Archive for the 'Healthcare Investment' Category

Could Doctors Go the Way of Record Companies?

June 15, 2009

Those of us who follow health care may be overlooking the big picture. Most of the profound (and sometimes disruptive) changes of the last half century – computers, the Internet, social networks – weren’t initiated by the political process. They arose at the intersection of technology, economics, and mass social change. So here’s something to think about:

Could the medical profession go the way of the record industry?

Consider the path that led to the current crisis in the music business:

1. An industry with a near-total monopoly experiences a minor disruption (in music’s case, with the invention of cassette tape recording).
2. It ‘relaxes’ and assumes the crisis has past.
3. An even better technology comes along (the Internet) that includes lateral as well as vertical connections. (Individuals could only make tapes for themselves; sharing was possible but cumbersome, until the Net and mp3s made it instantaneous and worldwide.)
4. The industry fails to recognize the long-term significance and risks of this new tech.
5. Enterprising individuals use this new technology to distribute “information” of mutual interest – songs – through “P2P” (peer-to-peer) file sharing.

The result? A massive and ongoing implosion of the music biz. (David Byrne provided an excellent overview in Wired, with some corrections on his blog.)

Could the same thing happen to the medical profession? Many people’s immediate reaction will be to say ‘no.’ They’ll list the many barriers to what we might call a ‘P2PMed’ disruption of our medical economy (with ‘P2P’ here meaning either ‘peer-to-peer’ or ‘patient to patient’.) Doctors are too respected. Regulations won’t permit it. Doctors control access to medications. Medical information is walled off behind expensive, subscription-only medical journals. It’s unthinkable.

That’s pretty much how the record industry reacted in the 1990s. Let’s look at those objections:

160 million people looked up medical information on the Internet circa 2007, according to Harris polling data. Yet they still go to doctors. That’s true – just as millions of people made tape copies of music for decades without seriously undermining musical economics.

Each of these searches was a solitary activity. The difference will come when a new technology allows lateral information-sharing in a way that people trust. It hasn’t happened yet, but smart people are banking on the idea that it will soon. I agree with that assessment, although none of the many projects I’ve looked at so far struck me as a breakthrough. But a lot of folks are working on it.

Doctors monopolize access to medications through the power of the prescription pad. That monopoly’s already eroding as online pharmacies provide low-cost ‘doctor consults,’ a legal work-around that allows – to an sometimes disturbing extent – easy access to meds. Where there is demand, there will be suppliers.

People won’t spend money based on self-referral. The multi-billion dollar complementary medicine industry demonstrates this is untrue. Most “CAM” (complementary and alternative medicine) transactions are based on self-referral out of the traditional MD/patient relationship.

Medical information is walled off. True, but a backlash against the sequestering of research data is already underway. Case in point: A new publication called The Journal of Participatory Medicine hopes to provide peer-reviewed articles on self care for patients, as board member Kevin Kelly writes.

The Journal’s Advisory Board reads like a Who’s Who of Internet and medical business pioneers (and it’s an open-source publication, meaning its content will be free to all). The Journal goal of helping patients take “responsibility for their own health and healing” (in Kevin Kelly’s words) aligns with decades of movement toward a more patient-centric model championed by both the Left (as “patient’s rights”) and the Right (as with high-deductible “consumer-directed health plans”).

Once again, the left/right paradigm is ill-suited for new developments … and don’t blame initiatives like the Journal if medicine goes the way of record labels. They’re symptoms of broader socio-informational change, not its cause.

We can only guess what such change would look like: A widely trusted P2PMed platform catches fire, followed by widespread adoption of a model we might call “self-directed care.” People use online resources (best practices guidelines, diagnostic tools, etc.) to choose their own care path, then find direct or indirect ways to access the care they’ve chosen.

Not all doctors would go out of business after such a transition, of course. They’re still selling some CDs, too. So who would be most likely to thrive after the transformation?

