tag:blogger.com,1999:blog-48561389724648545942024-03-13T19:03:07.458-04:00Healthcare DMSDocument Management Solutions in Healthcare: evolving standards for records, privacy, ITBusybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.comBlogger35125tag:blogger.com,1999:blog-4856138972464854594.post-75799073861740220422013-02-01T13:46:00.000-05:002013-02-01T13:48:53.119-05:00Sharing healthcare data<div dir="ltr" style="text-align: left;" trbidi="on">
<a href="http://en.wikipedia.org/wiki/John_Wilbanks">John Wilbanks</a> makes an eloquent case for why medical privacy rules, created more than 70 years ago, are now standing in the way of innovation. This blog previously explored the tension between privacy and innovation (see for example <a href="http://hcdms.blogspot.com/2010/10/privacy-safeguards.html" target="">this</a> or <a href="http://hcdms.blogspot.com/2010/07/how-to-deal-with-deb-peel.html" target="">this</a>) and it's great to see the emergence of a well crafted argument that recognizes the risks of not addressing this tension.<br />
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In his talk, John says:<br />
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<i>I'm proposing … that we reach into our bodies and we grab the genotype, and we reach into the medical system and we grab our records, and we use it to build something together.</i></blockquote>
See the <a href="http://www.ted.com/talks/john_wilbanks_let_s_pool_our_medical_data.html" target="_blank">full talk</a> here:<br />
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<iframe allowfullscreen="" frameborder="0" height="315" mozallowfullscreen="" scrolling="no" src="http://embed.ted.com/talks/john_wilbanks_let_s_pool_our_medical_data.html" webkitallowfullscreen="" width="560"></iframe>
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Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-26679624743110164202013-01-29T14:16:00.002-05:002013-01-29T14:16:16.880-05:00Revival<div dir="ltr" style="text-align: left;" trbidi="on">
I'm pleased to report that, after a year-long hiatus, I will be reviving <a href="http://hcdms.blogspot.com/">HCDMS</a>. The blog will be revamped to focus on network-enabled business models in healthcare.<br />
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Stay tuned.</div>
Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-84473722976508291532011-06-26T15:45:00.001-04:002011-06-26T15:47:01.022-04:00RIP Google Health<div dir="ltr" style="text-align: left;" trbidi="on">The announced demise of <a href="http://www.google.com/health">Google Health</a> was greeted by industry observers as a long overdue termination of a service that had simply failed to catch on with the general public. That <a href="http://blog.aperio.com/2009/08/google-health-vs-microsoft-healthvault.html">Google Health was lagging Microsoft's HealthVault</a> is no surprise: commentators had <a href="http://www.fiercehealthit.com/story/how-far-has-google-health-really-fallen/2011-05-11">consistently ranked Microsoft's offering above Google's service</a>.<br />
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Whether this is simply a failure of Google to develop a viable business model or a larger failure of the PHR world is a more interesting question and one that will be debated endlessly in the weeks to come.<br />
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Here are two perspectives: the first from <a href="http://geekdoctor.blogspot.com/2011/06/update-on-google-health.html">John D. Halamka recognizing the role Google Health played</a> in raising public awareness of PHRs. Halamka writes:<br />
<blockquote><i>Google Health is truly innovative and broke new ground when it created interfaces to hospitals, labs, and pharmacies in 2008. I was there at the beginning and can definitively state that it was Google's reputation and vision that broke down the political barriers keeping data from patients</i></blockquote>The counter view is from<a href="http://histalk2.com/2011/06/25/monday-morning-update-62711/"> HISTalk that claims Google Health's failure</a> was due to the lack of appreciation of unique requirements of Healthcare.The author states:<br />
<blockquote><i>Google predictably did what its know-it-all technology company predecessors have done over the years: dipped an arrogant and half-assed toe into the health IT waters; roused a loud rabble of shrieking fanboy bloggers and reporters (many of them as light on healthcare IT experience as Google) who instantly declared it to be the Second Coming that would make all decades-old boring vendors instantly obsolete or subservient to the Googleplex</i></blockquote> My own reaction to this is that no matter what view you take on the merits of Google's strategy, PHRs play a critical role in getting consumers to own their own healthcare choices. This is in a limited way comparable to how consumers must own their financial choices and can benefit from tools (such as <a href="http://www.mint.com/">www.mint.com</a>) to manage their decisions. From that perspective, the demise of Google Health is a step backwards for Healthcare 2.0.</div>Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-43310849806469970102011-03-21T13:02:00.000-04:002011-03-21T13:02:57.026-04:00Where are we headed?<div dir="ltr" style="text-align: left;" trbidi="on">As <a href="http://wistechnology.com/articles/8361/">Stage 2 of Meaningful Use</a> takes shape, I've been wondering whether the Healthcare IT revolution will indeed achieve its main objective: improving patient care while keeping costs in check. The answer that seems to emerge, based on many conversations and much reading, is "not yet." There's little doubt that the <a href="http://hcdms.blogspot.com/2010/08/gold-rush-redux.html">Healthcare IT revolution, driven by Federal funding, is driving IT adoption</a>. What is less clear is whether this is on a trajectory that leads to better patient care and lower costs.<br />
