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Posts Tagged ‘innovation’

innovationIf it is one thing that the healthcare IT industry doesn’t lack, it is innovation – or it least innovation on the edges. A quick search on Google for health IT innovation challenges will serve you up over 23K hits. From Sanofi, to HHS, to Cigna and other stakeholders, there seems to be no lack of challenges, code-a-thons and the like but one has to wonder, do the results of any of these challenges actually end up in the hands of consumers and/or clinicians? If yes, and I have my doubts, the number that actually make it over that last threshold is exceedingly small.

That’s not to say these challenge grants do not serve a purpose. Such challenges do attract young developers into the healthcare sector where they can apply their well-honed skills to solve a problem. Maybe it will never be a commercial success, but it does expose them to the market, the needs therein and maybe they’ll stick around by joining one of the many HIT companies.

Beyond these challenges though, larger healthcare organizations (HCO) have their own internal centers of innovation. A couple of weeks back I had the opportunity to participate in a workshop at Kaiser-Permanente’s Garfield Innovation Center where 22 innovation center leaders gathered together to share their successes, challenges, best practices and ultimately forge relationships for the future. This event was organized by BluePrint Healthcare IT, of which I am on the Advisory Board.

Participating in a number of breakout sessions and conversing with various leaders of these innovation center leaders I came to the conclusion that the greatest impact these centers could have on their respective organizations was to all join together to identify  and measure lost opportunity costs that are the result of poor or insufficient interoperability across systems.

The healthcare industry remains a cottage industry with even the largest HCOs, such a Kaiser-Permanente or Partners Healthcare not having enough clout to drive interoperability across systems, be they hardware or software. If innovation centers were to rally together, develop a clear and consistent set of metrics to measure lost opportunity costs, in aggregate, they may be able to start driving change that will lead to more open systems.

Yes, it is a tall order and will require strong leadership but frankly, this industry is long overdue for tackling this issue. In the manufacturing sector, this challenge was address over a decade ago with the creation of the HART standard for device interoperability. Continua Health Alliance is trying to do something similar but still has a long ways to go. Won’t even begin talking about interoperability across disparate IT systems.

Yes, there seems to be some movement, but it is almost entirely regulatory-driven. What will it take for this industry to wake up and actually do something? Hard to say, but I would place my bets on these innovation centers, if they heed the call to collectively define metrics, to be very influential in the future.

Note: As of midnight in Cambridge on December 4th we will be closing down the ability for one to leave comments on posts. This will continue till Dec 20th. The reason? We will be launching a completely new website that will have a lot of cool features that will make it easier for you to get to know Chilmark Research, engage with us and of course continue to receive our thoughts and view on trends in the HIT sector. Stay tuned.

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As in most sectors, innovation in healthcare IT (HIT) is by and large incremental. A tweak here and added feature there to some existing application, e.g., what we are seeing today from EHR vendors as they strive to meet meaningful use criteria. Occasionally, we may see a vendor develop something new and novel – one might put porting their EHR application onto an iPad as an example of such – but really, is that innovation or just an attempt to meet existing customer needs by tweaking software to meet the design criteria of a new form factor?

Innovation, true innovation that breaks from existing norms is exceedingly rare. Even in an industry sector such as HIT where we are seeing an unprecedented amount of money being spent, it has been difficult for this analyst firm to find real innovation that gets us excited and thinking beyond the limited constructs that seem to keep this industry perpetually incased, like an insect, in amber. Part of the reason lies with tradition (culture), another part with entrenched interests (existing/legacy IT vendors) and arguably the most important business models.

But that may begin to change as nothing elicits innovation more than a substantial change to core models of doing business. The Center for Medicare and Medicaid Services (CMS) recently released proposed rules for the establishment of Accountable Care Organizations (ACOs), which is a move towards bundled payments. Here in Massachusetts, the Governor announced introduced a bill as well to “expand the use of alternative payments and significantly reduce fee-for-service payments by end of 2015.” It is actions such as these that will open the floodgates ushering in some truly innovative approaches to optimizing the delivery of quality care.

