Sunday, June 26, 2011

Friday, June 24, 2011

Google to Kill Google Health

If we needed any further confirmation that the Personal Health Record, where patients store their own personal health information, has a steep hill to climb before becoming a viable business model, the mighty Google has now signaled that they are getting out of this race altogether according to Modern Healthcare. Apparently the service will be shuttered by January 1, 2012. When a firm with more than $100 billion in cash decides to discontinue investment in a given business model that, on the surface, would appear to have strong long term potential it is worth taking note.

With the PHR model, I believe a major challenge comes from the closed nature of current EHR / EMR (electronic health records) vendors. These vendors each want their own PHR modules to be used by patients eliminating the possibility for a system like Google Health to get widespread automated data input into its patient accounts. Left without that automated information stream, patients have to manually enter the data and the average person does not see the benefit to what would result in a partial picture of the healthcare encounters and associated data at best.

This announcement comes on the heels of a recent article in the Wall Street Journal where new CEO Larry Page talked about cutting unprofitable businesses, eliminating red tape, and getting back to the agile, productive environment that made Google great to begin with.

Here is an excerpt from the WSJ article -
"Some managers believe Mr. Page will eliminate or downgrade projects he doesn't believe are worthwhile, freeing up employees to work on more important initiatives, these people said. One project expected to get less support is Google Health, which lets people store medical records and other health data on Google's servers, said people familiar with the matter."

Thursday, June 23, 2011

Ind. health exchange connects with immunization registry | Modern Healthcare

As a leader in healthcare innovation, Indiana is home to one of the most innovative and most widely adopted health information exchanges in the country - Indiana Health Information Exchange, or IHIE.

IHIE has achieved another major milestone by connecting 1,700+ physicians to information on immunization records of patients.  

"Providers, including 1,700 physicians connected to the Indiana Health Information Exchange, will be able to check on the immunization records of their young and older patients when the Indianapolis-based health information organization connects as planned with the state health department's Children and Hoosiers Immunization Registry Program, or CHIRP."

IHIE is also a Bostech customer and our team is excited about the opportunity to work with a nationally recognized HIE.  IHIE has already achieved many significant goals and many more exciting capabilities are in store for Indiana's healthcare organizations thanks to IHIE's efforts.

Wednesday, June 22, 2011

Patient health records lost on subway train results in $1 million fine

With all of the concerns over cyber attacks and digital security, it is interesting to consider the state of security of private health information like patient records in general.

Often times, health information is stored in paper charts that are handled by various people, photocopied, FedEx'd, and otherwise shuttled around in an analog fashion. The reality is that this approach to managing personal health information is much less secure than properly encrypted digital files.

In one case, Mass General lost scheduling documents for hundreds of patients on a subway train...
"Massachusetts General hospital system agreed to a $1 million settlement with the civil rights office for losing scheduling documents for 192 patients. The documents -- which bore personal information such as names, insurance data and diagnoses -- were accidentally lost on a subway train."
The next step up from paper charts has been in-office computer systems that store patient information electronically. This is a step in the right direction. However, the basic password protection available on these systems is easy to crack, the servers and PCs running the software that contains this information are relatively easy to pick up and steal, and any sort of natural disaster (like a flood or tornado) can decimate these records rendering the information impossible to retrieve.

This all argues for a shift to healthcare cloud computing, implemented with proper security measures, as the next major leap in information security. With encryption in flight and at rest, striped drives, geographically distributed data centers, and two phase authentication, health information is much more secure in the cloud than it is when on a subway train in a paper file.

Here is an article that addresses this subject -

Why ACOs Are Like Oakland

The implications of the accountable care organization, or ACO, in healthcare are far-reaching. The ACO federal rules are defined in 429 pages provided by the Centers for Medicare and Medicaid Services at the end of March 2011.