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What seems more likely, like we've seen in other technological phase shifts, is that the first revolution will create something of a bubble that will eventually pop. Based on the infrastructure work done during the first bubble, a new revolution will rise and eventually deliver the goods. We saw it with the internet. It happened with ATMs (until <a href="http://www.wired.com/thisdayintech/2010/09/0902first-us-atm/">ATMs started accepting checks</a>, they didn't have as much of impact on costs). It seems the likely path for Healthcare.<br />
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Bubbles aren't inherently bad. They provide an opportunity to break old barriers, develop new innovations, test business models. But <a href="http://en.wikipedia.org/wiki/Dot-com_bubble">bubbles pop </a>and cause a lot of collateral damage along the way.<br />
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Agree? Disagree?</div>Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-50704331837346731002011-02-01T13:50:00.000-05:002011-02-01T13:50:03.318-05:00Meaningful Use Update<div dir="ltr" style="text-align: left;" trbidi="on">Late last year, a College of Health Information Management Executives (CHIME) survey indicated that <a href="http://www.modernhealthcare.com/article/20101208/NEWS/101209955">confidence in meeting meaningful use deadlines had dropped</a> in the months following the launch of the program. Previous reports were a lot more optimistic putting <a href="http://hcdms.blogspot.com/2010/09/meaningful-use-for-90-hospitals-in-next.html">the number of first year adopters at 28%</a>.<br />
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It is important to note that the overall results have not changed: even with the new survey, almost 90% respondents expect to meet Stage 1 criteria by 2012. In a large change management exercise, it is common to see early optimism shift as the realities of implementation take hold. That said, the report is likely to spur additional debate on the extent of the impact of HITECH funding.<br />
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Observers generally agree that <a href="http://hcdms.blogspot.com/2010/07/it-priorities-and-government-mandates.html">Meaningful Use will drive the Healthcare IT agenda</a> for the next few years; whether it makes a meaningful impact on the quality of care is another matter.</div>Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-28110458925279412532010-12-10T13:57:00.000-05:002010-12-10T13:57:54.109-05:00PCASTThe Healthcare IT world is abuzz with the report by the President's Council of Advisors on Science and Technology (<a href="http://www.whitehouse.gov/administration/eop/ostp/pcast">PCAST</a>) on realizing the full potential from HIT. Here is a link to the full report:<br />
<a href="http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-report.pdf">http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-report.pdf</a><br />
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In John <a href="http://geekdoctor.blogspot.com/2010/12/spirit-of-pcast.html">Halamka's review of the PCAST report</a>, he writes:<br />
<blockquote><i><span class="Apple-style-span" style="color: #333333; font-family: Georgia, serif; font-size: 13px; line-height: 20px;">"In the spirit of my recent blog about</span><span class="Apple-style-span" style="color: #333333; font-family: Georgia, serif; font-size: 13px; line-height: 20px;"> </span><span class="Apple-style-span" style="color: #333333; font-family: Georgia, serif; font-size: 13px; line-height: 20px;"><a href="http://geekdoctor.blogspot.com/2010/12/glass-half-full.html" style="color: #5588aa; text-decoration: none;">The Glass Half Full</a></span><span class="Apple-style-span" style="color: #333333; font-family: Georgia, serif; font-size: 13px; line-height: 20px;">, I believe the PCAST report is a positive set of recommendations that builds on the Meaningful Use Stage 1 effort to date. ONC should be congratulated for creating a foundation that is so consistent with the PCAST vision for the future"</span></i></blockquote>Do you agree that the work on HIT thus far (via ONCHIT, Meaningful Use, etc) is consistent with the PCAST recommendations?Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-81850423647859812402010-10-14T13:36:00.000-04:002010-10-14T13:36:11.331-04:00Privacy safeguardsFor the past few months, the Wall Street Journal has run a great series on the use of electronic personal information by commercial entities. The series is titled "<a href="http://www.wsj.com/wtk">What They Know</a>." While the emphasis of this series has mostly been on the tracking of web browsing behavior, the latest article in this series discusses the <a href="http://online.wsj.com/article/SB10001424052748703358504575544381288117888.html">"scraping" of personal data from a patient support network called PatientsLikeMe</a>.<br />
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This is a troubling development.<br />
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Like the electronic commerce IT revolution before it, the anticipated healthcare IT revolution depends upon the proper security (and associated trust) of private data. I have covered Privacy in healthcare before (see <a href="http://hcdms.blogspot.com/2010/07/de-identified-patient-data-and-right-to.html">this</a>, for example) and my summary conclusion remains that this topic will receive a disproportionate amount of attention in the coming months.<br />
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I don't agree with alarmists like Deb Peel who advocate against use of <i>any </i>patient data (and <a href="http://hcdms.blogspot.com/2010/07/how-to-deal-with-deb-peel.html">consequently put a number of patients at risk</a>). The right answer is to put well understood safeguards in place and use de-identified data in a manner that promotes innovation in outcomes based treatment. This is an opportunity for companies to innovate in this space.<br />
