e-CareManagement blog

Earlier this week Healthways issued a press release describing their progress in pursuing a Phase II Medicare Health Support (MHS) project.   Read Dr. Jaan Sidorov’s blog commentary for additional background.

In brief, Healthways position is that the Centers for Medicare and Medicaid Services (CMS) is statutorily required to expand into Phase II of MHS if Phase I is “successful”. While I’m very sympathetic with Healthways predicament and their frustration with CMS, I’m not optimistic that their tactics are likely to work.

In making the case, Healthways CEO Ben Leedle quoted the legislation authorizing MHS.

For a moment, let’s get legalistic and look closer at this legislation.  What exactly is CMS required to do? (I’ve put the more relevant wording in bold). Continue reading “Healthways Fights an Uphill Battle on Medicare Health Support Phase II”

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 The Healthcare Unbound Conference is a highlight of my year and I always look forward to it!

What’s so special about this conference?

First, the caliber of the people attending.  It’s a stimulating mix of high-level clinical, technical and business types.  The energy is flowing and many people have told me how much they like to go just for the networking.

Second, the caliber of the conference organizer.  I’ve worked with many conference planners, and Satish Kavirajan is not your ordinary conference organizer.

Satish really knows his stuff and he’s a pleasure to work with.  I’m impressed how from a year in advance of the first Healthcare Unbound in 2004 he delved into the substance of the topics.  He read every link and every report I sent him, he talked with experts in the field, he asked deep questions about how best to structure a session or find the right mix of people for a panel.  In addition to many years of conference experience, Satish has an MBA in finance from Columbia — not your typical conference organizer.

Finally, there’s the caliber of the faculty.  Here’s the list of session titles and keynoters for Day 1 of this year’s Healthcare Unbound Conference:

• The Personal Health Information Network (PHIN): Opportunities and Implications for Healthcare Unbound. Vince Kuraitis, Better Health Technologies and David C. Kibbe, The Kibbe Group; American Academy of Family Physicians
• Healthcare Everywhere - How the New Culture of Wellness Is Opening the Door for Healthcare Unbound. Liz Boehm, Forrester Research
• A Behavioral Economist, a Roboticist, and a Healthcare Unbound Advocate Walk Into a Bar: Meanings for the Rest of Us. Mike Barrett, Critical Mass Consulting
• Keynote (title pending). Jay Srini, University of Pittsburgh Medical Center
• From Mainframe to Personal Healthcare: A Progress Report on Addressing Technology, Policy, and Cultural Challenges. Eric Dishman, National Chair, CAST; Intel Corporation
• The Internet of Bodies. Don Jones, Qualcomm
• Google Health Overview. Jerry Lin, Google
• Continua Health Alliance:  The Next Generation of Personal Telehealth is Here! Dave Whitlinger, Continua Health Alliance; Intel Corporation
• Microsoft HealthVault Overview. David Cerino, Microsoft
• Disruptive Healthcare Innovation - Changing the Rules of Diabetes Management by Marrying Wireless and Clinical Innovation in the Healthcare Ecosystem. Anand Iyer, WellDoc; In-Building Wireless Alliance
• Improving Health Outcomes and Lowering Costs Using a Distributed Care Management Model. Larry Leisure, iMetrikus

I hope to see you at the 5th Annual Healthcare Unbound Conference! Please consider attending, sponsoring and/or exhibiting.

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Daniel Goldberg of the Medical Humanities Blog has posted the latest edition of the Health Wonk Review. Daniel puts a unique slant on his writing:

As I see it, the key role for a medical humanist – if they wish to be consistent with an ethos of medieval and Renaissance humanists – is to focus on the translation of theory into practice. 

…and he throws in some humor to boot.  Great reading!

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My colleague Dr. Dave Rearick asked me to review his recent book, Good Health is Good Business.  I’m pleased to recommend it enthusiastically.

While the book is targeted at small to medium size employers, the lessons go far beyond this audience.

By the end of the 3^rd chapter, Dr. Rearick had convinced me of two conclusions that I’d describe as indisputable, but uncomfortable:

• The only way employers are going to control their health care costs is to influence the health of their workforce.
• You (the employer) need to take charge

What’s uncomfortable here?  Continue reading “Book Review: Good Health is Good Business”

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Google Wants to Index Your DNA, Too Business Week; April 18, 2008

A few years ago I remember reading a vivid description of how much information is contained in one person’s genetic code:  a stack of phone books high enough to reach the top of the Washington Monument.

