Archive for the 'Innovation, Opportunity, Entrepreneurship' 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.


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.

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’s 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)

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.

Are ‘Medical Googlers’ Really A Problem?

December 12, 2007

After dozens of ventures to create health sites for health consumers, most people still seek medical information through Google. That surprises some tech investors. What’s more, the very act of searching ticks off at least one doctor, and probably many more.

Dr. Scott Haig is aggravated by “Susan,” a patient he considers a “medical Googler” (as he writes in TIME Magazine and as covered in the New York Times). ” We had never met,” he begins, “but as we talked on the phone I knew she was Googling me.” Sounds a little defensive to me. That clackety-clack typing sound he heard could have been her making notes on the conversation, or Googling her health condition, or any number of other less personal activities. (Presumably she Googled him before she placed the call.)

It is rude to surf the Net while you’re on the phone – I’ve been busted for it myself. But no need to jump to conclusions.

Dr. Haig goes on to describe Susan’s irritating personality and seemingly inept parenting – as if those two were inevitable and inseparable characteristics of the “medical Googler.” But guess what? Studies indicate more than 130 million Americans sought medical information online last year. Are they all obnoxious jerks?

Dr. Haig’s reaction is indicative of a deeper trend that troubles many doctors: Patients are arming themselves with medical information and making their own decisions. In the abstract, that’s what they should do. But in practice, it results in a shift away from the doctor-centric model – physician as priest – that many practitioners understandably find more comfortable. And there are risks, which technology has been slow to address.

But here’s the bottom line: They’re here, they’re search-engine is near, get used to it.

If Dr. Haig’s description is accurate, Susan sounds like the kind of annoying patient doctors have had to tolerate since the dawn of the profession. Her ‘Googling’ doesn’t make her who she is – and she won’t change.

But physicians like Dr. Haig will have to adapt – or spend the rest of their careers in a state of heightened aggravation. The ‘Medical Googler’ (and her descendents on newer platforms) are the wave of a future that’s already here.

Health Privacy Creates Policy and Technology Challenges

November 14, 2007


Last summer the Wall Street Journal ran a piece about inaccurate data on medical records, which is a common problem. That led WSJ blogger Jacob Goldstein to observe that, when it comes to obtaining health coverage, medical records are the new “credit score.”

He’s absolutely right – although you can argue that, as reporters say, he “buried the lede.” Most people don’t even realize that insurance companies ever see their personal medical records. That’s a significant story. In fact, most people have no idea who sees their medical information or where it goes. I’m not aware of any comprehensive study on the collection and distribution of medical information.

I do recall seeing a research paper on insurance information in the 1980’s that said that the typical medical bill is handled by 25 different people before it is paid or denied. (No citation available, though I’ve tried to track it down – so consider it apocryphal if you must.)

Policy Need #1: Public awareness, debate, and accountability for the sharing of medical information in the claims administration process.

The digitization of medical information is the new “bipartisan” issue of the 21st Century, uniting politicians from Hillary Clinton and John Edwards to Newt Gingrich. And there are compelling reasons for it, whatever shape health care reform eventually takes. But there are risks.

There have been many security breaches of health data involving hundreds of thousands of patients and their medical records, as we’ve discussed before. (The total number of people involved in any type of data breach over a three-year period? 159 million.)

Technology Need #1: A health security coding system for providers and payers that really works. A number of people are working on it, and there’s a university study group tackling the issue, but nobody’s cracked the code yet in a way that these various markets can embrace.

Then there’s the growing area of health data mining. This can be a very good thing, encouraging both research and better services for individuals. Yet the political state of the art lags behind the technology, which keeps developing. Esther Dyson has an attractive solution: informed consent. Answer those online questionnaires and search for medical information all night if you like, she suggests, but insist that your digital content providers allow you to control what is and isn’t shared.

Policy Need #2: Extend informed consent to health technologies of the future, too, such as telemedicine. It’s an elegant, simple solution to a growing problem – a solution that arose in the private sector. But it doesn’t cover all possibilities. That’s why the American Medical Informatics Association offered some suggested guidelines for the secondary uses of medical data that includes public debate and consensus; a health data taxonomy; and a redirection of the debate away from the ownership of data and toward the the topics of access, use, and control.

