"Things come from civilian medicine, and then we take it into the cauldron of the war and focus it, test it and evaluate it, and then use it many, many, many more times than the civilians have. And then whatever spits out in the end is better.”
Army Col. John Holcomb, M.D. commander of the U.S. Army Institute of Surgical Research, 2007
On this Memorial Day, it is time to remember, celebrate, and commemorate military doctors.
We sometimes forget military doctors have served in every American war since 1775.
We sometimes forget lessons learned and innovations developed by military doctors carry over to civilian life in operating rooms, trauma, and rehabilitation centers across the land.
We sometimes forget doctors in the Spanish-American war learned mosquitoes cause yellow fever, in World War I that transfusions saved lives, in World War II that penicillin and sulfa drugs were indispensable for treating infections, in Korea and Vietnam that prompt helicopter evacuations reduced death tolls, and in Iraq and Afghanistan that hemorrhage can be stopped on the spot by new types of bandages and drugs.
We sometimes forget that military medicine in times of war is very intense because of new treatment methods, recognition that time passed before treatment is the enemy of life. For the military physicians, there’s no wasted moments, no wasted movements, military treatment is very, very focused.
We sometimes forget we have a medical school, the Uniformed Services University in Bethesda devoted to educating and training doctors for military duty in peace and war.
We sometimes forget that 80% of our civilian doctors spent part of their education and training in Veterans Hospitals affiliated with teaching centers.
We sometimes forget our military hospitals – Walter Reed in Washington, over 190 Veterans Hospitals comprising the largest hospital system in the world, and military clinics q43 strewn all across the U.S. and over the world. Sometimes these hospitals even exist in the sky, during flights from Iraq to Germany.
We sometimes forget that the famed comedy series MASH (Mobile Army Surgical Hospitals) was based on a book MASH: A Novel About Three Army Doctors, was written by an Army surgeon, Richard Hooker, MD. With death and chaos of war, sometimes comes humor. But risk also comes, especially in wars without front lines. Doctors, nurses, and other medical personnel in Balad in northern Iraq are ordered to carry firearms.
We sometimes forget that the managerial and leaderships experiences gained in the military carry over into civilian life. In the armed services, doctors learn to organize, to treat populations of patients, to train paraprofessionals, to function and work as teams, and to improvise and innovate.
So let us not forget on this day our heroes – military doctors
Monday, May 31, 2010
Sunday, May 30, 2010
Observations of a Techno-Skeptic and Telemedicine-Advocate
It is plausible to be skeptical while advocating technological solutions to human health care problems.
It depends on what the problem is:
• If the problem is health endangered by an implacable enemy, like the Vietgong or Al-Queda or the Taliban, room for skepticism exists. Geurillas or terrorists can always hide in the bushes or among followers.
• If the problem is changing human behaviors leading to drug addiction, alcoholism, or obesity, I am skeptical one can alter human mindsets through technological social engineering.
• If the problem is cultural – like poverty, poor education, economic malaise, or disintegrating family conditions, crime or violence – it is important to remember most of these conditions or beyond the reach of medical technologies.
• If the problem is a natural disaster – like an underwater well gushing oil, an erupting volcano spewing ash, a hurricane, a tsunami, or a tornado wreaking havoc – technologies has limitations.
• If the problem is human aging , curing all cancers, and prolonging useful life beyond 100, medical technologies , no matter how sophisticated, are unlikely to succeed.
Yet we , as the New York Times reminds us “ Our Fix-It Faith, May 30, 2010), “Americans have long had an unswerving belief that technology will save us – it is the cavalry coming over the hill, just as we are about to lose the battle."
As Andrew Kohut, president of the Pew Research Center, remarks, “Americans have a lot of faith that over the long run technology will save everything that somehow we’re going to find a way to fix it.”
I believe this faith is well-founded when it comes to information technologies
• If the problem is educating patients to understand how to cope with diseases that afflict themselves or others with the same condition, I believe websites like www.PatientsLikeMe.com or www.CureTogether.com are useful and instructive.
• If the problem is using the Internet to empower consumers to take control of their health and spot value among providers, information technologies have a bright future.
• If the problem is lowering costs and gaining direct access to medical expertise, like rural regions, prisons, remote locations, worksite or offshore clinics, astronauts in space, travelers abroad, and the home, using videos to consult a doctor without leaving where you are will lower costs and improve care.
Interactive videos, and face-to-face telemedicine, is gaining market share, investors, and health plan payer support each day, as costs rise, technologies improve, reimbursement grows, video-quipped booths in retail clinics proliferate, audio video devices next to the bedsides of chronically ill, home bound patients become popular , patient and doctor satisfaction grows, and new physician-directed, venture backed companies like www. Nuphysicia.com sprout..
Suddenly, as costs rise, the interactive telemedicine business has gone mainstream , growing 10 percent each year and garnering more than $500 million in annual revenues. TDistance may no longer hinder physician access.
It depends on what the problem is:
• If the problem is health endangered by an implacable enemy, like the Vietgong or Al-Queda or the Taliban, room for skepticism exists. Geurillas or terrorists can always hide in the bushes or among followers.
• If the problem is changing human behaviors leading to drug addiction, alcoholism, or obesity, I am skeptical one can alter human mindsets through technological social engineering.
• If the problem is cultural – like poverty, poor education, economic malaise, or disintegrating family conditions, crime or violence – it is important to remember most of these conditions or beyond the reach of medical technologies.
• If the problem is a natural disaster – like an underwater well gushing oil, an erupting volcano spewing ash, a hurricane, a tsunami, or a tornado wreaking havoc – technologies has limitations.
• If the problem is human aging , curing all cancers, and prolonging useful life beyond 100, medical technologies , no matter how sophisticated, are unlikely to succeed.
Yet we , as the New York Times reminds us “ Our Fix-It Faith, May 30, 2010), “Americans have long had an unswerving belief that technology will save us – it is the cavalry coming over the hill, just as we are about to lose the battle."
As Andrew Kohut, president of the Pew Research Center, remarks, “Americans have a lot of faith that over the long run technology will save everything that somehow we’re going to find a way to fix it.”
I believe this faith is well-founded when it comes to information technologies
• If the problem is educating patients to understand how to cope with diseases that afflict themselves or others with the same condition, I believe websites like www.PatientsLikeMe.com or www.CureTogether.com are useful and instructive.
• If the problem is using the Internet to empower consumers to take control of their health and spot value among providers, information technologies have a bright future.
• If the problem is lowering costs and gaining direct access to medical expertise, like rural regions, prisons, remote locations, worksite or offshore clinics, astronauts in space, travelers abroad, and the home, using videos to consult a doctor without leaving where you are will lower costs and improve care.
Interactive videos, and face-to-face telemedicine, is gaining market share, investors, and health plan payer support each day, as costs rise, technologies improve, reimbursement grows, video-quipped booths in retail clinics proliferate, audio video devices next to the bedsides of chronically ill, home bound patients become popular , patient and doctor satisfaction grows, and new physician-directed, venture backed companies like www. Nuphysicia.com sprout..
Suddenly, as costs rise, the interactive telemedicine business has gone mainstream , growing 10 percent each year and garnering more than $500 million in annual revenues. TDistance may no longer hinder physician access.
Friday, May 28, 2010
Memorial Day Washington Report on Sustainable Growth Rate Fix for Doctors
The Physicians Foundation regularly features “The Washington Report.” Lee Stillwell, Founder of the Stillwell Group, a public affairs consulting group in the nation’s capitol, writes the report.
Stillwell has worked for a Western Republican, an Eastern Democrat, and the AMA Advocacy Group. In his report, he gives Physician Foundation members a candid look inside Beltway politics.
In his Memorial Day report, Stillwell focuses on the continuing saga of the Sustainable Growth Rate (SGR) formula. Congress uses this formula as the basis for paying physicians for Medicare services.
For the last ten years, Congress has been unwilling and unable to fix the SGR to pay doctors at rates which they can sustain their practices in order to continue to see existing and new Medicare patients. Congress, in short, seems incapable of delivering on its promises to provide physician access to Medicare patients or even to deliver on its pay-go promises.
The reasons for Congressional fiddling, dithering, and stalling are political and economic.
According to Stillwell,
“First, take a look at the fiscal impact at the years of delay in fixing the SGR. The Congressional Business Office (CBO) estimate indicates the price tag for a “doc fix” now is $275 billion through 2010, assuming it is a freeze. That is a 33 percent increases from last year’s legislative projections of $207 billion. Now, if you were to include cost-based raises fo this period in the 0.7 percent to 1.8 percent, the costs climb to $329.9 billion. . If you gave physicians a modest two percent raise, the costs climb to $374.2 billion!”
Congress, if you’ll recall, promised Obamacare would cost under $1 trillion over the next 10 years – a number the OMB just shattered by estimating it would cost an extra $115 billion to implement. Add over $300 billion to that, and you blast the $1 trillion figure to smithereens.
Stillwell observes,
“The estimates, quite frankly, drive the nail in the coffin, killing efforts for a long-term fix. A Congress and Administration that has spent and spent now refuses to offset these mounting costs under the pay-go promises.”
Stillwell goes on,
“Whether another 30-day extension, or a longer temporary fix, will be adopted when Congress returns from next week’s Memorial weekend recess, SGR fatigue will grow among physicians, tired and weary with this political consequences.”
What would the political consequences if Congress fails to rescind the 21.3% SGR cut scheduled for June 1? It won’t happen, of course, Congress will kick the fix further down the road.
But if it did not executive a temporary fix, Stillwell says,
“An informal AMA survey found that 68 percent of physicians would either stop taking new Medicare patients or stop seeing Medicare patients altogether if the 21.3 percent were to take effect.”
An American Osteopathic survey indicated 37 percent would not accept new Medicare patients, 32 percent said they might, and 30 percent said they would.
With 78 million baby boomers coming on board the Medicare train in 2011 at the rate of 13,000 each day, doctors not accepting new Medicare patients would put Congress in a pretty political pickle, with a good chance of incumbent members drowning in the electoral pickle barrel. A physician access crisis will be upon us, and it will dwarf the growing current discontent over Obamacare. The latest Rasmussen poll indicates 64 percent disapprove of the health care bill, versus 32 percent who approve. This is the first time disapproval has exceeded 60 percent.
The information contained in this blog does not necessarily reflect the views or position of the Physicians Foundation or its Board members or of Lee Stillwell in the Washington Report or of the Stillwell group.
Stillwell has worked for a Western Republican, an Eastern Democrat, and the AMA Advocacy Group. In his report, he gives Physician Foundation members a candid look inside Beltway politics.
In his Memorial Day report, Stillwell focuses on the continuing saga of the Sustainable Growth Rate (SGR) formula. Congress uses this formula as the basis for paying physicians for Medicare services.
For the last ten years, Congress has been unwilling and unable to fix the SGR to pay doctors at rates which they can sustain their practices in order to continue to see existing and new Medicare patients. Congress, in short, seems incapable of delivering on its promises to provide physician access to Medicare patients or even to deliver on its pay-go promises.
The reasons for Congressional fiddling, dithering, and stalling are political and economic.
According to Stillwell,
“First, take a look at the fiscal impact at the years of delay in fixing the SGR. The Congressional Business Office (CBO) estimate indicates the price tag for a “doc fix” now is $275 billion through 2010, assuming it is a freeze. That is a 33 percent increases from last year’s legislative projections of $207 billion. Now, if you were to include cost-based raises fo this period in the 0.7 percent to 1.8 percent, the costs climb to $329.9 billion. . If you gave physicians a modest two percent raise, the costs climb to $374.2 billion!”
Congress, if you’ll recall, promised Obamacare would cost under $1 trillion over the next 10 years – a number the OMB just shattered by estimating it would cost an extra $115 billion to implement. Add over $300 billion to that, and you blast the $1 trillion figure to smithereens.
Stillwell observes,
“The estimates, quite frankly, drive the nail in the coffin, killing efforts for a long-term fix. A Congress and Administration that has spent and spent now refuses to offset these mounting costs under the pay-go promises.”
Stillwell goes on,
“Whether another 30-day extension, or a longer temporary fix, will be adopted when Congress returns from next week’s Memorial weekend recess, SGR fatigue will grow among physicians, tired and weary with this political consequences.”
What would the political consequences if Congress fails to rescind the 21.3% SGR cut scheduled for June 1? It won’t happen, of course, Congress will kick the fix further down the road.
But if it did not executive a temporary fix, Stillwell says,
“An informal AMA survey found that 68 percent of physicians would either stop taking new Medicare patients or stop seeing Medicare patients altogether if the 21.3 percent were to take effect.”
An American Osteopathic survey indicated 37 percent would not accept new Medicare patients, 32 percent said they might, and 30 percent said they would.
With 78 million baby boomers coming on board the Medicare train in 2011 at the rate of 13,000 each day, doctors not accepting new Medicare patients would put Congress in a pretty political pickle, with a good chance of incumbent members drowning in the electoral pickle barrel. A physician access crisis will be upon us, and it will dwarf the growing current discontent over Obamacare. The latest Rasmussen poll indicates 64 percent disapprove of the health care bill, versus 32 percent who approve. This is the first time disapproval has exceeded 60 percent.
The information contained in this blog does not necessarily reflect the views or position of the Physicians Foundation or its Board members or of Lee Stillwell in the Washington Report or of the Stillwell group.
Thursday, May 27, 2010
Practice Interruptus: Those Invisible, Inevitable Interruptions
The world teems with practice management experts.
They are full of advice telling doctors how to practice more efficiently: consolidate time, delegate to others, avoid useless meetings, have patients submit questions to be answered, let nothing interrupt time with patients.
But somehow: bureaucracy always wins, it’s not over until the paperwork is done, the telephone and the computer are enemies. In other words, Interruptus Uber Alles.
Don’t take my word for it.
Richard Baron, MD, an internist in a small group in Philadelphia, using electronic health records, documented exactly how many phone calls, emails, prescription refills and lab reports he and his colleagues handled during an average day in 2008. His analysis gives a peek into the “invisible” work not involving a patient visit. Here’s a breakdown of the metrics per doctor, per day:
• 23.7 telephone calls, most of which the doc handled directly
• 16.8 emails, most for interpreting test results
• 12.1 prescription refills, not including those part of a patient visit
• 19.5 lab reports
• 11.1 imaging reports
• 13.9 consult reports
A group of Australian researchers carried out a time-and-motion study in the emergency department of a 400-bed teaching hospital, observing 40 doctors for more than 210 hours.The researchers found each doctor was typically interrupted 6.6 times per hour; 11 percent of all tasks were interrupted, 3.3 percent of them more than once. They calculated time spent on tasks and found that physicians spent less time on interrupted tasks than on uninterrupted tasks. In addition, doctors were multitasking 12.8 percent of the time. Doctors did not return to 18.5 percent of the interrupted tasks.
Wesley Curry, MD, a California ER physician, says the computer is a big time interrupter. He spends 2-3 hours each workday logging in, inputting or requesting information, and logging out of 6 to 8 software programs that have become mandatory in the patient encounter. One program may be for obtaining lab results, one for x-ray, one for discharge, one for recalling past charts, and so forth – and each one log-in log-out requires more time for getting through the various security screens which shut down the program if there is no activity after a few minutes, when the provider is away from the computer seeing patients. logging takes at least 30 seconds to one minute for each program, and in aggregate takes a significant amount of time which could be used to see patients. These programs help retrieve past medical records, and other useful information and document the encounter, but, he asserts. They have little value in creating real time efficiency. Proliferating independent electronic medical records and other software programs are simply not clinically useful yet.
Of this comedy of inefficiency, Groucho Marx might say,
Hello, Goodbye, I’ve got to be going, I’ve outlived my stay.
Because you again interrupt,
I really must be abrupt.
My time, it’s gone that away.