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What products/innovations do you think we need?Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-24652618613936326402010-10-08T15:15:00.000-04:002010-10-08T15:15:00.044-04:00The Art of Product ManagementAs a product manager, I think a lot about how I can better understand my customers. A funny incident made me realize that one can't ever assume to know customers well enough: it's always a work in progress.<br />
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During the last week of September, I joined several other colleagues at the annual <a href="http://www.ahima.org/">AHIMA </a>conference in Orlando, Florida. The conference is a gathering of Health Information Management (HIM) professionals. Topics cover transcription, coding, release of information (or as the healthcare industry calls it, simply, 'ROI'), audits, and compliance. My company's booth was organized around our themes of connecting the patient record, EMR enablement, and compliance.<br />
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Emily, our Manager of Experiential Marketing, had developed a booth activity around building a bracelet as a metaphor for what we do: link the discrete elements in the physical and digital worlds and create a complete, valuable, patient record. For each bracelet that visitors made, we would donate money to a good cause. To obtain charms needed to build this bracelet, visitors would have to visit various stations and learn about our solutions. I didn't think this was a practical idea because I wasn't sure our customers would want to build bracelets at a conference. I thought an Apple iPad giveaway might have been more appealing.<br />
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It turned out--I was totally wrong and our booth visitors LOVED the activity! Emily knew this audience a lot better than I did. We ended up oversubscribed (mobbed?) and many customers told me that this was one of the most active booths at the show. Mission accomplished! Well done Emily and the team!<br />
<!-- Converted from text/rtf format -->Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-90603973074269458482010-09-21T20:56:00.001-04:002010-09-22T14:26:08.139-04:00Ingenix acquires coding companyHISTalk reports that <a href="http://histalk2.com/2010/09/21/unitedhealth-group-to-acquire-a-life-medical/">Ingenix is acquiring A-Life Medical</a>. I have speculated on the grand strategy behind Ingenix's acquisition spree (see for example, <a href="http://hcdms.blogspot.com/2010/07/ingenix-buys-picis.html">this</a>, <a href="http://hcdms.blogspot.com/2010/08/ingenix-buys-executive-health-resources.html">this</a>, <a href="http://hcdms.blogspot.com/2010/08/ingenix-continued.html">this</a>, or <a href="http://hcdms.blogspot.com/2010/08/ingenixyet-again.html">this</a>) and it's getting more clear now: Ingenix wants to have a presence in multiple touchpoints in the healthcare IT value chain. They are assembling data collection and analytical components that used together will provide a powerful analytics-driven (outcomes driven?) healthcare delivery model.<br />
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This has been a busy week at work with our planning projects in full swing. I'm looking forward to <a href="http://www.ahima.org/">AHIMA</a> later this week and I plan to resuming a more predictable posting schedule after that. Much to report on based on what I've learnt in these past few weeks!Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-12266883149777211102010-09-17T17:01:00.001-04:002010-09-17T17:01:31.527-04:00Blumenthal Vs. O'NeilONCHIT chief David Blumenthal and former Treasury Secretary, Paul O'Neill debated EMRs and national standards: see <a href="http://www.massdevice.com/news/blumenthal-emrs-debate-raging-over-competition-vs-standards">related story from Mass Device.</a><br />
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I'm back from several field visits this week to hospitals in North Carolina. I'll summarize observations in a future post; and then from Sept 26 through Sept 29th, I'm back on the road for <a href="http://www.ahima.org/">AHIMA</a>. I look forward to further conversations with healthcare executives and I'll report findings soon thereafter.Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-40261434446039050492010-09-13T10:55:00.001-04:002010-09-13T10:56:54.935-04:00Meaningful Use for 90% hospitals in the next two yearsThe Wall Street Journal today reports that <a href="http://blogs.wsj.com/health/2010/09/10/survey-most-hospital-cios-plan-to-get-first-round-it-incentives/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+wsj/health/feed+(WSJ.com:+Health+Blog)">28% hospitals expect to qualify for incentives in 2011 and 62% in 2012</a>. This is consistent with my expectation from a few weeks ago that <a href="http://hcdms.blogspot.com/2010/07/it-priorities-and-government-mandates.html">Meaningful Use will be item #1</a> on the agenda for healthcare IT. <a href="http://hcdms.blogspot.com/2010/08/gold-rush-redux.html">The Gold Rush</a> is about to begin, even though questions remain on whether<a href="http://hcdms.blogspot.com/2010/08/how-long-will-it-take-to-adopt-emrs.html"> true adoption can be achieved in this time frame</a>.<br />
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I'm visiting a number of hospital CIOs this week (and posting will be light as a result) but I'll report back on first-hand impressions from the field.Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-58853665196362416222010-09-07T04:46:00.006-04:002010-09-07T09:23:30.197-04:00Eric Dishman on taking health care off the mainframe<a href="http://www.ted.com/talks/eric_dishman_take_health_care_off_the_mainframe.html">Eric Dishman</a> has a wonderful TED Talk on moving our healthcare system "off the mainframe." This talk was part of <a href="http://www.tedmed.com/what">TED MED</a> 2009. Mr. Dishman makes a compelling case for why we need a shift in mentality away from crisis-driven (or event-driven) institutional healthcare model to a more proactive personal-driven model of care.<br />
