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February 18, 2012

The Other HIE

The acronym HIE is confusing. It stands for two very different concepts. The first, which high tech types know, is health information exchange. This exchange involves sending clinical documents such as care summaries from physician to physician using a common standard on the Internet. It sounds simple, but it has been difficult to accomplish because until recently many physicians didn’t have an EHR and even if they did many EHRs can’t exchange documents in standard templates.

The other kind of HIE is a health insurance exchange. The 2010 “Obamacare” health reform law called for each state to open its own insurance exchange where consumers can shop for policies and tap health insurance tax credits. But for states that chose not to or couldn’t get it up-and-running, the law called for the federal government to step in and handle the exchange.

The Wall Street Journal reported last week that a number of Republican-led states such as Wisconsin and Florida have rejected on political grounds setting up a state-run HIE. A number of other states have indicated they will run their own exchange but made little progress to date. As the WSJ reports

“Only 28 states and the District of Columbia have made significant progress in setting up their own insurance exchanges.”

As a result, the Obama Administration asked for $860 million in its new budget to implement the HIEs at the federal level. As the Washington Post reports

“There’s little expectation that Congress will actually appropriate the funds the White House has requested, especially when the ask is so big and would pretty much go directly toward health reform implementation. What happens to the federal exchange if Congress turns down the request? Center for Consumer Information and Insurance Oversight director Steve Larsen tells Bloomberg that the government ‘will work with existing, available funding sources.’”

For the states that have committed to operating their own exchanges, the pressure is on. The Colorado Springs Gazette recently interviewed Patty Fontneau, the CEO and executive director of what is formally called the Colorado Health Benefit Exchange.

Ms. Fontneau, an attorney, made these points:

“The exchange does make sense to do regardless of what happens with the Affordable Care Act. It’s a smart business decision. It allows a competitive marketplace. It will allow a competitive marketplace to have appropriate influence on the cost of health insurance.

“I can’t tell you how it’s going to different from the federal plan. I would be surprised if the federal plan met the unique needs of Colorado. In order to get both individuals and small employers to act to purchase insurance, to use the services available to them, we’re going to have to have a tremendous education campaigns. The really broad-based education efforts won’t be until 2013 — you really want to get people aware of this project a little bit closer to when it’s going to launch.”

February 11, 2012

HIMSS Hot Topics

What will be the hot topics at HIMSS? Having talked with a number of journalists and exhibitors in the last week, I think three will stand out:

Stage 2 Meaningful Use rules

Interoperability, health information exchange

Mobile device software (iPads)

The HHS has said it will introduce the final version of the Stage 2 MU rules next week. While no one is sure exactly what will in the new requirements, they are bound to be tougher than Stage 1. Explanations of what they mean and suggestions for how to meet them are bound to be popular topics. There are already half-a-dozen educational sessions scheduled on MU, with one promising to include senior HHS officials on the panel.

Another hot topic will be interoperability and exchange of health information. To use the current buzz phrase, crossing enterprise boundaries. This need is driven by the success of MU Stage 1 in spurring the widespread adoption of EHRs. As several industry analysts have noted in recent weeks, for the first time in the 30-year history of healthcare information technology, we now have widespread and diverse collection of healthcare data by physicians and hospitals.

The challenge now is to collect, share and analyze the data. My client ChartLogic is participating in the Health Story Project, which will be giving demonstrations in the interoperability booth at HIMSS. Based upon the preview information I’ve seen, some very dramatic capabilities are going to be displayed, including the use of Apple’s Siri natural language processing program to move “hands free” between EHR applications and send specific data to remote locations.

Apple devices, along with Android tablets and phones, are very popular with physicians. One study claims 80% of physicians own a smart phone. These highly sophisticated devices can have a major impact on the collection and display of clinical information. Many vendors will be showing how their software can be used on iPhones or iPads.

I’ve been attending HIMSS for eight years and it gets bigger and crazier every year. The HIMSs organizers are predicting record attendance this year, more than 38,000. Fortunately, Las Vegas has some 200,000 hotel rooms, so there will be plenty of places to stay.

Some readers may remember the 2007 HIMSS, held in New Orleans, just five months after Hurricane Katrina. Several large hotels were closed, forcing some people to stay in motels miles from the convention center. Las Vegas won’t have that problem, but will add a note of weirdness to this annual spectacle of wealth and technology

February 5, 2012

A Fading EHR Rose

Has the bloom left the EHR rose? Has it reached its peak of attractiveness and is now destined to slowly wither into faded petals?

Several recent articles suggest that EHR sales will soon plateau and then slowly taper off.

Healthcare IT News, reporting on a conference on recent healthcare finance conference in Nashville, reports that a leading bank analyst predicts just 5 to 10 percent growth this year. Factors contributing to growth in 2012 include more meaningful use requirements and the impending conversion to ICD-10.

Separately, John Moore, founder of Chilmark Research, opined in his blog recently that “There will be plenty more EHR sales in the year to come, but over 2012 we will also see EHR sales growth begin to plateau and level off by end of Q4 ‘12.”

