computers and software, he says, emphasis should be placed on training people, and adapting practices to take advantage of what the data can do. As in any business a failure to adapt means you’re wasting money.

Dr. Jha made this point in the School of Public Health’s in-house publication last month. Speaking at a University-sponsored public forum in September, he said this:

The money in the stimulus bill is going to help a lot in terms of getting systems adopted. You’re going to see this entire field change dramatically in the next several years. You’re going to see new vendors getting into this field who haven’t been there before. I’m hopeful this will mean better products that will require less training. There’s no doubt in my mind that five years from now, we are going to have far more widespread use of electronic health records.

Whether we are going to get to 90% as President Obama has said he wants, I’m not sure. But the bottom line is that this train has left the station. We’re moving towards electronic records. The only question is whether we can do it well. The big challenge for us is to make sure we adopt these systems effectively, that we remember the prize is not electronic records; the prize is higher quality at lower cost. And that’s only going to happen if we really think through how to adopt these systems in a more organized and effective way.

Those are the words of an EHR enthusiast, not a skeptic, and certainly not a cynic.

Fact is the EHR revolution has barely begun. The Health Internet is still being implemented. Barely one hospital in 10 has a functioning EHR system. Moore’s Law of Training (there is no Moore’s Law of Training, we learn as fast as we learn) has barely kicked in.

The health IT revolution will not happen like the turning on of a light switch, as people in every other industry that has been touched by computers, including journalism, will tell you.

It’s a long-term process.

November 11th, 2009

Why not pay for what works?

Posted by Dana Blankenhorn @ 11:44 am

Categories: Drugs, Gadgets, General, Government, Home Health Care Equipment, Hospital Equipment, Insurance IT, Medical Equipment, Medical IT, Medical Office Equipment, Rehabilitation, U.S., state government

Tags: Patient, Health Care, McCaughey, Insurance, Financial Planning, Vertical Industries, Benefits, Healthcare, Business Operations, Corporate Insurance

In all the hullabaloo over health reform, Charles Silver and David Hyman write at The Health Care Blog, a key point of cost control has been lost.

Paying only for what works.

Silver and Hyman are law professors, not doctors. They point to a RAND Corp. study saying that “one-third or more of all procedures performed in the United States are of questionable benefit.” (The illustration is from the study.)

What happened to this simple idea?

The way to enforce it is through comparative effectiveness. Analyze data from millions of patients, develop best practices, and move physicians toward the most cost-effective solution.

This is what every other country does, regardless of how they pay for care. Formularies drive care, based on cost effectiveness. Anyone who wants to go outside what works had better have a good explanation. Often, going outside what works is simply forbidden, or patients are told to buy it with their own money.

Isn’t that how you set priorities? Why should governments or insurance companies act differently?

Unfortunately this was one of the first dominoes to fall in the debate. Reform opponents like Betsy McCaughey called this “getting between a patient and their doctor.”

This happened in conjunction with the debate over the Obama stimulus, and the subject was health IT. The purpose of the HITECH Act’s $19.2 billion in stimulus was to collect the data that would drive decisions on what to pay for.

McCaughey’s scare worked. Explicit promises were made not to use comparative effectiveness in any way to deny care, not to use evidence to decide what we should pay for.

The alternative to evidence is politics. Silver and Hyman note that millions of insurance dollars are spent annually on entirely non-medical treatments like Christian Science, but there’s more:

Lobbying from providers and supportive patients explains why many states already mandate coverage of elective services like in-vitro fertilization, massage therapy, and visits to athletic trainers. Concerns about the efficacy and cost-effectiveness of treatments are washed away by a stream of campaign contributions, and sad stories about patients who can only obtain the “necessary” services if the insurer will pay for them.

This is what is wrong with the present system. State regulation of insurance is based on politics, so your coverage includes any procedure that becomes politically powerful in your state. That’s why insurance costs are rising through the roof.

There is nothing wrong with paying for prayer but it’s not medicine, they write. There’s nothing wrong with in-vitro fertilization but it’s optional, not something everyone should have to cover.

Thus, by tossing away evidence as a way to rule-out certain coverages, you pay for a lot of stuff you don’t need.

Silver and Hyman wrote to argue against a politically-motivated individual mandate. Any mandate should be based on science, not politics, and by giving up on comparative effectiveness early in the process, it became impossible to set that standard, either through the federal government or through the states.

If this was Betsy McCaughey’s intent, she is fiendishly clever. Health care will remain a growth industry, because Americans will keep having to pay for stuff that doesn’t work, regardless of whether reform passes or fails.

November 11th, 2009

CCHIT going on almost as if nothing happened

Posted by Dana Blankenhorn @ 8:53 am

Categories: General, Hospital IT, IT Management, Medical IT, Medical Office IT, Medical Records, Physician Information, U.S.