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David C. Kibbe, MD, MBA and Vince Kuraitis

Drs. Mandl and Kohane begin their recent article in NEJM with the statement that “large corporations are seeking an integral and transformative role in the management of health care information,” and then warn that this “will profoundly affect the biomedical research enterprise.”   

At issue for the authors is who controls the information about you and me, our health and healthcare data. Without coming right out and saying it directly, they worry that data in the hands of consumers and patients made possible through PCHR service providers like Google and Microsoft could be dangerous to the nation’s health because of  “commercial interests”.  

So, they are warning us, too.

But, let’s examine the presumption that your personal health information is safest in the hands of the medical establishment (incumbent service and health care provider organizations and the biomedical research enterprise). The real question that their article in NEJM begs is:

how good a job of stewarding our health data is the medical establishment doing?

Continue reading “Is the Medical Establishment the Best Guardian of Your Medical Data?”

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Vince Kuraitis and David C. Kibbe, MD MBA 

Tomorrow’s edition of the New England Journal of Medicine contains an article entitled “Tectonic Shifts in the Health Information Economy”.  While we have not yet fully digested this article, it’s clear that the authors’ description of the “Health Information Economy” closely parallels our initial description of the Personal Health Information Network (PHIN). 

The main thrust of the NEJM article is to discuss implications (good and bad) relating to clinical research. The NEJM article is also highlighted in a New York Times piece entitled “Warning on Storage of Health Records.”

In anticipation of our webinar tomorrow sponsored by Healthcare Informatics, we wanted to bring these articles to your attention ASAP. 

As a first pass at discussing these important articles, here are a few highlights from the NEJM article.  Whether you prefer the label the “Health Information Economy” or “Personal Health Information Network (PHIN)”, these excerpts describe the potential magnitude of the tectonic shifts: Continue reading “NEJM and NYT Discuss “Tectonic Shifts” of a Personal Health Information Economy”

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Writing in ZDNet, Mary Jo Foley ponders the question of whether it might make sense for Microsoft to link HealthVault (HV) and Amalga.

I’ll take this a step further and ask “Could a linkage between HealthVault and Amalga become a centerpiece of Microsoft’s broader health care strategy?”

Continue reading “Could a Linkage Between Amalga and HealthVault Become a Centerpiece of Microsoft’s Healthcare Strategy?”

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• What are companies like Google, Microsoft, and Dossia (sponsored by Intel, Wal-Mart, AT&T and others) hoping to accomplish in health care?
• What is the emerging Personal Health Information Network (PHIN) and why should you care?
• What’s the Continuity of Care Record (CCR) Standard, and how is it destined to become an initial focal point of data exchange initiatives?
• Why is the PHIN potentially disruptive to many business models? What types of companies or organizations could be affected the most?
• What are opportunities and threats to major health care players — hospitals, physicians, health plans, enterprise HIT vendors, ambulatory HIT vendors, and others?
• What specific actions can you take to be a leader in advancing the PHIN and positioning your company for success?

In a recent blog posting, David C. Kibbe, MD, MBA and I wrote an overview of our vision for the PHIN. 

Now, for the first time, we look forward to discussing our vision for the PHIN. This Healthcare Informatics webinar will be held:

Thursday, April 17, 1 PM Eastern, 10 AM Pacific.

Click here for details….read “Event Info” to see a more specific description of the webinar.  Get a 15% discount by using Promo Code VK15.

Here’s a diagram of the PHIN as we see it today:

(click on the picture for a larger version)

The Speakers

Continue reading “Healthcare Informatics Webinar: Google, Microsoft, & Dossia Create the Personal Health Information Network”

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While not providing anything close to the “final answer”, The New York Times does a good job summarizing the onoging Medicare Health Support (MHS) fracas.  To borrow from one of my colleagues, it’s more “enlightened ambiguity” about the ultimate fate of the MHS beached whale. 

Medicare Finds How Hard It Is to Save Money, The New York Times; April 7, 2008

For One Company, Role in Medicare Experiment Has Hurt Stock, The New York Times; April 7, 2008

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Our colleague Dr. Aniruddha Malpani, MD has posted a diverse and enlightening latest version of the Medicine 2.0 Blog Carnival. 

