Comments to ONC: PCAST HIT Report Becomes a Political Piñata

The PCAST Report on Health IT has become a political piñata. 

Early Feedback on PCAST 

Like many of my colleagues, I was taken aback by the release of the Report in early December 2010 — I didn’t know quite what to make of it. Response in the first week of release was: 
  • Limited. The first commentaries were primarily by technical and/or clinical bloggers. The mainstream HIT world had remarkably little initial reaction to the Report. 
  • Respectful of the imprimatur of “The President’s” Report and noting some of the big names associated with the report (e.g., Google’s Eric Schmidt and Microsoft’s Craig Mundie.)
  • Focused on technical and/or clinical perspectives around two broad themes.
    • The vision is on target:  “extraordinary”, “breathtakingly innovative”.
    • These guys didn’t do all their technical homework. The range varies, but the message is consistent. 

Today’s POV on PCAST 

What  a difference a six weeks makes. 

Verizon Abandoning Walled Garden Network & Business Model: Implications for Healthcare

Wha…?  why are we talking about Verizon…isn’t is a healthcare blog?

When a major, multinational company does a complete turnaround on its operating and business model, it’s worth noting and examining the reasons behind the switch.

Wireless Week reported on a presentation made at the CTIA conference this week by Verizon COO, Lowell McAdam:

In a nod to the future, McAdam also said Verizon Wireless will scratch its “walled garden” approach because “in a 4G world, we need to turn that guarded model inside out.” The operator will transform its business model, he said, because it realizes that innovation in applications and use will come from outside the company.  Verizon will open its network, applications and location technologies to outside developers…[emphasis added].

Ars Technica reported further on McAdam’s commentary: 

I think collaboration and openness will be the operating platform for the future if we’re to bring the full promise of what 4G LTE brings. That’s really the new paradigm, the new model for operating in the entire wireless industry.

“Now I know that some of you in the audience are saying, ‘C’mon Lowell, you guys are the poster child for walled garden.’ What I’d say is that for the first 25 years that garden approach of closed systems served the industry pretty well. But in a 4G I think we need to turn that garden model inside out.”

How big a deal is this? Here’s an imaginary comparable statement that might be made by Judy Faulkner, CEO of Epic:

Digital Medical Office of the Future Conference. Las Vegas, Sept. 9-10

CLICK HERE FOR THE CONFERENCE WEBSITE

Healthcare providers face critical choices in selecting and implementing Electronic Health Records (EHRs). In addition, physicians and hospitals will need to develop the capacity to exchange clinical information in order to meet Meaningful Use requirements. This program will offer detailed and practical information on EHR selection and implementation, as well as strategies for creating a sustainable health information exchange (HIE). The program also features sessions on legal/regulatory issues, clinical platforms and applications as well as strategies for optimizing workflow in order to accelerate clinical transformation.

Distinguished Speakers Include:

Steve Adams, Executive Vice President, Collaborative Care, Alere & President, Clinical Groupware Collaborative
Mark R. Anderson, FHIMSS, CPHIMS, CEO & Healthcare IT Futurist, AC Group, Inc.
Beverly Bell, RN, MHA, CPHIMS, FHIMSS, Partner, Clinical Implementation Practice Director, CSC Healthcare Group
Soma Bulusu, MS, CIO, Marin General Hospital
Proteus Duxbury, Managing Consultant, PA Consulting Group
Andrew Ganti, MSIE, Principal, Workflow IT Solutions
Kennedy Ganti, MD, Virtua Lumberton Family Physicians & Chair, New Jersey Health Information Technology Commission
Arthur Gasch, Founder, Medical Strategic Planning, Inc. & Author of Successfully Choosing Your EMR: 15 Crucial Decisions (Wiley Press)
David C. Kibbe, MD MBA, Senior Advisor, American Academy of Family Physicians & Principal, The Kibbe Group LLC
Vince Kuraitis, JD, MBA, Principal, Better Health Technologies, LLC
Arien Malec, Coordinator, NHIN Direct, Office of the National Coordinator for Health Information Technology
Debbie Newman, MBA, CPHIMS, Director of Process Improvement, Licking Memorial Health Systems
Gordon Norman, MD, MBA, EVP & Chief Innovation Officer, Alere
Keith Parker, Regional Extension Center, Nevada
Deborah Smith, PhD, Chief Strategic Planning and Quality Officer, Alaska Native Tribal Health Consortium
Carlos Vigil, DO, Internal Medicine Physician & CEO, United Hospitalist Group