They are full of advice telling doctors how to practice more efficiently: consolidate time, delegate to others, avoid useless meetings, have patients submit questions to be answered, let nothing interrupt time with patients.
But somehow: bureaucracy always wins, it’s not over until the paperwork is done, the telephone and the computer are enemies. In other words, Interruptus Uber Alles.
Don’t take my word for it.
Richard Baron, MD, an internist in a small group in Philadelphia, using electronic health records, documented exactly how many phone calls, emails, prescription refills and lab reports he and his colleagues handled during an average day in 2008. His analysis gives a peek into the “invisible” work not involving a patient visit. Here’s a breakdown of the metrics per doctor, per day:
• 23.7 telephone calls, most of which the doc handled directly
• 16.8 emails, most for interpreting test results
• 12.1 prescription refills, not including those part of a patient visit
• 19.5 lab reports
• 11.1 imaging reports
• 13.9 consult reports
A group of Australian researchers carried out a time-and-motion study in the emergency department of a 400-bed teaching hospital, observing 40 doctors for more than 210 hours.The researchers found each doctor was typically interrupted 6.6 times per hour; 11 percent of all tasks were interrupted, 3.3 percent of them more than once. They calculated time spent on tasks and found that physicians spent less time on interrupted tasks than on uninterrupted tasks. In addition, doctors were multitasking 12.8 percent of the time. Doctors did not return to 18.5 percent of the interrupted tasks.
Wesley Curry, MD, a California ER physician, says the computer is a big time interrupter. He spends 2-3 hours each workday logging in, inputting or requesting information, and logging out of 6 to 8 software programs that have become mandatory in the patient encounter. One program may be for obtaining lab results, one for x-ray, one for discharge, one for recalling past charts, and so forth – and each one log-in log-out requires more time for getting through the various security screens which shut down the program if there is no activity after a few minutes, when the provider is away from the computer seeing patients. logging takes at least 30 seconds to one minute for each program, and in aggregate takes a significant amount of time which could be used to see patients. These programs help retrieve past medical records, and other useful information and document the encounter, but, he asserts. They have little value in creating real time efficiency. Proliferating independent electronic medical records and other software programs are simply not clinically useful yet.
Of this comedy of inefficiency, Groucho Marx might say,
Hello, Goodbye, I’ve got to be going, I’ve outlived my stay.
Because you again interrupt,
I really must be abrupt.
My time, it’s gone that away.
Perspective: Who Speaks for America's 650,000 Independent Private Physicians, Part II
Who,
-talks of doctor’s desire for more personal patient relationships and the patient’s distaste for doctor switching , both caused by health plans changing physician networks,
- appreciates that most patients do not know doctors are forbidden to enter into private contractual relationships with patents should patients desire treatment outside of Medicare,
-contradicts the often-heard liberal message that the U.S. system ranks 37th in the world is based on a deeply flawed 10 year old WHO study that has since been repudiated by WHO itself,
-has ever heard of another WHO study ranking U.S. health care number one among other nations in “responsiveness” – more attention to patients, shorter waiting times, more amenities, and greater access to world-class care,
-reveals shortcomings of evidence-based care, i.e., care based on statistical data on large populations, which may have little relevance to individual patients,
-talks of diagnostic uncertainties, that vast gray zone of vague symptoms of unknown cause, which may require multiple tests and procedures before a diagnosis surfaces.
-informs patients that physicians can spend little time with them in order to gain the revenue to pay malpractice fees, staff overhead, rent, and other costs of doing business,
-has the courage to say that poor outcomes may rest on what patients do after leaving the doctors, i.e., returning to adverse life styles, not filling prescriptions, resorting to ineffective alternative therapies, rather what the doctor does or recommends in the presence of the patient.
-speaks of shortcomings of electronic medical records among doctors – the expense, maintenance costs, lack of return on investment, practice disruptions, 30% dies-installment rate, 25% drops in productivity, mixed records of efficiency and quality improvement, and lack of relevance to solo and small practices.
- forewarns government policy wonks that electronic medical records are virtually useless to doctors as communication tools unless physicians are able to enter progress notes using speech-recognition information, or to have access to useful diagnostic support information,
- to sum up, informs the outside world of the story of independent practitioners - the backbone of American medicine?
Who articulates these things?
I would like to say, I do. And I have in my blog, Medinnovation, in my books, and in www.modernmedicine. where I regularly submit blogs and interview national thought leaders.
But a more reliable , consistent, and prestigious source is the Physicians Foundation, a nonprofit C01C3 organization that represents all American doctors belonging to state medical societies. These societies are close to the ground and who know what moves them, what discourages them, and what is good and bad for their patients. Visit their website, www.physiciansfoundation.org, and listen to the beat of of the culture of individual physicians, who provide 80% of care for patients in the United States.
The information contained in this blog does not necessarily reflect the views or position of the Physicians Foundation or its Board members.
-talks of doctor’s desire for more personal patient relationships and the patient’s distaste for doctor switching , both caused by health plans changing physician networks,
- appreciates that most patients do not know doctors are forbidden to enter into private contractual relationships with patents should patients desire treatment outside of Medicare,
-contradicts the often-heard liberal message that the U.S. system ranks 37th in the world is based on a deeply flawed 10 year old WHO study that has since been repudiated by WHO itself,
-has ever heard of another WHO study ranking U.S. health care number one among other nations in “responsiveness” – more attention to patients, shorter waiting times, more amenities, and greater access to world-class care,
-reveals shortcomings of evidence-based care, i.e., care based on statistical data on large populations, which may have little relevance to individual patients,
-talks of diagnostic uncertainties, that vast gray zone of vague symptoms of unknown cause, which may require multiple tests and procedures before a diagnosis surfaces.
-informs patients that physicians can spend little time with them in order to gain the revenue to pay malpractice fees, staff overhead, rent, and other costs of doing business,
-has the courage to say that poor outcomes may rest on what patients do after leaving the doctors, i.e., returning to adverse life styles, not filling prescriptions, resorting to ineffective alternative therapies, rather what the doctor does or recommends in the presence of the patient.
-speaks of shortcomings of electronic medical records among doctors – the expense, maintenance costs, lack of return on investment, practice disruptions, 30% dies-installment rate, 25% drops in productivity, mixed records of efficiency and quality improvement, and lack of relevance to solo and small practices.
- forewarns government policy wonks that electronic medical records are virtually useless to doctors as communication tools unless physicians are able to enter progress notes using speech-recognition information, or to have access to useful diagnostic support information,
- to sum up, informs the outside world of the story of independent practitioners - the backbone of American medicine?
Who articulates these things?
I would like to say, I do. And I have in my blog, Medinnovation, in my books, and in www.modernmedicine. where I regularly submit blogs and interview national thought leaders.
But a more reliable , consistent, and prestigious source is the Physicians Foundation, a nonprofit C01C3 organization that represents all American doctors belonging to state medical societies. These societies are close to the ground and who know what moves them, what discourages them, and what is good and bad for their patients. Visit their website, www.physiciansfoundation.org, and listen to the beat of of the culture of individual physicians, who provide 80% of care for patients in the United States.
The information contained in this blog does not necessarily reflect the views or position of the Physicians Foundation or its Board members.
Wednesday, May 26, 2010
Perspective: Who Speaks for America's 650,000 Independent Private Physicians, Part I
Who,
-observes that independent physicians care for 80% of America’s patients,
-describes the physician culture – its belief system, desire for autonomy, and reliance on clinical judgment,
-deplores independent private practice decline, which has shrunk by about 10 % over the last 10 years? (See “The Independent Physician: Going, Going ….” NEJM. February 12, 2010),
-explains accelerating departures of private doctors into retirement, non-clinical careers, hospital employment, and new practice models devoid of 3rd party interference.
- comments at length on the fast-growing physician movement, locum tenens, traveling physicians for hire.
-says that much of American medicine’s costs stem from lack of competition, open-ended comprehensive plans, mandated guaranteed benefits, restrictive regulations, physician malpractice expenses, ensuing defensive medicine practices, and litigious practice environments,
- discerns that much of the so-called fraud and abuse occurs in Medicare and Medicaid and is perpetrated by non-physicians using stolen identities, rather than physicians in their practices,
-notes that hospital-based medicine, with salaried physicians, as opposed to ambulatory-based medicine conducted by private physicians, drives costs up,
-warns the American people about the impending doctor shortages, the coming access crisis, and longer waiting lines for doctor appointments,
-highlights polls indicating patients trust their doctors more than government data-wielding bureaucrats,
-tells Americans that only 2% of medical students are entering primary care, and that these are the physicians they are expected to visit to sort out problems and to coordinate care,
-points out to Americans that many of the new 34 million who may gain insurance will be assigned to Medicaid rolls and that fewer and fewer doctors will accept new Medicaid recipients because of low reimbursements,
-explains problems imposed by third parties that erode time spent with patients,
-documents that for every hour spent seeing patients, another hour is spent on paperwork and getting permission to perform a test or a procedure?
Who articulates these things?
I would like to say, I do. And I have in my blog, Medinnovation, in my books, and in www.modernmedicine.com, where I regularly submit blogs and interview national thought leaders.
But a more reliable , balanced, and prestigious source is the Physicians Foundation, a nonprofit C01C3 organization that represents all American doctors belonging to state medical societies. These societies are close to the ground. The Foundation and state societies know what moves physicians , what discourages them, what is good and bad for their patients, and how to improve the system.
Visit the Physicians Foundation website, www.physiciansfoundation.org, read about its charitable work, listen to the beat of the culture of individual physicians, who provide most of the care for patients in the United States.
Part II will be continued in my next Medinnovation blog.
The information contained in this blog does not necessarily reflect the views or position of the Physicians Foundation or its Board members.
Tuesday, May 25, 2010
A Doctor’s Reaction to Harvard Business School's List of Ten Health Care Transformative Innovations
I just ran across the Harvard Business School’s list of ten innovations written by Gardiner Morse for its Health Care Innovation Insight Center. You can find it on Google under "Ten Innovations That Will Transform Medicine."
Here is how I react on a scale of One to Ten as someone who has frequently trekked down the health care innovation road.
ONE, CHECK LISTS- Hospitals will require health care providers to follow strict protocols for procedures that benefit from routinization—from preparing a patient for surgery to inserting a central line.
I’ll give this a EIGHT , But with this caveat: giving a doctor a checklist for each patient is not the same as giving pilot a checklist when 200 passengers are on board.
TWO, BEHAVIORAL ECONOMICS - Health care will incorporate insights from behavioral economics–everything from weight loss incentives to using peer pressure to change how doctors work.
Barely a SEVEN. Put me down as dubious. Changing ingrained lifestyles and doctors’ practice styles isn’t easy.
THREE, PATIENT PORTALS - Consumers will use secure web connections to make and check appointments, see lab results, renew prescriptions, and communicate with doctors and nurses.
Definitely an EIGHT. We’re getting there as personal computers with broad band access become ubiquitous.
FOUR, PAYMENT INNOVATION - Payment schemes that reward good outcomes and value rather than volume of procedures will become the norm.
At best a FOUR. Good patient outcomes are often beyond the reach of doctors. Patients may return to bad habits and often don’t comply with instructions.
FIVE, EVIDENCE-BASED DECISION MAKING - Electronic medical records collect important information for coordinated care, and physicians and nurses are alerted to potential errors and best practices.
A mere FIVE. The thesis that EMRs improve care is unproven. EMRS may generate more errors. Medicine is still full of uncertainties without evidence and is still Art as well as Science. Still depends on relationships, not necessarily on”facts,” and the placebo effect is powerful.
SIX, ACCOUNTABLE CARE ORGANIZATIONS – Hospitals and doctors will coordinate care for shared patients in order to keep them well-rather than simply treat them when they’re sick-and share in savings that result from improved quality.
A weak FIVE. This assumes doctors will join multispecialty groups and integrated delivery systems, often hospital-based. Reverse may be occurring as patients seek more private personal care, and as doctors form concierge and cash-only practices and shun 3rd party care.
SEVEN, REGENERATIVE MEDICINE - Stem cell research will lead to treatments for cancer, multiple sclerosis, spinal cord injuries, and other intractable conditions.
A hopeful FIVE- I hope this is so, but I have yet to see concrete evidence. Body remains a mysterious “black box.” Mysteries may take years to unravel.
EIGHT, VIRTUAL VISITS - Health care will be done at a distance with videoconferencing and remote monitoring of blood sugar, blood pressure, heart rate, and other health data.
A strong
NINE. I agree, as this is happening rather fast as health plans pay for virtual visits and as remote monitoring improves. Problems remain on how to pay for it, how to across care jurisdictions, and how to minimize malpractice tangles.
NINE, GENETIC MEDICINE - Individual genetic profiles will help doctors to prescribe the most effective treatments, tailored to the patient.
A SEVEN. This is becoming routine in evaluating predisposition to breast cancer. And I notice Walgreen put a kit for 42 DNA profiles on market before withdrawing it. We shall see what happens in this political controversy fraught field which smacks of social engineering.
TEN, SURGICAL ROBOTICS -Though ready for prime time technologically, the technology may be ahead of the usefulness. They don’t—yet—necessarily improve outcomes or deliver better value but may offer exciting potential.
A pragmatic NINE – We’re already there, as hospitals and specialists seek marketing edge, and 833 hospitals have purchased de Vinci surgical robot.
Here is how I react on a scale of One to Ten as someone who has frequently trekked down the health care innovation road.
ONE, CHECK LISTS- Hospitals will require health care providers to follow strict protocols for procedures that benefit from routinization—from preparing a patient for surgery to inserting a central line.
I’ll give this a EIGHT , But with this caveat: giving a doctor a checklist for each patient is not the same as giving pilot a checklist when 200 passengers are on board.
TWO, BEHAVIORAL ECONOMICS - Health care will incorporate insights from behavioral economics–everything from weight loss incentives to using peer pressure to change how doctors work.
Barely a SEVEN. Put me down as dubious. Changing ingrained lifestyles and doctors’ practice styles isn’t easy.
THREE, PATIENT PORTALS - Consumers will use secure web connections to make and check appointments, see lab results, renew prescriptions, and communicate with doctors and nurses.
Definitely an EIGHT. We’re getting there as personal computers with broad band access become ubiquitous.
FOUR, PAYMENT INNOVATION - Payment schemes that reward good outcomes and value rather than volume of procedures will become the norm.
At best a FOUR. Good patient outcomes are often beyond the reach of doctors. Patients may return to bad habits and often don’t comply with instructions.
FIVE, EVIDENCE-BASED DECISION MAKING - Electronic medical records collect important information for coordinated care, and physicians and nurses are alerted to potential errors and best practices.
A mere FIVE. The thesis that EMRs improve care is unproven. EMRS may generate more errors. Medicine is still full of uncertainties without evidence and is still Art as well as Science. Still depends on relationships, not necessarily on”facts,” and the placebo effect is powerful.
SIX, ACCOUNTABLE CARE ORGANIZATIONS – Hospitals and doctors will coordinate care for shared patients in order to keep them well-rather than simply treat them when they’re sick-and share in savings that result from improved quality.
A weak FIVE. This assumes doctors will join multispecialty groups and integrated delivery systems, often hospital-based. Reverse may be occurring as patients seek more private personal care, and as doctors form concierge and cash-only practices and shun 3rd party care.
SEVEN, REGENERATIVE MEDICINE - Stem cell research will lead to treatments for cancer, multiple sclerosis, spinal cord injuries, and other intractable conditions.
A hopeful FIVE- I hope this is so, but I have yet to see concrete evidence. Body remains a mysterious “black box.” Mysteries may take years to unravel.
EIGHT, VIRTUAL VISITS - Health care will be done at a distance with videoconferencing and remote monitoring of blood sugar, blood pressure, heart rate, and other health data.
A strong
NINE. I agree, as this is happening rather fast as health plans pay for virtual visits and as remote monitoring improves. Problems remain on how to pay for it, how to across care jurisdictions, and how to minimize malpractice tangles.