High-touch practitioners: Empathetic, comforting, and warm doctors.
“Mechanics”: The most gifted and accomplished surgeons sometimes use this word to describe themselves. We will need talented neurosurgeons, cardiac surgeons, and other “fixers” for the foreseeable future (at least until the self-programmable nanobots take over).
Innovators: Doctors who are always exploring, changing, and trying new things, staying one step ahead of the curve.
Integrators: Doctors who can bring together seemingly unrelated ideas and solutions, whether in diagnosis or in treatment. Integration is the foundation of creativity, and creative doctors will always be valued.

Who’ll fail? Doctors who function by rote, who make routine diagnoses, and who connect patients to other resources based on past relationships and not need. Anyone whose expertise and connections are easily replicated on the Internet (think “travel agents”) will struggle to survive.

Watching the AMA defend its turf on issues like doctor reimbursement is like watching the RIAA file copyright lawsuits against teenagers, even as its business model collapses around it. You can’t fight your own market and win, and you can’t fight yesterday’s battles. Doctor groups should look more like think tanks and less like a lobbying groups. (Come to think of it, so should the RIAA.)

A topic this complex can’t be properly covered in a piece this short. And predicting this kind of change is not the same thing as endorsing it. But, like it or not, we should be talking about it now.

Because – like it or not – it, or something like it, is coming.


Health Noir: $10 Million Ransom Demand for Data – and Stranger Crimes Are Coming

May 8, 2009

(originally written for The Huffington Post)

“Attention, Virginia!” the ransom note begins. “I have your shit! In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh ūüė¶ ”

“For $10 million, I will gladly send along the password. You have 7 days to decide.”

Someone says they’ve stolen 8.3 million patient records, and now the FBI is on the case. However strange this crime may sound, it was a predictable event. Stranger and more severe crimes are coming, if they’re not here already. I’ve been tracking health data breaches for a while, and it’s one of six scenarios I sketched out (but chose not to publish). It’s important now to ensure that these concerns are given a high enough priority – and proper funding – in future health IT initiatives.

Whatever your position on health reform, nobody wants health data to be the topic of the next private eye novel or film noir. Philip Marlowe wouldn’t be happy working at HHS.

Since they’re now playing out in public, I’ll briefly mention those other five scenarios. They are:

1. Individuals are blackmailed using information obtained from stolen medical records.
2. “Medical identity theft” – using stolen information to fraudulently obtain medical care
3. Stolen information is used to submit fraudulent bills to Medicare, Medicaid, and insurance
4. Electronic funds transfers are intercepted using stolen data
5. Medical data is used to obtain controlled substances and sell pharmaceuticals online

There are no doubt other ideas out there, and inventive minds will find them. Authorities say the Virginia hackers breached the system’s security, but it’s less clear whether they can do what they’ve threatened. Either way, the language in their ransom threat seems to fit the hacker profile of young American kids with time on their hands. We don’t know whether that’s real or a ruse, but it raises a couple of disturbing questions:

– What happens when organized crime gets into the stolen health data business?
– Who says they haven’t already?

Crime syndicates could become brokerages for acquiring and selling health information, which can be traded online.

It would be a mistake to use the threat of these crimes to oppose health IT initiatives, however. These crimes will continue, no matter what, because the exchange of data is embedded in every aspect of our insurance-based health system. Doing nothing will not protect us. It makes more sense to use this historical moment to take bold preventive steps.

If stolen health data fits the pattern of other cybercrimes, publicly reported breaches don’t reflect the full scope of the problem. So what should the Administration and private industry do next?

  1. Acknowledge the problem. Don’t lose control of the debate by letting health reform opponents raise the topic first.
  2. Provide funding for security software and solutions.
  3. Clarify the security levels and procedures expected of all health IT users. (You’d be surprised how many of these breaches occurred because someone left a laptop in an airport or a computer disk on their front seat.)

What should private industry do? Those industries that will benefit from reform and IT initiatives could establish a reward – something like the “X Prize” – for innovative security solutions in healthcare.

Organized crime – or even disorganized crime – has no place in the world of healthcare.