Tags: U.S. Department Of Health And Human Services, Electronic Health Record, Health Care, Standards, CCHIT, Blumenthal, E-health, Quality, Healthcare, Vertical Industries

One of the big controversies early this year was over the role CCHIT was playing, certifying vendors to sell Electronic Health Record (EHR) software.

CCHIT (Certification Commission for Health Information Technology) was formed in 2004 out of HIMSS (Healthcare Information and Management Systems Society), an industry group, and began certifying EHR systems in 2006. Until this year you entered the EHR market by first undergoing CCHIT certification.

Was their approach right, or was it too rigid? Was it really helping buyers, or just pointing them toward expensive solutions from members of the HIMSS industry group?

When we last left the story the good guys seemed to have won. The standards under which software will be approved for stimulus cash are functional, requiring meaningful use. They’re not programmatic. It’s not what the software does, but whether it’s used, and for what, that counts.

So what happened to CCHIT? They’re going along pretty much as before.

In an extended interview with Healthcare Informatics, CCHIT head Mark Leavitt (above) said the group has added a new Preliminary ARRA 2011 Certification to its suite of products.

“It doesn’t really matter” what the National Coordinator of Health IT, David Blumenthal, or his policy committee come up with, Leavitt told Anthony Guerra.  CCHIT’s “Get Certified” seminar in October drew an overflow crowd.

Blumenthal’s policy committee called its government standard “HHS certification.” Leavitt called the same set of criteria “Preliminary ARRA Certification” because the Department of Health and Human Services (HHS) may give it yet-another name, and because the rules on all this don’t go out until next month in any case.

Even after that there will be time for CCHIT and others to comment, and for those comments to be digested, before they are final. Then certifying authorities must be appointed, and CCHIT has applied to be one. Meanwhile hospitals and doctors are having to make decisions that may haunt them through their professional lifetimes.

In his interview, Leavitt called the ARRA rules “basic” and his own rules “comprehensive,” but in fact one is the government standard and the other CCHIT’s private one.

What has happened is that CCHIT has been forced to take a step back, from being the gatekeeper of market entry to being one of perhaps several groups looking to be certification authorities under the new rules.

This is not Leavitt’s spin on the matter:

We’ve heard from provider groups, we’ve heard from the specialties that the marketplace was not making adequate progress in making the products they needed with all the features they needed.

There’s more than just federal standards, there are other requirements they have as providers, such as supporting workflows and maintaining a legally adequate record. They really thought CCHIT was a way to have a community conversation and move the entire marketplace forward.

We’re not a gatekeeper. We’re a community conversation. The CCHIT “comprehensive” standards aren’t for the  “sophisticated CIO,” in Leavitt’s words, but for small hospitals, for small practices, the people who need help in making an informed choice.

Maybe, but these same customers also have the most constrained budgets, and fairly basic needs. Do they need something a private industry group has deemed meets “comprehensive” standards or not?

That is a question the market will have to decide. Will hospital administrators and practice managers insist on the comprehensive CCHIT-approved label, or will they accept any solution that brings them that sweet, sweet stimulus cash?

November 6th, 2009

Canadians get a taste of American medical system with IMS Health buy

Posted by Dana Blankenhorn @ 7:28 am

Categories: Finance, General, Government, Medical Office IT, Payment Processing, Research, SaaS

Tags: IMS Health Inc., IBM IMS, CPP, CPP Investment, Sales Strategy, Sales Force Management, Personal Finance, Benefits, Payroll Solutions, Sales

You have likely never heard of IMS Health, but they’re a big deal in the current IT environment of American medicine.

IMS buys prescription records in bulk from big pharmacies, strips out the patient names but identifies the doctors, then tells drug companies of the doctors’ prescribing habits. This lets the drug companies target their sales efforts.

The picture at the right, taken from IMS’ current home page, illustrates the firm’s view of it. The little blue ball represents sales, and the nice lady has IMS knowledge to shoot it accurately.

Critics have their own view. New Hampshire sought successfully to stop IMS data collection in court, and the American Medical Association (AMA) runs a program through which doctors can opt-out.

Regardless of your view, it’s a data processing company that makes money. IMS earned $311 million on sales of $2.3 billion last year. This made it attractive, and a leveraged buy-out of the company was announced yesterday.

Which is where the Canadians come into the story. The main player here is TPG Capital, run by the renowned financier David Bonderman, but his partner in this deal is the CPP Investment Board.

CPP is the investment arm of the Canada Pension Plan, which you might compare with a privately-run Social Security system. CPP Investment seeks a return on the pension contributions of Canadians. The CPP collects the fees and pays the pensions.