NINE, GENETIC MEDICINE - Individual genetic profiles will help doctors to prescribe the most effective treatments, tailored to the patient.
A SEVEN. This is becoming routine in evaluating predisposition to breast cancer. And I notice Walgreen put a kit for 42 DNA profiles on market before withdrawing it. We shall see what happens in this political controversy fraught field which smacks of social engineering.
TEN, SURGICAL ROBOTICS -Though ready for prime time technologically, the technology may be ahead of the usefulness. They don’t—yet—necessarily improve outcomes or deliver better value but may offer exciting potential.
A pragmatic NINE – We’re already there, as hospitals and specialists seek marketing edge, and 833 hospitals have purchased de Vinci surgical robot.
Monday, May 24, 2010
Medical Innovations and The Search for More Private, More Personal, More Decentralized Care
There is something curious and paradoxical going on out there. It combines high tech, low tech, high touch care innovations. It is a back-to-the-home movement - a yearning to escape from hospitals, specialized clinics, specialists, and those health plans we’ve come to dislike. It seeks high-tech alternatives to high-cost care. It wants high tech tests done at home by patients at home and monitored by doctors.
Here is how Steve Lohr, the New York Time’s health care innovation expert describes the high-tech aspects of this transformation,
“Mention health care reform and the image that springs to mind is a big government program. But there is another broad transformation in health care underway, a powerful force for decentralized innovation. It is fueled in good part by technology – low-cost computing devices, digital sensors, and the Web.”
“The trend promises to shift a lot of diagnosis, monitoring, and treatment of disease from hospital and specialized clinics where treatment is expensive, to primary care physicians and patients themselves – at far less cost.”
But there is another leg to this transformation, Lohr did not mention - the search for more private , more personal care. Patients are seeking refuge from the digital revolution, where nothing is hidden and everything is known about their personal habits, illnesses, financial status, and health care shopping patterns. Doctors seek to escape from the expenses and irritation and the prohibitive overheads posed by third party overseers.
Patients yearn for a more intimate relationship, eye-to-eye contract with their personal doctor, absent a computer interposed between them, recording every nuance of the encounter.
In an April 13, 2010, WSJ Health Blog, Katherine Hobson writes,
“Patients already lie to their doctors. And almost half of respondents in a new survey said if there was any hint their health information — even stripped of identifying details like name or date of birth — would be shared with outside organizations, they might be even less forthcoming. “
“A study on electronic medical records use by the California HealthCare Foundation, a philanthropic group, found that 15% of the 1,849 adults surveyed said they’d conceal information from a physician if “the doctor had an electronic medical record system” that could share that info with other groups. Another 33% would “consider hiding information.”
“Privacy concerns still hover around EMRs, with 68% of survey respondents reporting some degree of worry about what happens to their personal information once it’s stored in a doctor’s computer.”
Doctors yearn to break loose from the fetters of third party reimbursement which account for most of their practice’s overheads, now often in the 60% to 70% range and which requires extensive and expensive documentation to justify charges.
In an interview I conducted with Donald Copeland MD, a seasoned family physician who has practiced and taught family medicine for decades, he expressed this dissenting opinion on the need for electronic records to document the patient encounter, monitor doctors, and justify fees, in response to a question of mine,
“Q. President Obama has recommended the government spend $20 billion over the next five years to make electronic medical records mandatory, and there is an underlying threat to restrict payment only to those doctors with electronic records. What do you think?
A: I think it’s ludicrous. You and I know that I know enough about electronic records to know that all EMRs are just a way to keep records. You can teach how to practice primary care or judge how they perform with medical records. How can EMRs transform medicine? EMR advocates say EMRs are a way of teaching or telling us how to practice medicine, but most of the people promoting them have never practiced medicine. “
Doctor Copeland’s opinion is not an isolated one. More and more physicians are not accepting Medicare, Medicaid, HMO, and PPO patients, and many are forming concierge or cash-only practices, or letting patients collect the payment from insurers.
In a May 23 interview on CBS’s 60 minutes, Marty Cooper, inventor of the cell phone, and the first person to make a cell phone call in 1973, shrugged off the privacy issue by saying, “There is no such thing as privacy anymore.”
With wireless technologies, Facebook,Twitter, cellphones, and I-pad, we are being told privacy is no longer the social norm.
The age of privacy may be over. But many of us prefer to think that what occurs behind closed doors between a patient and doctor is a private matter. The interchange during the encounter is confidential, and for the doctor’s ears only. And the outside world should not be privy to what goes on there – particularly things that could be used against us.
The health system is being transformed as patients and doctors alike seek more personal, private, and decentralized, high tech/high touch relationships.
Here is how Steve Lohr, the New York Time’s health care innovation expert describes the high-tech aspects of this transformation,
“Mention health care reform and the image that springs to mind is a big government program. But there is another broad transformation in health care underway, a powerful force for decentralized innovation. It is fueled in good part by technology – low-cost computing devices, digital sensors, and the Web.”
“The trend promises to shift a lot of diagnosis, monitoring, and treatment of disease from hospital and specialized clinics where treatment is expensive, to primary care physicians and patients themselves – at far less cost.”
But there is another leg to this transformation, Lohr did not mention - the search for more private , more personal care. Patients are seeking refuge from the digital revolution, where nothing is hidden and everything is known about their personal habits, illnesses, financial status, and health care shopping patterns. Doctors seek to escape from the expenses and irritation and the prohibitive overheads posed by third party overseers.
Patients yearn for a more intimate relationship, eye-to-eye contract with their personal doctor, absent a computer interposed between them, recording every nuance of the encounter.
In an April 13, 2010, WSJ Health Blog, Katherine Hobson writes,
“Patients already lie to their doctors. And almost half of respondents in a new survey said if there was any hint their health information — even stripped of identifying details like name or date of birth — would be shared with outside organizations, they might be even less forthcoming. “
“A study on electronic medical records use by the California HealthCare Foundation, a philanthropic group, found that 15% of the 1,849 adults surveyed said they’d conceal information from a physician if “the doctor had an electronic medical record system” that could share that info with other groups. Another 33% would “consider hiding information.”
“Privacy concerns still hover around EMRs, with 68% of survey respondents reporting some degree of worry about what happens to their personal information once it’s stored in a doctor’s computer.”
Doctors yearn to break loose from the fetters of third party reimbursement which account for most of their practice’s overheads, now often in the 60% to 70% range and which requires extensive and expensive documentation to justify charges.
In an interview I conducted with Donald Copeland MD, a seasoned family physician who has practiced and taught family medicine for decades, he expressed this dissenting opinion on the need for electronic records to document the patient encounter, monitor doctors, and justify fees, in response to a question of mine,
“Q. President Obama has recommended the government spend $20 billion over the next five years to make electronic medical records mandatory, and there is an underlying threat to restrict payment only to those doctors with electronic records. What do you think?
A: I think it’s ludicrous. You and I know that I know enough about electronic records to know that all EMRs are just a way to keep records. You can teach how to practice primary care or judge how they perform with medical records. How can EMRs transform medicine? EMR advocates say EMRs are a way of teaching or telling us how to practice medicine, but most of the people promoting them have never practiced medicine. “
Doctor Copeland’s opinion is not an isolated one. More and more physicians are not accepting Medicare, Medicaid, HMO, and PPO patients, and many are forming concierge or cash-only practices, or letting patients collect the payment from insurers.
In a May 23 interview on CBS’s 60 minutes, Marty Cooper, inventor of the cell phone, and the first person to make a cell phone call in 1973, shrugged off the privacy issue by saying, “There is no such thing as privacy anymore.”
With wireless technologies, Facebook,Twitter, cellphones, and I-pad, we are being told privacy is no longer the social norm.
The age of privacy may be over. But many of us prefer to think that what occurs behind closed doors between a patient and doctor is a private matter. The interchange during the encounter is confidential, and for the doctor’s ears only. And the outside world should not be privy to what goes on there – particularly things that could be used against us.
The health system is being transformed as patients and doctors alike seek more personal, private, and decentralized, high tech/high touch relationships.
Sunday, May 23, 2010
Is Practice Fusion’s “Free” EHR for Real?
As I was writing three recent blogs, I kept pondering these questions: Is Practice Fusion, Inc, a San Francisco-based company offering a “free” EHR to physicians an example of “disruptive innovation”? After all, its EHR appears to be simpler, more convenient, more affordable, and intuitively easier to use than other EHRs– the criteria usually applied to disruptive innovations. Does it signal a “breakthrough” towards a decentralized technology deployable at the site of care? How can Practice Fusion offer its EHR for “free”? What triggered this “breakthrough”?
When all is said and done, I believe this “breakthrough,” if it is that, is not attributable to new EHR software or hardware, but to a new revenue model. Or you might say, it is a “fusion” of all three of these elements.
Here is how Ryan Howard, CEO of Practice Fusion, explains this model,
‘Our revenue model works in a few different ways. We monetize transactions from our partners. We do some lead generation. So if the doctors are looking for a billing service, for example, we have a billing service that they can use. We do some advertising to the physicians: different health care services, insurance companies, device manufactures and pharmaceuticals as well.”
If you think about it, Practice Fusion has adopted and modified the revenue model that has made Google so successful, namely gathering revenues from online advertising and lead generation tied to “free” access by users. It does not require physicians to install new hardware and software, but to off-load what they need in an EHR to the Internet using their existing office computers.
The beauty of it is, of course, is that you can use your own computer and somebody else – people and businesses who want access to physicians to sell them products – pays the freight for the EHR.
In other words, someone else, not physicians, is paying the bill. According to Howard,
“The product is provided to physicians fully subsidized. It’s not a “take now, pay later” or get half of the product now and then pays for the rest of it. Every feature that’s included with the product in any capacity is offered at no cost, so it’s truly free. It’s offered with support, training, and hosting. It’s the only totally free model on the market.”
Back to my recent posts for context.
• On May 22, in “Will Innovation Save America’s Health Care?” I wondered out load whether innovations from largely web-based technologies and systems would save us from Europe’s fate- the crushing cost and ensuing debt of unsustainable social welfare programs.
• On May 21, in “EHR ‘Inevitability’ and the Physician ‘Waiting Game,’“ I questioned whether EHR systems were ready for prime time, and I implied physicians were right in waiting for useful, affordable, and intuitively and clinical compatible systems.
• On May 20, in “EHRs – Size of Physician Market, Numbers Sold, By Whom, Comprehensiveness of Systems,” I reprinted an article by Chris Thorman of Software Advice, on the scope, players, and nature of the EHR market.
In the May 20 blog, I shared a chart showing EHR vendors and number of physician users.
Vendor Physician Users Practices Served
Epic 45,000
AllScripts 40,000
eClinicalWorks 40,000
GE Centricity 35,000
NextGen 35,000
SOAPWare 30,000
Practice Fusion 18,500
Eclipsys 11,000
Sage Health 10,000 .
Greenway Medical 6,000
On May 21, I received the following email from Emily Peters, Director of Communications for Practice Fusion,
“Hi Dr. Reece,
“I’ve been closely following your blog coverage this week about market share, innovation and Practice Fusion.”
“We do see some element of the “waiting game” that you described with physicians, but much less than even just six months ago. Practice Fusion now serves about 40,000 users and 2 million patients across the country – making us, not only the fastest growing EMR community, but also one of the largest. “
Before that on May 13, I had read a podcast interview with Ryan Howard, CEO of Practice Fusion, in which he said, “We just broke 15,000 users.”
I have no reason to question or challenge these physician user figures, which bespeak of explosive growth. But I can ask: how could one EHR company grow so fast?
Maybe it’s simply a matter of timing, namely, the physician market is primed and ready to get into the EHR game. Maybe it’s the marketing magic of the word “free.” Maybe it’s because Practice Fusion has the only “free” EHR on the market. Maybe it’s word getting around among physician users that this EHR really works. Maybe it’s because the Practice Fusion model profits physician users because it qualifies them as “meaningful users” and therefore qualifies them for federal reimbursement. Maybe it’s because most physicians now have broad band Internet access in their offices and can put this EHR to work in a short time frame without elaborate training and installation preparation.
Or maybe Practice Fusion is not what it’s cracked up to be and is too good to be true. There are no perfect systems in the EHR world, all are evolving, and there is always room for skepticism, or as one pessimistic wag with a weakness for puns observed, there is always gloom for improvement.
Perhaps readers of this blog will give me insight into what they think of Practice Fusion? Is it for real, or does it have blemishes that I do not see? Please feel free to comment one way or another.
When all is said and done, I believe this “breakthrough,” if it is that, is not attributable to new EHR software or hardware, but to a new revenue model. Or you might say, it is a “fusion” of all three of these elements.
Here is how Ryan Howard, CEO of Practice Fusion, explains this model,
‘Our revenue model works in a few different ways. We monetize transactions from our partners. We do some lead generation. So if the doctors are looking for a billing service, for example, we have a billing service that they can use. We do some advertising to the physicians: different health care services, insurance companies, device manufactures and pharmaceuticals as well.”
If you think about it, Practice Fusion has adopted and modified the revenue model that has made Google so successful, namely gathering revenues from online advertising and lead generation tied to “free” access by users. It does not require physicians to install new hardware and software, but to off-load what they need in an EHR to the Internet using their existing office computers.
The beauty of it is, of course, is that you can use your own computer and somebody else – people and businesses who want access to physicians to sell them products – pays the freight for the EHR.
In other words, someone else, not physicians, is paying the bill. According to Howard,
“The product is provided to physicians fully subsidized. It’s not a “take now, pay later” or get half of the product now and then pays for the rest of it. Every feature that’s included with the product in any capacity is offered at no cost, so it’s truly free. It’s offered with support, training, and hosting. It’s the only totally free model on the market.”
Back to my recent posts for context.
• On May 22, in “Will Innovation Save America’s Health Care?” I wondered out load whether innovations from largely web-based technologies and systems would save us from Europe’s fate- the crushing cost and ensuing debt of unsustainable social welfare programs.
• On May 21, in “EHR ‘Inevitability’ and the Physician ‘Waiting Game,’“ I questioned whether EHR systems were ready for prime time, and I implied physicians were right in waiting for useful, affordable, and intuitively and clinical compatible systems.
• On May 20, in “EHRs – Size of Physician Market, Numbers Sold, By Whom, Comprehensiveness of Systems,” I reprinted an article by Chris Thorman of Software Advice, on the scope, players, and nature of the EHR market.
In the May 20 blog, I shared a chart showing EHR vendors and number of physician users.
Vendor Physician Users Practices Served
Epic 45,000
AllScripts 40,000
eClinicalWorks 40,000
GE Centricity 35,000
NextGen 35,000
SOAPWare 30,000
Practice Fusion 18,500
Eclipsys 11,000
Sage Health 10,000 .
Greenway Medical 6,000
On May 21, I received the following email from Emily Peters, Director of Communications for Practice Fusion,
“Hi Dr. Reece,
“I’ve been closely following your blog coverage this week about market share, innovation and Practice Fusion.”
“We do see some element of the “waiting game” that you described with physicians, but much less than even just six months ago. Practice Fusion now serves about 40,000 users and 2 million patients across the country – making us, not only the fastest growing EMR community, but also one of the largest. “
Before that on May 13, I had read a podcast interview with Ryan Howard, CEO of Practice Fusion, in which he said, “We just broke 15,000 users.”
I have no reason to question or challenge these physician user figures, which bespeak of explosive growth. But I can ask: how could one EHR company grow so fast?
Maybe it’s simply a matter of timing, namely, the physician market is primed and ready to get into the EHR game. Maybe it’s the marketing magic of the word “free.” Maybe it’s because Practice Fusion has the only “free” EHR on the market. Maybe it’s word getting around among physician users that this EHR really works. Maybe it’s because the Practice Fusion model profits physician users because it qualifies them as “meaningful users” and therefore qualifies them for federal reimbursement. Maybe it’s because most physicians now have broad band Internet access in their offices and can put this EHR to work in a short time frame without elaborate training and installation preparation.