But a successful innovation is more than just a brilliant idea. To be successful an innovation needs four key ingredients:

1) Have a perceived value that is greater than the risk to try it.
2) The innovation can be created/built at a cost that the customer/market is willing to bear.
3) The innovator has sufficient funding and resources to start and bridge the “Chasm”.
4) The innovator has a marketing and distribution strategy to get the product to market.

Assuming the innovation delivers sufficient value, that takes care of number 1. The inherent advantage of IT is that unlike a physical product, there is very little upfront production costs to produce the product. Sure, there is the cost of developers, but that is usually far cheaper than a production line that is required to produce a physical product. Provided your development costs are low, that takes away issue number 2 and leaves us with the funding and route to market.

There are numerous sources of funding today, both equity (Venture Capital firms and the like) and non-equity, federal SBIR grants, various innovation challenges, etc. that are targeting the healthcare sector and in particular the HIT market. In a recent meeting with one VC partner here in Boston, the partner commented that at the recent HIMSS conference he was surprised at the shear number of VC  and other equity firms in attendance wandering the exhibit halls looking for the next big idea (this VC firm shared our impression, very little innovation on display though we both liked what Nuance is attempting to do with its language processing software). Therefore, we can assume there is plenty of money in the wings, that takes care of issue number 3.

In conversations we have had with many a young company, time and again what these companies are looking for from an analyst firm such as Chilmark Research is market visibility. When we ask them what are their key challenges, an almost universal response is getting in front of the right people in a healthcare organization.

With the multitude of challenges facing today’s healthcare CIO, from insuring their EHR and use thereof will meet meaningful use criteria, to supporting physician demands to use their mobile devices to tap into healthcare information systems (HIS) to dealing with the ICD-9 to ICD-10 transition and the list goes on – let’s just say that these CIOs have a lot on their plate and it is near impossible to get their attention.

What is a young innovative company to do?

There are a couple of encouraging developments. The first is the Bay Area HIT App incubator, Rock Health. Rock Health’s stated objective is to solicit a number of proposals, pick the best and provide these innovators the seed capital and connections to help them build and take a product to market. While Rock Health appears to be more consumer focused, they do have the Mayo Clinic as one of their advisors so there may be some in-roads into the provider market as well.

The second is the BluePrint HIT Innovation Summit Series. The Innovation Summit is structured much like a speed dating event matching up hospital executives with a select group of innovative companies that have a product ready for market, but are struggling to get in front of the right people in a healthcare organization. By bringing these two together in an intimate one day workshop on May 26th in Philadelphia PA, the Summit will create an environment for deep conversations that lead to future adoption of an innovation. Chilmark Research really likes the concept and have joined the effort as a member of the Advisory Board.

If you are part of a young company with an HIT innovation and are looking to get an audience with executives who can “write the check” at leading healthcare institutions, then submit your proposal. But you better act quickly as the deadline of April 29th is fast approaching.

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cashJust finished reading/scanning HR 1, the House Stimulus bill focusing on the HIT section, to which some $20B greenbacks will flow. This Bill just went just the Appropriations Committee and will likely pass the full house later this week. The HITECH Act (HIT for Economic and Clinical Health), is massive at some 190 pages, beginning on page 395 covering everything from codifying the Office of the National Coordinator (ONCHIT), to the numerous reports that ONCHIT has been instructed to fund, to how that $20B will be spent.

HITECH Act also carries with it a legacy of the Bush era: “The utilization of a certified EHR for each person in the US by 2014.”

Following are some quick, interesting highlights:

ONCHIT budget to soar over 4x to $250M for FY09 from the $61M it received in FY08.  Guess they’ll need all that money to fund those research reports, as well as support the new version of HITSP and AHIC, which is now called NeHC.

Both HITSP and NeHC become key advising entities to ONCHIT, HITSP on standards and NeHC on HIT policy.  Quite sure the folks in both groups are happy to hear this, especially NeHC as there was some question as to their survival if the feds did not dump $$$ in their coffers.

National Institute of Standards & Technology (NIST) to take a leadership role in testing standards and implementation specifications.

Substantial amount of writing on privacy, particularly consumer notification process should their health information be compromised.  Even had a special section on notification process for PHR vendors going so far as to reference third part data repositories (e.g, Dossia, GHealth and HealthVault).  Good to see formal procedures put in place, at the federal level to guide notification process – it’s about time!