It’s More Than an Electronic Health Record — Call It a “Health Information Highway”

March 3, 2009

(cross-posted at The Huffington Post)

The stimulus package includes a great deal of money for healthcare information technology, or health IT. Much of this funding is directed toward “wiring” doctors and hospitals with electronic health records, or EHRs. Why should anyone care, other than health software vendors and other industry insiders?

Here’s why: Because the digitizing of medical records could have a far more profound effect on health — and on our economy — than most people realize. The president said the recovery plan will “invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives.” All that and much more is possible. With a new HHS Secretary and health czar, and a White House health care summit scheduled this week, this is the right time to act.

“Electronic health records” don’t sound like a particularly exciting or innovative idea. But neither did “a network that could quickly reroute digital traffic around failed nodes” in case of military attack, or “dynamic routing protocols to constantly adjust the flow of traffic” between computers. Yet those were the modest original goals of ARPANET — which evolved into the Internet as we know it today.

Paradoxically, computerizing the health system in this country could make it much more humane than it is today. But that calls for a broad vision of health IT as an “information highway” that stores information, looks for problems, and eases the many routine interactions that make up the health system. A well-designed “health highway” would have features like these:

A common set of programming specifications for coding, storing, sharing, and manipulating health information. Just as XML (eXtensible Markup Language) allowed web designers to create sites that interact with one another, a health markup language or “HML” could allow systems used by doctors, hospitals, patients, and others to easily “talk” with one another.

The ability for systems to “look for” adverse medical reactions together. Certain harmless drugs become deadly in combination with other drugs, or when a person has other medical conditions. One way this technology could be used is to automatically look for these interactions every time a prescription is electronically “written.”

Personal convenience. A doctor recommended minor surgery for me last week. What if her office had been able to schedule an appointment for me on the spot, send me a before-and-after personal care plan (tailored to my medical history), pre-authorized the treatment — and checked my health plan to tell me how much it was going to cost me?

More privacy than we have today. I began tracking health privacy breaches a couple of years ago, but had to stop — because they’re too frequent. Laptops get stolen with medical information on them, storage disks get misplaced, or computers get hacked. (I wrote a paper about potential criminal uses of stolen medical data, but decided not to publish it …) A comprehensive health IT system would include better protections for health data.

Tools for primary care doctors to manage your health. US and Canadian primary care doctors – the ones who should be managing your overall health — have historically lagged behind their European counterparts in some vital IT capabilities. Health reform depends on stronger primary care – and health IT can help.

Automatic claim submission. Why shouldn’t the health IT network automatically submit my claim after I’ve received medical treatment? Why shouldn’t it tell me how far I’ve gone in meeting my deductible, and share any other financial information I might need? Our current system is too clerical, too bureaucratic, and too difficult to navigate.

For that matter, why should I have to fill out the same forms over and over — not only each time I see a new doctor, but when I fill out multiple forms in the same doctor’s office? This is a pet peeve of mine. And after I’ve had to write down my birthday four times during one doctor’s office visit — then I need to tell them my age, too! (I want to ask, if I just gave you my birthday can’t you figure out how old I am? Well, a computer can …)

The government can’t create systems to do all these things, even with the dollars that have been budgeted. But that shouldn’t be necessary. A comprehensive strategy should lay the foundation for a boom in private initiatives. If the Internet’s any example, people will meet these needs… and hundreds of others nobody’s thought of yet. That won’t just help us save money and improve healthcare. It could also create a new mini-boom in the technology and service sectors of our $2 trillion health economy.

And that sounds a lot like a stimulus to me.

An “electronic health record” may sound dull. Software based on paper-based objects seem inert. But that’s what Facebook was originally — an electronic version of the “facebooks” given to new college students so they can get to know one another. Whenever anything is digitized it becomes dynamic, changeable, active. It acquires the ability to interact with other things. It becomes less like a paper form, and more like a gateway.

Or a highway.

Bail Them Out? Why Not Take Over Their Healthcare Instead?

