My guess is you’ve probably never asked yourself this question. A quick preview:
- Technical barriers aren’t the limiting factors to Facebook becoming a care coordination platform.
- Facebook’s company DNA won’t play well in health care.
- Could Facebook become the care coordination platform of the future? If not Facebook, then what?
1) Technical barriers aren’t the limiting factors to Facebook as a care coordination platform.
Can you imagine Facebook as a care coordination platform? I don’t think it’s much of a stretch. Facebook already has 650 million people on its network with a myriad of tools that allow for one-to-one or group interactions.
What would it take to make Facebook a viable care coordination platform?
- More servers to handle the volume — not a problem
- Specialized applications suited for health care conditions — not a problem
- Privacy settings that made people comfortable — more on this later
- A mechanism to identify and connect the members of YOUR care team — really tough, BUT this is NOT a technological problem, but a health system one
Suppose you are a 55–year-old woman who is a brittle diabetic. Your care team might include a family physician, an endocrinologist, a registered dietitian, a diabetic nurse, a ophthalmologist, a podiatrist, a psychologist, and others. Ideally you’d have one care plan that coordinates the care among members of the team, including you.
What’s the reality of today’s health care non-system?
- There is no formal designation of “your team.”
- There is no mechanism to designate one “plan” that coordinates the plays among your team members.
- It’s possible that multiple quarterbacks are calling the plays for your care.
- It’s possible that members of your team have no knowledge THAT you are being treated by others and HOW you are being treated by others.
Care coordination today is in the stone ages — there is no system for care coordination.
Supplying a modern Facebook-type technology platform doesn’t change this. The major limiting factors in Facebook’s becoming a care coordination platform aren’t technological.
Let’s look a bit deeper.
Deven McGraw is the Director of the Health Privacy Project at the Center for Democracy & Technology.
The Health 2.0 movement has seen incredible growth recently, with new tools and services continuously being released. Of course, Health 2.0 developers face a number of challenges when it comes to getting providers and patients to adopt new tools, including integrating into a health system that is still mostly paper-based. Another serious obstacle facing developers is how to interpret and, where appropriate, comply with the HIPAA privacy and security regulations.
Questions abound when it comes to Health 2.0 and HIPAA, and it’s vital we get them answered, both for the sake of protecting users’ privacy and to ensure people are able to experience the full benefits of innovative Health 2.0 tools. We can’t afford to see the public’s trust in new health information technology put at risk, nor can we afford to have innovation stifled.
To help solve this problem, the Center for Democracy & Technology (CDT) has launched a crowdsourcing project to determine the most vexing Health 2.0/HIPAA questions.
This is where you come in:
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.
The September issue of Wired magazine and an article in last Sunday’s New York Times illustrate a central debate in technology circles. The debate is not new — it’s being going on for two decades — but it has newfound vibrancy. The essence of the debate is about competing tech/business models: walled gardens vs. the open world wide web (web).
The debate is highly controversial and nuanced. There are “experts” on both sides.
My point today is not to take sides (although I’ll admit my canine partiality to the open web), but rather:
- to point out that the debate is occurring
- to explain what the discussions are about
- to suggest that competition between walled gardens vs. the open web is creating healthy competition and providing consumers with great choices (e.g., Apple iPhone as a walled garden vs. Google Android OS as a more open approach)
- to point out that health care has not had much to say in this debate…until very recently.
A while back I started writing a series “Healthcare Crosses the Chasm to the Network Economy” . This essay continues that series.
OK, let me be the first to admit that today’s “just-the-facts-ma’am” post might be a little dry…but trust me, its really important stuff to know in understanding the process of how the Health IT Policy Committee (HITPC) and its workgroups are approaching formulating recommendations for HITECH Stages 2 and 3.
At this point at least two different workgroups are involved in developing recommendations for HITECH Stages 2 and 3.
A newly formed Quality Measures Workgroup
. This group will “produce initial recommendations on quality measure prioritization and the quality measure convergence process pertaining to measure gaps and opportunities for Stage 2 Meaningful Use”. The group is chaired by Dr. David Blumenthal and held its first meeting
on September 10.