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Don't miss it! (you may need to click the direct link above: RSS readers may not show the video below)<br />
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I was speaking to a friend recently who works for a major life insurance company. That company has recently moved to a high-deductible plan, meaning employees are now responsible for several thousand dollars of medical expenses before any insurance kicks in. For younger healthier people, skipping healthcare is an option but for young families or older employees this is effectively a 5%+ pay cut.<br />
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I'm not one to argue against patients taking more responsibility, and consequently more costs, for their health and well being. However, the issue here is less about individual responsibility and more about the social contract we have with our employers. The contract that if we do our jobs well and if we work hard there are certain measures of security that accrue. See this article from the Financial Times from a few weeks ago on the <a href="http://www.ft.com/cms/s/2/1a8a5cb2-9ab2-11df-87e6-00144feab49a.html">crisis in Middle America</a>.<br />
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How does one reverse this decline?Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-48281828048448722532010-08-31T12:11:00.001-04:002010-09-10T14:19:22.202-04:00How Long Will It Take to Adopt EMRs?<span class="Apple-style-span" style="font-family: inherit;">One story that got </span><a href="http://blogs.wsj.com/health/2010/08/27/only-2-of-hospitals-could-have-met-meaningful-use-in-2009/"><span class="Apple-style-span" style="font-family: inherit;">a lot of press </span></a><span class="Apple-style-span" style="font-family: inherit;">last week was </span><a href="http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2010.0502"><span class="Apple-style-span" style="font-family: inherit;">Prof. Aashish Jha's research update on the adoption of Electronic Medical Records</span></a><span class="Apple-style-span" style="font-family: inherit;">. Prof. Jha has observed that only about 12% of US hospitals have a fully operational EMR at the end of 2009 and only 2% would have complied with Meaningful Use guidelines release this July that determine whether Providers can receive Federal incentives starting next year. </span><br />
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</span><br />
<span class="Apple-style-span" style="font-family: inherit;">Common sense suggests that electronic medical records should have much wider adoption, particularly since most sides agree that a </span><a href="http://hcdms.blogspot.com/2010/08/best-care-anywhere-reviewed-by-andy.html"><span class="Apple-style-span" style="font-family: inherit;">properly implemented EMR improves patient care</span></a><span class="Apple-style-span" style="font-family: inherit;">. After all, as <a href="http://www.healthinnumbers.com/">one advertisement by United Healthcare recently noted</a>, "your Pizza delivery guy stores your orders electronically. Why can't your doctor do the same?" The reality is that EMRs have not been widely adopted because there are many counter forces:</span><br />
<ul><li><span class="Apple-style-span" style="font-family: inherit;">Medical information </span><span class="238531519-30082010"><span class="Apple-style-span" style="font-family: inherit;">like health status </span></span><span class="Apple-style-span" style="font-family: inherit;">is not as determininistic as, say, financial data. </span><a href="http://zengeranalytics.wordpress.com/2009/10/05/health-plans-and-data-mining/"><span class="Apple-style-span" style="font-family: inherit;">There is no unique score, or set of scores that can uniquely pin point the state of your health </span></a><span class="Apple-style-span" style="font-family: inherit;">in a way that two reasonable, independent observers would always agree. In banking, there is no ambiguity on your bank balance when it is viewed by two separate observers. Similarly, your Pizza preferences are, in general, mostly deterministic and can be described in a way that is interpreted in the same way. I buy this argument, but it doesn't explain it all.</span><span class="Apple-style-span" style="font-family: inherit;"> </span></li>
<li><span class="Apple-style-span" style="font-family: inherit;">Some commentators have suggested that medicine is viewed as an art by an older generation of physicians and as long as that group makes decisions for the medical community</span><span class="238531519-30082010"><span class="Apple-style-span" style="font-family: inherit;">,</span></span><span class="Apple-style-span" style="font-family: inherit;"> EMRs and other metrics-driven tools are likely to remain on the backburner. This is an artful argument, but again, it cannot explain the widespread inability of Providers to adopt EMRs.</span><span class="Apple-style-span" style="font-family: inherit;"> </span><span class="Apple-style-span" style="font-family: inherit;">Some (more cynical?) observers have even claimed that the </span><a href="http://www.andykessler.com/andy_kessler/2009/06/technology-review-a-pound-of-cure.html"><span style="color: black;"><span class="Apple-style-span" style="font-family: inherit;">Providers don't want EMRs because it allows them to preserve inefficiencies and make more money</span></span></a><span class="Apple-style-span" style="font-family: inherit;">.</span><span class="Apple-style-span" style="font-family: inherit;"> </span></li>