Dr. M summarizes 4 major influences which will help patients to regain control over their healthcare:

1. Patients will keep their own medical records using a PHR ( Personal Health Record)

2. Information Therapy can be prescribed to them, tailored to their needs, based on their medical problems captured in the PHR

3. Web 2.0 technologies will allow them to form social communities to help and support each other

4. We can deliver this information to them 24/7 through their mobile, wherever they may be, whenever they need it!

I’m amazed how quickly creative and convergent thinking is crossing international boundaries.

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The Continua Health Alliance is doing a good job in getting remote patient monitoring (RPM) devices to become plug-n-play — where devices and peripherals from different manufacturers complying with Continua Guidelines will be able to talk to one another.

Continua’s work-to-date is a necessary, but not yet sufficient effort to make RPM devices mainstream.

Knocking down the barrier of device-incompatibilty exposes the bigger barrier of lack of data interoperability among RPM technologies and between RPM devices and health care IT systems.  Jonathan Edwards, research VP and lead telemedicine analyst for Gartner, nails the issue:

Continue reading “Data Incompatibility Remains A Barrier to Remote Patient Monitoring (RPM) Devices Reaching the Mainstream”

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The ever-gracious and ever-eloquent Brian Klepper has written up the latest rendition of the Health Wonk Review.  Check it out here on The Health Care Blog.

…and check out Brian’s own website here.

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Older Americans 2008: Key Indicators of Well-Being, AgingStats.gov, Federal Agency Forum on Aging-Related Statistics

Healthy@Home, commissioned by AARP and the Blue Shield of California Foundation

State of Technology in Aging Services, Center for Aging Services Technology (CAST)

These reports are succinctly profiled with links to the full studies at Profiles of older health care consumers: living longer, longing for technology on Jane Sarasohn-Kahn’s Health Populi blog. A great read!

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Vince Kuraitis and David C. Kibbe, MD MBA

Who is the federal  government calling on to breathe life into the Nationwide Health Information Network (NHIN)? Google and Microsoft.

In our first article of this series describing the Personal Health Information Network (PHIN), we noted early entrants as Google Health, Microsoft HealthVault, and Dossia.  We also noted that the network could grow rapidly, and that others would want to join or link to the PHIN.

With Uncle Sam announcing plans to link to the PHIN, even we are surprised at the speed at which developments are occurring. 

Government Executive reports:

The federal office in charge of creating a national network of electronic health records plans to integrate the system with the health care databases that Google and Microsoft launched last year, on which individuals can store their health records, a top official with the Health and Human Services Department said….

(The HHS official) provided few details on how the office would incorporate personal health records….

Federal interfaces to the health network will be through an entity called NHIN Connect.

Here’s a simplified diagram of our current understanding of how NHIN Connect will link to the Personal Health Information Network (click on the diagram for a larger version):

Commentary Continue reading “Feds Call on Google and Microsoft to Breathe Life into the NHIN”

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When using a search engine, should results be customized based on your personal health information (PHI)?  Should your search engine of choice take into account your previous history of medical searches, or even provide results tailored from data about your personal medical history?

Two companies — Aetna and Microsoft — have come up with 180 degree different answers.

In this post, I will:

• Describe how Aetna’s and Microsoft’s approaches differ
• Speculate on why their approaches make strategic sense for the respective companies
• Explore how technology and expectations about using PHI for search are likely to change over time

Aetna’s SmartSource and Microsoft HealthVault 

Aetna has adopted a more aggressive strategy of using your PHI to improve search results. Microsoft HealthVault is employing a much more cautious strategy and (for now) has pledged NOT to use personalized health information to target health search.

Aetna is a health insurance plan with an existing member base of 17 million members.  Aetna’s recent press release announced a partnership with Healthline introducing

Aetna SmartSource, the first-ever personalized search engine that mines information from Aetna’s vast data resources to deliver meaningful, personalized health and health benefits information to Aetna members. 

Based on existing medical claims data that Aetna already has about members, your search term will be matched against your own medical history to provide the most relevant results.

Microsoft HealthVault search is different.  From the Microsoft HealthVault Fact Sheet:

Microsoft does not link users’ personal information with HealthVault search queries.

Why the Difference? Continue reading “Search Engines Using Your Personal Health Information: Creepy or Cutting Edge?”