The Meaningful Use (MU) Workgroup
. Most recently, the MU Workgroup solicited expert testimony on Care Coordination (August 5) and Population Health (July 29).
Important recent HITPC and Workgroup activities are summarized below.
Who has the most comprehensive data about YOUR clinical conditions?
For most people, the answer today is “your health plan”, but it’s not at all clear that health plans will continue to have this role in the future.
As physicians and hospitals adopt EHRs, it’s foreseeable that clinical data about patients will be far more available and accessible.
Will patient data become:
- A jockeying point for control and business advantage between health plans and care providers,
- A collaborative opportunity to optimize clinical care and care coordination, or
by Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA
Pop quiz: Among early-stage companies that are successful, what percentage are successful with the initial business model with which they started (Plan A) vs. a secondary business model (Plan B)?
Harvard Business School Professor Clay Christensen studied this issue. He found that among successful companies, only 7% succeeded with their initial business model, while 93% evolved into a different business model.
So let’s take this finding and reexamine our human nature. In light of these statistics, what makes more sense:
- Defending Plan A to your dying breath?
- Assuming Plan A is probably flawed, and anticipating the need for Plan B without getting defensive?
We question many of the assumptions underlying HITECH Plan A. We also want to talk about the need and content for Plan B in a constructive way.
In this essay we’ll discuss:
1) The Need for HITECH Plan B
2) Questioning Assumptions — Issues to Reconsider in Plan B
a) Rewarding Incremental Progress
b) Addressing Root Causes for Non-adoption of EHR Technology
c) Questioning Health Information Exchanges (HIEs) as Building Blocks for the Nationwide Health Information Network (NHIN)
d) Catalyzing Movement Toward Modular EHR Technology
e) Focusing Incentives on High Leverage Physicians
f) Recalibrating Expectations for EHR Technology Adoption
g) Getting Bang-for-the-Buck in Achieving Meaningful Use Objectives
h) Comprehensively Revamping Privacy/Security Laws vs. Tweaking HIPAA
i) Maximizing Sync Between HITECH and PPACA
j) Leveraging Potential for Patient-Driven Disruptive Innovation
k) Promoting EHR Adoption Beyond Hospitals and Physicians, e.g., long-term care, home health, behavioral health, etc.
l) Dumping Certification
3) Summing Up
We concluded our last post in this series with a blunt prediction that “key physicians will sit on the sidelines” and that clinician non-adoption of EHR technology is a potential “deal-breaker for the success of HITECH”.
While this might sound like a criticism of the way HITECH has been implemented, it’s not intended that way — it’s a commentary on 1) the complexity and scope of change that will be required to make HITECH successful, and 2) the level of protective entrenchment existing American health care today.
Rather, we believe that the Office of the National Coordinator (ONC) for Health IT – Dr. David Blumenthal and his staff — have done a superb job in interpreting and defining key aspects of HITECH legislation. We’re big fans.
For those of you who have been following our writings over the past 18 months, think of this post as a summary and status report on the extensive incumbent (cat) vs. innovator (dog) dialogue:
A Recap — The Stagnant Electronic Medical Record (EMR) Market Before 2009
ONC Gets It Right In Three Major Interpretations and Definitions of HITECH
a) Meaningful Use (MU) Emphasizes “Meaningful”, Not “Use”
b) Vendors Get a Level Playing Field With Certification
c) Lightweight, Open Standards Promote EHR Interoperability and Modularity
by Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA
The rationale for hospitals having to play in the HITECH game is straightforward: the financial carrots through 2015 are helpful, and the financial sticks after 2015 will be very painful.
- Financial Impacts on Hospitals
- Survey Data Showing Hospitals Will Play
- Why Success is Not Guaranteed
Financial Impacts on Hospitals
Even prior to HITECH, most hospital executives already had passed the threshold decision and concluded that they need to implement EHR technology. Thus, the issue for most hospitals isn’t “whether” to implement EHR technology, but “when”, “at what cost”, and “how”.