<li><span class="238531519-30082010"><span class="Apple-style-span" style="font-family: inherit;">The m</span></span><span class="Apple-style-span" style="font-family: inherit;">ost compelling reason for the lack of adoption is simply that the benefits of EMR accure to those that don't pay for it. Put in other words, those that have to pay for EMRs aren't the ones that benefit the most. So, cash strapped hospitals are not very likely to want to make a huge IT investment if they don't see direct returns of some form. The Federal goverment has recognized this misalignment of incentives and much of the HITECH funding through Meaningful Use attempts to address this deficiency.</span></li>
</ul><div><span class="Apple-style-span" style="font-family: inherit;">So, if you believe this logic, it would stand to reason that EMRs will see a much more rapid pace of adoption as Federal incentives kick in.</span><span class="238531519-30082010"><span class="Apple-style-span" style="font-family: inherit;"> Prof. Jha's paper seems to make a similar conclusion. </span></span></div><div></div><div><span class="238531519-30082010"><span class="Apple-style-span" style="font-family: inherit;">For more on the topic, </span><a href="http://www.redorbit.com/news/technology/361009/predicting_the_adoption_of_electronic_health_records_by_physicians_when/"><span class="Apple-style-span" style="font-family: inherit;">Prof. Eric Ford and others published a bass diffusion analysis applied to EMRs</span></a><span class="Apple-style-span" style="font-family: inherit;">. This study was published in 2006 and concluded that EMR adoption would take a decade longer than the 2014 target set by the Bush Administration as part of E.O. 13335 that established the ONCHIT. I have yet to see an update on this study, post Meaningful Use incentive payments, but the paper is still worth a read for its analysis of buying behavior in the medical community. Specifically, the paper examines the similarity in buysing behavior between healthcare IT and consumer goods, given that both are influenced by the coefficient of imitation (doing what key opinion leaders do) than coefficient of innovation (buying the latest and greatest). Heady stuff.</span></span></div>Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-8779898079301821432010-08-24T17:50:00.000-04:002010-08-24T17:50:00.417-04:00Ingenix...yet againIn <a href="http://hcdms.blogspot.com/2010/07/ingenix-buys-picis.html">several</a> <a href="http://hcdms.blogspot.com/2010/08/ingenix-buys-executive-health-resources.html">recent</a> <a href="http://hcdms.blogspot.com/2010/08/ingenix-continued.html">posts</a>, I have tried to determine the grand strategy behind Ingenix's recent acquisition spree.<br />
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For a much more comprehensive analysis, see today's <a href="http://histalk2.com/2010/08/23/healthcare-it-from-the-investors-chair-82310/">HISTalk Investor's Chair briefing</a>.<br />
<br />
So, what's your take on the real story behind all this momentum? What is Ingenix (and United Healthcare by extension) trying to do?Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-5637365613106267872010-08-23T22:15:00.000-04:002010-08-23T22:15:34.416-04:00Using Crowdsourcing Principles for CDSOne of the emerging challenges for <a href="http://www.himss.org/ASP/topics_clinicalDecision.asp">Clinical Decision Support</a> systems is the problem of how to describe the data that is input into the rules engine. For a detailed description of this problem, see Keith Boone's <a href="http://motorcycleguy.blogspot.com/2010/08/standards-activity-around-clinical.html">Standards Activity Around Clinical Decision Support</a>.<div><br />
Of course, with <a href="http://mycourses.med.harvard.edu/ec_res/nt/401D45C0-6F53-44EE-9BC5-87454E612FCD/MUfinal.pdf">Meaningful Use</a> still in Stage 1, the emphasis is currently on data capture rather than clinical decision support. <a href="http://www.healthcareitnews.com/blog/googles-window-healthcare-it-market">Healthcare IT has an article on how Google's IP</a> from its <a href="http://googleblog.blogspot.com/2010/08/update-on-google-wave.html">failed Wave product</a> may be of help in digitizing hard-to-read physician notes. Most providers today perform some form of scanning of physical files; the approach proposed in the article essentially involves principles of "<a href="http://www.amazon.com/Crowdsourcing-Power-Driving-Future-Business/dp/0307396207">crowdsourcing</a>" where a complex translation is farmed out to a large number of people that work on tiny bits of the problem, usually only for a few seconds each.<br />
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When the focus shifts towards CDS in Stage 2 of Meaningful Use, a similar crowdsourced approach could be used to create CDS rules databases. Hosted EMR vendors like <a href="http://www.athenahealth.com/">athenahealth</a> are most likely to be in a position to mine their databases for such an effort.</div>Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-66378400416046942672010-08-19T10:26:00.000-04:002010-08-19T10:26:12.561-04:00Best Care Anywhere Reviewed by Andy OramFor those of you that read my <a href="http://hcdms.blogspot.com/2010/07/best-care-anywhere.html">review of Best Care Anywhere</a>, please see Andy Oram's comprehensive and insightful read: <a href="http://radar.oreilly.com/2010/08/the-software-behind-the-va-tra.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+oreilly/radar/atom+(O'Reilly+Radar)">The Software Behind the VA's health care transformation</a>.<br />
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Andy ends the post with a call for help:<br />