Or maybe Practice Fusion is not what it’s cracked up to be and is too good to be true. There are no perfect systems in the EHR world, all are evolving, and there is always room for skepticism, or as one pessimistic wag with a weakness for puns observed, there is always gloom for improvement.
Perhaps readers of this blog will give me insight into what they think of Practice Fusion? Is it for real, or does it have blemishes that I do not see? Please feel free to comment one way or another.
Saturday, May 22, 2010
Will Innovation Save America Health Care?
For the last three years, I’ve been writing blogs touting health care innovation. I’ve maintained returning to market-based principles, allowing patients spend more of their own money, encouraging more personal responsibility for their health, offering entrepreneurs more capital for health ventures , giving patients more choices, ,making value-based information more available. encouraging doctors to compete, and innovating across the board hold the answers to a sustainable system. I even wrote a book on the subject, Innovation-Driven Health Care (2007).
But to little avail. Clearly, President Obama does not share this world view. Instead he has opted for more government intervention, expansion of the social welfare state, and a more European-type health system to protect all population segments.
An article in today’s New York Times, of all places, sends a warning shot across Obama’s bow.
The article “Crisis Imperils Liberal Benefits Long Expected by Europeans,” , opens,
“PARIS — Across Western Europe, the “lifestyle superpower,” the assumptions and gains of a lifetime are suddenly in doubt. The deficit crisis that threatens the euro has also undermined the sustainability of the European standard of social welfare, built by left-leaning governments since the end of World War II. “
The author reports, among other things, Europe will have to save itself from crushing, unsustainable debts created by rapidly aging and declining populations by doing some of the following: raising its retirement and pension ages, freezing public sector pay, changing inflexible hiring and firing rules, and maybe even changing the slogan of the European Union, “The Europe that protects” through cradle-to-grave social welfare safety-nets.
European countries , and the United States, may even have to consider national policies on innovation to stimulate their economies to outgrow the cost of its health care burdens.
Writing in today’s The Health Care Blog, “National Health Insurance Isn’t Enough- Six Crucial Steps to Improve Health Care,” Dr. Albert Waxman, CEO and founding partner of Psilos Group, co-headquartered in the Bay Area and New York City, which has funded and developed more than 38 innovative companies dedicated to this vision, including ActiveHealth, AngioScore, Click4Care, Definity Health, ExtendHealth and OmniGuide, has these six suggestions to offer.
• Preventing and managing chronic illnesses, such as diabetes and hypertension. These account for 78 percent of all health care expenses in Medicare. Technology can help improve care management to prevent costly procedures and to incentivize consumers to live healthier lifestyles.
•Reducing errors in inpatient, ambulatory, and post-acute care. These errors – 19 percent e in medication administration errors at hospital bedsides alone -- are the result of poor information flow and fallible human behavior. Innovative solutions to help care administrators avoid costly and tragic mistakes have begun emerging and have demonstrated positive clinical outcomes.
•Addressing and reducing the obesity and diabetes epidemic, which costs an estimated $170 billion annually in the U.S.
• Using mew medical technologies to enable earlier and better diagnosis and thus earlier intervention to mitigate the impact of high-cost, high-morbidity diseases. Continued innovation around technologies that help identify diseases earlier will have a vital financial and clinical impact.
•Fostering the development of medical devices for less invasive and more effective surgical interventions.
•Lastly, recognizing and sponsoring entrepreneurs committed to developing solutions for most of the previously mentioned challenges. Venture capitalists must assume a leadership role in spurring the innovation needed to save not just America’s health care economy but its overall economy.
Unless we innovate, we may become just another European boiled frog, dying a slow, unrecognized, but certain death from slowly rising debt temperatures engendered by an aging population, lowered birth rates, and social welfare burdens. We have an advantage over Europe because of our public-private mix, our tradition of entrepreneurship, and our birth rates, which exceed those of Europe.
.
But to little avail. Clearly, President Obama does not share this world view. Instead he has opted for more government intervention, expansion of the social welfare state, and a more European-type health system to protect all population segments.
An article in today’s New York Times, of all places, sends a warning shot across Obama’s bow.
The article “Crisis Imperils Liberal Benefits Long Expected by Europeans,” , opens,
“PARIS — Across Western Europe, the “lifestyle superpower,” the assumptions and gains of a lifetime are suddenly in doubt. The deficit crisis that threatens the euro has also undermined the sustainability of the European standard of social welfare, built by left-leaning governments since the end of World War II. “
The author reports, among other things, Europe will have to save itself from crushing, unsustainable debts created by rapidly aging and declining populations by doing some of the following: raising its retirement and pension ages, freezing public sector pay, changing inflexible hiring and firing rules, and maybe even changing the slogan of the European Union, “The Europe that protects” through cradle-to-grave social welfare safety-nets.
European countries , and the United States, may even have to consider national policies on innovation to stimulate their economies to outgrow the cost of its health care burdens.
Writing in today’s The Health Care Blog, “National Health Insurance Isn’t Enough- Six Crucial Steps to Improve Health Care,” Dr. Albert Waxman, CEO and founding partner of Psilos Group, co-headquartered in the Bay Area and New York City, which has funded and developed more than 38 innovative companies dedicated to this vision, including ActiveHealth, AngioScore, Click4Care, Definity Health, ExtendHealth and OmniGuide, has these six suggestions to offer.
• Preventing and managing chronic illnesses, such as diabetes and hypertension. These account for 78 percent of all health care expenses in Medicare. Technology can help improve care management to prevent costly procedures and to incentivize consumers to live healthier lifestyles.
•Reducing errors in inpatient, ambulatory, and post-acute care. These errors – 19 percent e in medication administration errors at hospital bedsides alone -- are the result of poor information flow and fallible human behavior. Innovative solutions to help care administrators avoid costly and tragic mistakes have begun emerging and have demonstrated positive clinical outcomes.
•Addressing and reducing the obesity and diabetes epidemic, which costs an estimated $170 billion annually in the U.S.
• Using mew medical technologies to enable earlier and better diagnosis and thus earlier intervention to mitigate the impact of high-cost, high-morbidity diseases. Continued innovation around technologies that help identify diseases earlier will have a vital financial and clinical impact.
•Fostering the development of medical devices for less invasive and more effective surgical interventions.
•Lastly, recognizing and sponsoring entrepreneurs committed to developing solutions for most of the previously mentioned challenges. Venture capitalists must assume a leadership role in spurring the innovation needed to save not just America’s health care economy but its overall economy.
Unless we innovate, we may become just another European boiled frog, dying a slow, unrecognized, but certain death from slowly rising debt temperatures engendered by an aging population, lowered birth rates, and social welfare burdens. We have an advantage over Europe because of our public-private mix, our tradition of entrepreneurship, and our birth rates, which exceed those of Europe.
.
Balancing Health Care Expectations Of Seniors with Reality: The Case of Hips and Knee Replacements
Everybody knows politics is a balancing act. One must balance promises against reality.
For example, how does government keep Medicare intact for seniors while cutting $500 billion out of Medicare when government has no track record of cutting entitlement spending?
And how one do it without losing the vote of seniors, who hold the key to the balance of power?
The Obama administration and the Democrats hope to keep power by winning the senior vote for the next ten years through the following argument.
Medicare will keep Medicare intact be reducing fraud and abuse, which now consumes $60 billion, or 15% of Medicare payments. It will reduce regional variation, which varies by 30% from one Medicare region to another. It will save $136 billion by virtually eliminating Medicare Advantage plans, which offer such things as gym memberships, visual, and dental care, for which one quarter of Medicare recipients now pay extra. It will do it through 160 new government agencies and programs.
And it will slash another $200 billion out of Medicare by reducing payment increases to hospitals, doctors, nursing homes, home health agencies and other providers and basing those payments on performance and quality improvements. In senior circles, these cuts smack of rationing by another name.
And government will do it by adding only $1 trillion to the national debt over the next ten years, and another $2 trillion or so over the subsequent ten years.
Other than cutting out Medicare Advantage plans, most of these promises and projections are vague, lack specificity, and require unfunded mandates taking massive bureaucratic intervention to carry out. They also require trust in government, which is lacking at the moment in history.
So far national polls indicate about 60% of seniors oppose Obamacare and favor its repeal.
When it comes to the political balancing act, hip and knee replacements are a case in point. They have increased dramatically among older patients, statistics from the American Academy of Orthopaedic Surgeons show. Between 2002 and 2007, the 65- to 84-year-old population saw a 16 percent increase in hip replacements and an almost 44 percent rise in knee replacements. Among patients over 85, the increases were higher still: 21 percent for hips, 54 percent for knees.
Hip and knee procedures are generally successful among seniors. Mortality rates are low, and a return to a full pain-free existence is the rule rather than the exception.
Among seniors, word of mouth of these successes passes quickly. Seniors have come to expect quick access to these life-style savings joint procedures, which account for an increasing proportion of Medicare revenues.
How to deal with seniors’ rising Medicare expectations accompanied by skepticism about Medicare cuts and the skyrocketing national debt, will continue to be a political balancing act.
For example, how does government keep Medicare intact for seniors while cutting $500 billion out of Medicare when government has no track record of cutting entitlement spending?
And how one do it without losing the vote of seniors, who hold the key to the balance of power?
The Obama administration and the Democrats hope to keep power by winning the senior vote for the next ten years through the following argument.
Medicare will keep Medicare intact be reducing fraud and abuse, which now consumes $60 billion, or 15% of Medicare payments. It will reduce regional variation, which varies by 30% from one Medicare region to another. It will save $136 billion by virtually eliminating Medicare Advantage plans, which offer such things as gym memberships, visual, and dental care, for which one quarter of Medicare recipients now pay extra. It will do it through 160 new government agencies and programs.
And it will slash another $200 billion out of Medicare by reducing payment increases to hospitals, doctors, nursing homes, home health agencies and other providers and basing those payments on performance and quality improvements. In senior circles, these cuts smack of rationing by another name.
And government will do it by adding only $1 trillion to the national debt over the next ten years, and another $2 trillion or so over the subsequent ten years.
Other than cutting out Medicare Advantage plans, most of these promises and projections are vague, lack specificity, and require unfunded mandates taking massive bureaucratic intervention to carry out. They also require trust in government, which is lacking at the moment in history.
So far national polls indicate about 60% of seniors oppose Obamacare and favor its repeal.
When it comes to the political balancing act, hip and knee replacements are a case in point. They have increased dramatically among older patients, statistics from the American Academy of Orthopaedic Surgeons show. Between 2002 and 2007, the 65- to 84-year-old population saw a 16 percent increase in hip replacements and an almost 44 percent rise in knee replacements. Among patients over 85, the increases were higher still: 21 percent for hips, 54 percent for knees.
Hip and knee procedures are generally successful among seniors. Mortality rates are low, and a return to a full pain-free existence is the rule rather than the exception.
Among seniors, word of mouth of these successes passes quickly. Seniors have come to expect quick access to these life-style savings joint procedures, which account for an increasing proportion of Medicare revenues.
How to deal with seniors’ rising Medicare expectations accompanied by skepticism about Medicare cuts and the skyrocketing national debt, will continue to be a political balancing act.
Friday, May 21, 2010
EHR “Inevitability”and the Physician "Waiting Game"”
In my last blog,”EHRs – Size of Physician Market, Number Sold, By Whom, and Comprehensiveness of Systems Sold,” I reprinted a report by Software Advice, Inc, on the state of the EHR market “without editorial comment.”
I shall make that comment now.
Perception of EHR “Inevitability”
The perception persists in all quarters that EHR adoption is inevitable. This perception assumes payers, government and private, health consumers, and the public at large will come to expect and demand EHRs as the standard of care and the exemplar of quality. IT technologies and HITECH information technologies, the theory goes, will dominate. The Internet will reign, and we will all dance to its tune.
But for now the world of EHRs remains split between the conceptual and impatient “true believers” and the behavioral, more patient“late adopters,” who are dragging their feet and playing the “waiting game.”
Among the powerful true believers are,
• Big Government, specifically the Obama administration, who placed $20 billion in the HITECH basket in its February 2009 stimulus package.
• Related government enterprises – The VA, the Department of Defense, Indian Health Services, Community Clinics – all of whom are committed, pledged, and destined to adopt EHRs.
• The EHR industry and its 300 vendors, who foresee and thirst for hundreds of thousands of new jobs, new products, new revenues and the makings of an even vaster enterprise.
• Integrated delivery systems, like Kaiser, who has already poured $3 billion into adopting system-wide interoperable EHRs.
• Large physician organizations and societies – like AAFP, CAP, MGMA, and AMGA – which are committed to EHR adoption by its members.
• IT Giants, like Google, GE, Intel, and Microsoft. Microsoft has been in EHR market for three years now, has three products on the market, and is rumored to be anticipating acquisitions of one or more EHR vendors.
• Young IT savvy physicians, reared on computers and inspired by YouTube, Facebook and Twitter and now I-Pad, who take EHRs as a given and who migrate to groups, hospitals, and other physician employers with existing EHR platforms.
• Organizations like Health 2.0, a consortium of consumer-oriented health IT companies and vendors, who see EHRs and Personal Health Records as transformers of the health care landscape.
The Waiting Game
These are powerful and formidable agents and forces for change but practicing doctors continue to exhibit caution and to play the waiting game. Despite a 6 to 8 year push by government IT aficionados, industry, and Internet gurus, only 1.5% of hospitals and 6% of doctors have “fully functional” EHRs. A full-fledged “interoperable” system remains a pipe-dream, albeit one that continues to evolve and promises to burst into full flower sometime soon.
Reasons to resist change are legend – high installation costs, training and maintenance expenses, drops in clinical productivity, disruption of practice patterns, altered doctor-patient relationships, and little or no return in investment. Understated, but tangible nevertheless, is the feeling that EHRs violate or compromise doctors and patient privacy and confidentiality or will be misused to the detriment of both. To doctors, these are real, and sometimes profound, reinforced by the recession, and calls for cautionary waiting. Waiting for further developments, most doctors believe, at least those on the mean practice streets, is safer than plunging into the maelstrom.
Hospitals, meanwhile, are experiencing lower admission rates, declining revenues, and difficulties accessing capital. Doctors too are having trouble acquiring capital for recruiting new physicians, meeting operating expenses, and dealing with demands for more information infrastructure. It should be no surprise, then, that the AMA and the AHA are saying forced digitization demands are “too much, too soon” and are pushing back against too fast and too much EHR adoption.
We are in a period of watchful waiting for further developments.
• Waiting to see if EHR costs will come down with competition.
• Waiting to see which EHR companies will survive.
• Waiting to see if new “free” EHR business models, such as Practice Fusion, Inc, where advertisers, not doctors, pay for installation and maintenance, are for real.
• Waiting to see if payers, government and private, will demand EHR adoption for participation.
• Waiting to see if hospitals will offer more financial and technical support for EHRs. .
• Waiting to see if EHRs are as good as promised in reducing errors and improving care – as good in concrete practice as in the abstract theory.
• Waiting so to see if EHRs become more user friendly and functional in clinical use.
• Waiting to see if benefits to insurers and patients outweigh the headaches to doctors.
• Waiting to see if physician transitions and adjustments to new business models – HSAs with high deductibles, cash-only models, concierge practices, hospital employment – offer escapes from having to climb the EHR learning curve.
And so, the EHR waiting game and merry-go round continues. How fast forward it goes, when and where it stops, grinds to halt, or plunges over the cliff to a new nirvana no one knows.
A New Yorker cartoon captures the dilemma of waiting for EHR inevitability. A group of cavemen are keeping count by making vertical slashes in groups of five on the wall and counting with their fingers. The caveman leader explains to a visitor at the mouth of the cave,” It will take longer than we thought to go digital.”