Here are a couple of interesting excerpts from a post that thoroughly addresses the topic of ACO's including what is currently there and what is not:

"Under the rubric of "Medicare Shared-Savings Programs," an ACO was defined in the PPACA as a group of health care providers—it could be a physician group; a network of medical practices; a joint venture or partnership among a hospital, community physicians and ancillary providers; or a hospital that employs them—working together under shared governance with primary care physicians in the leadership role, managing and coordinating care for at least 5,000 Medicare fee-for-service beneficiaries."
"An ACO will need processes to measure and report the quality and cost of its care and to promote evidence-based medicine from outpatient disease prevention and health maintenance, through hospital admission, to post-discharge community follow-up. Mature ACOs will be paid by CMS for episodes of care rather than for à la carte services, and the ACO will be responsible for distributing the payments among its providers, dividing any savings realized through care improvement as bonuses."
This article draws the comparison between ACOs and Oakland by contending that "like the city of Oakland in Gertrude Stein's famous putdown—there's no there there."

Healthcare organizations need to implement processes and systems to measure and report the quality and cost of the care they are providing while promoting evidence-based medicine. Cloud-based solutions (including hc1.c0m) are the ideal way to address these challenges as they can be designed to span the continuum of care and unite all of the information silos and disjointed processes enabling this type of monitoring and measurement.

See the entire post in Hospitals & Health Networks (H&HN) here - Why ACOs Are Like Oakland

Tuesday, June 21, 2011

Walgreens to walk away from $5 billion

In the continuously evolving landscape of healthcare payments and reimbursements, Walgreens is in a deadlock with pharmacy benefits manager Express Scripts as the two giants struggle to come to terms that satisfy both parties.

In this case, Walgreens is apparently willing to take a 7 percent haircut on annual revenue because the payments from Express Scripts are not sufficient to generate acceptable profits on that business. Express Scripts handles about 90 million annual prescriptions for Walgreens.

"The Walgreen Company said on Tuesday that it was willing to walk away from more than $5 billion in annual revenue because the pharmacy benefits manager Express Scripts did not pay it enough to fill prescriptions."

Healthcare adoption of cloud computing is skyrocketing | Healthcare IT News

A recent poll of 1,200 IT professionals across multiple industries found that 30% of healthcare organizations already adopted cloud computing and many have recorded savings of more than 31% as a result.

The poll conductor, CDW, defines cloud computing as a model for enabling convenient, on-demand access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications and services) that can be rapidly provisioned.

Reaching 30% adoption and climbing clearly signals that cloud computing is now commonplace in the healthcare industry. Given the many challenges healthcare organizations must address to improve care while reducing costs, cloud computing is an excellent strategy as it eliminates the need to purchase and maintain hardware and software.

Those surveyed... "said they expect to spend no more than one-third of their IT budget (34 percent) on cloud computing by 2016, and at the same time, to save 31 percent of their IT budget by using cloud resources and applications..."

You can download the full report here -

Monday, June 20, 2011

Data alone does not result in better healthcare

Healthcare organizations are increasingly gathering data about clinical activities within their electronic health records (EHRs) and other systems which is intended to improve the quality of care. However, simply focusing on logging this data is not sufficient to bring about truly positive change in the quality and cost effectiveness of healthcare.

This point, which ultimately relates to treating providers and patients as highly valued customers, is at the heart of the next major wave of change healthcare truly needs. The first phase of this change, which has been underway for more than a decade, is to gather data electronically.  Phase two - where the real benefit comes in - is to actually begin transforming that data into meaningful information that can be accessed in real-time by individuals who can use it to make better decisions.  This can be as simple as automatically recognizing a patient and retrieving their registration information so they don't have to re-register (the most irritating part of the healthcare process for most people) or as sophisticated as matching a patient's DNA profile with a known disease that individual is predisposed to getting in order to preempt what could potentially be a fatal outcome before symptoms are present.  

A recent HIMSS 2011 Clinical Transformation Survey provides results that support this view. Solutions such as (a product developed by Bostech) are designed to tap into these disparate stores of data and generate meaningful, tailored information that can improve the quality of care.