We’ll have even bigger problems in the future, including the collection and use of genome data. Dyson understands the implications of genomic information on the insurance industry better than the Economist does, but neither addresses the possibility of genomic data being used for, say, pre-employment examinations.

Would Abraham Lincoln ever have become President if the country knew in advance that he had a tendency toward severe depression? And if he hadn’t been, would the country have been better off?

Technology Need #2: A genomic “reader” that is sophisticated enough to categorize an individual’s enhanced abilities as well as their vulnerability to disease.

Policy Need #3: A national debate on the proper uses of genomic data.

So, when do we begin the public discussion of health data and privacy? And who’s going to meet those tech challenges and reap the economic rewards that will follow?

(Image of secure public health data center licensed under Creative Commons from HMS, Inc.)

Santa Barbara Data Initiative: The Lessons of Failure

August 21, 2007


The California Health Care Foundation (CHCF) has published the results of a study to determine why its pilot program to develop a RHIO (Regional Health Information Organization) failed in Santa Barbara. The report is clear, well-written, and instructive.

The goal was admirable: CHCF wanted to create a centralized database of patient information that was readily available to hospitals, physicians, and other providers as they delivered medical services to area residents. It was hoped that this RHIO would become a model for similar efforts around the country.

In its summary, CHCF cites “lack of a compelling business case, distorted economic incentives, passive leadership among participants, vendor limitations, software delays, and privacy and security issues as factors that played a significant role in the project’s eventual closure.”

But the report itself (caution: pdf) is even more interesting. Dr. David Brailer, who led the software company engaged for the project, later went on to head President Bush’s technology initiative. One report described him as the man whose “job was to sell Bush’s rewiring of American medicine.”

Dr. Brailer is a brilliant and innovative man, and the authors say that the project suffered from the loss of his charismatic leadership after he went to Washington. But they also suggest that either he or his organization (CareScience) oversold their own capabilities and the available technology, and undersold the difficulties involved – no doubt unintentionally.

The authors also say that Dr. Brailer differed other stakeholders in CareScience over the extent to which the company should supplement CHCF’s initial investment as a form of R&D for its own products – which CHCF had hoped would result from this project.

Reading the report, a couple of other possible reasons for its failure come to mind – reasons that help explain that “passive leadership” and some of the other problems:

Failure to understand participants’ motives

Each of the participants in the health economy have reasons for participating in it. These are primarily, but not exclusively, economic. They also have well-ingrained behaviors. This extends from physicians and senior hospital administrators to ward clerks and front desk staff. Failure to examine the motives of each of the players led to an unwillingness to either assume new expense, which the authors note.

What they don’t note, but is also significant, is that these participants won’t change their behavior unless they are given reasons to do so that make sense to them – and speak to their economic, social, and personal motivations.

More research into these motivations is needed, and practical suggestions for changing them need to be developed.

The behavioral dynamics of medical care

It’s very difficult to persuade physicians – or patients – to change long-standing methods of interacting with one another. For the RHIO concept to be fully successful, physicians need to become comfortable with pausing to retrieve information from a computer. That may mean teaching them new behavior – or, emphasizing PDAs and other less-intrusive handheld technologies. As an alternative, office staff might be trained to retrieve the information and give it to the doctor before the patient arrives.

Further research in the sociology and anthropology of physician/patient behavior could help solve this problem.

Forgetting to heed the “cui bono” principle

Because the U.S. healthcare system is economically decentralized, changes in one area may result in financial benefits elsewhere. In this case, the theory behind the CHCF initiative was that care would improve and operating efficiencies would increase under a working RHIO.

But, as the lawyers ask, “Cui bono?” Who benefits? In this case, a broad array of private insurers could save money from better efficiencies and outcomes. But these payers weren’t brought in as stakeholders in the process. To complicate matters further, additional investment today may save future insurers money – and we can’t know who those future insurers might be. This is one of the reasons why wellness programs have taken so long to find a foothold.

Additional research should be conducted into alternative funding models for RHIOs that involve private and public payers.

One large-scale payer was involved as a stakeholder: The Santa Barbara County Health Care Initiative, which pays Medi-Cal claims in the area. The report’s authors don’t provide much detail on the Initiative’s role in this effort.*

The report’s authors do a fine job of detailing many other problems with the project, but these two areas might deserve further study at some point.


* Conflict-of-interest alert: I worked as a Systems Analyst for the vendor that set up the Santa Barbara County Health Initiative under an HMO-like data model – way back in 1982.

Tomorrow Calling: News From the IT Front

July 18, 2007


There’s a flood of interesting news in the Health IT world.  Each item deserves its own extended entry.  Hopefully someday …


A recent study suggests that electronic health records don’t improve ambulatory health care – at least not unless they’re designed to take advantage of the things IT can do better than paper records can. As one of the study’s leaders, Dr. Jeffrey Linder, observed:

“There’s nothing magical about electronic health records. You need to have tools in place that take advantage of technology to show improvements in quality. You need to do additional work instead of just turning on the computer.”

EHRs must be joined to other knowledge-driven technology in order to enhance medical care. First, however, we need to catch up with Europe. Primary care doctors there have better access to IT than do their counterparts in North America.

Web-Based Messaging

A pilot project at Kaiser Permanente indicates that linking doctors and patients with web-based messaging reduces the number of office visits. While project leaders expected younger, more tech-savvy enrollees to be the primary users, they were surprised to discover that older patients were enthusiastic users of the system. Their health needs, especially regarding chronic care, led them to make the most use of messaging. That’s good news for a country with an aging population.

Now the nation’s economic model has to catch up with the technology. Reducing office visits is fine for Kaiser, where doctors are on salary. Fee-for-service medicine will be a hostile environment for messaging as long as doctors are giving up their time to message and losing income in return. As I’ve said for a long time, insurers will need to come up with a fee schedule for online consultation – a nominal fee of, say $5 with no patient copay – in order for programs like this to succeed.

Technology With a Human Touch

Dr. Thomas Lee has written an interesting piece about the human/technology interface and its relevance to health IT. We’re of like mind. IT won’t change or enhance human behavior in the health care system (using “system” in the global, socio-economic sense) until its easier to use.

Speaking of which, I thought I had weathered the iPhone craze without sparking my own techno-lust. But I saw one at a friend’s house this weekend. I’m trying to fight the phenomenon of craving that it triggered.

Rapid Learning

And speaking of health as a system – a dynamic organization with inputs, outputs, and behaviors that are observable, predictable, and changeable – there’s an exciting (to me, anyway) special edition of Health Affairs onRapid Learning”: using information from current and future electronic sources to monitor the changing epidemiological and behavior picture in order to respond rapidly to changing patterns of disease and treatment.

I hope to write more about this in the future. In a related effort, the DHS recently joined with bloggers from across the political spectrum in a very smart attempt to mobilize blogs and other web-based resources to help in case a pandemic strikes. Their first effort was Pandemic Flu Awareness Week. Hopefully there will be more such enlightened efforts in the future.

And it’s nice to be able to praise the Feds for a change.

Will PHPs Succeed or Fail? It’s All About Execution … Which Means Investment

May 24, 2007


Highmark (Blue Cross Blue Shield of PA) is offering an online Personal Health Record portal, or PHR. As reports:

Available through a secure page at, the Pittsburgh-based insurer will automatically populate PHRs with relevant claims and administrative data that includes dates of service, diagnoses and treatments, medications and other information.

The PHR includes tracking technology that enables users to keep records on certain health status measures, such as blood glucose, blood pressure, cholesterol level and weight. Other recordkeeping functions include medication tracking, immunizations, physician information, treatment history and allergies. Members also can enter additional information in their PHR, which is printable to share with clinicians.

Highmark further will offer PHR users personalized plans for improving their health. The PHR includes links to educational materials.

There are a lot of factors to consider in good web portal design – including variations in literacy rates, ease of access, generational/cultural differences in how people interact with a screen, identifying the “teachability moment” in health education, and much more. That doesn’t even touch the issue of content. Execution will determine the success or failure of the PHP concept.

There’s a good opportunity for the right team to build the content and develop design templates for PHPs. The question is: Where is that team? There’s an investment opportunity out there for the right partners …

(courtesy iHealthBeat – California HealthCare Foundation)