Continuing on privacy, Bill also instructs ONC chief to appoint a CPO, Chief Privacy Officer.  This individual will have the uneviable task of attempting to coordinate helth data privacy policies across this great land of ours where it seems as though every State has their own unique twist.  Without some reconciliation on these privacy policies, the whole NHIN is nothing but a pipe dream.

A whooping $300M or RHIOs.  All those small RHIO software vendors must be licking their chops as this is a significant amount of money (about double the market size in 2008).  Expect to see consolidation and acquisitions as bigger HIT players look to get into this lucrative market.

Establishing an Extension Program for HIT.  Much like the existing Land Grant and Sea Grant programs and their extension services for agriculture and marine industries, the Bill proposes the establishment of a similar program for  HIT.  At one point in my career, I actually worked for Sea Grant, thus I know the model intimately and have mixed feelings.  Yes, it can be a very good model to reach out to small business and assist them in adopting best practices in the adoption and use of HIT, but often these programs, while well-intended, are not terribly efficient.  There is a universal benefit, however, in that often these extension services are located in academic institutions and thus can foster undergraduates and graduates to pursue research/careers in this field and right now, we can’t have too many.

trainFor the most part, we are comfortable with the above, but where the Bill really flies off the tracks is with the term:

“Certified EHR”

This term is used throughout the HITECH Act and refers to an EHR that is “certified” as:

‘‘(5) CERTIFICATION.—
‘‘(A) IN GENERAL.—The National Coordinator, in consultation with the Director of the  National Institute of Standards and Technology, shall develop a program (either directly or by contract) for the voluntary certification of health information technology as being in compliance with applicable certification criteria adopted under this subtitle… (want to dig deeper – go to page 407)

Basically what this states is that any reimbursements, payments, anything coming out of that $20B largess towards the support for adoption of HIT will only go to those instances where a “certified” EHR has been adopted or used.  And what it implies is that funding/reimbursements/incentives will onlygo to those who adopt nd use a CCHIT certified EHR.

This is a MASSIVE MISTAKE for the simple reason that it results in technology lock – technology locked to specific, “certified” criteria/standards resulting not in new innovative products, but actually retarding their introduction.

Need evidence?

Turn to the EPA and the Clean Air Act (CAA) (I did quite a bit of research at MIT for EPA on technology adoption in regulated markets, hmm, is healthcare much different, surprisingly no). The CAA when first promulgated specified specific technologies to be used to control and measure stack gases.

Benefit: Clear articulation of what technologies industry needed to adopt to comply to the CAA.

Outcome: Rapid adoption and use of these technologies leading to dramatic reductions in air pollutants.

Unintended consequence: When new and better technologies arrived on the scene, the EPA had no ready approach to get industry to adopt better technologies (without an Act of Congress) and as for diagnostic techniques for measuring stack gases, they were stuck as well.

Result: This stifled the US market for technology developers and subsequently, new technologies, once the regs were changed to incentives (trading emission credits) came from overseas, where the market was structured to advance their development and use.

Unfortunately, it does not appear that today’s legislature, nor those in HHS remember what happened at EPA with the CAA and have created an incentive program within this Bill that will result in exactly the same outcome as we saw in the environmental sector, rapid adoption, widely deployed HIT, technology lock-in with archaic standards such as HL7’s CCD and ultimately a technology frozen wasteland with other countries beginning to take the lead in HIT development, deployment and use.

Rather than follow this path, the Senate, in negotiation with the House, can strike the term certified from this legislation and instead encourage the adoption of HIT in support of scenarios that are based on information sharing and not just within an IDN but across a more expansive network.  For example, information sharing could be demonstrated by a physician being able to export of a health record, at a customer’s request, to that consumer’s personally-controlled online health account using CCR, CCD or other standard. Is that not in support of the objectives of data portability?  Of course, there is also the example of sharing health information within the context of an HIE or RHIO or other, more loosely formed network.

Therefore, it is not so much requiring that an EHR comply to specific criteria to be certified and thereby, the adoption of only certified EHRs will be reimbursed, rather it is to provide incentives that encourage what is our ultimate goal, putting health information into a digital form factor that can be securely shared among all relevant stakeholders in support of a healthier public.  After all, at the end of the day, is this not what we are all trying to accomplish?