Embracing clinical improvement but still need data analysis tools (WTN News): "Healthcare organizations are embracing the need for information transparency to drive clinical transformation, but they still require the tools and capabilities to make data available in real time and reduce the burden on scarce resources. These are among the key findings from the HIMSS 2011 Clinical Transformation Survey"

A 10 Step Program to a Better Pricing Model from OpenView Labs

When building companies and launching new products, identifying the market need, developing the solution, finding pilot customers, etc... takes precedence over defining a pricing model - as it should.  In fact, although product pricing is undoubtedly one of the most critical factors in the success of any product, it is typically left until the last minute and delegated to someone who is not necessarily the best person to establish the pricing structure.

Having been through a wide range of product launches - some more successful than others - this "10 step program" for developing a pricing model caught my attention at OpenView Labs.

A 10 Step Program to a Better Pricing Model | OpenView Labs: "The problem is that too many companies work on their pricing models at the last minute. Many times the person responsible for pricing is a product manager who has little time to focus on the task and may even be the least experienced person on the marketing team."

The health information exchange spectrum - Point-to-point vs. statewide options explored

In this blog post, Charles does a great job of describing the advantages of true health information exchange connectivity vs. basic point-to-point integration in healthcare. The ability to access important patient information across the continuum of care creates numerous benefits including those mentioned in this post.

Moving beyond the basics with health information exchange - Healthcare business news, research, information and opinions | Modern Healthcare: "Statewide exchanges are on the other end of the spectrum and are able to aggregate a broader range of information and data, helping to provide answers to questions related to population health, statewide reporting and registry services, while reducing redundant testing, identifying drug abusers, spotting trends and potential bio-threats, among other capabilities. However, statewide exchanges take time to build, and there are often a multitude of legal hoops to go through. This model does not try to anticipate where care will occur or where the information will be needed or required."

Here is the full text from Charles' post:

Moving beyond the basics with health information exchange

By Charles Christian
Posted: June 20, 2011 - 11:00 am ET

I'm certain that most everyone reading this has heard about health information exchanges, and if you want to hit all the marks of the meaningful-use criteria, there is no question that you have to be able to at least accomplish a test or two using health information exchange capabilities and technologies. The real question is, exactly what size and type of exchange will be coming to your facility?

Should you opt for the simpler, straightforward approach of the Direct Project or hold out for a full-blown, industrial-strength health information exchange? That is a question that many of us are currently debating in the varied corners of our healthcare industry.

Please keep in mind that I've lived and worked in Indiana for more than 20 years and have had the opportunity to watch the birth of one of—if not the first—health information exchange in the country (although I'm certain that this point can be debated). Having said that, I may be a little biased in some of my thoughts. I've also had the privilege of working with a state-level group to accomplish much of the early groundwork on how to expand and connect several regional exchange offerings.

I’d like to take just a moment to briefly explore both ends of the health information exchange spectrum—The Direct Project and the full-featured health information exchange.

The Direct Project's initial focus has been on simplifying the process for providers to comply with Stage 1 meaningful-use requirements for health information exchange. The specifications are concerned with only point-to-point message transport using the Internet’s ubiquitous Simple Mail Transport Protocol, using secure Internet e-mail.

While this may be a good "on ramp" for the health information exchange highway and enable providers to meet the intent of the Stage 1 requirements, it's doubtful that this solution will satisfy the longer-term data and information requirements of coordinating a patient's care in the more complex environment of an accountable care organization. The Direct model assumes that the sender will know where the next stop for the information should be or where the next care encounter will occur.

Statewide exchanges are on the other end of the spectrum and are able to aggregate a broader range of information and data, helping to provide answers to questions related to population health, statewide reporting and registry services, while reducing redundant testing, identifying drug abusers, spotting trends and potential bio-threats, among other capabilities. However, statewide exchanges take time to build, and there are often a multitude of legal hoops to go through. This model does not try to anticipate where care will occur or where the information will be needed or required.

There also are other opinions related to how health information exchange should be implemented and how quickly it should occur. The PCAST report states that the healthcare industry is not moving fast enough to get on the health information exchange highway and that the ONC is not putting enough emphasis on health information exchange in stages 2 and 3 of its meaningful-use criteria.

