I just received another email from another EHR Vendor pandering to physicians to implement their technology so that the physician so they can access some unsustainably incentive to use technology that they should already be using. Here is the offending language:
“State Medicaid providers across the country have an unprecedented opportunity to collect over $21,000 in EHR incentives in the last few weeks of 2011. If you’re already using Xxxxxxxx Xxxxxx, there are a few easy steps you can take to earn your incentive.“
This is just so wrong on so many levels to me. First, I find it completely incongruous that we have to incent physicians to use a simple tool that is designed to make their life easier, their practice more efficient, and their care more effective. I can’t recall, but I didn’t see the need to incent the stethoscope, antibiotics, or any other health innovations.
Second, the offer itself is just dripping with the grease and slime of “taking” something “while the getting is good”. Does anyone care that this “stimulus” money is subject to the grossest abuses? That it will be misapplied? That most of it is being doled out to people who have already implemented these technologies and now are getting a little gloss on top? Does anyone care that our country is broke and this is just another program that is unsustainable, unnecessary, and incapable of producing its intended results. Is there any evidence that this is having an impact?
And third, perhaps most fundamentally, we are incenting the wrong thing. The EHR is not the end all be all technology to implement into practices across the country. One of the most thoughtful newer EHR companies puts this entire notion into perspective. ClearPractice, a subsidiary of Essence Health Group, list out 22 capabilities that are required to achieve the triple aim of lower costs, increased quality, and improved outcomes. The EHR is only ONE aspect of the requirements to achieve this. Double take on that – only One of Twenty Two core capabilities – less than 5%. That is the point.
I personally believe that the EHR, while a useful tool, is a commodity being overtaken by an entirely new range of capabilities, integration, and technologies that are allowing innovators to help make health a more seamless and less disruptive part of their life. I am thinking about data aggregation and visualization like Mint.com (showing all your spend, claims, and health planning) real life timeline and interactions (complete with pictures, images, labs, results, etc) in a Facebook Timeline motiff, and making it fun and engaging by making the ultimate social experience (your health and that of those you love) much more social and interactive regarding a much more comprehensive view of what “health” actually is.
So EHR, thank you for your venerable service in helping to establishing a foundation of health. Now, rest in peace.
A mirror, such as one attached to a motor vehicle, that provides a view of what is behind.
I always enjoy people talking in futurity about the day when there will be “data liquidity” within the health care industry. They talk of a day when information will be pervasive, available, translatable, portable, and accessible to the people who need it the most to make essential decision. I smile knowingly as I hear the starry eyed “Health 2.0″ers talk about data in terms of flow, mythical health exchanges, and “data utility layers” that while found every in other industries remain in absentia within health care.
Health Care is one of the few data intensive industries that has not enjoyed widespread adoption of analytics information management tools. Even when we do, it is most a retrospective analysis of the distant past.
The reason for my sanguine chagrin is that I have been to that party, am currently fighting the good fight, and will continue to break my back against the institutionalized information constipation that remains the standard operating procedure within health care. We have been very fortunate to work with some of the most progressive thinkers in the space, some of the most advanced technologies, and some employers that have enough understanding to want to actually want to look at their own data and more importantly begin to develop interventional services around their findings.
Several months back, there was a nice article from the George Pantos is the executive director of the Healthcare Performance Management Institute. While self-interested in nature (they do after all represent the interest of all the performance management companies, consultants, and vendors), it highlights the complete irony that employers who are paying for health care cannot even get their own data to understand and know how to best manage their health care costs. Can you imagine if your credit card company refused to provide you with the information on your charges?
But even in the rare event that you do get it, and you do have the tools to analyze and understand it, the view you are getting is most often in the rear view. I can see what I historically did and make a best guess about what I need to do in the future. Unfortunately, most employers have no guidance nor insight into where the road is going to go, how to avoid those painful curves or steep climbs, or when to expect the next respite ahead.
At Crossover Health, we are working every day to help provide employers at least the very basics of health analytics so they can at least see where they have been. We hope in the near future to lift their sights to at least see and understand what is happening in real time. But more importantly, we hope to be a part of the future when we can squarely point them forward to not only see the road ahead, but to drive with confidence to their chosen destination. We believe, that will be the power of next generation health care.
Read more: http://www.post-gazette.com/pg/10317/1102927-432.stm#ixzz1ajGGnn6X
“This process of analyzing claims data is at the core of a business strategy called Healthcare Performance Management (HPM). Unfortunately, many businesses are walled off from their medical claims data. Insurance companies often refuse to share it with health plan sponsors. The insurers’ resistance is not always consistent with their clients’ own business interests. If a company doesn’t know how it is spending its health dollars, it will be less able to question ever-increasing premiums.