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Highlights of this morning’s keynote by Craig Mundie, Chief Strategy Officer at Microsoft.

Computers will be more pervasive and work in the context of what an individual is doing – think GPS and restaurant search ala iPhone. More broadly, and in a healthcare context, think real-time diabetes monitoring, coupled to intelligent alerts. Last week’s Project HealthDesign had a good example of a diabetes monitoring system that is well worth watching.

Spatial Computing: Computing outside the normal PC construct and compute within the Cloud. As cost of sensors continue to fall they will increasingly be a part of the fabric of future computing. This will lead to computing becoming model based, vs. the discreet applications we have today. More humanistic computing will be the result including the moving to 3D display and highly adaptive systems.

Mundie gave a brief example during this part of his talk of a controlling a robot representation in a 3D visual environment with objects, which were obeying first principle physical laws falling over as the robot bumped into them. Thought to myself, doesn’t look much different than a gaming environment. Then it struck me, damn, this looks familiar! Willing to place a very heavy bet that what he was actually demonstrating is a gaming computing environment from what was a small and very innovative French software company, Virtools. Virtools was acquired by my former employer Dassault Systemes a few years back and no, this is not something new that has yet to reach the market, which to me Mundie inferred, but a technology that has been in the market for several years now – it just doesn’t have that much visibility outside game development community.

Demos:

  • Photosynth: A new technology developed at MS that takes numerous 2D photos and creates a composite to create a 3D composite model of the real world.
  • Robotic Receptionist: Plan to beta test at MS campus in next couple of months. Using an 8-core high performance computer, uses roughly 40% of computing power continuously – what a CPU hog! Most dual-core processors on one’s PC use only a few percent in any given computing task. Gave a quick demo, very bizarre is the best way to describe it. Still on the crude side, but not unlike something you would read in a Gibson SciFi novel.

Concurrency and Complexity: Applications that are loosely coupled, asynchronous, concurrent, composable, decentralized and resilient. This is what the Internet is bringing to the future of application development but the tools today to create such are really not there yet. Creates new challenges for computer programmers. Certainly creates challenges for MS who is so tied to the PC construct.

Making things simple for the end user is an incredibly difficult task for programmers. Developing applications that understand the context by which the user interacting with the computer is something that MS is still trying to figure out. Mundie readily admits that today, programs still make the user conform to the computer rather than the computer conform to the user. This is the next big issue to tackle in the comuter industry.

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I’m here today at my alma mater, MIT to attend Technology Review’s annual conference, EmTech (short for emerging technologies). And why am I attending an event that appears to have little relevance to healthcare? Well, there is one session this afternoon addressing EMRs and another tomorrow on personalized medicine, but those are periphery to my real reason to attend.

Simply, I am a firm believer that in any industry sector, the Black Swans will almost always come from outside the industry. In healthcare, this will be particularly true as this industry is calcified with countless special interests unwilling to give ground to improve the overall system. Healthcare will see some pretty serious tectonic shifts over the coming years and innovations (black swans) will be a key contributor to those shifts.

I’ll be reporting sporadically from the event throughout the day. Warning – usually I take notes at an event, digest them and publish a summary a couple of days later. Today, I’ll report live the distillation process that usully occurs will not be present today.

10:15am First keynote was giving by V. Khosla, founder of Khosla Ventures. Very interesting and engaging talk on the principles that Khosla uses to assess innovations to invest in. Though the company focuses on “Green Technology”, here are some takeaways for healthcare innovators and investors. (Khosla’a presentation was so much better than Clayton Christensen’s that I heard last April at the WHCC. If you ever get a chance to hear Khosla speak, do it!)

Rules of Investing
Attack manageable, but material problems
Technology that achieves unsubsidized competitiveness
Technology that scales, scales at a competitive cost structure
Manageable start-up cost & short innovation cycles

Forecasts are almost always horribly wrong. Don’t trust them.

Always look at the total relevancy of an innovation. Understanding potential impact of technology requires one to look at what is relevant scale, without this, you do not/will not be able to capture the full opportunity if full relevancy is not considered.