Richard L. Reece, MD, is the author of Obama, Doctors, and Health Reform (2009) and Innovation-Driven Health Care (2007. He blogs at Medinnovationblog.blogspot.com.
I shall make that comment now.
Perception of EHR “Inevitability”
The perception persists in all quarters that EHR adoption is inevitable. This perception assumes payers, government and private, health consumers, and the public at large will come to expect and demand EHRs as the standard of care and the exemplar of quality. IT technologies and HITECH information technologies, the theory goes, will dominate. The Internet will reign, and we will all dance to its tune.
But for now the world of EHRs remains split between the conceptual and impatient “true believers” and the behavioral, more patient“late adopters,” who are dragging their feet and playing the “waiting game.”
Among the powerful true believers are,
• Big Government, specifically the Obama administration, who placed $20 billion in the HITECH basket in its February 2009 stimulus package.
• Related government enterprises – The VA, the Department of Defense, Indian Health Services, Community Clinics – all of whom are committed, pledged, and destined to adopt EHRs.
• The EHR industry and its 300 vendors, who foresee and thirst for hundreds of thousands of new jobs, new products, new revenues and the makings of an even vaster enterprise.
• Integrated delivery systems, like Kaiser, who has already poured $3 billion into adopting system-wide interoperable EHRs.
• Large physician organizations and societies – like AAFP, CAP, MGMA, and AMGA – which are committed to EHR adoption by its members.
• IT Giants, like Google, GE, Intel, and Microsoft. Microsoft has been in EHR market for three years now, has three products on the market, and is rumored to be anticipating acquisitions of one or more EHR vendors.
• Young IT savvy physicians, reared on computers and inspired by YouTube, Facebook and Twitter and now I-Pad, who take EHRs as a given and who migrate to groups, hospitals, and other physician employers with existing EHR platforms.
• Organizations like Health 2.0, a consortium of consumer-oriented health IT companies and vendors, who see EHRs and Personal Health Records as transformers of the health care landscape.
The Waiting Game
These are powerful and formidable agents and forces for change but practicing doctors continue to exhibit caution and to play the waiting game. Despite a 6 to 8 year push by government IT aficionados, industry, and Internet gurus, only 1.5% of hospitals and 6% of doctors have “fully functional” EHRs. A full-fledged “interoperable” system remains a pipe-dream, albeit one that continues to evolve and promises to burst into full flower sometime soon.
Reasons to resist change are legend – high installation costs, training and maintenance expenses, drops in clinical productivity, disruption of practice patterns, altered doctor-patient relationships, and little or no return in investment. Understated, but tangible nevertheless, is the feeling that EHRs violate or compromise doctors and patient privacy and confidentiality or will be misused to the detriment of both. To doctors, these are real, and sometimes profound, reinforced by the recession, and calls for cautionary waiting. Waiting for further developments, most doctors believe, at least those on the mean practice streets, is safer than plunging into the maelstrom.
Hospitals, meanwhile, are experiencing lower admission rates, declining revenues, and difficulties accessing capital. Doctors too are having trouble acquiring capital for recruiting new physicians, meeting operating expenses, and dealing with demands for more information infrastructure. It should be no surprise, then, that the AMA and the AHA are saying forced digitization demands are “too much, too soon” and are pushing back against too fast and too much EHR adoption.
We are in a period of watchful waiting for further developments.
• Waiting to see if EHR costs will come down with competition.
• Waiting to see which EHR companies will survive.
• Waiting to see if new “free” EHR business models, such as Practice Fusion, Inc, where advertisers, not doctors, pay for installation and maintenance, are for real.
• Waiting to see if payers, government and private, will demand EHR adoption for participation.
• Waiting to see if hospitals will offer more financial and technical support for EHRs. .
• Waiting to see if EHRs are as good as promised in reducing errors and improving care – as good in concrete practice as in the abstract theory.
• Waiting so to see if EHRs become more user friendly and functional in clinical use.
• Waiting to see if benefits to insurers and patients outweigh the headaches to doctors.
• Waiting to see if physician transitions and adjustments to new business models – HSAs with high deductibles, cash-only models, concierge practices, hospital employment – offer escapes from having to climb the EHR learning curve.
And so, the EHR waiting game and merry-go round continues. How fast forward it goes, when and where it stops, grinds to halt, or plunges over the cliff to a new nirvana no one knows.
A New Yorker cartoon captures the dilemma of waiting for EHR inevitability. A group of cavemen are keeping count by making vertical slashes in groups of five on the wall and counting with their fingers. The caveman leader explains to a visitor at the mouth of the cave,” It will take longer than we thought to go digital.”
Richard L. Reece, MD, is the author of Obama, Doctors, and Health Reform (2009) and Innovation-Driven Health Care (2007. He blogs at Medinnovationblog.blogspot.com.
Thursday, May 20, 2010
EHRs – Size of Physician Market, Number Sold, By Whom, Comprehensiveness of Systems Sold
Today I received the following email from Chris Thorman, Senior Marketing Manager for Software Advice in Austin, Texas (chris@softwareadvice.com). I pass it along to you without editorial comment.
This article comes from Chris Thorman, who blogs about web-based EMRsat Software Advice
EHR Software Market Share Analysis
Calculating market share for the electronic health record (EHR) market is no easy task. There are over 300 software vendors, many market segments (consider: size of practice served, specialties services, inpatient/outpatient) and very “fuzzy” sources of data.
Nevertheless, the team at Software Advice set out to see what numbers we could pull together. We limited our analysis to the outpatient EHR software market. Moreover, we decided to measure market share based on the number of physicians users, rather than vendor revenue or other metrics. We tried to keep it simple. It’s not.
Number of Doctors Using EHR Software
First, let’s define the total size of the market we are analyzing. Of the approximately 788,000 physicians in the United States, 65% of them work in an outpatient facility or physician’s practice, according to the Bureau of Labor & Statistics. That’s 512,000 possible physicians who are in the outpatient EHR software market.
According to a recent study of office-based physicians released by the Center for Disease Control and Prevention (CDC), 44% of those of 512,000 office-based doctors had adopted either a partial, basic, or fully functional EHR system. That’s 225,000 outpatient doctors using an EHR to some extent. Here’s how EHR adoption breaks down among the total number (512,000) of outpatient physicians in the United States:
Outpatient EHR Adoption , 2009
• No EHR adoption, 56%
• Basic EHR adoption, 21%
• Partial EHR adoption, 17%
• Fully functional EHR adoption, 6%
The CDC defines “partial” EHR systems as those not exclusively used for billing. “Basic” systems include the following functionalities: patient demographic information, patient problem lists, clinical notes, orders for prescriptions, and viewing laboratory and imaging results.
Systems defined by the CDC as “fully functional” include all functionalities of a basic system plus these functionalities: medical history and follow-up, orders for tests, prescription and test orders sent electronically, warnings of drug interactions or contraindications, highlighting of out-of-range test levels, electronic images returned, and reminders for guideline-based interventions.
Outpatient EHR Market Share
So, what EHR software are the 225,000 physicians using? Based on number of physician users, here’s how the market breaks down:
Outpatient EHR software market share by vendor, 2010
• Epic, 17%
• AllScripts, 15%
• eClinicalWorks, 15%
• NextGen, 13%
• SOAPware, 12%
• GE Centricity, 10%
• Other Vendors, 10%
• Practice Fusion, 7%
Software Advice’s analysis showed that a handful of vendors – Allscripts, Epic, eClinicalWorks NextGen, and GE Centricity – own more than three-quarters of the ambulatory EHR software market. This is a similar trend that other EHR market reports and analysis have noted.
Here is the data Software Advice was able to gather on the top EHR vendors, based on volume of physician users:
Vendor Physician Users Practices Served
Epic 45,000 N.A.
Allscripts 40,000 N.A.
eClinicalWorks 40,000 6,500
GE Centricity 35,000 2,500
NextGen 35,000 2,000
SOAPWare 30,000 8,000
Practice Fusion 18,500 10,000
Eclipsys 11,000 N.A.
Sage Health 10,000 N.A.
Greenway Medical 6,000 1,400
Clarifications, Disclaimers, Footnotes, Contradictions, etc.
As mentioned in the introduction, the EHR software market has many “fuzzy” sources of data. In fact, when all of the physician users are calculated in the table above, the number of physicians using EHRs in the United States is more than 40,000 over what the CDC reported. Clearly, we need to dig into these numbers a bit more.
In most cases, the information was gathered directly from the EHR software vendors. For those vendors that weren’t able to be contacted, publicly reported information was used. In some cases, exact numbers of physicians and practices were available. In some cases, approximations were used by Software Advice and the software vendors (In the case of a discrepancy, please contact us).
Here are a few questions that came up during the research process whose answers would help refine our market share numbers:
• Sage Health. How many of Sage Health’s users are using their Intergy EHR product in conjunction with their practice management software versus those using just Sage’s practice management software, in particular, Medical Manager?
• Allscripts. How many of Allscripts users are still using Misys practice management systems? Like Sage, they have a huge practice management installed base, but not all of those customers are using their advanced EHR systems.
• Epic and NextGen. How many of their users are exclusively outpatient customers? Both of these EHR vendors are meaningful players in the inpatient EHR market. We need to exclude those physicians from our analysis.
• GE Centricity. General Electric didn’t distinguish between physician (MD) users and mid-level providers in their count of users. This would be a helpful distinction to have in this analysis.
• Practice Fusion. Being a free EHR system, it would be important to see how many of Practice Fusion’s EHR users are actively using their software, instead of just kicking the tires on a cool new web-based EHR and “freemium” business model.
Feedback (We Need Your Help)
Software Advice knows many of you are just as, if not more, intimately plugged into the EHR software market than we are. That’s why we’d like your feedback to help figure out these numbers.
Which vendors’ numbers are higher? Lower? Who are the up and coming players that will earn significant market share in the coming years?
For comments on this post, email Chris at chris@softwareadvice.com
EHR Software Market Share Analysis
Calculating market share for the electronic health record (EHR) market is no easy task. There are over 300 software vendors, many market segments (consider: size of practice served, specialties services, inpatient/outpatient) and very “fuzzy” sources of data.
Nevertheless, the team at Software Advice set out to see what numbers we could pull together. We limited our analysis to the outpatient EHR software market. Moreover, we decided to measure market share based on the number of physicians users, rather than vendor revenue or other metrics. We tried to keep it simple. It’s not.
Number of Doctors Using EHR Software
First, let’s define the total size of the market we are analyzing. Of the approximately 788,000 physicians in the United States, 65% of them work in an outpatient facility or physician’s practice, according to the Bureau of Labor & Statistics. That’s 512,000 possible physicians who are in the outpatient EHR software market.
According to a recent study of office-based physicians released by the Center for Disease Control and Prevention (CDC), 44% of those of 512,000 office-based doctors had adopted either a partial, basic, or fully functional EHR system. That’s 225,000 outpatient doctors using an EHR to some extent. Here’s how EHR adoption breaks down among the total number (512,000) of outpatient physicians in the United States:
Outpatient EHR Adoption , 2009
• No EHR adoption, 56%
• Basic EHR adoption, 21%
• Partial EHR adoption, 17%
• Fully functional EHR adoption, 6%
The CDC defines “partial” EHR systems as those not exclusively used for billing. “Basic” systems include the following functionalities: patient demographic information, patient problem lists, clinical notes, orders for prescriptions, and viewing laboratory and imaging results.
Systems defined by the CDC as “fully functional” include all functionalities of a basic system plus these functionalities: medical history and follow-up, orders for tests, prescription and test orders sent electronically, warnings of drug interactions or contraindications, highlighting of out-of-range test levels, electronic images returned, and reminders for guideline-based interventions.
Outpatient EHR Market Share
So, what EHR software are the 225,000 physicians using? Based on number of physician users, here’s how the market breaks down:
Outpatient EHR software market share by vendor, 2010
• Epic, 17%
• AllScripts, 15%
• eClinicalWorks, 15%
• NextGen, 13%
• SOAPware, 12%
• GE Centricity, 10%
• Other Vendors, 10%
• Practice Fusion, 7%
Software Advice’s analysis showed that a handful of vendors – Allscripts, Epic, eClinicalWorks NextGen, and GE Centricity – own more than three-quarters of the ambulatory EHR software market. This is a similar trend that other EHR market reports and analysis have noted.
Here is the data Software Advice was able to gather on the top EHR vendors, based on volume of physician users:
Vendor Physician Users Practices Served
Epic 45,000 N.A.
Allscripts 40,000 N.A.
eClinicalWorks 40,000 6,500
GE Centricity 35,000 2,500
NextGen 35,000 2,000
SOAPWare 30,000 8,000
Practice Fusion 18,500 10,000
Eclipsys 11,000 N.A.
Sage Health 10,000 N.A.
Greenway Medical 6,000 1,400
Clarifications, Disclaimers, Footnotes, Contradictions, etc.
As mentioned in the introduction, the EHR software market has many “fuzzy” sources of data. In fact, when all of the physician users are calculated in the table above, the number of physicians using EHRs in the United States is more than 40,000 over what the CDC reported. Clearly, we need to dig into these numbers a bit more.
In most cases, the information was gathered directly from the EHR software vendors. For those vendors that weren’t able to be contacted, publicly reported information was used. In some cases, exact numbers of physicians and practices were available. In some cases, approximations were used by Software Advice and the software vendors (In the case of a discrepancy, please contact us).
Here are a few questions that came up during the research process whose answers would help refine our market share numbers:
• Sage Health. How many of Sage Health’s users are using their Intergy EHR product in conjunction with their practice management software versus those using just Sage’s practice management software, in particular, Medical Manager?
• Allscripts. How many of Allscripts users are still using Misys practice management systems? Like Sage, they have a huge practice management installed base, but not all of those customers are using their advanced EHR systems.
• Epic and NextGen. How many of their users are exclusively outpatient customers? Both of these EHR vendors are meaningful players in the inpatient EHR market. We need to exclude those physicians from our analysis.
• GE Centricity. General Electric didn’t distinguish between physician (MD) users and mid-level providers in their count of users. This would be a helpful distinction to have in this analysis.
• Practice Fusion. Being a free EHR system, it would be important to see how many of Practice Fusion’s EHR users are actively using their software, instead of just kicking the tires on a cool new web-based EHR and “freemium” business model.
Feedback (We Need Your Help)
Software Advice knows many of you are just as, if not more, intimately plugged into the EHR software market than we are. That’s why we’d like your feedback to help figure out these numbers.
Which vendors’ numbers are higher? Lower? Who are the up and coming players that will earn significant market share in the coming years?
For comments on this post, email Chris at chris@softwareadvice.com
This article comes from Chris Thorman, who blogs about web-based EMRsat Software Advice
EHR Software Market Share Analysis
Calculating market share for the electronic health record (EHR) market is no easy task. There are over 300 software vendors, many market segments (consider: size of practice served, specialties services, inpatient/outpatient) and very “fuzzy” sources of data.
Nevertheless, the team at Software Advice set out to see what numbers we could pull together. We limited our analysis to the outpatient EHR software market. Moreover, we decided to measure market share based on the number of physicians users, rather than vendor revenue or other metrics. We tried to keep it simple. It’s not.
Number of Doctors Using EHR Software
First, let’s define the total size of the market we are analyzing. Of the approximately 788,000 physicians in the United States, 65% of them work in an outpatient facility or physician’s practice, according to the Bureau of Labor & Statistics. That’s 512,000 possible physicians who are in the outpatient EHR software market.