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Joe Paduda has posted the latest edition of the Health Wonk Review at his blogsite, Managed Care Matters. 

Joe is one of the founders of the HWR, so a big THANK YOU goes out to our  “Fearless Leader”.

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 Vince Kuraitis and Thomas Wilson, PhD, DrPH

Thanks to the continuing opacity of the Centers for Medicare and Medicaid Serices (CMS), we remain confused about the future of Medicare Health Support (MHS).

It’s been over a month since we last commented on MHS. What’s MHS?  It’s JUST the Federal Government’s most significant and visible effort to deal with one of the American health system’s biggest challenges — managing care for patients with chronic diseases.

In late January CMS announced that it planned to end MHS Phase I and did not plan to proceed with MHS Phase II.  Evidence presented to justify that decision was sketchy at best and opaque at worst  – as we wrote previously,  the evidence was “insufficient”.

We are not alone in our confusion and lack of clarity about the future of MHS: Continue reading “The Medicare Health Support Saga: Opacity in Government Going Strong”

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Aetna recently made another big announcement relating to their PHR.  While the concept of what they’re doing is very appealing, it strikes me that health plans in general face an uphill battle in getting consumers to adopt and use personal health records (PHRs).

I’ll describe 4 factors behind my thinking:

• Lack of Trust
• Lack of Access to Clinical Data
• Lack of Permission
• Lack of Convenience in Consumer Workflow

Continue reading “4 Reasons Why Health Plans Struggle with PHRs”

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About three weeks ago Cain Brothers Investment Bankers released a report that foreshadowed the collapse of HMO stock prices that has occurred over the past few days.  The report was entitled: FAREWELL TO A TIME OF PLENTY? Health Plan Strategies for Growth in a More Challenging Market. 

Here are a few highlights from the report: Continue reading “How Will the HMO Stock Meltdown Affect Chronic Disease Management?”

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1. Blogging started as an exercise in business development.  It’s turned into an adventure in personal development.
2. Blogging is more work than I ever imagined.
3. Blogging is also more rewarding than I ever imagined.
4. Think book, not diary  (with gratitude to Guy Kawasaki, How to Change the World blog).
5. Putting up 1/2 baked ideas is a great way to have a dialogue; putting up 1/4 baked ideas is a great way to look stupid.
6. Blogging is addicting.  I think of Jim Fixs’s book on running where he describes monks that ran for 24 hours straight.  It’s sometimes not easy to get in the right mindset, but then the runner’s high kicks in and you just keep going.
7. While you could go to www.blogger.com and get started writing your own free blog in 5 minutes — don’t. Do your homework.
8. Finding your voice isn’t easy.  I still feel like I’m working on it intensely, even after a year.

To all of you out there reading — THANKS — that’s what’s keeping me going.  To all of my advisors and others who have offered encouragement, perspectives and feedback — THANKS.

Here are some high level stats to share:

• An average of 300–400+ people are dropping by daily (green).
• Over 28,000 different people (red) have dropped by since my first post on March 11, 2007.

Finally, sometimes you wonder whether ANYONE, ANYWHERE is reading.  Then you get a trackback like the one below from http://blog.tsimzung.com/doctorlog/656 :) 

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by Jill Kuraitis 

Vince gave me Dorothy’s story to read, and here’s what I said:  GO DOROTHY!   ::::goofy little happy dance:::   Dorothy is my new hero. I love people who are willing to go to the mat for a cause, especially one having to do with the elderly, children, the disabled and less fortunate than we.

Since Vince and I have been overwhelmed by the swamp of details of taking care of our family elderly for about, oh, 13 years - my parents, his aunt and uncle, pretty soon his mom -  nobody knows better than us how utterly nonsensical the systems are.

Our friends call us “The Geezer Whisperers” and email us for advice dealing with their relatives’ health care paperwork nightmares.  Since Vince has a deep understanding of  how American health care got to a point of old ladies being dragged out of hospitals in chains and shackles, and I’ve  demanded a lot of things from hospitals and doctors over the years, our friends think we have all the answers.

Vince is lucky.  He’s famous for being the smartest, most levelheaded, steady, reliable and adorable guy in the world.  Me?  I get the notoriety of being the proverbial rock, as in “between a rock and a hard place.” Taking no for an answer is not in my playbook.  You don’t want to get in my way when I’m organizing something, or you will end up firmly clipped to a barbed-wire clothesline. I can get You-Knighted States Senators to park my car. I take every defective purchase back to the store and always get a cash refund.  When I call the bank, they just waive any fees to avoid the hassle of talking to, uh, me.