December 12, 2008

The auto industry bailout is stalled. Opponents can’t seem decide what’s most objectionable: the lack of punishment for bad planning, or the idea that taxpayer money is being used to pay decent wages. There’s a proposal to force UAW workers to accept the wage levels paid in the US by foreign auto companies, but that only amounts to about $3 per hour or so. The average cost for employee health care in the US is more than that.

So here’s another idea: Let’s have the government assume the cost of providing health care to auto workers, and have it take the lead in deciding how those health dollars are spent. If the government pays these costs for five years, the financial picture for these companies would improve significantly. And imagine what would happen if Tom Daschle directed the autoworkers health plan in his dual role as HHS Secretary and health reform chief. He could ensure that taxpayer dollars are being spent wisely, and he could build a working model for the reformed healthcare system of the future.

Come to think of it, those 2.5 million workers that will be working for the President’s infrastructure program could be part of this new health plan too.

Here’s one reason why this idea makes sense: Unlike other types of bailout, especially in the banking sector, a large portion of the health insurance dollar is spent in the first year of coverage. That means that most of this money will recirculate into the economy immediately, creating a short-term stimulus effect.

The automakers have some immediate cash needs, especially for $10 billion in outstanding bills. It would be reckless to allow these suppliers to go under. But overall, the numbers suggest that a plan like this could actually work. Here are some back-of-the-envelope calculations:

  • Let’s use one of the lower numbers being thrown around and say that 241,000 people work for the Big Three.
  • Employer health plan premiums were $12,000 per year in 2007. It’s gone up since then, but part of the cost is paid by the employee, and some employees will have health coverage through other sources (though not many in this case). So let’s conservatively assume a per-employee cost to the Big Three of $8,000.
  • That gives us an annual cost of just under $2 billion ($1,928,000) to cover these 241,000 employees. We would hope to reduce cost inflation, but we can’t promise that. But even if this plan suffers a raging 10% inflation rate, the total cost of a five-year “health bailout” would be less than $12 billion — which is less than the $14 billion previously proposed.

And look at what else we would get. Secretary Daschle and his team could use this process to build a model Data Exchange and health purchasing process. Even more innovative programs could be carried out, too, especially in Michigan (where 149,000 of the Big Three’s workers live). Electronic data records, online and in-person wellness programs, “medical homes,” new incentives for providers and enrollees — Michigan can become the breeding ground for new ideas, and the autoworker health plan can become the incubator for health reform.

What happens if you add 2.5 million infrastructure workers to the mix? You have a nationwide canvas for sketching out new reform ideas before rolling them out to the nation as a whole. Then there is the problem of retired autoworkers. The unfunded liability for their health care has been estimated at nearly $100 billion. These retirees could be folded into the plan, too.

What are the objections? Some will say that this is government-run health care. But the government will be paying for it anyway, no matter what happens. So why not manage our money wisely? And the President-elect’s reform proposals don’t call for single-payer, but for a blend of insurance programs. Even with government oversight, it will be a private-sector initiative. (I’d vote for a Medicare coverage option, though.)

There are also those who will object because it doesn’t punish the car companies enough for their bad decisions. That’s a discussion for another day, but here’s a thought: The car companies may deserve punishment for not building cars people want. But the credit crisis is not of their doing, and the lack of car loans is what’s hurting them most right now. The “serenity prayer” fits here: The car makers should change what they can change as a condition for aid. But there are some things that are beyond their control. We taxpayers, the ones who are bailing them out, should have the wisdom to know the difference.

Paul Krugman says that the current geographic concentration of the auto industry can’t continue, and he’s undoubtedly right. But that doesn’t mean the transition can’t be managed wisely and imaginatively, especially where employee health is concerned. And if we’re paying the bill, why not use our money to leverage some real change?

Plan for Uninsured in Florida Goes South (plus, Defending My Opponents)

August 11, 2008

This is one of the most predictable health insurance stories we’ve seen so far in 2008:

A report from the Center on Budget and Policy Priorities, a nonprofit policy research group in Washington, D.C., concluded that Cover Florida, a health plan recently implemented to provide coverage to some of Florida‚Äôs 3.7 million uninsured, is not likely to succeed …

Why was the failure of Cover Florida inevitable?¬† Because it avoided the tough questions.¬† Like so many political creations, it tried to please everybody.¬† It tried to reduce the number of uninsured without spending any real money, imposing any rules – or goring anyone’s ox.