Platinum Sponsor: Ingenix
Silver Sponsors: AC Group, Inc., Medical Strategic Planning, Inc., NextGen Healthcare
Bronze Sponsors: Cerner Ambulatory, EHS

CLICK HERE FOR THE CONFERENCE WEBSITE

For additional information, please contact TCBI:
Ph: 310-265-2570               Email: info@tcbi.org

Is HITECH Working? #4: While most attention has been focused on demand side incentives (will doctors and hospitals buy EHRs?), the supply (vendor) side of HIT is already transforming.

by Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA

Most of the press coverage and attention to HITECH has been to the “buy” side of the market:  The central question here has been: “Will doctors and hospitals buy and use EHR technology?”

Meanwhile — and much more quietly — the sell (vendor) side of the EHR market is already dramatically different than it was a year ago. We observe change occurring at at least three levels:

  1. HITECH as Policy Change
  2. HITECH as Mindset Change
  3. HITECH as Technology/Business Model Change

Complimentary Webinar: Introduction to Clinical Groupware and the Clinical Groupware Collaborative

CGCWebinar

BrightTALK is sponsoring a complimentary Electronic Health Record Summit this Tuesday, October 20, 2009.

David C. Kibbe MD, MBA and I will be presenting “Introduction to Clinical Groupware and the Clinical Groupware Collaborative”

Clinical groupware is a new and evolving model for the development and deployment of health information technology (HIT) platforms and applications having the following characteristics:

  • Use of the Internet and the web for EHR technology.
  • Explicit design for information sharing and online communication among providers and patients/consumers.
  • A modular or component architecture upon which applications can be aggregated to meet specific clinical and workflow tasks.
  • Patient/consumer engagement tools that facilitate ongoing health management and care coordination.
  • Interface and data exchange standards for information sharing that emerge in a market-driven manner.

The Clinical Groupware Collaborative is in a formative stage organization. To date, representatives from over 50 companies have expressed interest. We are working to be formally incorporated in November 2009.

To register, attend live, or view afterward on-demand, click the following link:  http://www.brighttalk.com/webcasts/6114/attend  

Here’s a full listing of the other Electronic Health Record Summit presentations:   

Kaiser Permanente’s Journey and Ultimate Success with Health IT, Andrew M. Wiesenthal, The Permanente Federation

Prescribing the Best Security for Your EHR System, Andrew Klein, Product Management at SonicWALL

Business Associates Now and Then: HIPAA, EHRs and the HITECH Act, Susan Miller, Security & Privacy Workgroup Chair, WEDI

Fraud & Abuse in the EHR, Jean Bishop, J Bishop Consulting

New HIPAA Rules and EHRs: ARRA & Breach Notification, Raj Goel, Brainlink International; Jim Sheldon-Dean, Lewis Creek Systems

Three Forcing Factors of Electronic Healthcare Records, Kim Singletary, McAfee

How Great EHRs Empower Participatory Medicine, e-Patient Dave deBronkart, Society for Participatory Medicine co-chair

Meeting Announcement: “Introduction to the Clinical Groupware Collaborative”

by Steve Adams, CEO, RMD Networks and Acting President, Clinical Groupware Collaborative  

Steve

I’m writing to extend a warm personal invitation to learn more about the Clinical Groupware Collaborative (CGC).  To-date, purely through word-of-mouth over 40 companies have expressed interest in the CGC, and we expect that you’ll be hearing a lot more about us over the coming months.

Our meeting will take place next Tuesday, September 22, 6 PM in conjunction with The Forum 09, the annual meeting of DMAA: The Care Continuum Alliance.  More details are provided at the bottom of this post.

