Two slides from Mary Meeker’s presentation at Web 2.0 this week really caught my attention.

Compare the proportions that “users pay” for desktop Internet services vs. mobile Internet services (the area inside the red lines — click on the graphics to see larger versions).

What do these slides tell us?

(more…)

I know — you’re thinking that using “geek” and “wisdom” in the same sentence is an oxymoron. Bear with me — I’m trying to make a really important point in today’s posting.

Interoperability has multiple dimensions — and I’d bet that most of us have never thought of interoperabilty as involving “process” — people working together and collaborating; I know I hadn’t.

The Interoperability Work Group of HL7’s Electronic Health Record (EHR) Technical Committee was formed in April 2005 to attempt to define the concept of interoperability. The group examined 100+ definitions of interoperabilty. Their work is summarized in their report: Coming to Terms: Scoping Interoperability for Health Care, February 2007.

3 Types of Interoperability: Technical, Semantic, Process

Through work group consensus, three principal types of interoperability were identified: technical interoperability, semantic interoperability, and process interoperability. Here’s an overview:

Type 1: Technical Interoperability

The most basic, hardware-based form of interoperability. IEEE-90 defines interoperability as, “The ability of two different systems to exchange data so that it is useful”

The focus of technical interoperability is on the conveyance of data, not on its meaning. Were it not for the fact that computers tend to use written language, this would be similar to the level of interoperability provided by voice communications, e.g., via a telephone.

Type 2: Semantic Interoperability

the ability of information shared by systems to be understood… so that non-numeric data can be processed by the receiving system.

HL7 also defined a quality that is necessary for optimal semantic interoperability to exist. The quality-based rationale of the HL7 semantic interoperability messaging standard asserts that health information systems will communicate information in a form that will be understood in exactly the same way by both sender and recipient.

Type 3: Process Interoperability

Process interoperability is an emerging concept that has been identified as a requirement for successful system implementation into actual work settings. It was identified during the project by its inclusion in academic papers, mainly from Europe, and by its being highlighted by an Institute of Medicine (IOM) report issued in July 2005 which identified this social or workflow engineering as key to improving safety and quality in health care settings, and for improving benefits realization.8 It deals primarily with methods for the optimal integration of computer systems into actual work settings and includes the following:

• Explicit user role specification
• Useful, friendly, and efficient human-machine interface
• Data presentation/flow supports work setting
• Engineered work design
• Explicit user role specification
• Proven effectiveness in actual use

Here’s another helpful angle on the three types of interoperabilty: (more…)

by John E. Riedel

Study breaks new ground in calculating the "normal impairment factor."

We know that poor health accounts for a considerable amount of productivity loss-anywhere from 1 ½ to 3 times direct medical costs.  The potential for disease prevention and disease management programs to reduce productivity loss has, for obvious reasons, caught the attention of healthcare purchasers.  But let’s be careful about making big claims to "recapture" productivity loss.  People find it tough to change health behaviors.  And, even if someone is perfectly healthy, they aren’t 100% productive 100% of the time!  (Possibly with the exception of the current reader.)

Although the association between poor health and reduced productivity is reportedly quite high, employers don’t know how much productivity loss can realistically be recaptured .  There is a need to quantify the portion of productivity loss that can be regained through health management strategies.

Without knowing that amount of impairment, employers and their population health management providers can’t set realistic objectives for their health and productivity strategies.  A recently published article in the Journal of Occupational and Environmental Medicine (Riedel et al with StayWell Health Management) sheds some light on this issue.

(more…)

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?  (more…)

Last week I did the major annual tune-up of my presentation on Disease Management Megatrends for the MCOL Future Care Web Summit. 

I’m pleased to share a copy of the PowerPoint presentation with you, and I hope you find it useful and provocative.  You can view and/or download a copy here (6MB).  This version contains 77 slides, which would be about the length I’d use for a 3 hour workshop; you’d see a more compact version for a conference keynote, Board summary, or management strategy session.

fyi, the DM Megatrends are:

MAGNITUDE: We are just scratching the surface of chronic disease challenges.
INTEGRATION:  The 50 year tide is shifting toward integration, away from specialization.
MEDICARE: While Medicare has endorsed the need for chronic disease management, disappointing results from recent demo projects make future direction unclear.
PROVIDERS: Care providers have woken up to DM opportunities and threats; they are promoting the medical home and the Chronic Care Model.
MAKE, ASSEMBLE, BUY? Fewer are buying as health management becomes increasingly strategic.
TECHNOLOGY:  DM in your home and your pocket.
BEHAVIOR CHANGE: DM is moving from a medical to a social model; behavior change has become the Holy Grail.
CLINICAL AND ECONOMIC ROI:  Round one is over, DM wins; Round 2 has just begun.
WILDCARDS! (employers, P4P, retail clinics, CDHPs, elections)

Comments are always appreciated.

Last week was a podcast of DM Megatrends…next week — the movie.  Brad has signed, Angelina is waffling.

Over the past week I’ve been doing a major tune-up of my presentation on Disease Management Megatrends for the annual MCOL Future Care Web Summit. 

More typically, DM Megatrends is 45–90 minute presentation with accompanying PowerPoint slides.

As part of the Web Summit, the good folks at MCOL asked me to do a short podcast on highlights of this presentation. They’re allowing me to share it with you… click here to save or listen to the podcast.

fyi, the DM Megatrends are:

MAGNITUDE: We are just scratching the surface of chronic disease challenges.
INTEGRATION:  The 50 year tide is shifting toward integration,  away from specialization.
MEDICARE: While Medicare has endorsed the need for chronic disease management, disappointing results from recent demo projects make future direction unclear.
PROVIDERS: Care providers have woken up to DM opportunities and threats; they are promoting the medical home and the Chronic Care Model.
MAKE, ASSEMBLE, BUY? Fewer are buying as health management becomes increasingly strategic.
TECHNOLOGY:  DM in your home and your pocket.
BEHAVIOR CHANGE: DM is moving from a medical to a social model; behavior change has become the Holy Grail.
CLINICAL AND ECONOMIC ROI:  Round one is over, DM wins; Round 2 has just begun.
WILDCARDS! (employers, PHRs, P4P, CDHPs)

From Christine Chen at the Foreign Policy Blog:

…a group of public health insurance officials in Osaka are trying a new way of combat in the battle of the bulge. Dieters can use their cell phones to take photos of meals they’re about to eat, and then send the photos to a health expert who can then evaluate the meal for calorie count and nutrition.

The only drawback is that it can take three days for the results to get back.

No wonder people are losing weight on this diet!

The tagline to a recent article in the Wall Street Journal [subscription required] reads: Employers, Insurers Bet That Covering More of the Cost of Drugs Can Save Money Over the Long Term for Chronic Conditions

Desperate for ways to curb soaring health-care costs, a groundswell of employers and health insurers are turning to a radically different approach: motivate patients to take not just the cheapest medicines, but the ones they need the most….

Behind the about-face is mounting evidence that higher copayments may not make long-term economic sense. While they’ve curbed drug spending in the short run, studies show they’ve also discouraged some people from taking essential medicines. A 2004 Rand Corp. study of more than 80 corporate and commercial health plans, for instance, showed that chronically ill people used to taking regular drugs cut their medications by between 8% and 23% when their copays were doubled.

(more…)