Here’s a simple rule of thumb:¬† If the private sector could solve the problem of the uninsured on its own it would have done so already. It didn’t need Gov. Charlie Crist or the Florida Legislature to encourage it.

Cover Florida attempted to incubate inexpensive insurance plans that low-income Floridians could buy for $150 a month and up.¬† But economics is, in its own way, as inelastic as physics.¬† A plan that costs that little, and that receives no government subsidies, simply can’t provide very much coverage.

Besides, $1800 per year is a lot of money to lower-income people – more, in fact, that they can afford.¬† Most uninsured Floridians are in lower income brackets, and people in these brackets are rational economic actors like everyone else.¬† To the extent that they’re aware of Cover Florida, they’ll look at the premiums and find them unacceptably high.¬† Or if they get past that, they’ll look at the out-of-pocket costs and see that this plan won’t protect them from the risk of financial catastrophe …

… which is, after all, the original concept behind the invention of “insurance.”

Here’s the bottom line:¬† There was no way Cover Florida could provide a meaningful cost/benefit choice for uninsured Floridians.¬† Not without introducing something new into the equation: new revenue sources, new processes … new something.¬† And any plan like this will have low participation, which means adverse selection.

Gov. Crist made sweeping claims for Cover Florida:¬† “Competitive negotiations” would produce “an affordable, quality insurance product for Florida’s uninsured citizens.”¬† They would have “a robust set of benefits” with “no mandates for participation and no tax dollars.”

Sounds too good to be true … and it was.¬† A similar program called Health Flex had already failed in Florida, which raises this new initiative to the old definition of insanity as “doing the same thing over and over and expecting a different result.”

The problem of the uninsured will never be solved by “press-release policymaking.”¬† There are more than 40 million uninsured Americans, and sometimes it seems as if politicians have uttered a buzzword for every single one of them.

I’ll close with a defense of people I’ve disagreed with over the years:¬† Those of us who are health policy wonks have had more than our share of internecine battles.¬† I may think the folks at the Cato Institute are unrealistic about the free market, or that too many Democrats turned “shared responsibility” into an onerous burden for the working poor, or that some single-payer advocates are so inflexible it becomes counterproductive.¬† And they may all think far worse of me (if they think of me at all.)

But these sorts of policy debates need to happen if meaningful change is ever going to take place.¬† Everybody I’ve just named is willing to look past the bromides and feel-good cliches in order to fight the difficult fights.¬† They’re all willing to confront tough issues and struggle with hard choices in order to come up with real solutions.

I’ll take that over political happy-talk any day.

(Original reporting from the Orlando Sentinel via CovertheUninsured)

Stop Thief!

July 8, 2008

A Harris Interactive poll suggests that public awareness of health privacy concerns is on the rise, according to a report in Modern Healthcare.¬† The poll is described as an “online interactive” survey, however, which raises concerns about sampling validity.¬† That caveat aside, it’s interesting to note that there appears to be increasing public awareness of health data theft and data security issues – which, as we have written here before, are rampant.¬† (We’ve been following health privacy concerns for some time now.)

The poll also suggests that data thefts could be undermining public support for Electronic Health Records (EHR), which is another reason to get this problem under control before it escalates any further.

The Modern Healthcare article also reports that Booz Allen Hamilton was awarded a $450,000 grant in order to

…do an “environmental scan” to get its arms around the problem, then convene a meeting to gather ideas on how medical identity theft should be addressed, and then to write up an action plan recommending ways to deal with the problem.

I would’ve liked to have that contract, and I could’ve done it for a lot less.¬† We haven’t begun to explore the full implications of rampant health data theft – and we shouldn’t, at least in a public forum.

Still, I suspect the real solution to this problem is going to come from an imaginative entrepreneur, not a Federally-funded study.