What do the larger insurance companies know that we don't? It appears that they are counting on the use of health information exchange technologies to enhance their business models, because they are acquiring information-exchange technologies companies such as Axolotl and Medicity.

So the question might be, "How much health information exchange do we really need?" Do we just need to move the information from one care encounter to the next, or do we need to think outside the box a little and take a longer view of how care encounter data and information could be used? Could it be used for something more than to provide care for the patient—for example, to assist in the coordination of the patient’s care without having to know where the data needs to be next? I think my bias might be showing a little—OK, it's showing more than a smidgen.

Based on what I've experienced using the health information exchange technologies available in Indiana, I believe we've just begun to scratch the surface of how secure and appropriate data interchange can be used to improve our healthcare delivery system while at the same time providing an excellent tool for us to coordinate extremely high-quality care wherever and whenever the patient encounter occurs.
Charles Christian


Good Samaritan Hospital

Vincennes, Ind.

Vice chairman

Policy steering committee

College of Healthcare Information Management Executives

Sunday, June 19, 2011

Apple's App Store model setting the stage for enterprise vendors to win big

Apple's success with its App Store has proven that cloud computing and leveraging a community of third parties to generate discrete functionality is undoubtedly the recipe for success with consumer-focused software. But what about for the enterprise?

I strongly believe enterprise SaaS solutions, following's lead, will ultimately generate massive revenue growth and profits that will dwarf consumer purchases.

This blog post by Dennis Howlett offers some worthwhile insight on this topic.

Regarding Apple...

"Despite the fact many of the apps you find are…err…useless, Apple managed to earn $743 million in the last quarter from this source. Pundits reckon that will rise 30% in the coming year. But that only scratches the surface. If you take the six month numbers, double up and add for growth then an annual figure of $3.5 billion could be in the ballpark."
Regarding the enterprise cloud opportunity...
"Who would not give their right arm for a slice of the Apple pie as applied to the enterprise space? How big could those numbers get? I’ve done some back of fag packet calculations and reckon there is every possibility that in the SAP space alone, we could be looking at numbers in the $24-60 billion range."
The post can be found in its entirety here -

Where Apple walks will the enterprise vendors follow? | ZDNet

Patient chugs 6 bottles of hand sanitizer

A patient downed six bottles of hand sanitizer - the equivalent of about 20 bottles of beer.  This is apparently not an isolated incident and actions are being taken to prevent this in the future.

See the article here - Patient downs sanitiser

Electronic records mandate strains rural hospitals - Turn to the Cloud for help!

I came across this article about the adoption of electronic medical records in rural hospitals and the following quote really stood out -

"Even if hospitals and clinics do get the money to buy a system, says Wivoda, 'There is the matter of finding the help to do it. Most rural hospitals don't have many, if any, IT people, let alone a health care IT person. There is a massive shortage there.'"

A flawed assumption reflected by this quote is that hospitals and clinics have to "buy a system" that requires "IT people" to install it. Cloud computing solves this dilemma in a much more efficient and practical manner. By moving to cloud-computing, these organizations can utilize software-as-a-service ("SaaS") offerings to meet the "meaningful use" mandates. This means that, rather than buying servers and software, you are able to access these capabilities securely via the Web from a provider who continuously updates the system and supports the infrastructure required to support it.

Friday, June 17, 2011

FAQ On ACOs: Accountable Care Organizations, Explained - Kaiser Health News

In the new healthcare reform law, there is a key new concept called the ACO or Accountable Care Organization. This concept can be extremely confusing and it has taken me the better part of the past year to fully understand and appreciate its implications.

First off, an ACO is not a single organization as its name would imply. Rather, it is a collection of many healthcare organizations and physicians who have aligned together to provide comprehensive care and to be accountable for that care. Said another way, its intention is to make it so physicians and healthcare organizations are incentivized not merely based on the number of procedures they do (transaction medicine) but instead on the quality and economics of the care they provide.

The analogy in this article is that of a television. A television is made up of many different components from a variety of suppliers (circuit boards, screen, etc...) and is assembled by an organization, such as Sony, who delivers the final product to the customer and who is accountable for the quality of that product.