I’ll address a few questions that might be on your mind.

Q. What is Clinical Groupware? 

What’s a Network Industry? Is Healthcare One?

Network

This post is a foundational overview of characteristics of network industries.  Much of the terminology will deserve deeper discussion, but we have to start somewhere.

In his book The Economics of Network Industries, Professor Oz Shy lists four characteristics of network industries.

The main characteristics of these markets which distinguish them from the market for grain, dairy products, apples, and treasury bonds are:

  1. Complementarity, compatibility and standards
  2. Consumption externalities [network effects]
  3. Switching costs and lock-in
  4. Significant economies of scale in production

In this essay, I’ll quote from Dr. Shy in explaining each of these characteristics.  I’ll also offer a few thoughts as to how these characteristics apply to healthcare. More specifically, I’ll discuss physician adoption of EHRs (electronic health records) and patient adoption of PHRSs (personal health record systems).  

Why a PHRS instead of a plain old PHR?  Think of a PHRS as a PHR data repository platform bundled with multiple high-value applications. For a more detailed explanation, read here.   

Let’s look at the characteristics of network industries one at a time.

Table of contents for the series--Healthcare Crosses the Chasm to the Network Economy

  1. Intro to a New Series
  2. What’s a Network Industry? Is Healthcare One?
  3. We’re Building a REALLY BIG Health Internet!

“Meaningful Use” Criteria as a Unifying Force

by Vince Kuraitis, Steve Adams, and David C. Kibbe MD, MBA

Over the past several years, many diverse initiatives have arisen offering partial solutions to systemic problems in the U.S. health care non-system. 

We see Meaningful Use Criteria recommended by the HIT Policy Committee as a unifying force for these previously disparate initiatives. These initiatives have included:

  • Patient Centered Medical Homes (PCMHs)
  • Regional Health Information Organizations (RHIOs)/Health Information Exchanges (HIEs)
  • Payer Disease/Care Management Programs
  • Personal Health Record Platforms — Google Health, Microsoft HealthVault, Dossia, health banks, more to come
  • State/Regional Chronic Care Programs (e.g., Colorado, Pennsylvania, Improving Performance in Practice)
  • Accountable Care Organizations — the newest model being proposed as part of national reform efforts

Today

While there are some commonalities and overlap, to-date these initiatives have mostly arisen in isolation and are highly fragmented — they’re all over the map. Here’s a graphic representation of the fragmentation that exists today:

MU1

 

Tomorrow

The HIT Policy Committee recently recommended highly detailed Meaningful Use criteria for certified EHRs.  Doctors and hospitals who hope to receive HITECH Act stimulus funds will have to demonstrate that they are meeting these criteria; the criteria are not yet finalized.

The Committee website describes the central role of the Meaningful Use criteria:

The focus on meaningful use is a recognition that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care.

The HIT Policy Committee also is recognizing that there are multiple routes to achieving Meaningful Use beyond the traditional EMR 1.0, e.g., modular Clinical Groupware software.

While some might view the Meaningful Use criteria as limited to the world of health IT — something happening “over there” — we see much more going on. We believe the Meaningful Use criteria are becoming a powerful unifying force across the health system, with potential to converge previously disparate initiatives.  Here’s our conceptual representation:

Overcoming The Penguin Problem: Setting Expectations for EHR Adoption

Penguins3

 

 

 

 

 

 

 

 

Economists call it “The Penguin Problem”  — No one moves unless everyone moves, so no one moves. 

The role of user expectations is crucial in getting penguins to move off of ice floes and in the successful adoption of new network technologies.  I’ll cover two main points in today’s essay:

  • How “The Penguin Problem” Helps Explain Low EHR (electronic health record) Adoption To-Date
  • How Recent Federal Actions Are Setting Higher Expectations for EHR Adoption

The Penguin Problem and Low EHR Adoption To-Date

While not the only factor, the role of user expectations is a crucial element in explaining the adoption of new network technologies. Harvard Business School Professor Tom Eisenmann explains: