Schwartz Healthcare IT Blog

Quit Your Whining

2008-07-02T14:43:01Z

Kudos to the North Carolina Medical Board for wanting to post doctors' malpractice information on its Web site. And thumbs down on the state’s physician association for opposing it, claiming it could be misleading.

The Better Business Bureau has long served a role in helping consumers make decisions about what vendors they should use. The public is intelligent enough to understand the context and weight for individual plans. Egotistical doctors don’t think so however.

Actual malpractice payment amounts or patient names aren’t disclosed, according to the article in the Raleigh News & Observer. The Web site would note that malpractice payments don't always suggest negligence, and that some specialties draw more lawsuits. North Carolina says that about four percent of the state’s doctors are on the malpractice list.

Doctors need to face the inevitable tide of quality and cost transparency. They are vendors like everyone else. North Carolina is the 23rd state to disclose medical practice information.

CCHIT on PHRs

2008-06-28T16:45:43Z

CCHIT, the Certification Commission for Health Information Technology, will be certifying personal health records (PHRs) next year. Criteria will be proposed in April, 2009, along with a comment period. Certification will officially start in July 2009.

CCHIT’s certification of EMRs met with mixed reactions early on, with smaller vendors crying foul over the $20,000 fee. Since then, it’s become a somewhat important stamp of approval in large enterprise purchasing decisions. This will likely happen with PHR certification as well.

PHR vendors should watch criteria development and participate in the comment period to provide your view.

]]> Co-chairs of the task force are Mark Leavitt, M.D., chair of CCHIT; and Paul Tang, M.D., vice president and CIO, Palo Alto Medical Foundation.

Other members include:

* Abha Agrawal, M.D., director of medical informatics and associate medical director, Kings County Hospital Center in Brooklyn;
* Richard Benoit, director of Dossia ecosystem development, Intel Corp.b s digital health group;
* Lorraine Doo, senior policy advisor, Office of e-Health Standards and Service at the Centers for Medicare and Medicaid Services; and
* Steve Findlay, health care analyst, Consumers Union;
* Meighan Girgus, executive vice president, American Heart Association;
*Theresa Hancock, acting director, Office of Information, Veterans and Consumers Health Informatics, Department of Veterans Affairs;
* Leslie Harris, president and CEO, Center for Democracy and Technology;
* Missy Krasner, product marketing manager, Google Health;
* Steve Lampkin, vice president, benefits services and strategic initiatives, Wal-Mart Stores Inc.;
* Holly Miller, M.D., vice president and chief medical information officer, University Hospitals in Cleveland;
* Don Mon, vice president of practice leadership, American Health Information Management Association;
* Anna-Lisa Silvestre, vice president of online services, Kaiser Foundation Health Plan;
* Michael Stokes, principal program manager, Microsoft Corp.;
* Michael Ubl, director of e-health and I.T. strategy, Blue Cross Blue Shield of Minnesota.

AHIP Pix

2008-06-26T16:54:06Z

And speaking of payor technology vendors, last week’s AHIP conference was considerably smaller than 2007. Our intrepid Account Executive Melissa Bruno provided a pictorial report:

Getting priorities straight - the busiest booth of the conference.

The second busiest booth of the conference.

Make sure your health plan covers Wii wrist sprains before visiting Portico’s booth.

This boat manufacturer was selling new technology paradigms. Fish love them.

Your Premiums at Work

2008-06-23T12:47:22Z

It seems that health plans have a little money left after paying all those healthcare costs. The trend of health plans acquiring technology vendors continues. Care management vendor MEDecision is to be acquired by Health Care Service Corporation (HCSC), which operates Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahoma and Texas. HCSC paid $121 million and will keep MEDecision independent.

BlueCross BlueShield of Tennessee and The Regence Group Blue are taking a minority ownership in TriZetto Group, which will be going private. Others include UnitedHealth’s Ingenix , Aetna’s ActiveHealth Management, and Independence Blue Cross’ AllOne Health Management Solutions.

As I’ve written before, payors will be the major players in pushing technology adoption in healthcare, be it provider side with EHRs or consumer side with PHRs.

Great Expectations

2008-06-20T16:27:06Z

A survey by HealthNewsReview.org published in the current issue of PLoS Medicine shows that the media could do a better job at covering medical news.

An analysis of 500 stories on medical topics by U.S. consumer print and broadcast media showed that “journalists usually fail to discuss costs, the quality of the evidence, the existence of alternative options, and the absolute magnitude of potential benefits and harms.”

These observations may be right, but what do you expect from the media, particularly consumer outlets? Space and time is money, all information is dumbed down, long form pieces don’t sell ads and eyeballs, and there will never be this level of desired accuracy. That’s what blogs, Web sites and peer-reviewed academic journals are for.

Some findings:

CBO: What Savings?

2008-06-16T11:16:08Z

A recent report from the Congressional Budget Office joins several other reports in asserting that the health IT won’t deliver significant cost savings. The report specifically attacked the often-cited RAND report number of $77 billion in annual cost savings.

According to the report, health IT will only yield cost savings if implemented with broader healthcare reform measures. Also, government-mandated technologies such as e-presecribing could generate savings.

Coming from the Congressional Budget Office, many pundits have said that the report could effect prospects for legislation to boost the use of health IT. I don’t think so, given the number of reports that claim otherwise and the growing political importance of healthcare to the new administration soon to be in power.

Plans and Progress

2008-06-11T19:15:15Z

Last week at a conference I heard doc Kolodner, head of the Office of the National Coordinator for Health Information Technology (his business card is extra long), talk all about the federal government’s health IT five-year strategic plan for 2008-2012. Kolodner was refreshingly frank about the level of progress given government bureaucracies, but at the same time optimistic.

The plan lays out a road map and milestones in more than 40 areas, including interoperability, security, privacy and IT adoption. In this last area, the government would like to see PHRs linked to EMRs by 2010. The full strategic plan is available here.

PR pros should review the plan to see what aspects are applicable to your products and services. Then position yourself with media as helping with the government's efforts by offering solutions today to enable the healthcare future of tomorrow. Media who write about HHS and government health IT efforts would be good to target.

For those interested in looking back over the last four years since the Office was founded, please hit the “continue to read” link below.

•    2004: Laying the Foundation
•    2005: Initial Steps and Progress
•    2006: Major Accomplishments
•    2007/8: Major Accomplishments/Next Steps

]]> This recap is taken from the HHS Web site.

2004: Laying the Foundation

The President, by Executive Order, established the position of National Coordinator for Health Information Technology. The National Coordinator for Health IT is the chief advisor to the Secretary of HHS on the actions needed to meet the President’s call for widespread availability of secure, interoperable health IT.

In November, 2004, the National Coordinator issued a request for information to gather public input on the development of a Nationwide Health Information Network (NHIN). In analyzing the more than 500 responses in early 2005, the Office of the National Coordinator for Health IT (ONC) found that a lack of uniform standards was a key obstacle to the success of a NHIN.

2005: Initial Steps and Progress

American Health Information Community (AHIC)

In 2005, Secretary Leavitt announced the formation of the American Health Information Community (AHIC), a federal advisory committee made up of public and private sector leaders who represent a broad spectrum of health-care stakeholders. The AHIC was established to make recommendations to the Secretary on how to accelerate adoption of interoperable electronic health IT in a smooth, market-led way.

HHS Contracts

The Office of the National Coordinator for Health Information Technology (ONC) was established within the Office of the Secretary at HHS in 2005. That year, the Department awarded nine contracts to conduct work in several key areas of the health IT initiative:

•    Health Information Technology Standards Panel (HITSP) – To harmonize industry-wide health IT standards
•    Certification Commission for Healthcare Information Technology (CCHIT) – To develop a certification process for health IT products
•    Privacy and Security – To enhance safety of health information by addressing variations in policies and State laws affecting privacy and security practices
•    Anti-Fraud for Electronic Health Records – To identify ways to enhance health-care anti-fraud activities with the use of health information technology
•    Nationwide Health Information Network (NHIN) – To create prototype architectures for widespread health information exchange
•    Adoption of Electronic Health Records – To develop a standardized way to measure adoption of electronic health records
•    Clinical Decision Support – To form a group of qualified experts to advise federal activities concerning clinical decision support
•    Health Information Exchange – To develop consensus for best- practice guidelines from existing, state-level efforts to exchange health information
•    Hurricane Katrina Information Network and Digital Health Information Recovery Project – To foster widespread use of interoperable health IT in Gulf Coast regions affected by hurricanes in 2005

HHS’ progress on health IT in 2005 provided momentum to produce many tangible results in 2006.

2006: Major Accomplishments

HHS’ many accomplishments on the health IT initiative in 2006 are already beginning to provide tangible value to health-care consumers today, while continuing to build momentum for the rapid advancement of interoperable health IT into the future.

American Health Information Community (AHIC)

In May, 2006, the American Health Information Community (AHIC) delivered its first set of recommendations to the Secretary of HHS. The Secretary officially accepted these unanimous recommendations in four work group areas:

•    Consumer Empowerment – To create a consumer-directed and secure electronic health-care registration information and medication history for patients
•    Chronic Care – To use secure messaging, such as email, for communication between patients and their health-care providers
•    Electronic Health Records – To create standardized, secure records of past and current laboratory test results that is accessible by health professionals
•    Bio-surveillance – To enable the transfer of standardized and anonymized health data to authorized public health agencies within 24 hours
Standards Harmonization

In August, the AHIC recommended three sets of “Interoperability Specifications” approved by the Health Information Technology Standards Panel (HITSP)—a standards panel established by the American National Standards Institute (ANSI)—an organization contracted by HHS to develop a process for harmonizing hundreds of competing standards. Secretary Leavitt accepted these standards that form the basis of interoperability. He also accepted the AHIC’s recommendation for federal health-care delivery systems, which provide direct patient care, to develop an adoption plan to integrate these standards into their software systems by December, 2007.

Executive Order on Value-Driven Health Care

In August, 2006, the President issued an Executive Order committing federal departments and agencies that purchase and deliver health care to require the use of health IT that is based on interoperability standards recognized by the Secretary of HHS as new upgrades or systems are implemented within the federal system.

Product Certification

In 2006, the Certification Commission for Healthcare Information Technology (CCHIT) certified the first 37 ambulatory—or clinician office-based—electronic health record products. The CCHIT seal of approval is awarded to products that meet base-line criteria for functionality, security, and interoperability. This certification encourages adoption of health IT by assuring providers that their systems can be a part of the future of health IT.

Changes to Regulations

HHS issued new regulations to allow certain arrangements in which a hospital or other health-care entity donates health IT and training services to health-care providers. These new regulations will accelerate adoption by health-care providers by giving them access to increased financial assistance in implementing health IT.

Health IT Adoption Measurement

Through a contract with HHS, George Washington University conducted a health IT adoption survey of physician offices to establish the baseline for current physician use of electronic health records at 10 percent. The survey also provided the criteria necessary to measure success in encouraging further adoption.

Results

These accomplishments will encourage broad, standards-based adoption of health IT that will improve the health and health care of all Americans. Already, markets are responding to federal leadership.

1.    Just one month after HHS published rules allowing for increased donations of interoperable health IT to providers, health IT vendors were reporting substantial increases in buyer interest.
2.    The CCHIT received and evaluated dozens of applications for product certification as buyer interest in certified systems dramatically increased.
3.    Nearly 200 public and private health-care purchasers, including several States, counties, and cities, have agreed to implement the principles of the President’s Value-Driven Health Care Executive Order in their health-care procurement programs. This includes the first corner stone: to do business exclusively with those who adopt health IT systems that use interoperability standards recognized by the Secretary of HHS as their systems are updated.