ACO's follow that type of concept - that rather than having a piecemeal healthcare equation where you are buying a circuit board here, a screen there, etc... you would get the total product from an organization that was accountable for its quality.

In theory, this makes sense to me but as is the case with any broad initiative, there are likely to be unintended consequences.

This article from Kaiser Health News does an excellent job of explaining the ACO model.

In healthcare, as in life, it all comes down to relationships

Massive energy and activity is being invested into healthcare reform and many of our best and brightest leaders in government and industry are working to improve the state of healthcare.  The topics garnering headlines tend to be related to the escalating cost of healthcare, the availability of health insurance, and sophisticated government-led initiatives such as "meaningful use" of electronic health records by healthcare providers that is intended to reduce cost and improve care.

While all of this is important, I strongly believe the secret to improved healthcare is to focus on the age old concept of customer service.  If our healthcare organizations were focused primarily on providing outstanding service to customers (which would first require a cultural shift among many healthcare providers toward viewing patients as customers) the other issues, including reduced cost and improved quality of care would coincidentally be resolved.

What's that you ask?  How can you provide both better service and higher quality while lowering costs?  Let me give one simple example we can all relate to...

You arrive at your general practitioner's office for your annual checkup.  Upon arrival, you are greeted with a clipboard full of redundant paperwork you have filled out the last ten times you visited this establishment.  You fill out the paperwork, including your name, address, and phone number in three different places, and stand in line to give the paperwork to the registrar.  You are then asked for your insurance card and driver's license, both of which you have given previously, so those can be copied and placed into your file.  Plus, you sign a consent to treat, HIPAA privacy form, and a few other documents that you are not reading at this point so they may actually assign all of your assets to someone in Afghanistan for all you know.  All of these documents were previously signed and given to the office on multiple occasions, but alas you have now added yet another stack of paper to be placed in your physical file.

Not only is this process extremely inefficient, wasteful, and unnecessary, but more importantly, it is completely alienating to the patient.  How is it that I can walk into any retailer in the free world one time and later arrive at a different location on the opposite side of the country and they know who I am but the doctor I visit year after year can't figure out how to identify me?

Now let's say your general practitioner determines that pain in your knee requires an MRI and sends you next door to have that procedure done.  The clipboard and redundant paperwork greeting begins anew.

This same cycle repeats as you are routed through a disconnected chain of events that will hopefully result in you being better off than when it began.

The costs involved with this type of processing - and the associated paperwork, labor, and patient dissatisfaction - are massive.  Additionally, if you focus carefully on the customer, and meeting his or her needs in a manner that makes them feel like you actually know them as a person, the impact on risk of costly litigation which, unfortunately, creates massive costs to the insurers would be greatly reduced.  For it is not the best doctors who are sued least often but rather the doctors who have the best bedside manner.  In fact, the technical competence of the doctor, although crucial, is not the best indicator of the likelihood of litigation.

The bottom line is that above all else, treating every customer like they are your most important customer is the best recipe for success in any business.  This applies to healthcare just as it applies to retail or any other business aimed at achieving great outcomes due to their services.

Of course there are solutions to this challenge...

This massive need for a focus on excellence in customer service within the healthcare market was the inspiration behind our new solution at Bostech.  hc1 ("Health Cloud One") provides a unique healthcare relationship management capability, delivered via the cloud in a software-as-a-service (SaaS) model, that allows a patient to register once and be easily identified everywhere throughout a healthcare network. also gets at managing relationships between healthcare organizations to promote continuity of care and higher quality such as in the exchange of information between labs and hospitals.

Thanks to new secure cloud computing capabilities, and the work of some of the most talented people I have ever known, delivers these capabilities without the lab or healthcare provider having to purchase any hardware or software - eliminating the headaches that traditionally come from many IT related software purchases.

The good news is that many healthcare providers, labs, radiology groups, and organizations throughout the continuum of care are shifting their thinking toward providing outstanding client service.  I will share some first-hand examples of this in upcoming blog posts.