That has to change. Policymakers should require carriers to give employers access to claims data that are rightfully theirs. Texas provides a model for reform. Two years ago, legislators granted employers access to select privacy-protected employee health information, including total paid claims, their employees’ general census data, and total monthly premiums.”
During my days selling an electronic health records, I would often get into client conversations regarding the features and functions of the software as the differentiator between software platforms. Whenever we digressed to this point, I knew that the client really didn’t have an accurate understanding of both the power and potential of the software. I would run through the whole value chain concept, discuss how the CCHIT certifications makes features and functionality commodity, and that they should be focused on what the software can do not so much on how it does it. This was particularly true when we were selling the homely, but fully featured VistA Electronic Health Record.
Its Official! The EHR Is now a Commodity.
But today, as I was thumbing through some mail, I saw that Costco now is selling enterprise health care software. Jeez, I was just thinking the other day that I would go to Costco to pick up a party pack of Tweezlers and my new EMR system. Better, yet, can’t you see some of those booth babes hanging out in the crowded aisles working people in between bites of skewered polish sausage niblets? Hey, did you try the new salsa? Hey, did you know your decision analytics will automatically cross check drug compatability?
Mmmm. It just does not compute.
I just want to buy my party pack of Tweezlers in peace without some care gap reminder firing off!
“In every block of marble I see a statue as plain as though it stood before me, shaped and perfect in attitude and action. I have only to hew away the rough walls that imprison the lovely apparition to reveal it to the other eyes as mine see it.” – Michaelangelo
An unfinished Michealangelo sculpture.
I just re-read this quote – I think it is a powerful metaphor for any innovator that is out there trying to change the world.They are the ones that can see the fully defined, fully articulated, and fully functional end product within the building blocks that others pass off as mere landscape material. I think this gift of vision – this ability to “see” what others cannot – and the doggedness to stick to the mindless chipping away until others can see it enough to give you the tools you need to finish it off.
We are privileged to be working on a HUGE project right now with a highly innovative company that sees the value of what we are doing and wants to be a part of changing health care. It has been fun to work with them to begin the process of “hewing” away and to literally see the game changing product we have always seen begin to take shape from the dust, the chipped stone, the dirty hands, and the bleeding fingers. The process of discovery and refinement is almost as fun as seeing how the end product will move people.
I am on an email list of Bill DeMarco’s, a reputable industry insider who has written and consulted extensively in the physician group and medical management space. He recently sent me a note about several physician aggregation events in New Jersey.
For some reason it struck a nerve with me . . . which led me to fire off the response below:
My question for you . . . besides banding together in some megagroup – what are these physicians doing to actual change the delivery of medicine? ACO is just the latest buzzword excuse to aggregate physicians under a new moniker and a supposed new model.
I am highly suspect that these physicians are doing anything to change the relationship with their patients, to use enabling technology to create team based care, or actually be accountable for the outcomes they produce. What systems are they using to tie themselves together? What financial alignment do they have? What measures are they using to demonstrate superior outcomes? What about the patient experience – 7 minute visits that push pills as the “treatment” won’t get it done in the future.
I think your closing statement, “Representatives from Summit and Optimus were unavailable for comment” says it all.
Am I seeing this the wrong way? Is there anything new about this model this time around? Am I getting old enough to see these things cycle through?
PS – and no, I don’t mean a wolf. The sheep get nervous and band together waiting to get pounced on by wolves.
1. Having to do with the matter at hand; to the point
I read with amusement Susanna Fox’s redux review about the relevance of Health 2.0 in general and in changing patient’s behavior specifically. Here questions reveals her bias in a very limited definition of Health 2.0 that I attempted to abolish originally in some of my bantering with Matthew Holt. I always saw Health 2.0 as a “movement” that would not be defined so much by its technology but rather enabled by it. As an “enabler”, the technology can help people do new things in new ways but I never believed technology in and of itself had the power to truly change health, health behaviors, or health care delivery in and of itself.
That is why my definition of health 2.0 was always more expansive and contemplated an entire “movement” to the next generation health care “system”. This new system must include new delivery models, new financing mechanism, and the new tools and technology that bring all of this together in a simple, efficient, and affordable way. Clearly this next generation of care would include technology, the new tools, but until we had a new delivery system that is financed in a new way we are going to continue to have the same behaviors across the patient, physician, provider, and payor continuum.
So Susanna, I don’t think your version of Health 2.0 (Tools and Technology) do much to get us to the behavior change you seek. In fact, getting to the root of behavior change requires almost a religious experience. Interestingly enough, the health care industry provides plenty of “religious” experiences including passing close to death, unbelievably poor customer experiences that invoke deep passions (ie, the birth of ePatient Dave), and promise of a far better world than we currently enjoy. So while the tools and technology show us what is possible, health care delivery and health finance are the catechismal doctrines we must reform first that actually incent the behavioral change we all seek.