Since I’m sure you get the picture by now, just imagine what hospital records departments have had to deal with. When told “you can’t have that” and it’s something I need to take care of someone I love, I am relentless. I’ve always gotten what I came for, but not without some big damned silly, er, disturbances.  No handcuffs have been involved yet, but ….(HINT:  When the guys in uniforms show up, smile and suddenly become unfailingly reasonable. Pisses ‘em right off.  When they leave, you can just swipe the folder and bolt.) (Oops….Um, Vince?  Did you know about that one?)

I’m proud to report that one doctor’s office staff refers to me as “that woman” and now gives me anything I want immediately.  Reputation is not as high on mine and Dorothy’s  lists as taking care of loved ones. If I remain kind and reasonable as long as possible, and only escalate to teeth-gritting, death-stare, devil-voiced determination when the refusals go on and on and on…..it comes out  even with Heaven.

I’ve always wondered if they are suspicious of imposters demanding strangers’ medical records. Do they think I’m selling them on eBay, or something?

So. What would REALLY happen if people like Dorothy were simply handed Auntie’s medical records?  Would anyone turn purple and explode? Would the hospital walls come-a tumblin’ down? Would Britney Spears wake up and smell the coffee? Continue reading “Going to the Mat for Dorothy”

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Vince Kuraitis and David C. Kibbe, MD MBA 

The Internet and digital technologies have transformed many aspects of our lives over the past twenty years.  We can get cash at ATMs all over the world; we can book our own airline reservations; we can shop and get best prices over the Internet.

Why hasn’t this happened in health care?  Something is missing.

Recently, major global information and communication companies have announced their intention to bring their technologies and business models to health care.  While the creation of Google Health (GH), Microsoft HealthVault (HV), and Dossia (sponsors include Intel, Wal-Mart, AT&T) are important news items by themselves, what’s more important is what they represent collectively — a new Personal Health Information Network (PHIN). The PHIN and applications developed around the PHIN will fill in many missing pieces and bring health care into the Information Age.

For example, suppose you just found out you have high blood pressure - that’s not uncommon.  Suppose you could easily submit information about your condition using the Google Health platform to receive a service that does the following:

• informs you whether there are clues in your medical history that point to a cause for your high blood pressure
• explains why being overweight can be a contributing factor
• tells you in easy-to understand language what the top number and the bottom number mean (”140 over 90″)
• explains which laboratory tests are necessary
• alerts you to the possibility that one of your prescription or over the counter  drugs could be making your high blood pressure worse
• advises you about the usefulness of using non-drug approaches to treatment
• tells you which treatment drugs have the greatest efficacy and safety for your specific circumstances
• tells you if any of those generics high blood pressure drugs are available at Walgreens for $4 a month
• offers to provide you a map with several Walgreens stores in your city that carry those $4 a month medications

…and many more possibilities we have not yet begun to imagine!

This essay:

• Is the first in a series of articles we’ll be writing to describe the PHIN and why it’s important — expect about a dozen follow-up posts.
• Is an overview of the basic idea — think executive summary or long abstract
• Introduces some new concepts, which we’ll try to simplify and define.  We understand that some of this is not easy reading. ….so we suggest you refill your cup of coffee and settle in.

Continue reading “Birth Announcement: the Personal Health Information Network (PHIN)”

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We underestimate how much people REALLY want medical infomation about themselves and their loved ones. 

Dorothy Tillman wanted it so badly that she was arrested!  Read more at Jaz-Michael King’s blog, A Scanner Brightly.

Hat tip to Jen McCabe Gorman for spotting this amazing story.

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While details are thin, here’s a first pass at comparing and contrasting Google Health (GH) and Microsoft HealthVault (HV).  Overall, there are many common features, some differences, and many common challenges between these two platforms. 

A High Level Comparison

Google Health and Microsoft HealthVault Personal Health Information (PHI) Platforms

There’s still not much information available about the specifics of GH, although they did release sketchy information on the Official Google Blog.  I’ll comment on a few of the particulars. Continue reading “A First Comparison of Google Health and MS HealthVault”

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