2007: Next Steps

HHS accomplishments leading up to 2007 have laid the foundation of a robust health IT initiative that is already bringing value to health-care consumers and providers. With the organizations and contracts in place and a standards process established, additional progress for the year ahead will be rapid.
Nationwide Health Information Network (NHIN)

Four prototype architectures for a Nationwide Health Information Network (NHIN) were delivered in January, 2007. These prototypes were developed with functional requirements and security and business models for health information exchange. Their delivery marks the beginning of the next phase of NHIN work – to connect the prototypes and state and regional health information exchange efforts in “trial implementations” that will make up the “networks of networks” of the NHIN.

American Health Information Community (AHIC)

The American Health Information Community formed workgroups in 2006 that will make recommendations to the AHIC in the following areas:

•    The Confidentiality, Privacy and Security Workgroup – To address privacy and security policy issues for nation-wide use of health IT
•    The Quality Workgroup – To identify the role of health IT in the development of health-care quality measures, their automation, and the use of clinical decision support to improve their performance
•    The Personalized Health Care Workgroup – To plan for standardized integration of genomic test information into electronic health records
Privacy and Security across State Lines

To ensure that every patient’s privacy is consistently protected no matter where they receive care, a regular forum will convene state leaders to reach consensus on cross-border issues of privacy, security, physician licensure and health-care practice, and the states’ roles in health information exchange. In addition, a nation-wide summary of state privacy and security assessments, solutions, and implementation plans will be presented and used to consider national policy issues.

The Federal Health Care Delivery System

Plans will be completed across the federal government to implement the requirements of the President’s 2006 Executive Order on Value-Driven Health Care in a consistent and effective manner. These plans will apply to the federal government’s adoption of interoperable health IT within its own delivery system and the contracts it negotiates.

Product Certification

The Certification Commission for Healthcare Information Technology will expand certification to inpatient—or hospital—electronic health record products. This will significantly increase patients’ (and their subsequent providers’) access to the health information generated during a hospitalization.

Summary

Each of these efforts is significant individually, and taken together, they will accelerate adoption of interoperable health IT and will form the basis of a health-care system that provides better care at lower cost to more Americans.

Rated PG: Physician Good

2008-06-06T14:51:12Z

CIGNA announced a national website ranking doctors and hospitals by cost and quality measures. As I’ve written before on doctor ratings, this movement is inevitable despite all the my-patients-are-sicker claims by doctors, or the efforts of various Attorney Generals. Such watchdogs efforts are important though to see that health plans don’t skew the data for their own financial goals.

Cigna’s site names hospitals in specific regions with the lowest death and complication rates. It also offers lists of questions patients can ask their doctor about specific conditions and tools to help patients locate pharmacies with the lowest prices.

In New York, Cigna was one of many plans who pledged in writing to detail its ranking criteria. They’ve also tapped the National Committee for Quality Assurance to guide their ranking program.

Meanwhile in Massachusetts the MA Medical Society is up in arms about the state’s doc rankings. They sued the Group Insurance Commission to stop the rankings, claiming low-ranking doctors will be defamed and those patients who have to pay higher copayments based on their doctor’s ranking have been defrauded.

And last but not least, though most confusing to Joe Smith consumer, will be Consumer Reports new hospital rating service for 3,000 organizations. Their “intensity of care” index of 1 to 100 will rate how intensely a hospital treats patients, based on time spent in the hospital and number of doctor visits for nine serious conditions. This strikes me as a controversial and incomplete criteria compared to other methods.

Ring the Bell

2008-06-03T02:23:48Z

A quick plug for Schwartz Communications' award winning night at the Publicity Club's Bell Ringer Award ceremony. Among the 12 Bell Ringers and 15 Awards of Merit that we won were six for healthcare. These include:

- Feature or Commentary Placement: Online—ResMed/Respironics
- New Media: Epocrates
- Print Feature or Commentary Placement - Regional Business Publication: Spring Medical Systems
- Print Feature or Commentary Placement - Regional General Interest Publication: Hologic/MammoSite
- Product/Service Publicity: Healthcare: Cyberonics and Epocrates

Don't Believe the Hype?