So is Health 2.0 Relevant? I think it depends on your definition!
I recently took a great road trip with my two boys. We rented one of the new Kia Soul’s which my boys recognized from a very funny commercial developed to highlight its hipster (hamster?) vibe. The commercial reminded me of the old Hamburger A or Hamburger B commercials from Wendys back in the late 80′s wherein this ludicrous contrast is set up to demarcate the dichotomy between two distinct choices.
This modern reinvention of that age old contrast struck me because it is something that I deal with everyday in explaining Crossover Health to people. It all stems from a pervasive misconception about the term “Health Insurance”
Understanding the components parts of our modern conception of "Health Insurance" is the our first step toward meaningful reform.
The challenge is that “Health Insurance” is a confused term which most people equate with both Health Care (care delivery) and Health Finance (how you pay for it). Our current employer based system (wherein your employer provides and in most cases pays for your insurance) as well as a third party insurance payment system (we have the insurance pay for us) creates all kinds of weird incentives but also results in no accountability in terms of cost, quality, or outcome. It is currently imploding before our eyes.
Our reaction, both opportunistic as well as obligatory, is to do something totally different by blowing up the current Health Insurance model and separating out Health Care from how you pay for it (Health Financing). We say that there is a better way to do BOTH – pay your physician directly for the care you need and then get smart about how you pay for it with the right insurance product. In fact, you should “self insure” with the highest deductible plan you can find and then take responsibility for your health for all the small stuff or hire someone to do that for you (like Crossover Personal Health Advisory Service). There is no reason to intermediate with a parasitic organizations that are taking your premium dollars and wasting it on overhead, fancy offices, mindless phone trees, and my all time favorite “this is not a bill” disinformation pamphlets.
As people begin to take this in (they always get how the practice model is a radically improvement), they immediately revert back to the combined “Health Insurance” concept. Does Crossover Health want to replace my current “Health Insurance”? The answer is slightly nuanced, but a resounding YES! I want to replace what you call “Health Insurance” with a direct “Health Care” product (Crossover Health) and a smarter Health Finance product (highest deductible you can get).
We believe there are large and significant opportunities to roll this into a single product that can be purchased by employers, families, and other organizations seeking fresh alternatives that can demonstrate not only trend bending improvements but trend busting outcomes.
One of the great promises of technology is to make things simpler, easier, and more affordable for end users. In the medical practice, we have so much complexity, difficulty, and cost in most of our processes that when we find something that actually works as advertised we fall in love.
I had one such “appealingly provocative” experience this weekend. While attending a high school football game in support of one of my member patients (leading passer in Orange County by the way!), the player was injured. I initially thought it was a concussive injury but the reason he remained down was the he knew he had severely rolled his ankle. His father called me from the field (I was in the stands) and I followed along by text messaging as he was treated initially by the trainer and later by the team orthopedic surgeon. He was unable to continue playing due to the injury and it was iced and wrapped overnight.
The next morning I met him at our clinic, fired up our new TRX GP-5 machine (all digital x-ray machine), and took some beautiful images. These were captured on our PC based OmniView rendering software (proprietary and expensive) and fed to our OsiriX viewing software (open source and free!). I was able to manipulate the image at will, contrast and enlarge as needed to highlight all the structures, and automatically send the image to a remote radiologist for reading. No films to carry, no chemicals to purchase, and no storage required – ever. Simple, Efficient, and Affordable.
But I was just warming up.
The process we are using at Crossover Health to acquire an x-ray image to the iPad
The piquant was my ability to wirelessly transmit the image from my MacBook (serving as a server) to the iPad. This process is made possible by the fact that I have can move the standards based DICOM image from a PC to a MAC (using OsiriX), and then push it out to my iPad. While I thoroughly enjoy technology, I often get frustrated because I lack the technical expertise and patients to work out all the kinks. I was pleased to see that I was able to point and direct all the connections where they needed to go and the images appeared neatly onto my iPad without any problems.
From the patient experience, all they knew was that the image was shot, its being read by a board certified radiologist, and they are seeing, touching, and experience the iPad as a new device in our patient-physician relationship. The patient was intrigued, impressed, and engaged (entertained?) by the whole process. I dare say it was a “fun” visit (why does the typical health care experience have to be so lame anyway?) for them to participate in this process, see their physician pushing the technology barriers, and engaging in the diagnostic process in a way they never have before.
The piquant experience certainly piqued the interest of their family who had the family.