Out of the CPP’s $116.6 billion in assets, private investments like this represent “just” $18.4 billion. But that’s enough money, and the law offers CPP Investment enough leeway, for it to get into some very interesting deals.

Like this one.

All of which means that Canadian pensions may be riding on the success of an American company performing computing feats that would be incomprehensible in their own country, which is a single-payer system run through the nation’s provinces.

November 5th, 2009

PriceDoc bringing price transparency to you

Posted by Dana Blankenhorn @ 11:45 am

Categories: Curioisities, General, Internet, Medical Office IT

Tags: Patient, Health Care, Price, PriceDoc, Patrick Bradley, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

Whenever I write about health care policy at ZDNet Healthcare one demand comes from readers loud-and-clear.

People want price transparency. They want to know what things cost. They want doctors to compete the way everyone else does.

That’s what PriceDoc is starting to offer, and it’s going national.

PriceDoc launched earlier this year, using Seattle as a test market. It’s now soliciting doctors nationwide to list their prices for $49/year$49/month, aiming to sign up 10,000 by the end of the year and then “turning on the spigot” with a little consumer advertising in 30 major markets.

NOTE ON CORRECTION: All doctors are listed free. The $49 fee covers their filing of profiles with credentials, descriptions of specific services, listing prices, and participating in special offers. The company is looking to reduce or eliminate the fee in the future.

Patrick Bradley is the CEO. “We can deliver new cash-paying patients. Physicians love cash-paying patients.”

While the focus in Washington is the health insurance market, expanding it or controlling its costs, Bradley says there is already a $200 billion cash market for health care. It’s not just the uninsured, but patients who may lack specific coverage for their teeth, their eyes, or for alternative treatments like chiropractic.

Buyers in this market want very much to know how much something will cost before they get it done. PriceDoc delivers.

In the PriceDoc model doctors sign up to show their qualifications and specialties, and are encouraged to post prices for common procedures.

Initial reaction from doctors was mixed. “Some are very big believers in transparency. Others are more reluctant to post prices. They want patients to call them. What we’re finding is those who are getting called for a price decide to post prices, knowing they’ll get more hits.” Play the game by the rules and you can win.

The current site is organized with folders, but Bradley has already seen the future and has a patent pending on a bidding system.

“You search out a provider, and if they have a posted price you can make a counter offer. That online negotiation and verification is covered in the patent.”

Even without direct bidding, PriceDoc has had one big impact on price. Bradley calls it the PriceDoc special price.

“We post those at the top of the page. It is a price for a procedure with a special condition. An orthodontist may post a special price for a specific time of day. You come in between 10-2 I’ll give you a better deal.” Airlines call this yield management.

So if you’re uninsured, or just not insured for a specific procedure or discipline you need (you want nice acupuncture, Mister?) you should soon be able to give PriceDoc a whirl.

And we’ll find out if the claim that transparency lowers prices is right.

November 5th, 2009

What the Google Privacy Dashboard can mean for health

Posted by Dana Blankenhorn @ 8:34 am

Categories: Consumer Information, General, Home Health Care, Hospital IT, Insurance IT, Internet, Medical IT, Medical Office IT, Medical Records, Wellness

Tags: Google Inc., Privacy, Dashboard, Health Care, Personal Health Record, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

If you have checked out the Google Privacy Dashboard, you may not have noticed that it covers all Google products.

This includes Google Health, the company’s Personal Health Record (PHR).

The media focus here has been on what Google knows about you, and the oh noes that Google will use that data against you.

But with the Dashboard’s access to Google Health, it occurs there might be another use for it.

What if you could find out where all your health data is? What if you could learn just which doctors, which hospitals, which insurers have what types of electronic data on you?

Knowing what’s out there, and knowing the rules for releasing that data, you can have full control of your privacy as we move from paper records to electronic records.

Given the trend within health IT toward more open standards, and more standards generally, it should not be too hard to provide support for this capability within, say, the NHIN-Connect system, which the Administration now calls the Health Internet.

There are lots of ways for this to go down, but the most efficient might be for the Health Internet to support a spidering technology that lets service providers offer a full health dashboard to consumers. Where within the NHIN system are what types of data on you. Not the specific data, but who has stuff, which is information we should all be entitled to.

I’ll bet that would be an incredibly valuable service, because it’s something we don’t have right now. The availability of such a service might even drive consumer acceptance of the Health Internet itself.

Take my case, for instance. In addition to my regular doctor, I have an eye doctor, I’ve seen an orthopedist, I have an insurance company, and a guy who did my colonoscopy. I also have a pharmacist. All that data, in time, is supposed to feed my Personal Health Record, along with data I might create, like my workout data.

Knowing who has what puts me in charge. Computers can tell me that. This encourages me to embrace computers, and powers the movement toward PHRs.

Did I mention Google Health is a PHR?