(via CHCF’s iHealthBeat; image courtesy Medical Informatics Insider)

Are We Asking the Wrong Questions About Disease Management and Medicare?

April 8, 2008

A recent study suggests that Medicare’s Disease Management (DM) experiment has failed to cut medical costs. DM advocates argue that Medicare’s methodology was flawed. So what’s the answer? A New York Times article asks: Does Medicare DM cut costs, or should it be stopped?

That may be the wrong question.

As far the first part of the question is concerned, it wouldn’t be surprising if the answer turned out to be “no.” Revenues for disease management companies grew from $78 million in 1997 to $1.2 billion in 2005, according to the Disease Management Consortium, largely on the belief that DM programs cut medical costs and were therefore a good investment for private payers. Yet to date, no study has demonstrated conclusive medical cost savings from DM.

That doesn’t, however, mean that DM is a bad idea – especially for Medicare. 160,000 Medicare beneficiaries have been served by the Medical Health Support program, which provided chronic disease patients with periodic calls from nurses. The nurses give patients medical information, encourage them to seek treatment, remind them about their medical needs, and provide other forms of support.

The DM companies had financial incentives: Either achieve a 5% reduction in medical costs for their enrollees, net of service costs, or return their fees. When it became clear last year they weren’t going to make that goal, Medicare relaxed their requirements. Now, only a net savings is required in order for the vendors to keep their fees. It’s not clear if they’ll reach that goal, either. (The CMS pdf fact sheet politely describes the cost impact of these programs so far as “nominal.”)

It’s too early to draw definitive conclusions about this experiment, especially since the data are not yet publicly available. But here are some thoughts to consider:

  • Cost savings may not be the appropriate goal for DM with a population of this kind. Convenience (especially for those with limited mobility or money) and health improvement outcomes are also worthwhile objectives. The program should be evaluated for these indicators, and not for cost alone.
  • While the entire program may not be cost-effective, elements of it might be. Medicare should continue the experiment under modified conditions.
  • There may be opportunities to reduce program costs and improve efficiencies while delivering similar results.

Senators from the home states of the companies involved, including John Kerry and Lamar Alexander, think the experiment should be continued. The Times implies they’re just providing a constituent service to home state employers, but they may in fact be right. There is more to be learned about the role of DM in Medicare, and in the overall health system.

Overall, the DM industry is likely to experience a shakeout in the next year or two – for both private and public payers. Assumptions about its cost-effectiveness are likely to be overturned. The most likely end result? A re-engineered DM concept, which differs from today’s both in design and in outcome measurements. Medicare can play a vital role in DM research, discovering which elements work, which need to be added, and which can be discarded.

Health Information Online: New & Interesting Developments

January 28, 2008


People keep trying to provide comparative cost information that health “consumers” can use to make their treatment decisions. Many of us have predicted that someone would try to be the Travelocity of health purchasing, and says it wants to be exactly that (as reported in the Minneapolis Star Tribune).

I tried the site. It’s ambitious, and in its own way it’s also overtly political. “Competition has changed every market but health care,” the Flash introduction says. “That’s about to change.” Some would argue that there are many reasons why health care can never fit simple market models, including confusion about what exactly is being bought and sold. (Is it “wellness”? A fix for your specific health problem? Or just a set of individual treatments, none of which can be predicted in advance?)

I had some difficulty following the process for acid reflux, the condition I’d selected as a test. It came up with only one “price” of $213, from one provider – but what was it for? Diagnosis? Treatment? End-to-end cure? How much will I need to pay for pharmaceuticals? Will I need to return quarterly? Annually? Ever? If it’s just one office visit, it should say so. If it’s a treatment plan, it should say that.

This is not to knock’s creators unfairly. They have an interesting take on this often-discussed idea, and according to the Star Tribune they’ve already affected some unit pricing in the area. And I love their attempt to use decision trees to help people figure out what they need. (Try it – it’s interesting.)

But they need to be cautious about over-promising, and they need to recognize that most of their users will be insured – which will make their pricing information misleading, if not irrelevant. Most of all, they need to define the commodity that’s truly being bought and sold in the health market. That’s the hard part.