When considering innovation scenarios, consider true total costs. Gave a very good example of photovoltaics and the current policies/push for low cost/low efficiency. The big costs in solar farms are, according o their calculations, infrastructure and construction costs – both of which scales dramatically in costs when pursuing low cost photovoltaics. Makes me wonder what in the healthcare sector has strong support today but total costs of adoption will negate its true long-term value.

11:00 Second morning keynote by Ning founder & CEO Gina Bianchini. Ning is a Web 2.0 type of social networking platform and not a “Walled Garden” which Gina called other social network sites such as Facebook, mySpace & YouTube. Gina demonstrated, through static screenshots, ala PowerPoint, a wide array of current Ning social community sites.

Honestly, not all that impressed with what I saw or her presentation. Static presentation that focused on only the big success stories and not the challenges/market needs that they are really trying to solve – the interesting problems today that Ning may facilitate in getting answers to.

Became quickly bored with her talk and went to the Ning site. Did a search on healthcare to see what kind of communities have been created. Search turned up loads of communities addressing a whole wide range of issues from job postings, to HIT, to consumer drected health and healthcare marketing. There are now over 400 different healthcare communities on Ning. Sounds like a lot doesn’t it.

Dig a little deeper and what I find is that most of these communities are very sparsely populated (e.g., almost all the ones I visited had less than 10 members) and not exactly dynamic (most “discussions” in these communities I visited were several months old). Looks like another emperor has no clothes story to me.

Hot Technology Tip: Most recent highpoint: great little demo by one of the TR35, an incredibly slick application for managing your Outlook email called Xobni (inbox spelled backwards). Technology was developed by an MIT grad while he was in the undergraduate program. Though I run on the Mac (Xobni is lost on me), person sitting next to me whispered he uses Xobni and absolutely loves it.

Panel on Mobile Technology of the Future:

Motorola rep just stated that Google’s Android does not have much of a future. Requires too much computing resources for the low cost mobile phones that make up the majority of the market.

Google responded that yes, Android is targeted at more full-featured phones but due to Moore’s Law, within 18 months, mid and even some low tier phones will be able to run Android. Claims that they have already run Android on phones at the $100 price point.

Adobe rep (Kevin Lynch, CTO) stated that most apps are still developed with the PC in mind, that developers have yet to fully re-think how apps might be used, displayed and leverage within the context of mobile platforms. Went on to say that there are far too many OSs for mobile platforms which makes it difficult for developers to create apps, becomes too expensive. Holy grail – develop once, use on any platform.

Ques: When will be see SDKs for mobile platforms based on Web technology? Web app development environments for mobile apps is still not there yet. Must use native apps today. Google stated that they are quickly moving in that direction and fuly believe in Web app development environments. Adobe also stated that their development of “Air” is targeted at creating a Web-based development environment for mobile apps, but it is still at least a year to two out.

Ques: How big and how fast will this market grow:

  • Google response: Android has had 100M downloads so far. It is moving very fast and changing very quickly.
  • Motorola: Yes, calling is still the primary function and will remain so until some really interesting apps arrive on the market and shift consumer perspectives
  • Adobe: We need break-throughs in battery technology for today, Moore’s Law does not apply to mobile until this problem is solved.

12:30 Lunch talk by Amazon CTO: Spoke of Amazon’s hosting services (Elastic Compute Cloud), how they came into being, how they leverage Amazon’s existing infrastructure, etc. More of a techie sales pitch. Gave some examples of those using the Amazon services. Focused on multi-media companies that are targeting consumers. Not exactly barn burner/difficult, services to provide. Definitely not “mission critical” examples. Will have to talk with him at one of the breaks to see if Amazon hosted services are being used in more challenging applications that may give some perspective as to how it might be used in healthcare.

Big selling point for something like Amazon services is that it is nearly infinitely scalable and can be tapped, as needed at a fairly reasonable cost. Such a service could be of value to PHR vendors (note, most are already using hosted services/data farms for their PHR). More broadly, HIEs and RHIOs als appear to be ideal applications for Amazon’s services. Though Amazon is not a “covered entity” I’d place my bet on them on keeping my health records secure and private than any hospital or IDN in the country today.