According to a recent study of office-based physicians released by the Center for Disease Control and Prevention (CDC), 44% of those of 512,000 office-based doctors had adopted either a partial, basic, or fully functional EHR system. That’s 225,000 outpatient doctors using an EHR to some extent. Here’s how EHR adoption breaks down among the total number (512,000) of outpatient physicians in the United States:
Outpatient EHR Adoption , 2009
• No EHR adoption, 56%
• Basic EHR adoption, 21%
• Partial EHR adoption, 17%
• Fully functional EHR adoption, 6%
The CDC defines “partial” EHR systems as those not exclusively used for billing. “Basic” systems include the following functionalities: patient demographic information, patient problem lists, clinical notes, orders for prescriptions, and viewing laboratory and imaging results.
Systems defined by the CDC as “fully functional” include all functionalities of a basic system plus these functionalities: medical history and follow-up, orders for tests, prescription and test orders sent electronically, warnings of drug interactions or contraindications, highlighting of out-of-range test levels, electronic images returned, and reminders for guideline-based interventions.
Outpatient EHR Market Share
So, what EHR software are the 225,000 physicians using? Based on number of physician users, here’s how the market breaks down:
Outpatient EHR software market share by vendor, 2010
• Epic, 17%
• AllScripts, 15%
• eClinicalWorks, 15%
• NextGen, 13%
• SOAPware, 12%
• GE Centricity, 10%
• Other Vendors, 10%
• Practice Fusion, 7%
Software Advice’s analysis showed that a handful of vendors – Allscripts, Epic, eClinicalWorks NextGen, and GE Centricity – own more than three-quarters of the ambulatory EHR software market. This is a similar trend that other EHR market reports and analysis have noted.
Here is the data Software Advice was able to gather on the top EHR vendors, based on volume of physician users:
Vendor Physician Users Practices Served
Epic 45,000 N.A.
Allscripts 40,000 N.A.
eClinicalWorks 40,000 6,500
GE Centricity 35,000 2,500
NextGen 35,000 2,000
SOAPWare 30,000 8,000
Practice Fusion 18,500 10,000
Eclipsys 11,000 N.A.
Sage Health 10,000 N.A.
Greenway Medical 6,000 1,400
Clarifications, Disclaimers, Footnotes, Contradictions, etc.
As mentioned in the introduction, the EHR software market has many “fuzzy” sources of data. In fact, when all of the physician users are calculated in the table above, the number of physicians using EHRs in the United States is more than 40,000 over what the CDC reported. Clearly, we need to dig into these numbers a bit more.
In most cases, the information was gathered directly from the EHR software vendors. For those vendors that weren’t able to be contacted, publicly reported information was used. In some cases, exact numbers of physicians and practices were available. In some cases, approximations were used by Software Advice and the software vendors (In the case of a discrepancy, please contact us).
Here are a few questions that came up during the research process whose answers would help refine our market share numbers:
• Sage Health. How many of Sage Health’s users are using their Intergy EHR product in conjunction with their practice management software versus those using just Sage’s practice management software, in particular, Medical Manager?
• Allscripts. How many of Allscripts users are still using Misys practice management systems? Like Sage, they have a huge practice management installed base, but not all of those customers are using their advanced EHR systems.
• Epic and NextGen. How many of their users are exclusively outpatient customers? Both of these EHR vendors are meaningful players in the inpatient EHR market. We need to exclude those physicians from our analysis.
• GE Centricity. General Electric didn’t distinguish between physician (MD) users and mid-level providers in their count of users. This would be a helpful distinction to have in this analysis.
• Practice Fusion. Being a free EHR system, it would be important to see how many of Practice Fusion’s EHR users are actively using their software, instead of just kicking the tires on a cool new web-based EHR and “freemium” business model.
Feedback (We Need Your Help)
Software Advice knows many of you are just as, if not more, intimately plugged into the EHR software market than we are. That’s why we’d like your feedback to help figure out these numbers.
Which vendors’ numbers are higher? Lower? Who are the up and coming players that will earn significant market share in the coming years?
For comments on this post, email Chris at chris@softwareadvice.com
EHR Software Market Share Analysis
Calculating market share for the electronic health record (EHR) market is no easy task. There are over 300 software vendors, many market segments (consider: size of practice served, specialties services, inpatient/outpatient) and very “fuzzy” sources of data.
Nevertheless, the team at Software Advice set out to see what numbers we could pull together. We limited our analysis to the outpatient EHR software market. Moreover, we decided to measure market share based on the number of physicians users, rather than vendor revenue or other metrics. We tried to keep it simple. It’s not.
Number of Doctors Using EHR Software
First, let’s define the total size of the market we are analyzing. Of the approximately 788,000 physicians in the United States, 65% of them work in an outpatient facility or physician’s practice, according to the Bureau of Labor & Statistics. That’s 512,000 possible physicians who are in the outpatient EHR software market.
According to a recent study of office-based physicians released by the Center for Disease Control and Prevention (CDC), 44% of those of 512,000 office-based doctors had adopted either a partial, basic, or fully functional EHR system. That’s 225,000 outpatient doctors using an EHR to some extent. Here’s how EHR adoption breaks down among the total number (512,000) of outpatient physicians in the United States:
Outpatient EHR Adoption , 2009
• No EHR adoption, 56%
• Basic EHR adoption, 21%
• Partial EHR adoption, 17%
• Fully functional EHR adoption, 6%
The CDC defines “partial” EHR systems as those not exclusively used for billing. “Basic” systems include the following functionalities: patient demographic information, patient problem lists, clinical notes, orders for prescriptions, and viewing laboratory and imaging results.
Systems defined by the CDC as “fully functional” include all functionalities of a basic system plus these functionalities: medical history and follow-up, orders for tests, prescription and test orders sent electronically, warnings of drug interactions or contraindications, highlighting of out-of-range test levels, electronic images returned, and reminders for guideline-based interventions.
Outpatient EHR Market Share
So, what EHR software are the 225,000 physicians using? Based on number of physician users, here’s how the market breaks down:
Outpatient EHR software market share by vendor, 2010
• Epic, 17%
• AllScripts, 15%
• eClinicalWorks, 15%
• NextGen, 13%
• SOAPware, 12%
• GE Centricity, 10%
• Other Vendors, 10%
• Practice Fusion, 7%
Software Advice’s analysis showed that a handful of vendors – Allscripts, Epic, eClinicalWorks NextGen, and GE Centricity – own more than three-quarters of the ambulatory EHR software market. This is a similar trend that other EHR market reports and analysis have noted.
Here is the data Software Advice was able to gather on the top EHR vendors, based on volume of physician users:
Vendor Physician Users Practices Served
Epic 45,000 N.A.
Allscripts 40,000 N.A.
eClinicalWorks 40,000 6,500
GE Centricity 35,000 2,500
NextGen 35,000 2,000
SOAPWare 30,000 8,000
Practice Fusion 18,500 10,000
Eclipsys 11,000 N.A.
Sage Health 10,000 N.A.
Greenway Medical 6,000 1,400
Clarifications, Disclaimers, Footnotes, Contradictions, etc.
As mentioned in the introduction, the EHR software market has many “fuzzy” sources of data. In fact, when all of the physician users are calculated in the table above, the number of physicians using EHRs in the United States is more than 40,000 over what the CDC reported. Clearly, we need to dig into these numbers a bit more.
In most cases, the information was gathered directly from the EHR software vendors. For those vendors that weren’t able to be contacted, publicly reported information was used. In some cases, exact numbers of physicians and practices were available. In some cases, approximations were used by Software Advice and the software vendors (In the case of a discrepancy, please contact us).
Here are a few questions that came up during the research process whose answers would help refine our market share numbers:
• Sage Health. How many of Sage Health’s users are using their Intergy EHR product in conjunction with their practice management software versus those using just Sage’s practice management software, in particular, Medical Manager?
• Allscripts. How many of Allscripts users are still using Misys practice management systems? Like Sage, they have a huge practice management installed base, but not all of those customers are using their advanced EHR systems.
• Epic and NextGen. How many of their users are exclusively outpatient customers? Both of these EHR vendors are meaningful players in the inpatient EHR market. We need to exclude those physicians from our analysis.
• GE Centricity. General Electric didn’t distinguish between physician (MD) users and mid-level providers in their count of users. This would be a helpful distinction to have in this analysis.
• Practice Fusion. Being a free EHR system, it would be important to see how many of Practice Fusion’s EHR users are actively using their software, instead of just kicking the tires on a cool new web-based EHR and “freemium” business model.
Feedback (We Need Your Help)
Software Advice knows many of you are just as, if not more, intimately plugged into the EHR software market than we are. That’s why we’d like your feedback to help figure out these numbers.
Which vendors’ numbers are higher? Lower? Who are the up and coming players that will earn significant market share in the coming years?
For comments on this post, email Chris at chris@softwareadvice.com
Physician Recruiting and Retention
Yesterday I interviewed Lori Schutte, President of Cejka Search, a St. Louis-based physician recruiting firm. The interview focused on a 2009-2010 Physician Retention and Recruitment Survey conducted in partnership with the American Medical Group Association (AMGA).
The AMGA represents 95,000 doctors in group practices , 67% of whom practice in multispecialty groups of 50 or more. The survey was sent by email to all AMGA members. The response rate was 11% and included 12,452 physicians.
I will not go into the details of the interview which is now being transcribed. Lori and I and another Cejka executive, Mary Barber. Vice-President of Recruitment Partnerships and Marketing , covered the physician retention and recruitment landscape.
Lori said she was surprised that there was so little change since the previous four surveys conducted with AMGA. She did note that an upsurge in demand for part-time work, more among male physicians than female. And she observed that recruited physicians these days often come in pairs, husband and wife, and creativity is required to create a place for the couple within one organization.
The survey was conducted before passage of Obamacare, and the physicians surveyed at the time apparently had few strong opinions about reform, other than being interested in prospects for increased pay for primary care to compensate for shortages and where the medical home concept might be headed.
The strongest recruitment drawing cards were: compensation 65%, income guarantees, 61%, and signing bonuses , 42%. Groups with established EMR platforms strongly attracted IT savvy young physicians. Both younger and older primary care physicians often asked about hospitalist support. With regard to hospitalists, Lori said, physicians tended to be for hospitalists or against them. The against doctors preferred to follow their patients throughout their hospital stay.
We also spoke at some length about the special needs of women physicians who have a greater need for flexible hours than their male counterparts, particularly early in their careers.
We discussed physician turnover, which has modestly decreased over previous surveys, perhaps because physicians preferred to stay put during the economy and real estate uncertainties. . Turnover tends to peak at about 11% in the third year after recruitment when the “bloom is off the rose,” but is less than 6% overall.
Groups, Lori explained, are growing in size and are acquiring solo or small group practices to establish more of a market presence. She also said hospital-physician consolidation into integrated delivery systems is picking up in intensity.
We touched on the need for innovation. This need is usually not formalized, but is addressed under the mantras of increased efficiency and continuous quality improvement.
Many practices are marginally concerned about physician burnout, but most have not yet come to grips of how to deal with it in a formal way, such as sabbaticals. Physicians leadership and administrative duties are a growing concern , and identifying physician leaders and appropriately rewarding them is another emerging issue.
The AMGA represents 95,000 doctors in group practices , 67% of whom practice in multispecialty groups of 50 or more. The survey was sent by email to all AMGA members. The response rate was 11% and included 12,452 physicians.
I will not go into the details of the interview which is now being transcribed. Lori and I and another Cejka executive, Mary Barber. Vice-President of Recruitment Partnerships and Marketing , covered the physician retention and recruitment landscape.
Lori said she was surprised that there was so little change since the previous four surveys conducted with AMGA. She did note that an upsurge in demand for part-time work, more among male physicians than female. And she observed that recruited physicians these days often come in pairs, husband and wife, and creativity is required to create a place for the couple within one organization.
The survey was conducted before passage of Obamacare, and the physicians surveyed at the time apparently had few strong opinions about reform, other than being interested in prospects for increased pay for primary care to compensate for shortages and where the medical home concept might be headed.
The strongest recruitment drawing cards were: compensation 65%, income guarantees, 61%, and signing bonuses , 42%. Groups with established EMR platforms strongly attracted IT savvy young physicians. Both younger and older primary care physicians often asked about hospitalist support. With regard to hospitalists, Lori said, physicians tended to be for hospitalists or against them. The against doctors preferred to follow their patients throughout their hospital stay.
We also spoke at some length about the special needs of women physicians who have a greater need for flexible hours than their male counterparts, particularly early in their careers.
We discussed physician turnover, which has modestly decreased over previous surveys, perhaps because physicians preferred to stay put during the economy and real estate uncertainties. . Turnover tends to peak at about 11% in the third year after recruitment when the “bloom is off the rose,” but is less than 6% overall.
Groups, Lori explained, are growing in size and are acquiring solo or small group practices to establish more of a market presence. She also said hospital-physician consolidation into integrated delivery systems is picking up in intensity.
We touched on the need for innovation. This need is usually not formalized, but is addressed under the mantras of increased efficiency and continuous quality improvement.
Many practices are marginally concerned about physician burnout, but most have not yet come to grips of how to deal with it in a formal way, such as sabbaticals. Physicians leadership and administrative duties are a growing concern , and identifying physician leaders and appropriately rewarding them is another emerging issue.
Tuesday, May 18, 2010
Eruptive Consolidation: Insurers and Doctors Consolidate Their Businesses in Wake of ObamaCare's Passage
President Obama guaranteed Americans that after health reform became law they could keep their insurance plans and their doctors. It's clear that this promise cannot be kept. Insurers and physicians are already reshaping their businesses as a result of Mr. Obama's plan.
Scott Gottlieb, MD. “No, You Can’t Keep Your Health Plan, “ Wall Street Journal, May 18. 2010
Lost in the rhetoric after Obamacare's passage are some of its consequences. One of these is the rapid increase in premiums for individuals, somewhere in the 10% to 30% range in 2010 alone; and the other is loss of access of patients to individual physicians in the neighborhood and region.
Because of expenses entailed in marketing to the individual market and Obamacare’s 20% cap on health plan money spent on marketing and administration, health plans are offering fewer policies for individuals and ratcheting up premiums, making care not only less affordable but less accessible as well.
To manage their expenses, health plans are also reducing fees to hospitals and doctors, particularly in such high-tech fields of radiology, cardiology, and orthopedics. These cuts are expected to average about 10% these year, and up to 40% in Medicare fees for high tech specialists.
As a result, “eruptive consolidation” is already well underway. Physicians and hospitals are engaging in CYA “Cover Your Ass” defensive business arrangements. Doctors , primary care practitioners as well as specialists, are lining up to sell their practices to hospitals. Insecure physicians have read the handwriting on the wall – mandates to buy and install electronic health records, rising malpractice rates, falling Medicare reimbursements, increasing business and regulatory expenses, an unfriendly political environment – and bailing out. The number of doctors in private practice has dropped from 67% to less than 50% in the last two years.
Hospitals can read the handwriting too. They read projections that Obamacare will cause 15% of hospitals to fail because of the onslaught of 34 million more insured, most of whom are being paid for at Medicaid rates that do not meet practice expenses, and of the 78 million baby boomers becoming eligible for Medicare in 2011, at the rate of 13,000 each day, reimbursed at Medicare rates, which did not meet the cost of providing hospital care.
Furthermore, hospitals know that forced interoperable digitization to rationalize and monitor care will be too much expense too soon, with little or no return on investment("Too Much, Too Soon, Electronic Medical Record Effort Gets Pushback," WSJ Health Blog" May 18, 2010). It is an expense hospitals and doctors can ill afford. Hospitals know their bottom lines rely overwhelming on high ticket, high tech specialty care. So hospitals are only too happy to buy out specialty practices and the primary care doctors who feed the specialists.
Despite the high flown rhetoric about “disruptive innovation” and “disruptive decentralization,” with greater access and greater affordability, the reform pendulum for the moment, at least, is swinging the other way, towards eruptive consolidation between hospitals and doctors, more limited access to doctors, and higher expenses in centralized, consolidated institutions, where costs are often twice as high as on the outside in ambulatory, decentralized settings.