Meanwhile, Kaiser Permanente seems to be pioneering an different model for Internet interaction with the health process. iHealthBeat summarizes the features of Kaiser’s new member portal (free registration required), as originally reported in the Sacramento Business Journal. Features include appointment scheduling, prescription refills, viewing lab results, and e-mailing doctors (who will presumably write back).

A staff model HMO like Kaiser is the obvious place to develop a successful service of this kind. All the needed information is present under one roof. Since doctors are employees and not independent businesses, they can take time to answer emails without losing income.

The logical next step is to develop a similar service for the majority of Americans who don’t belong to group or staff model HMOs. That will require some leg work and some cooperation, especially among physicians, laboratories, and other diagnostic providers. And it will require financial incentives for providers to participate, including a payment schedule for answering emails and a system for transferring medical information securely.

(, on the other hand, charges providers to participate. That may alter the blend of participants away from the lowest-cost providers, especially on the physician side. And who makes sure data is updated?)

What else will it take to succeed? A thorough knowledge of the inner workings of our so-called health “system,” and a clear-eyed look at the motivation of the participants.

In related news, California is posting a list of hospitals willing to provide discounts to uninsured patients, along with a comparison-shopping tool. Two Michigan health systems are posting their prices for common procedures (but note – these are charges, not the payments they typically receive for these services. Caveat emptor and all that.)

Prediction: Not very many people will use these California or Michigan portals. There will be one or more sites that do become popular someday, but they’ll look like a cross between, secure email, and a supercharged search engine.

The goal is to create the classic “knowledge pyramid”: Data needs to be organized into information, and information needs to be organized to become knowledge. If somebody builds it, they will come.

Global Warming And Individual Health

January 16, 2008


Add the fight against global warming to the list of political battles that impact the health arena.¬† A long-term study of global warming’s impact on medical needs was conducted by Australian researchers in order to help that country’s single-payer system plan for the future.

According to the Sydney Morning Herald, researchers found that¬† “heat waves – defined as a periods of three days or more in which the average temperature exceeded 35 degrees – produced a seven per cent increase in admissions to hospital and a four per cent increase in ambulance trips.”¬† The Herald adds that “the number of people admitted for kidney disease increased by 17 per cent (during heat waves), and the number admitted for mental illness increased by seven per cent.”

Melbourne’s Herald Sun (ironic name, that) quotes the study’s lead researcher, Prof. Kevin Parton, as saying that mosquito-borne diseases will also be on the upswing as the result of warming trends.

There are those who will say these reports are “alarmist,” of course, although they rely of widely accepted climatological and medical research.¬† The study is, unfortunately, not alarmist.¬†¬† On the upside, the long-term investment opportunities look good for related medical products – including antibiotics, antidepressants, dialysis technology, and bug repellent.

I wish I were kidding.

Bipartisan Support for More Provider Health IT

June 25, 2007


There’s a place for healthy partisan differences, and a place for bipartisanship. This initiative goes into the latter category. Whether you’re a free-market radical, a single-payer advocate, or something in between, better collection and analysis of information will help the delivery of medical care.

(Single-marketers take note: Primary physicians in Europe and the UK are well ahead of their U.S. and Canadian counterparts in the adoption of IT.)

A group of Senators that includes Ted Kennedy, Hillary Clinton, and Orrin Hatch has sponsored¬† a bill called The Wired for Health Care Quality Act of 2007. It provides $163 million over a four-year period (that’s not very much) to help providers who don’t make very much money adopt news IT strategies. It would also help states create low-interest loan programs for them, and provide funding for local and regional initiatives to collect and share health data.

The bill would also require that HHS designate an organization to create health care performance measures, which is an important step forward. If adopted, this bill will help create the electronic infrastructure for a better health system – whatever you imagine that system to be.

I don’t think there’s enough money in the bill.¬† It provides $40 million and change per year for four years.¬† That’s less than a few dozen costly medical cases will cost in each of those years.¬† But it’s a start, and that’s a good thing.