Do know one HIT company using Amazon today, MedCommons, who turned to Amazon due to Amazon’s proven ability to handle very rich data, for MedCommons, that means medical imaging. Spoken with one of the founders of MedCommons who has been quite impressed/happy with Amazon’s services.

1:30, Session on Cloud Computing: Nice panel representation that includes senior exec from Salesforce.com, Google exec, the Amazon CTO and one of the founders of VMWare (MIT has always done an excellent job of attracting some very talented, high-level speakers).

Overall theme – Internet as the platform, the operating system with applications sitting on top, this is what cloud computing is all about. Thus, not too surprising that there is a land-rush on right now by just about everyone in the computing industry (and even those you would not associate with hi-tech e.g., Amazon).

Comment by Salesforce.com – Right now the current regulatory structure and policies, on an international level are far-beyond where the technology is today. This could create some serious issues, potentially, in the future. Not unlike the current challenges and issues that have been raised regarding industry storage of medical records by non-covered entities.

Pricing for cloud computing services and apps are moving from user-based pricing to usage (pay as you go) pricing. In healthcare sector we’ll see a mixed model with a low subscription price supplemented with usage/transactional fees.

For software developers, start thinking about just the application and not worrying about the OS and underlying technologies so much. For example, it is now pretty easy to put together a service that combines Amazon data services, with Salesforce and Google to create an interesting offering for the market. Not much different than what Google and Microsoft are proposing with their healthcare plays. Will be interesting to see what someone like RelayHealth develops as they have a fairly high level strategic relationship with HealthVault.

3:15, Session on EHRs (note, I’ll use EMR acronym): Panel includes John Halamka (Beth Israel’s CIO), Karen Bell (HHS), Craig Feied, (Chief Strategy Officer, Microsoft Health Solutions, he developed Azzyxi at MedStar) and Girish Kumar Navani, (President, eClinicalWorks). Karen started off basically setting the stage giving a broad landscape overview of the challenges in healthcare and subsequently HIT, for the audience with the HIT Hierarchy of Needs slide (pyramid, privacy at the base up to public good at the pinnacle).

Decent size audience, easily a third of the total attendees at EmTech (there are currently 3 concurrent sessions).

Halamka followed with the common statement regarding lack of EMR adoption. Claims EMR is still too expensive at $40-60K per practice with a corresponding drop in productivity for first 6 months of 25%. Beth Israel s requiring all affiliated physicians to adopt and use an EMR. They are offering a hosted eClinicalWorks for these affiliated practices at a big discount to encourage adoption. Hopes that better P4P metrics will result in higher payments from CMS and other payers to augment the cost of hosting the EMR. Halamka also talked of consumer’s abilty to move PHR data from BI’s PatientSite to either Google Health or HealthVault. Today, the only thing you can move into either repository is medications and allergies. Not much value there!

Kumar was next. eClinicalWorks is now in over 20k physician offices. Talk in broad terms, not terribly specific. Does believe that “patient-center healthcare” is the next major change in healthcare that will be a forcing function for EMR adoption. Not to surprising to hear from an EMR vendor. He does not like the term of EMR, sees it more as a technology that helps patients get better care and allows a doctor to deliver better, more informed care. Hmm, like this statement – he is absolutely right, EMR is a dead term, we need something new.

They just did a quick survey of audience, Managing Personal Health Information: 14% would trust lab or pharmacy, 32% would trust a company such as Google or Microsoft and 54% would trust only themselves or a doctor.

Craig talked about the development of Azzyxi and how what all he wanted to do was try to provide the most information possible at the point of care, in this case the ER. Believe that errors/failures in medicine are not about Execution, but in Planning. Unfortunately, he claims all the effort now is on Execution (meds, wrong patient, wrong procedure, etc.), rather than upfront Planning. Talked of the “Spectrum of Wellness” as core to MS’s health sector strategy – a rethinking of what healthcare is and how it is delivered, not only when you are sick, but when you are well. Good speaker, a bit heavy on the sales pitch.

Q&A Session: What’s the value to a primary care physician in adopting EMR. Halamka claims that P4P and quality reporting is becoming an ever bigger issue for physicians and that these systems can actually help doctors ultimately earn more and earn it easier (HT can greatly facilitate all sorts of transactional processes). Kumar also followed up stating that it will help physicians better understand what they are doing as well as help doctors prepare more effectively for patient visits. Supported Halamka’s view that quality and P4P will also push adoption going forward. These programs start to really put some cost justification behind EMR adoption. Craig thought that it is up to software vendors to create sufficient value in their solutions that will lead to adoption.

Status oF PHRs: Halamka – we have 40K users of Patientsite and believe in patient control, thus opening up to Google Health and HealthVault. Karen, still informative stages but right now pretty wide open as the apps are simple today and maybe not what consumer will use tomorrow.

Addendum to EMR Session – picked-up through conversations after formal session:

  • According to recent HHS calculations, there is over $700M in incentives, via payers, through various P4P and quality improvement programs that can be used to subsidize EMR adoption by practicing physicians. Clearly, there is money to be had, not sure though that most physicians know how to capitalize on it. EMR vendors need to start educating the market on these opportunties and not leave it up to the physicians to learn about them.
  • Today, Beth Israel is allowing their customer to export their PatientSite PHR data to either Google Health or HealthVault. Problem is, they are only exporting medications (includes immunizations) and allergies. Ask Halamka why they are not exporting the full record and he told me that neither Google nor Microsoft’s offerings can handle anymore than that – the data model is just not there yet. So, all you consumers waiting with baited breadth for a full feature service from either of these companies will be waiting a little longer.
  • eClinicalWorks is seeing no issue with reluctance in adoption of EMR solutions, Kumar told me they have plenty of business and are still on a very rapid growth path. Early problems precipitated by a couple of huge orders (e.g., NYC) are behind them now. Also, despite all the rumors, and the fact that Kumar is originally from India, over 80% of all employees are based right here in the US. Kumar does use resources in India, but on a flex model to address pressing, unexpected customer needs – not an every day occurrence.

As I mentioned earlier, this is the first time that I have just reported directly from the event. Let me know, via comments, if you found this useful or prefer my former approach of distillation then reporting within a couple of days of actual event.

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While at the AHRQ conference last week I sat in on a Town Meeting style discussion wherein the AHRQ was looking for feedback and suggestions on their newly released Healthcare Innovations Exchange.  A novel idea, this Exchange is intended to bring visibility to numerous “innovations” that have been put into practice so that others may learn and even emulate.

The big problem I have is trying to get my mind of putting the words innovation and government agency together – seems more like an oxymoron to me. But hey, I’m willing to give them the benefit of the doubt.

Beware, this is not an innovations exchange where you will read reports about one cool technology innovation after another.  No, this is a bit more pedestrian than that with innovations that are focused on “processes” (in fact, it looks like they all are) with such titles as:

Coping Skills Training Helps Adolescents Improve Quality of Life and Ability to Manage Their Diabetes,

Comprehensive Program Virtually Eliminates Preventable Birth Trauma

or my favorite…

Hair Stylists Who Serve as Lay Health Educators Encourage Clients to Adopt Healthy Behaviors that Reduce Health Risks

While I applaud this effort  by AHRQ to “get the word out” on innovative practices, I am not a big fan of its execution for a couple of reasons.

First, a vetting process by which Innovations are chosen is not readily apparent.  A cursory look at the innovations listed does not inspire confidence to dig that deep.  Most innovations seem simplistic and I mean really, a process to get employees to wash their hands to prevent spread of MRSA is an innovation? Please, it is hardly that but rather simply, a good business practice.

Secondly, for a new site with a name like exchange, not all that impressed with the ability to exchange ideas and comments with others regarding the various innovations listed.  Would strongly encourage AHRQ to plagiarize Amazon.com’s rating and comment feature (unless of course Amazon has slapped a patent on it – there’s innovation for you, or at least innovation perversion) and allow individuals an opportunity to rate innovations and provide comments.  This would create a far more dynamic site – truly an Exchange.

Hopefully, this is but V1.0 of the Innovations Exchange and V2.0 will be a marked improvement.

Side Note: Can someone please explain to me why the majority of federal government websites are just so difficult to navigate?  Just went back to check for the Innovations Exchange link on the home page of AHRQ, oh boy – you try to find it.  Ah, Google, you are God sent.

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Last year, I attended one of my first healthcare conferences, that sponsored by the federal agency, Agency for Healthcare Research and Quality (AHRQ). While I had mixed feelings about that inaugural event (at least inaugural for me), I returned this year to see what progress has been made on the quality front and whether or not the growing trend of consumerism in healthcare is having any impact.

I may have been expecting too much as it seemed more like a step back in time, a deja vu event.

First off, this is by and large an academic research crowd, not a group prone to uttering such phrases as “the business case of quality” or “consumerism”. No, this is a crowd that talks of patients, patient safety, research methodologies, and the like. Nothing wrong with that, from a strict research sense, but I see big problems with this if AHRQ wants to transition funded research to something beyond an academic exercise, something AHRQ has stated some intention to do with their new Innovations initiative.

But maybe it is not entirely AHRQ’s fault. The lack of innovation in healthcare, as it relates to quality, may be systemic. AHRQ Director Clancey, basically inferred such in her keynote stating that there is a lack of linkage among healthcare institutes between quality and profitability that needs to change, that today, focus is on short-term results and not long-term impacts.

In all the presentations I heard thereafter, however, never was profitability/business case for quality mentioned again. No talk of quality and cost savings, no mention of quality metrics and customer retention – Nothing. Maybe AHRQ needs to begin rethinking its grant proposal process and prompt researchers to consider such factors, develop metrics to measure such, and deliver such results as part of a researcher’s final report.

As for quality, Clancey stated that AHRQ analysis of quality metrics has found no significant change in the last several years. In fact, in some cases quality is actually decreasing, particularly disparities in care for at risk populations. The proverbial ball is not moving forward – it is in stasis or worse, like Sisyphus, rolling backwards.

Makes me begin to wonder: If quality is not improving then why exactly is AHRQ in business and why are they funding all these various research projects at institutions, that honestly, should be paying for this research themselves – that is of course if these institutions see the business value of quality?

Some quick impressions and highlights:

  • Attendees are a tight knit group of researchers (~85% from academia), AHRQ employees and a smattering of government contractors. Incestuous
  • Lots and lots of “Quality” templates being created to overlay on top of EMR systems to report on quality metrics. Seems as though everyone is building their own set of templates unique to their organization – a lot of reinventing the wheel here. Is this a business opportunity???
  • Universal number one factor hindering adoption of quality initiatives is time. Does the reporting of quality metrics/actions put a time burden on clinicians, if yes, forget about it, it will not be adopted. Strategies to overcome include: deploying speech recognition. streamlining process as much as possible through pre-populating data fields (pull from existing EMR/PM data stores), and/or look more broadly at clinician workflow to find opportunities to “save time”.
  • Clinicians prefer unstructured text entry versus pick lists as pick lists often do not adequately capture an encounter. This has led to design of multiple micro templates with branching logic for quality reporting to minimize unstructured text inputs, but provide needed flexibility.
  • Majority of quality research efforts have no tie-in at the institution level to P4P programs. Again, getting back to the business case – where is it? Did ask one presenter if there was any tie-in to P4P. She stated that they are thinking about P4P, see it coming and what they are doing today should set them up to capitalize on this opportunity once it is presented to them by payers.
  • According to one researcher/presentation, there are no metrics to measure quality improvements resulting from HIE/RHIO programs. Wow, that was a shocker! If true, quite embarrassing seeing as how much money federal, state and other organizations have invested in such programs to date.
  • In a telehealth demonstration project, the lead investigator spoke of the numerous issues they had while working with the HIT/telehealth service vendor. This researcher stated that the market is full of telehealth service providers with such a wide range of capabilities, service level agreements, privacy policies etc., that it really needs some form of oversight, be it certification or regulation. This industry needs to get its act together and start self-policing, or else they’ll have regulators on their back in the very near future which could become a very big problem for this extremely young and rapidly evolving sector.

That’s all for now as I need to run into the next session. Will provide a brief recap, some notes on AHRQ’s Innovation Initiative, etc. in a follow-on post.

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