Other studies are more optimistic. According to a new study released last week by Millennium Research Group, the EHR market will enjoy 12 percent growth per year, and is expected to reach more than $8.3 billion by 2016. The report comes on the heels of a Frost & Sullivan report that predicts that market revenues for EHR systems will peak at $6.5 billion in 2012 for new licensing and upgrades.

In the current, heated-up environment for healthcare information technology, a “mere” 5-10% growth seems disappointing, but some other industries (e.g. airlines, utilities, retail) would rejoice in those numbers.

Venture capital firms still take a very positive view of healthcare info tech. They poured $633 million into the field last year, InformationWeek Healthcare reported. That was the highest amount since 2001, when they invested $759 million.

One unknown is the exact rate of adoption by small physician practices, where 60% of the nation’s physicians work.

Mickel Phung, a market analyst for Frost & Sullivan, said he expected higher growth, since “Early reports from 2008 and 2009 indicated 20 percent growth. That didn’t happen.”

He said many office-based physicians are still “hesitant and confused” by the number and type of EHRs available. There are currently more than 350 EHR systems being actively marketed, he said. Physicians are starting to gravitate towards “the bigger, better known vendors.”

January 28, 2012

Can’t Get Over Overuse

In the movie Casablanca, Police Captain Renault announces with feigned surprise that he “shocked” to find out that gambling is going on at Rick’s Casino.

If you needed proof that yes, overuse of health services is going on here in the U.S., it comes in a new study out last week. It reports with alarm that over overuse of therapeutic procedures accounts for as much as 30% of healthcare spending in our nation.

The article, published in the current issue of the Archives of Internal Medicine, reported on a review of 241 separate studies of overuse published between 1978 and 2009. Overuse was defined as interventions in which negative consequences, including unnecessary costs, outweighed the benefits of care.

The 4 most common health services examined in the studies included in the review were antibiotics for upper respiratory infections, coronary angiography, carotid endarterectomy, and coronary artery bypass grafting and revascularization.

One healthcare service that appeared to be significantly overused was follow-up screening colonoscopies, with up to a 60.8% rate of overuse; also hysterectomy, at up to 70.0% overuse.

“Despite broad acknowledgment that overuse is common and costly, overuse research has been underemphasized compared with research on underuse of health services,” the authors write.

Captain Renault attempted to deal with the gambling “problem” by closing Rick’s Casino for one night, thus averting a fight between the Free French citizens and Major Strasser and her evil Nazi thugs.

Here in the U.S., one attempt to quantify and reduce overuse is the new Patient-Centered Outcomes Research Institute (PCORI) which issued its much anticipated first report on national priorities on January 23.

The 22-page report stopped short of specifying any diseases or conditions that would be targeted for comparative effectiveness research.

Instead it made a series of general statements, intended to “define the boundaries” and “define the types of questions that we want to invest in,” said one panel member.

In Casablanca, Humphrey Bogart was forced to abandon the girl (Ingrid Bergman) and along with Claude Rains (Captain Renault), was forced to flee the city, heading for a French army camp deep in the North African desert. An initial setback for the two men, but “the beginning of a beautiful friendship,” said Bogart.

Let us hope the PCORI panel members maintain their sense of optimism as they begin a long struggle against the huge problem of overuse which may generate opposition from some entrenched interests.

January 16, 2012

Best Buy Offers Aetna Products

Best Buy has started selling “wellness plans” from Aetna, reports MobileHealthNews. According to the article,

“Three Best Buy stores in the suburban Chicago area are now selling four wellness programs offered by Aetna focused on fitness, weight management, smoking cessation, and stress management. Shoppers can buy hanging cards that explain each of the online programs that they can then access online. Each program costs $19.99.”

The article doesn’t define exactly what the consumer gets for $19.99, although it must be guidance or online advice, not actual health insurance. My first reaction, as someone who spent a decade working for a health insurance company, is that this marks the rehabilitation of the HMOs. At the height of the managed care hatred, 1995-2005, Best But would never have wanted to be associated with Aetna or any other health insurer. At one point, health insurers vied with tobacco companies as the most hated corporations.

According to the news article, Best Buy has created “health departments” in some of its stores and is selling “health devices like Withings’ blood pressure cuff, iHealth’s weight scale, the Basis B1 Band, Fitbit Ultra, or Jawbone’s UP.”

The article reported that an Aetna spokesperson said

“If shoppers are at Best Buy to purchase a pedometer or blood pressure cuff, they might also be interested in a program that helps them achieve health goals associated with the device. Best Buy employees at these three particular stores have been trained specifically to help shoppers in the health department sections.”

Will the new effort succeed?

The report points out that in 2004, Best Buy attempted to launch a new chain of retail stores, called Eq-Life, which “which aimed to help women shoppers buy technology and resources to manage their family’s health.”

The idea never gained traction and was quietly folded.