2008-05-30T15:12:32Z

But Don’t Let That Stop You Promoting It ;)

A sobering case study for CDHP/HSAs. Financial services company T. Rowe Price adopted its consumer-driven health plan in 2004. You’d think they’d succeed, given the 5,000 financially savvy U.S. employees and a sophisticated benefits program already in place. Enrollment in the plan hit 8 percent the first year, not bad.

Enrollment remained flat for three years, then rose in ’08 to 9 percent - too low to produce substantial savings. What could (maybe) make a difference? More incentives and tools for consumerism. A majority of consumer-driven plans today are stagnating like T. Rowe Prices. The most common plan designs don’t contain the seeds for their success.

It’s telling that when Towers Perrin wanted to quantify cost savings from CDHPs in a recent study, it found the CDHP landscape too small to do a credible survey. PR folks at vendors or companies succeeding in CDHP’s may have a media story in that success, going against the grain of poor performance through the solutions or approach that you offer.

Calling All IT Geeks

2008-05-23T13:07:48Z

A new AHIMA study says the HCIT workforce needs to expand considerably in coming years to meet demand. The study states that while there are 108,390 HIT professionals available in the U.S. today, providers will need an additional 40,784 to support widespread EMR adoption. The 40 percent increase is because when hospitals move from having no EMR to having EMRs, they need 0.082 IT staffers per bed compared to 0.2 IT staffers per bed.

Search and Destroy

2008-05-21T16:05:35Z

A quick commercial on a new service the Agency is offering, search marketing. Search marketing is changing marketing. Google prints money from their search advertising business. It's inexpensive, effective and very measurable.

However, many companies treat search marketing as a stand-alone initiative. Figure out some keywords, search engine optimize (SEO) the site, maybe run some pay-per-click (PPC) campaigns to generate leads. Inevitably, without any strategic context, the initiative putters out.

There's another, smaller group of companies that are navigating this roadblock by tightly integrating their search marketing programs with public relations. They tap the PR team to develop messages, turn those messages into keywords, use articles and other PR content to optimize the site and blast out strategic PPC campaigns coordinated with media campaigns.

This "surround-sound" approach hits key audiences with the same messages from two of the most influential sources out there--media (both traditional and social) and Google search.

Schwartz is sitting at the crossroads of PR and search marketing. For quite a while we've been optimizing releases, providing keyword advice and even figuring out compelling offers that will convert into qualified leads.

Today, we're diving in with a full-fledged search marketing offering. We believe PR and search marketing services fit naturally together. Contact me if you'd like more info.

CEOs Support Wired for Health Care Act

2008-05-19T17:46:18Z

Today brings a guest column on healthcare quality and technology by Maria Ghazal, director of public policy with the Business Roundtable, an association of CEOs of leading U.S. companies with $4.5 trillion in annual revenues and more than 10 million employees.

Health IT Will Save Lives and Money - First We Need Policymakers to Wire Us for Health Care Quality

Imagine if every few days a passenger plane crashed while travelling across America. There would be a massive outcry over safety standards and America would want answers…the airline industry would be investigated, held accountable and would make the necessary changes to ensure air travel is as safe as possible. Shockingly, the equivalent is happening in the healthcare space and no one seems to notice. Every year as many as 98,000 people die due to preventable medical errors, the equivalent of a 747 crashing every two or three days, and yet there is no public outcry, no call for reform and no alteration to our current health care system.

This must change. I work for the Business Roundtable – an association of CEOs of leading U.S. companies such as Verizon, Aetna and General Motors – who are pushing Congress to recognize that the cost we currently pay for our outdated system, in both human lives and dollars, is unacceptable. Based on both their business experience and their insights from insuring more than 35 million Americans, Business Roundtable CEOs believe that utilizing health information technology, more commonly known as health IT, will provide better quality of care while saving money and ensuring the security of private medical information.

]]> Advances in technology have been embraced by almost every industry in America, except the medical industry. It is amazing that we can download music while sipping a latte at our local Starbucks and pay bills on our cell phones, but we can’t walk into a doctor’s office or ER while on vacation and have our medical history available. Health IT enables our health information to keep pace with our lives; with it, people can keep their medical information with them at all times.