Doctors Are Focusing on Lifestyle When Practicing Medicine
Preface: When it comes to other bloggers reprinting my medinnovation blogs, I seem to be on a roll these days. Here Kevin Pho, MD, a Nashua, New Hampshire primary care physician and creator of Kevin Pho, MD, America’s premier health care blog, which is often quoted in the WSJ, NYT, and USA Today, has seen fit to reprint my blog interview with Elizabeth Chase, MD, an obstetrician and gynecologist in Dover, New Hampshire.
An interview with Elizabeth Chase, MD, obstetrician-gynecologist in Dover, New Hampshire
Elizabeth Chase, better known as Betsy, is a close and enduring college friend of my son, Spencer. She is a solid, pragmatic, hard working obstetrician-gynecologist, with two sons, and an architect husband, who spends his time caring for their children and their house in Dover, New Hampshire. She represents many of changes that occur when women become full-time physicians. The purpose of this interview is to give insight into trials, tribulations, and joys of being a woman physician in a transformed health care system.
Q: Dr. Chase, when did you graduate from medical school, and how old are you?
A: I graduated from Tufts University School of Medicine in 1992. I am 46 years old, and I have practiced for 12 years.
Q: Has your career lived up to your expectations? Has anything surprised you?
A: From the standpoint of the joys of being part of patients’ lives, listening to their stories, and the pleasure of doing surgery, it has lived up to my expectations.
Q: And what have been your disappointments?
A: The hardest part in my early years of practice in Pennsylvania was a combination of things — the shock of low reimbursements paying me half of what I expected to make, the negative malpractice environment, and inadequate amount of time I had to spend with patients to make up the difference. I just could not justify spending so little time with patients.
I left Pennsylvania for partly personal and partly professional. I was part of an exodus of doctors from Pennsylvania. I recall a full-page ad in the Philadelphia Inquirer, listing all the doctors who had fled Pennsylvania. I moved to Dover, New Hampshire.
Q: Give us some context of the community you’re in, the hospital you use, and your practice setting.
A: I practice in a community hospital with a level 2 nursery. We have about 900 births per year. Dover has 50,000 people, and its primary industries include the headquarters of Liberty Mutual insurance company and we have some high tech firms. The hospital employs a lot of people. We have a private practice, five doctors, and all women.
Q: You’re part of the gender revolution.
A: Yes, but Tufts was one of the first medical schools to accept women, and my class had 50% women. And OB/GYN at this point is something like 80/20 women/men entering the profession.
Q: That changes medical practice dynamics. Women require pregnancy leaves, spend more time with family, are more likely to be employees, retire earlier, and sometimes women doctors are working and the husbands are not. How many women in your practice have “house husbands?”
A: All four of us, including myself, have a “house husband.” It gets a little hectic, but we manage very well. We’re on call every fourth night, but we make our call easier by working with midwives. About half of our on call time is back up call, with the midwives taking primary call.
Q: Describe to me the hospital–physician practice environment. As you know, hospitals are hiring more and more primary care doctors these days and even specialists. How large is your hospital?
A: We have 155 beds and 10 Operating room suites.
All primary care practices are ‘owned.’ There are no independent generalists working out of our hospital. We have a fully staffed hospitalist program. And all primary care practices participate in the hospitalist program. We have 13 hospitalists on staff at this point. We have 24 hour ICU coverage by hospital-employed doctors. None of the surgical practices or sub-specialty practices is owned. There appear to be some collaborative agreements with plastic surgeons.
Hospitals like to own the physicians because they can control them. We are not owned, but the hospital has often suggested to us the only solution to any financial problem we might have is to be owned.
We feel much more comfortable with owning ourselves. We prefer the independence we have. We’re making it financially. We’re 5 women, and 4 of us have kids. All our midwives have children.
We call ourselves a ‘lifestyle practice,’ and we try to blend being mothers with a sustainable way of being a doctor. We give ourselves 6 weeks of vacation a year and we give ourselves 2 weeks of CME. We do not believe in working 24 hours a day, 365 days a year. Our salaries are not as high as the national average, but we are happy this way. We look after each other and we collaborate and cooperate with the town’s other OB/GYN practice.
I’ve learned how to deal with adversity, and not make it kill me. I like medicine too much to stop. We truly love our patients, and try to develop positive relationships with them.
Comments on blog.
1 PAUL MD May 15, 2010
I practice in New Hampshire as well…and our practice has maintained autonomy from hospital ownership. Congratulations for finding your place in the field. You sound truly happy!
2 Marie May 16
What a great model for other practices! Collaboration and looking out for each other, cooperation with other practices, working with midwives…it truly sounds like the perfect arrangement.
Thanks for demonstrating it really can be done.
3. Medinnovation, May 17, 2010
You only live once, and you might as well make the most of it on your terms.
Monday, May 17, 2010
Medinnovation Post , "Americans and Their Medical Machines, "Appears on The Health Care Blog
I am pleased to report that my recent post, “Americans and Their Medical Machines, “ has been reprinted in the May 17 edition of America’s most widely read blog – The Health Care Blog. That blog is the brainchild of Matthew Holt, a British-born San Francisco based policy geek. Matthew, with his partners, created the Health 2.0 movement. It empowers health consumers to seize control of their health care and to work in concert with their physician partners.
Here are three comments on my blog, along with my response to their comments.
Comments
Food for thought. Thank you for the perspective and well written blog. We appreciate anything & everything that keeps the inner machine (brain) operating smoothly.
Posted by: s. williamson | May 17, 2010 8:49:28 AM
So I guess ECMO, dialysis, Bypass pumps, Defibrillators should all have been nonstarters? By extention, there was no need to invent the refrigerator since folks were getting by with ice-boxes. Bring on the Luddites.
Posted by: Doc99 | May 17, 2010 11:37:42 AM
What a wonderful post. If this idea can be combined by an individual visiting http://www.websightmd.com/index.html i hope things will totally work together for good.
My Response to Comments
I am all for innovation. I have written a book promoting it Innovation-Driven Health Care, (Jones and Bartlett, 2007), and I have spent the last three years blogging at Medinnovationblog, which now has 1321 entries.
In this particular blog, I was simply trying to say we ought to put medical machines in perspective. They work, they save lives, we love them, they cost a lot of money, and they have created a vast industry.
I meet most mornings for coffee with a group of 65 year + males, and all of us have experienced an invasive medical procedure - cataract surgery, coronary stents, abdominal aneurysm stents, hip and knee replacements, rods in the vertebral column - and I'm happy to report because of these wonderful procedures, we're all productive and functioning.
On the payment side, however, collectively these procedures, more widely available and more quickly accessible than in any other country, are driving Medicare over the financial cliff.
Obamacare promises to cut $535 billion out of Medicare. Can this be done without rationing these procedure in some way and without running into stiff political resistance from those of us who have come to expect the benefit of these technological innovations.
I am no Luddite. Instead I am a medical machine advocate. My fondest hope is that we about to enter the age of Disruptive Innovation and Disruptive Decentralization, already signaled by Health 2.0 and portable devices that can be deployed in physicians offices and patients homes, to be put into action at lower costs in more convenient settings. In a more recent medinnovation blog I give practical examples of these disruptive devices that are already at work.
Dr. Reece, I would love for you to elaborate on that. There are multiple things that come to mind:
1) Americans seem to be particularly prone to machinistic and overly simplified explanations of complex physiologic processes (both physicians offering them ad patients expecting them).
2) The US has a culture of medical technology enthusiasm that is probably unmatched worldwide, leading to true innovation as well as nonsensical pseudo-progress.
3) From what I read, it is the UK that has developed the counterculture of technology skepticism and a stingy, conservative approach to medical technology. France and Germany are, as a whole, probably in--between.
4) If the body is a machine, then any problem has to be explainable in mechanistic terms. Medically unexplained symptoms are extremely common, and yet few Americans are willing to entertain the thought that their symptoms may be related to anxious over observation and psychiatric disease. And the latter, of course, is a chemical imbalance of brain transmitters.
Here are three comments on my blog, along with my response to their comments.
Comments
Food for thought. Thank you for the perspective and well written blog. We appreciate anything & everything that keeps the inner machine (brain) operating smoothly.
Posted by: s. williamson | May 17, 2010 8:49:28 AM
So I guess ECMO, dialysis, Bypass pumps, Defibrillators should all have been nonstarters? By extention, there was no need to invent the refrigerator since folks were getting by with ice-boxes. Bring on the Luddites.
Posted by: Doc99 | May 17, 2010 11:37:42 AM
What a wonderful post. If this idea can be combined by an individual visiting http://www.websightmd.com/index.html i hope things will totally work together for good.
My Response to Comments
I am all for innovation. I have written a book promoting it Innovation-Driven Health Care, (Jones and Bartlett, 2007), and I have spent the last three years blogging at Medinnovationblog, which now has 1321 entries.
In this particular blog, I was simply trying to say we ought to put medical machines in perspective. They work, they save lives, we love them, they cost a lot of money, and they have created a vast industry.
I meet most mornings for coffee with a group of 65 year + males, and all of us have experienced an invasive medical procedure - cataract surgery, coronary stents, abdominal aneurysm stents, hip and knee replacements, rods in the vertebral column - and I'm happy to report because of these wonderful procedures, we're all productive and functioning.
On the payment side, however, collectively these procedures, more widely available and more quickly accessible than in any other country, are driving Medicare over the financial cliff.
Obamacare promises to cut $535 billion out of Medicare. Can this be done without rationing these procedure in some way and without running into stiff political resistance from those of us who have come to expect the benefit of these technological innovations.
I am no Luddite. Instead I am a medical machine advocate. My fondest hope is that we about to enter the age of Disruptive Innovation and Disruptive Decentralization, already signaled by Health 2.0 and portable devices that can be deployed in physicians offices and patients homes, to be put into action at lower costs in more convenient settings. In a more recent medinnovation blog I give practical examples of these disruptive devices that are already at work.
Dr. Reece, I would love for you to elaborate on that. There are multiple things that come to mind:
1) Americans seem to be particularly prone to machinistic and overly simplified explanations of complex physiologic processes (both physicians offering them ad patients expecting them).
2) The US has a culture of medical technology enthusiasm that is probably unmatched worldwide, leading to true innovation as well as nonsensical pseudo-progress.
3) From what I read, it is the UK that has developed the counterculture of technology skepticism and a stingy, conservative approach to medical technology. France and Germany are, as a whole, probably in--between.
4) If the body is a machine, then any problem has to be explainable in mechanistic terms. Medically unexplained symptoms are extremely common, and yet few Americans are willing to entertain the thought that their symptoms may be related to anxious over observation and psychiatric disease. And the latter, of course, is a chemical imbalance of brain transmitters.
How-To’s of Health Care Innovation
In the opinion of many experts, the only way we are going to grow out of our present health care malaise is through innovation – doing things better, simpler, cheaper, and more humanely.
How to innovate in health care is a huge industry today. Many big American corporation claim to be innovative in the realm of health care. On national TV, GE constantly touts its efforts at medical innovation, through its electronic medical records and its new imaging machines. Tom Peters, the management guru, says American corproations can’t shrink their way to greatness, but they can thrive in chaos through innovation. Each time I write a blog on innovation, innovation companies – Innovation Management, Inc, Innovation Software, Inc, and Open Innovation Software, Inc. – place ads on my blog.
Peter Drucker, the late management guru, said every company should make innovation a centerpiece of their corporate strategy and make it systematic, organized, and purposeful. Kaiser has a center for innovation and has created the Innovation Learning Network, where big health care organizations across the land are mobilizing to bring us better health care. Small practices are innovating too, as they bail out of traditional practice models to form concierge, cash-only, home-care only, cosmetic-care only, Internet-based care , or to exploit other care niches that bring down costs, improve care, and the public will embrace.
Medical Innovations may come in big or small packages, but they must come in packages the public finds attractive, useful, and worth paying for. A medical innovation is useful only if the public or the payers accept it.
In a 2008 essay, Scott Berkun wrote,
An innovation can be big or small. Brand-new or just a bit different, it doesn't matter. An innovation can be clearly complex or seemingly simple. Innovations are often thought of in terms of technical achievement, but can also be a design. The type, industry and style of innovation are irrelevant; an innovation's impact determines its qualification.
The presence of a genius can help with innovation – it may speed up the end result by having a person who can see and make the future happen. However, innovation is more than the work of any one "Einstein." Innovation involves the taking of the work of an individual (or team) of inventors and taking it to a broader audience.
The future of many businesses depends upon their ability to innovate. Competition is fierce. Knowledge spreads quickly. The ability of a company to not only keep up with its current business practices, but to exceed its own – and its competition's – expectations are critical to survival.
But how? The how to’s, as I see them, are,
1) Encourage people to express wild and crazy ideas. A hospital in Pennsylvania does this routinely by having periodic “wild and crazy” sessions for its staff. . The only rule is “no snickering.”
2) Ask people on the front lines, nurses, other paraprofessional receptionists, and aides- what they think. They are more likely to know what people need and what will work. If you’re a doctor, ask them, “How can I do this better?”
3) Create and fund skunk groups, those outside your practice and bureaucracies, to try new things.
4) Appoint a chief innovative officer for your practice, anybody, for your practice, and reward them in some way.
5) Take multiple actions at the edge of your practice to see what attracts patients.
6) Ask “Why not?” Why not try something new? Even if it fails, you’ve learned something.
7) If what you’re doing isn’t working,
do something else.
If you want to do something, ‘
do something.
If you want to try something,
try something.
If you do not know that something,
ask yourself or others if you’re missing something.
There’s always a better way of doing something,
Doing nothing is not as good as doing something.
How to innovate in health care is a huge industry today. Many big American corporation claim to be innovative in the realm of health care. On national TV, GE constantly touts its efforts at medical innovation, through its electronic medical records and its new imaging machines. Tom Peters, the management guru, says American corproations can’t shrink their way to greatness, but they can thrive in chaos through innovation. Each time I write a blog on innovation, innovation companies – Innovation Management, Inc, Innovation Software, Inc, and Open Innovation Software, Inc. – place ads on my blog.
Peter Drucker, the late management guru, said every company should make innovation a centerpiece of their corporate strategy and make it systematic, organized, and purposeful. Kaiser has a center for innovation and has created the Innovation Learning Network, where big health care organizations across the land are mobilizing to bring us better health care. Small practices are innovating too, as they bail out of traditional practice models to form concierge, cash-only, home-care only, cosmetic-care only, Internet-based care , or to exploit other care niches that bring down costs, improve care, and the public will embrace.
Medical Innovations may come in big or small packages, but they must come in packages the public finds attractive, useful, and worth paying for. A medical innovation is useful only if the public or the payers accept it.
In a 2008 essay, Scott Berkun wrote,
An innovation can be big or small. Brand-new or just a bit different, it doesn't matter. An innovation can be clearly complex or seemingly simple. Innovations are often thought of in terms of technical achievement, but can also be a design. The type, industry and style of innovation are irrelevant; an innovation's impact determines its qualification.
The presence of a genius can help with innovation – it may speed up the end result by having a person who can see and make the future happen. However, innovation is more than the work of any one "Einstein." Innovation involves the taking of the work of an individual (or team) of inventors and taking it to a broader audience.
The future of many businesses depends upon their ability to innovate. Competition is fierce. Knowledge spreads quickly. The ability of a company to not only keep up with its current business practices, but to exceed its own – and its competition's – expectations are critical to survival.
But how? The how to’s, as I see them, are,
1) Encourage people to express wild and crazy ideas. A hospital in Pennsylvania does this routinely by having periodic “wild and crazy” sessions for its staff. . The only rule is “no snickering.”
2) Ask people on the front lines, nurses, other paraprofessional receptionists, and aides- what they think. They are more likely to know what people need and what will work. If you’re a doctor, ask them, “How can I do this better?”
3) Create and fund skunk groups, those outside your practice and bureaucracies, to try new things.
4) Appoint a chief innovative officer for your practice, anybody, for your practice, and reward them in some way.
5) Take multiple actions at the edge of your practice to see what attracts patients.
6) Ask “Why not?” Why not try something new? Even if it fails, you’ve learned something.
7) If what you’re doing isn’t working,
do something else.
If you want to do something, ‘
do something.
If you want to try something,
try something.
If you do not know that something,
ask yourself or others if you’re missing something.
There’s always a better way of doing something,
Doing nothing is not as good as doing something.
Saturday, May 15, 2010
Innovation - Automatic Cardiac Defibrillator and Other Examples of Disruptive Decentralization
Yesterday I wrote a blog “Limits of Innovation.” Its themes were that innovations may be good, bad, or ugly, and even good innovations don’t necessarily work in the complex world of markets and government regulations.
R. Lee Heath, inventor of pads making the automatic cardiac defibrillator , immediately and gently set my mind straight with this comment,
“I find this commentary very interesting. I just want to add something more on a positive note. I would add just one quote to this. "Show me a man who is content and I will show you a failure.", Thomas Edison.”
“I think it is best to approach innovation with at least the idea that anything is possible, if you put your mind to it. Things can be made simpler rather than complicated. Certainly politics can make everything a lot more complicated. “
Roger Heath
inventor making possible the modern automatic heart defibrillator
Needless to say, I was a little shame-faced. Roger is right. We should never be content with the status quo. We should strive to make the world better. And Roger has done that. His information on Google reads,
“Roger Lee Heath, invented the electrode pads (placed on the chest of cardiac arrest victims) making possible the modern automatic external defibrillator (AED).”
“He is the only individual to invent and patent, through multiple U.S. and foreign patents, the first standardized electrical interface for the human body. His invention is now in use by paramedics, hospitals, helicopter transport operations, critical coronary care units, cardiac catherization labs, even in the home, and aboard America’s space shuttle.”
“In 1995, he was recommended by American Heart Association officials, and other peers, for the Lemelson MIT Prize, the highest prize awarded inventors, and credited with making possible the modern AED (Automatic External Defibrillator) and related intermediate first responder programs. “
Heath's invention is a superb example of innovations and inventions designed for disruptive decentralization, whereby less sophisticated, even untrained people at the scene of an event – a cardiac arrest, an illness at home, an encounter in a physician’s office – can do what needs to be done, freely, at less cost, and effectively.
Other examples of disruptive inventions at decentralized locations immediately spring to mind.
• The grand daddy of them all, the personal computer and its offspring, Google.
• The portable hand-held ultrasound, with which physicians in their offices can determine if an abdominal mass or abdominal aneurysm exists.
• The portable Shape-HF cardiac-pulmonary testing device, which allows a physician in his office or a trained medical technician in any location to evaluate the cause of shortness of breath and the odds of hospitalization or sudden death.
• Audio-visual devices developed by American Telecare, Inc., at bedsides of home-ridden patients with chronic disease, which permit them to spot complications on their own and to communicate with doctors and nurses in remove locations, in the process dramatically reducing the need for hospital or ER admissions.
• Worksite clinics and retail clinics, wherein the power of proximity is at work, viz, patients can see convenient care near where they work and live for non-urgent problems.
. Practice Fusion, Inc, a "free" EMR for physicians that can be up and running in five minutes and is free to physicians because of its ad-based revenue model and its off-loading to the Internet.
. Instant Medical History, Inc, which allows patients to record their chief complaint, medical, social, and family history over the Internet before visiting the doctor and appearing in the exam room.
Chunking
I like to think of these various examples as “chunking,” a term introduced in a 1998 book Edgeware. Edgeware’s authors define chunking as “Growing complex systems by allowing complex systems to emerge out of the links among simple systems that work well and are capable of operating independently.”
In other words, the long journey towards an effective health system begins with small steps. As the mother said to her small son when she sent him out on a windy day, “Big wind. Take small steps. "
R. Lee Heath, inventor of pads making the automatic cardiac defibrillator , immediately and gently set my mind straight with this comment,
“I find this commentary very interesting. I just want to add something more on a positive note. I would add just one quote to this. "Show me a man who is content and I will show you a failure.", Thomas Edison.”
“I think it is best to approach innovation with at least the idea that anything is possible, if you put your mind to it. Things can be made simpler rather than complicated. Certainly politics can make everything a lot more complicated. “
Roger Heath
inventor making possible the modern automatic heart defibrillator
Needless to say, I was a little shame-faced. Roger is right. We should never be content with the status quo. We should strive to make the world better. And Roger has done that. His information on Google reads,
“Roger Lee Heath, invented the electrode pads (placed on the chest of cardiac arrest victims) making possible the modern automatic external defibrillator (AED).”
“He is the only individual to invent and patent, through multiple U.S. and foreign patents, the first standardized electrical interface for the human body. His invention is now in use by paramedics, hospitals, helicopter transport operations, critical coronary care units, cardiac catherization labs, even in the home, and aboard America’s space shuttle.”
“In 1995, he was recommended by American Heart Association officials, and other peers, for the Lemelson MIT Prize, the highest prize awarded inventors, and credited with making possible the modern AED (Automatic External Defibrillator) and related intermediate first responder programs. “
Heath's invention is a superb example of innovations and inventions designed for disruptive decentralization, whereby less sophisticated, even untrained people at the scene of an event – a cardiac arrest, an illness at home, an encounter in a physician’s office – can do what needs to be done, freely, at less cost, and effectively.
Other examples of disruptive inventions at decentralized locations immediately spring to mind.
• The grand daddy of them all, the personal computer and its offspring, Google.
• The portable hand-held ultrasound, with which physicians in their offices can determine if an abdominal mass or abdominal aneurysm exists.
• The portable Shape-HF cardiac-pulmonary testing device, which allows a physician in his office or a trained medical technician in any location to evaluate the cause of shortness of breath and the odds of hospitalization or sudden death.
• Audio-visual devices developed by American Telecare, Inc., at bedsides of home-ridden patients with chronic disease, which permit them to spot complications on their own and to communicate with doctors and nurses in remove locations, in the process dramatically reducing the need for hospital or ER admissions.
• Worksite clinics and retail clinics, wherein the power of proximity is at work, viz, patients can see convenient care near where they work and live for non-urgent problems.
. Practice Fusion, Inc, a "free" EMR for physicians that can be up and running in five minutes and is free to physicians because of its ad-based revenue model and its off-loading to the Internet.
. Instant Medical History, Inc, which allows patients to record their chief complaint, medical, social, and family history over the Internet before visiting the doctor and appearing in the exam room.
Chunking
I like to think of these various examples as “chunking,” a term introduced in a 1998 book Edgeware. Edgeware’s authors define chunking as “Growing complex systems by allowing complex systems to emerge out of the links among simple systems that work well and are capable of operating independently.”
In other words, the long journey towards an effective health system begins with small steps. As the mother said to her small son when she sent him out on a windy day, “Big wind. Take small steps. "
Friday, May 14, 2010
Limits of Medical Innovation
Innovate or die. The phase, popular in Silicon Valley in the nineteen nineties, has since become a mantra throughout the business world…The real questions is how do we keep the good parts of innovation without being stuck with the bad.
James Surowiecki, “ Financial Innovation: Too Clever by Half,” The New Yorker, May 17, 2010
The real problem with cheap eyeglasses in the developing world isn’t making cheap lenses, it’s testing eyes and writing accurate prescriptions for people with little of no access to medical care – a matter of politics and economics rather than technology. The world’s most urgent need, he has come to believe, is not some miraculous-seeming scientific break through but for a vast, unprecedented transformation of human behavior.
David Owen, “The Annals of Design: The Inventor’s Dilemma,” a portrait of Saul Griffith, inventor extraordinaire, The New Yorker, May 17, 2010
We just don’t know what happens in vivo. That’s why drug development is still so hard and so expensive, because the human body is such a black box. We are totally shooting in the dark. You have to have good science, sure. But once you shoot the drug in humans you go home and pray.
Lan Bo Chen, Scientist at Synta Pharmaceutical Corp., Annals of Innovation, The Treatment, The Difficulties of Making A Cancer Drug, The New Yorker, May 17, 2010
This morning the May 17 issue of The New Yorker crossed my desk. It contains three extraordinary articles on innovation - one devoted to innovation of new energy sources and climate change, which so far have fizzled out, the second on Wall Street innovations, which have been disastrous for the U.S. and the world economies, and the third on the sporadically fruitful but usually inconsistent search for drugs that cure cancer.
I believe these three articles have lessons to teach about the limits of medical innovation.
The energy piece describes the work of Saul Griffith, a PhD graduate of M.I.T. Griffith developed a device to grind eyeglass lenses dirt cheap, an invention that failed on the market, and he is now working in Silicon Valley on wind-energy devices that produce enough power to ease the energy crisis. His invention no commercial takers yet.
The Wall Street article concerns the excessive financial innovations -C.D.O. Centralized Debt Obligations, A,B.S (Asset Based Securities), C.D.S.(Credit Default Swaps)- and other computerized and bundled financial derivatives which nobody, including myself, understand , but which everybody thinks make financial risk opaque and capable of destroying the world’s economies. Greed may be good but massive greed bundled and computerized, is unsustainable.
The piece by Malcolm Gladwell on cancer drug development is about the hits, misses, odds, and dashed hopes in the search for cancer drugs.
The lessons for health care innovations are three fold.
One, medical innovation has limits. They may represent technological breakthroughs but often prove ineffective once human markets and human behavior comes into play. An example of this is the Google-ization of medicine. You can talk all you want about Health 2.0 or Health 3.0 or the value of universal transparency in judging value, new electronic horizons of consumer-doctor communication, and deploying data to define who well doctors and hospital perform. But unless transformation of human behavior and expectations occur to accompany the technologies, not much fundamentally changes. If patients do not fill prescriptions or take their medicine as ordered, or cannot afford to take medications, outcomes of chronic disease may not improve, and catastrophic events may not be prevented.
Two, medical innovations have economic consequences. It is sometimes said 70% of cost rises stem from medical innovations – new drugs for cancer, heart disease, diabetes, erectile dysfunction, or new niche diseases such as fibromyalgia, medical imaging CT, MRI, and PET scans; or restoration of life style function (stents, knee and hip replacements), and so on ad infinitum. It may be there is some massive innovation out there - an all-purpose magic pill with multiple ingredients for preventing diabetes and catastrophic cardiovascular disease, a cure-all for cancer , or a universal appetite suppressant without side-effects that eliminates obesity, the world’s number one health problem. But unless we find some way to achieve universal access through economic and political policies and transformations that alter normal human behavior, these and other innovations will have a limited effect.
Three, the human body remains a mysterious “black box,” and no two human bodies react the same. Even Juda Folkman’s beautifully elaborated theory about angiogenesis - curing cancers by cutting off the flow of blood vessels to tumors has had its ups and downs and inconsistencies.
Still, as I observed in my book Innovation-Driven Health Care (Jones and Bartlett, 2007), it is never too late to innovate - and in a complex adaptive society filled with complex adaptive human organisms. Maybe, just maybe, we can innovate our way out of the problems that beset us. There is always a better way after the bad ways have been exhausted.
Thursday, May 13, 2010
Will Medical Innovation Save Us from the Internet and Social Welfare Swamps?
When you’re up to your ass in alligators, it’s hard to remember your original objective was to drain the swamp.
Source unknown
I have a friend, Steve Merahan, MD. Steve is general manager of www.modernmedicine.com In this physician-oriented website, Steve is engaged in aggregating physician related content from print to online in one website. Modern Medicine now owns 17 medical print publications that have gone online to survive.
Steve is hard man to get a hold of. When I finally break through, I ask Steve where he’s been, he says, “In the swamp.” He is speaking of the electronic swamp created by Google. A swamp, for purposes of this blog, is an ecosystem in which everything is interconnected and bogs down or rises together. In traversing a swamp, one has great opportunities and great problems.
This transition from print to online is one of the greatest swamps of our time. The Google swamp threatens not only to drag down medical print publications, but other print organizations like Newsweek, now up for sale, book publishers, and the nation’s newspapers, like the New York Times.
In health care, it seems to me there are two inter-related swamps out there.
• One is the Internet Swamp. The Internet, and its viral carrier, Google, has taken the world by storm, interconnecting everything instantly. When all is known, geeks theorize, the Internet will lift all health care boats. It will improve care in one fell swoop through perfect information provided by an interoperable, ubiquitous, all-knowing, all -reporting, all-accessible electronic system.
There are only two problems with this. One, For many reasons, chief among drops in productivity, disruption of practice flow, and exorbitant costs, and fear of being inappropriately judged for quality , physicians are not buying the EMR gospels of efficiency and health care improvement. Two, patients are reluctant to give up their privacy and personal information to authorities outside the physicians’ offices. We are still up to our hips in an electronic swamp, pitting geeks, government officials, and health care managers against many doctors and patients, who think care is a personal business.
• Two is the Health Entitlement swamp, also known as the Social Welfare Swamp Different persons describe this swamp differently. Milton Berle, the late comedian, said, “When it comes to my health, money is no object.” Margaret Thatcher, the former conservative Prime Minister of Britain, said, “The trouble with Socialism is that sooner or later you run out of other people’s money.” Robert Samuelson, Washington Post columnist, describes “ the death spiral of the welfare state,” in these terms “Virtually every advanced nation, including the United States, faces the same prospect. Aging populations have been promised huge health and retirement benefits, which countries haven't fully covered with taxes.”
Thomas Friedman, the New York Times global guru, explains this debt spiral as Death of the Tooth Fairy requiring as Root Canal Politics to correct,
” Baby boomers in America and Western Europe were raised to believe there really was a Tooth Fairy, whose magic would allow conservatives to cut taxes without cutting services and liberals to expand services without raising taxes. The Tooth Fairy did it by printing money, by bogus accounting and by deluding us into thinking that by borrowing from China or Germany, or against our rising home values, or by creating exotic financial instruments to trade with each other, we were actually creating wealth.”
“After 65 years in which politics in the West was, mostly, about giving things away to voters, it’s now going to be, mostly, about taking things away. Goodbye Tooth Fairy politics, hello Root Canal politics.”
Which brings me to Obamacare. Can the United States afford to spend an estimated $3 trillion over the next 20 years to expand the health care welfare state, which already covers 100 million Americans, and with 32 million more uninsured and 78 million more baby boomers entering Medicare? Do we have the guts to do what needs to be done – extending the age of Medicare entry to 67 or maybe even 70, means testing Medicare so the wealthy pay more, and rationing care?
Will American Innovation Save the Day?
Can we claw our way out of the debt swamp through innovation? After all, we are, as Peter .F. Drucker observed in his classic book, Innovation and Entrepreneurship (1985), the world’s most innovative nation.
Can we do escape the debt-producing, health care alligators through electronic innovation? Can we do it treating people at home and remote locations through telemedicine? Can we do it by making e-visits to doctors routine? Can we do it by bringing physicians to heel by judging doctor performance and outcomes electronically and paying only for what works? Can we do through a magic interoperable information system connecting consumers, hospitals, doctors, health plans, and government?
I do not know, but I do know America is having a go at fixing health care through innovation. We have some 1200 innovation incubators around the U.S, focusing on launching successful high tech startups with access to venture capital. We have the federal government creating a Medical Innovation center at the Centers of Medicare and Medicaid (the Center for Medical Innovation, CMI). We have Kaiser creating an Innovation Learning Network, comprised of a handful of leading hospital and integrated health centers. We have multiple conferences on Disruptive Innovation, the concept that claims we can cheaper, simpler , more effective, more universal care can be provided by less sophisticated personnel.
Carry on - you forces for innovation. But watch out for alligators.
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