<blockquote><i>If you'd like to learn more about VistA, help to add features so it can become the nation's electronic health record system, or just meet the fascinating people who work with it, check out the WorldVistA community..... doctors are moving quickly to install electronic record systems ..... To play in this space, VistA needs both more promotion and.... changes to simplify deployment and configuration.</i></blockquote>Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-80463410418336863802010-08-16T19:16:00.000-04:002010-08-16T19:16:38.001-04:00Ingenix ContinuedI've reported on this blog that <a href="http://hcdms.blogspot.com/2010/08/ingenix-buys-executive-health-resources.html">Ingenix bought Executive Health Resources</a> not too long after <a href="http://hcdms.blogspot.com/2010/07/ingenix-buys-picis.html">picking up Picis</a>. Well, they've done it again: Ingenix announced yet another acquisition at close of business today: <a href="http://www.marketwatch.com/story/ingenix-and-axolotl-to-combine-2010-08-16?reflink=MW_news_stmp">Axolotl, an HIE Services provider</a>. <a href="http://hcdms.blogspot.com/2010/08/ingenix-buys-executive-health-resources.html">Ingenix was rumored to be entering the HIE space</a> and HISTalk reaffirmed it this morning. This acquisition confirms it.<br />
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<a href="http://histalk2.com/2010/08/16/ingenix-announces-axolotl-acquisition/">With a string of recent acquisitions</a>, UnitedHealthcare is inching closer to its vision of becoming a <a href="http://www.zdnet.com/blog/healthcare/unitedhealth-wants-to-be-kaiser/3853">Kaiser-like end-to-end provider</a> with a focus on outcomes. This also appears to be a pragmatic shift away from some of the more <a href="http://www.ingenix.com/content/attachments/5EssentialsforEvaluatingPMSolutions.pdf">fancy predictive modeling approaches</a> that hold promise but do not deliver near-term results.Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-1637084457701965292010-08-16T17:38:00.000-04:002010-08-16T17:38:24.812-04:00Organizational Models Behind Healthcare DeliveryIn a <a href="http://hcdms.blogspot.com/2010/08/china-study.html">review of the China Study</a>, I wrote about how Healthcare discussions often revolve around insurance, treatments, technology, operational excellence, etc. but not as often on driving factors like lifestyles, choices, etc. As a product manager, I'm often confronted by similar questions on strategy; for example, can organizational culture be a source of sustainable advantage? Are we overly focused on business models, technology leadership, incumbency when we should also think about how are teams operate and how members relate with each other?<br />
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<a href="http://histalk2.com/2010/08/14/monday-morning-update-81610/">Today's HISTalk</a> mentions how Epic, the <a href="http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=news&mod=News&mid=9A02E3B96F2A415ABC72CB5F516B4C10&tier=3&nid=19FD4AC896504277B2AF2EDF94745AE4">leader of the EMR vendor market if you measure momentum</a>, focuses not on hiring candidates with the best experience but instead selects those with the right traits, qualities, and skills. HISTalk states:<br />
<blockquote><i>"Epic emphasizes that many hospitals can staff their projects internally, choosing people who know the organization. However, they emphasize choosing the best and brightest, not those with time to spare. Epic advocates the same approach it takes in its own hiring: don’t worry about relevant experience, choose people with the right traits, qualities, and skills, they say."</i></blockquote>Top-tier management consulting firms like <a href="http://www.bcg.com/">BCG</a>, <a href="http://www.bain.com/">Bain</a>, and <a href="http://www.mckinsey.com/">McKinsey</a> have always known this. As a result, these firms test candidates on scenarios (or "cases") to evaluate how a candidate would think in a particular situation rather than evaluating the candidate on behavioral questions (that can generally be memorized). Other companies in other industries are catching on. <a href="http://www.slideshare.net/justindecker/culture9090801103430phpapp02-1829065">Netflix famously released it's Freedom and Responsibility Culture</a> reference guide that emphasizes context over control.<br />
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How much time do you spend on your organization's team dynamics? What methods do you use to select candidates?Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-13953587793441790832010-08-11T06:46:00.020-04:002010-08-11T06:46:00.556-04:00Data Classification<a href="http://healthcaresecprivacy.blogspot.com/2010/08/data-classification-key-vector-through.html">John Moehrke has a comprehensive post on Data Classification</a>. As privacy and security considerations are codified within electronic medical records, standards are essential. There are three areas that I see these standards playing a transformative role, but I'm sure there are others:<br />
<br />
<ol><li><b>HIE Consent Management:</b> There are <a href="http://healthcaresecprivacy.blogspot.com/2010/08/data-classification-key-vector-through.html">seven services needed for the creation of HIEs</a>. Many are still under development but the least developed area amongst these is most likely patient consent. See <a href="https://www.privateaccess.info/">Private Access</a>--one of the potential technology providers in this space.</li>
<li><b>Release of Information:</b> Much of the business of release-of-information, estimated to be a $1B market [1], depends upon the proper redaction of sensitive information from medical records. Codifying privacy preferences will eventually allow automated release-of-information processing. Mature data classification techniques may enable a disruptive technology to upend this market, which is currently dominated by <a href="http://www.healthport.com/">HealthPort with a $250M</a> annual revenue stream.</li>
<li><b>Data De-Identification:</b> De-identification is currently a somewhat manual process if you want data that retains some degree of usefulness. HIPAA requires a person with knowledge of general statistical principals to certify that reverse engineering of identity is not easily possible or it <a href="http://www.computerworld.com/s/article/9135898/Privacy_matters_When_is_personal_data_truly_de_identified_">requires the removal of 18 fields</a> that remove personally identifiable information. Data classification takes us one step closer to automated de-identification.</li>
</ol><br />
While on this subject, see <a href="http://motorcycleguy.blogspot.com/2010/08/data-classification-redaction-and.html">Keith Boone's contention that redacted documents should not be considered the same as the original document</a> and hence should not retain signatures that were used to sign the original.<br />
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<span class="Apple-style-span" style="font-size: small;">[1] market sizing from HealthPort, Inc. S-1 filing with the SEC, 2009</span>Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-71200811465289856632010-08-09T05:22:00.001-04:002010-08-09T11:42:21.004-04:00Gold Rush Redux?The <a href="http://www.boston.com/yourtown/watertown/articles/2010/08/05/athenahealth_going_for_gold/">Boston Globe's story this weekend on Athenahealth CEO Jonathan Bush</a> confirms what is becoming increasingly apparent: the EMR revolution is indeed a gold rush and federal incentives will <a href="http://hcdms.blogspot.com/2010/07/it-priorities-and-government-mandates.html">define the agenda in Healthcare IT</a> for the foreseeable future. <a href="http://histalk2.com/2010/08/08/monday-morning-update-8910/">A survey of news items in HIStalk</a> also lists several stories supporting this conclusion.<br />
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If you compare the current environment to the pre-bubble days of the internet, you could assume we are in 1994. Netscape has not been launched yet, but there's a wide expectation of a revolution to come. Web 2.0 proponents will claim that the <a href="http://oreilly.com/web2/archive/what-is-web-20.html">first wave of the internet did not produce productivity improvements comparable to those from Web 2.0</a> technologies. Similarly, skeptics might believe this gold rush will not truly transform healthcare IT, but it will set the stage for an eventual revolution in technology, patient engagement, and evidence-based medicine.<br />
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Whichever way you look at it, participants in the market will adapt their strategies in order to profit from this environment. News satire site, <a href="http://www.theonion.com/">The Onion</a> had a memorable headline a few years ago: "<a href="http://www.theonion.com/articles/recessionplagued-nation-demands-new-bubble-to-inve,2486/">Recession Plagued Nation Demands New Bubble to Invest In.</a>" I think that call is being answered.Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-85235703003240771122010-08-06T01:34:00.001-04:002010-08-06T01:34:00.282-04:00The China StudyOne of my good friends who is a senior-level executive at a major national Payer (and sometimes an industry source for this blog) recommended <a href="http://www.amazon.com/China-Study-Comprehensive-Nutrition-Implications/dp/1932100385">The China Study</a>. It sounded like an odd title for a book on health and nutrition so I was eager to find out what it said.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwbCi5dap3zbIkGo7uJMoL0jl6rPde-tJ4Tg1DZLx7WrJUNh8lGakVBTij4D6DBlAYivOSUnq4q9Mqly9HyWXMfGaNHC3nZbj9p17f9ooHElIfd07YeVGU6viFNY4inOjgi7zgpjSLj1c/s1600/the-china-study2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwbCi5dap3zbIkGo7uJMoL0jl6rPde-tJ4Tg1DZLx7WrJUNh8lGakVBTij4D6DBlAYivOSUnq4q9Mqly9HyWXMfGaNHC3nZbj9p17f9ooHElIfd07YeVGU6viFNY4inOjgi7zgpjSLj1c/s320/the-china-study2.jpg" /></a></div><br />
The book is authored by <a href="http://www.tcolincampbell.org/">T. Colin Campbell</a>, who has spent his career in science. This book isn't an opinion piece, it's a fact-based reporting of the correlation of several lifestyle factors on health outcomes. The book criticizes the "scientific reductionism"--the practice that assigns outcomes to single variables rather than considering the systemic nature of influencing factors.<br />
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The author shows, for example, how the presence of carcinogens themselves do not lead to as many cancers as <a href="http://www.tcolincampbell.org/courses-resources/articles/transitioning-to-a-plant-based-diet/">carcinogens in combination with complex proteins</a> (such as found in non-plant sources like red meat). The China Study itself is the analysis of relationship between diet and disease for about 100 communities in China that were relatively isolated and with differing diets and disease outcomes. This provides a snapshot of the effect of varying amounts of diet components in a manner that was not possible before.<br />
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The conclusion I have drawn from this research is that there's a large unexplored theme of modifying diets to improve patient outcomes. Much of the debate in Healthcare revolves around insurance, Healthcare IT, cost-reduction, technology innovations. So little time is devoted to the source: the foods we eat and the lifestyles we lead.Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-17679254421078413192010-08-04T19:06:00.000-04:002010-08-04T19:06:00.459-04:00Ingenix buys Executive Health ResourcesIngenix is <a href="http://www.healthcareitnews.com/news/ingenix-inks-deal-acquire-executive-health-resources">continuing its buying spree</a>. Just after <a href="http://hcdms.blogspot.com/2010/07/ingenix-buys-picis.html">acquiring Picis</a> two weeks ago, Ingenix is now adding medical necessity compliance and physician medical management solutions for hospitals by purchasing <a href="http://www.ehrdocs.com/">Executive Health Resources</a>. In a blog post this morning, John D Halamka suggested that <a href="http://geekdoctor.blogspot.com/2010/08/commercial-hie-products.html">Ingenix may also be looking at entering the HIE space</a>. If that's true, expect additional M&A activity on that front.<br />
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Is there a theme here? Some commentators have suggested that Ingenix is putting together the elements of a Kaiser-like solution. For example, <a href="http://www.zdnet.com/blog/healthcare/unitedhealth-wants-to-be-kaiser/3853">Dana Blankhorne at ZDNet writes this about United Healthcare, Ingenix's parent</a>:<br />
<blockquote><i>It’s trying to be more like Kaiser. That is it wants to control the hospitals and clinics it pays money to and see that they’re managed efficiently. Kaiser does this directly. It owns hospitals and clinics. UnitedHealth plans to do this indirectly, through Ingenix.</i></blockquote>Kaiser Permanente has an good track record of outcomes vs. dollar spent. One would expect it to have an overwhelming share of the market. Yet, it has garnered just a <a href="http://www.americanprogress.org/issues/2009/06/pdf/health_competitiveness.pdf">24% share</a> in California while failing to gain traction in other states (e.g. 5% in Georgia). Commentators believe this is because Kaiser limits <a href="https://brokernet.kp.org/broker/wcm/connect/d870f18041738f7cb0cafbed9f0eea1d/Atlanta-Business-Chronicle-Kaiser-Permanente-article.pdf?MOD=AJPERES">patients freedom in choosing how they receive care</a>. <div><br />
</div><div>The success of the next Kasier-like solution will be affected by how much choice it enables. I wonder what UnitedHealthcare thinks about patient choice?</div>Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-37007648635631972702010-08-02T17:48:00.003-04:002010-08-02T18:53:18.824-04:00Public Health DataGoogle makes it really easy to visualize large amounts of data. In the chart below, I've modified an example from the <a href="http://www.google.com/publicdata/home">Public Data Explorer website</a>: the chart compares Life Expectancy at Birth with Fertility Rates and the bubbles represent GDP of that country. I've only shown <a href="http://www.investopedia.com/terms/b/bric.asp">BRIC</a> countries, the US, Canada, Cuba, Afghanistan and Somalia.<br />
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<div style="text-align: center;"><iframe frameborder="0" height="325" marginheight="0" marginwidth="0" scrolling="no" src="http://www.google.com/publicdata/explore/embed?ds=d5bncppjof8f9_&ctype=b&strail=false&nselm=h&met_x=sp_dyn_le00_in&scale_x=lin&ind_x=false&met_y=sp_dyn_tfrt_in&scale_y=lin&ind_y=false&dimp_c=country:region&met_s=ny_gdp_mktp_cd&idim=country:AFG:SOM:CUB:BRA:IND:CHN:RUS:USA:CAN&ifdim=country&pit=1199145600000&hl=en&dl=en&iconSize=0.5&uniSize=0.035" width="400"></iframe></div><br />
<div style="text-align: left;">Click "Play" above. </div><div style="text-align: left;"><br />
</div><div style="text-align: left;">Notice how <a href="http://www.google.com/publicdata?ds=wb-wdi&met=sp_dyn_le00_in&idim=country:SOM&dl=en&hl=en&q=somalia+life+expectancy">Somalia's life expectancy falls dramatically in the 1990s</a> due to the ravages of war. Also, it appears there's an inverse correlation of fertility with GDP. Not entirely surprising. What is surprising is how much the other countries are catching up (to the US) in terms of life expectancy. When you layer the fact that the <a href="http://voices.washingtonpost.com/ezra-klein/2010/01/america_spends_way_way_way_mor.html">US spends a lot more on Healthcare than most other countries</a>, it's easy to think we're not getting better outcomes for more investment. </div><div style="text-align: left;"><br />
</div><div style="text-align: left;">Perhaps, that's another obvious conclusion?</div>Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0tag:blogger.com,1999:blog-4856138972464854594.post-8165193771496196732010-07-30T10:10:00.003-04:002010-08-04T18:01:29.330-04:00How to deal with Deb PeelFor those of you following the <a href="http://hcdms.blogspot.com/2010/07/de-identified-patient-data-and-right-to.html">battle over Privacy rights in Healthcare</a>, today's <a href="http://www.thehealthcareblog.com/the_health_care_blog/2010/07/use-emotion-to-drive-adoptionnot-rejectionof-health-it.html">post by Lygeia Ricciardi on The Healthcare Blog</a> is a must read.<br />
<div><br />
</div><div>Ms. Ricciardi suggests that factual responses to fear mongering often don't work because our response to fear is often stronger than our response to reason. She writes that one way to counter alarmists like <a href="http://online.wsj.com/article/SB10001424052748703580904575132111888664060.html">Deb Peel</a> is to offer your own alternate scary scenarios:</div><blockquote><i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">If it’s fear you’re after, we hardly lack material:</span></span></i></blockquote><blockquote><i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">- How about being given a drug you are dangerously allergic to?</span></span></i></blockquote><blockquote><i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">- How about receiving a radical misdiagnosis—and the treatment to match?</span></span></i></blockquote><blockquote><i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">- How about enduring prolonged, unnecessary pain?</span></span></i></blockquote><blockquote><i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">- What abut the cures not found, or contagions not contained?</span></span></i></blockquote><div>But, the post continues, a better way is to also use holistic, moving stories. Look for this battle to heat up in the coming months as more companies <a href="http://www.ehrbloggers.com/2010/04/using-de-identified-patient-data-to.html">monetize de-identified data</a>. Alarmists must not be allowed to derail progress.</div><div><br />
</div>Busybeehttp://www.blogger.com/profile/00343910896867805349noreply@blogger.com0