Electronic medical records aren’t just convenient, though – they help doctors save lives and Americans save money. Reducing the number of duplicate procedures, unnecessary lab tests, incorrect prescriptions and allowing doctors to use their time more efficiently could save $81 billion a year. This is more than double the level of annual U.S. public spending on all types of medical research. If you take into account all the indirect savings that would come from improved health, the total savings could be as much as $165 billion a year, enough to insure more than three-quarters of all uninsured Americans.

Unlike today’s paper-based security system, which relies on the sanctity of manila folders, health IT would finally provide the data protection necessary to ensure the privacy of people’s medical information. Health IT establishes a firewall around patient data, requiring passwords and permission to gain access…and leaving a trail of who accessed data, when and why.

The answer is clear: health IT must become a reality. Business Roundtable CEOs are standing by, waiting to develop and implement the technology needed to bring this system to life. All they need is a set of uniform, interoperable standards for health information technology platforms so that electronic medical records can be communicated and shared seamlessly among different providers.

What can you do? There is currently a bill before Congress that would create the legal authority for interoperable standards and provide America’s health care system with a much needed upgrade. Until Congress passes the bi-partisan “Wired for Health Care Act,” America’s health care system will continue to lag behind the times, to the extravagant price of 98,000 lives a year. E-mail your members of Congress today to urge them to pass this legislation.

Support Your Local HCIT Events

2008-05-16T17:19:56Z

Here in Massachusetts, the Massachusetts Technology Leadership Council’s Healthcare/IT Summit is being held Thursday, June 5, 2008, at the Hyatt Regency in Cambridge.

Is the Consumer the next big HealthCare IT Buyer?
Opportunities & Obstacles

Thursday, June 5, 2008
8:00-11:00am Program
7:30am Registration

According to MTLC, during the past 18 months, we've seen significant investment in patient-centric healthcare technology solutions from major IT vendors such as Microsoft (HealthVault), Google (Google Health), IBM (Center for HealthCare Management), Intel (Digital Health Group), and Apple (iPhone as healthcare platform -- Kleiner Perkins is investing $100M into companies developing new applications for the iPhone).

MTLC has convened a panel of thought leaders from the IT community to brief us on their investments and their vision for the healthcare IT market. They've also assembled a panel of healthcare CIOs and IT buyers to give their perspectives on these investments.

Participants:
- Michael Barrett, President, Critical Mass (moderator)
- Patrick Boyle, Vice President, America's Healthcare & Life Sciences, IBM
- John Halamka, CIO, Care Group/Beth Israel Deaconess Medical Center
- Paul Mattes, Managing Director, US Health & Life Sciences, Microsoft
- Dan Nigrin, CIO, Children's Hospital
- Gary Sevounts, Senior Director, Global Healthcare Solutions, Symantec

Care Management Thoughts

2008-05-12T18:55:04Z

At the recent World Healthcare Congress there was much talk about health plans and care management. In the increasingly competitive payor market differentiation is important, so some insurers are looking to move beyond disease management to “care management.” This focus on member care comes with longer term cost savings that go beyond comparatively simple utilization management.

Executing this care management beyond marketing pabulum requires a combination of new technologies, particularly in the data analytics and evidence based medicine realm, as well as more aggressive communication with members via HRAs, PHRs, clinical content and more health/wellness programs.

Some health plans are doing better than others in particular slices of the care management spectrum, but few have brought it all together in an integrated fashion. While outsourcing certain simple functions such as transaction processing remains an answer for many, the wisdom from WHCC attendees favored a holistic in-house effort to achieve care management.

The risk and reward of care management resides with both insurer and provider, as the specialized networks can gain from pay-for-performance initiatives aligned with different populations.

For the healthcare marketers, consider that the care management topic will be growing in popularity in the media. As more plans and vendors discuss care management, media will seek examples of approaches, tools and end users. This could mean a PR opportunity for you.