January 2, 2007

Brailer on Health IT

Before the holidays, the former National Coordinator for Health IT David Brailer, MD, gave an interview for iHealthBeat, the news digest of the California HealthCare Foundation. The full interview, released today, is available as an audio file (excerpts above, downloadable mp3 file below) or a PDF transcript.

From the interview:

  • “I always told people that the battle over health IT adoption was over. It was just a matter of time. The real fight, and this one I don’t have such optimism about, is the fight over patient centricity, or patient control of their health care, and, therefore, control over their health care information…And that’s not so much a health IT battle. That is a battle over the heart and soul of who owns controls and who sets the priorities for the health care system.”
  • “I think we don’t have the right privacy and security regiment. The one that we have under HIPAA and state laws was created largely in a world that didn’t anticipate electronic information that was stored for, or by, or used on behalf of the patient…And I think the American public has been very clear that they want to see privacy protections in place before they’re really willing to jump into [electronic medical records].”
  • “…incentives for adoption [of health IT]. We had the one-year fix to the sustainable growth rate…which gave physicians a bonus for submitting quality data. That has no effect whatsoever on health IT adoption. So it’s time to come back to the question that we’ve put aside during the whole pay-for-performance discussion for three years about the market incentives and the policy incentives to bring us into full adoption of electronic records. I, as a very keen supporter of incentives, withheld my judgment on that during the pay-for-performance period. I think it has now had its chance, and it hasn’t been able to deliver a policy with the impact that I think convinces me that it’s going to help us with adoption, particularly among doctors in rural areas, in a safety net and even small practices.”
  • “Well, I think the change…comes from every place but Washington…in states and in the private sector…I see states moving quickly, and they will do more in 2007 to create a more fertile environment for health IT.”
  • “But I think the promise of personal health information being shared goes beyond a record. I’m particularly excited by remote monitoring, remote patient management; things where it’s not just a static database but where we’re monitoring someone in their home so they don’t have to be in a nursing home or where someone can be monitored in an ICU bed and a doctor doesn’t have to be present all the time but can be tele-present…That is the same concept of a personal set of health information that is centered around the person, but it probably doesn’t meet our definition of what we would call a PHR today. I view more convergence happening between that concept of the database and the streaming set of information, as we really ask the questions about what problems the PHR solves or what opportunities it creates. I think as we start thinking that way, we will come back to this set of functional tools that help us improve the patient role in health care, just like health information has helped us in traditional care delivery beyond the electronic health record — medication administration, reduced errors in inventory management, the way communication occurs, let alone computerized physician order entry. These things that are unheralded heroes of how IT does help are a broad bundle of change, and I think you’ll see that on the personal side as well.”
  • “I think there are two subdebates that will play out, so it creates kind of a two-by-two table with four outcomes. The first one is whether we will go beyond all of the lip service. The patient should be in control of the health care system, in control of their care. They should have information to make treatment choices. They should have information to make a choice about a doctor. They should have the information to be able to make tradeoffs when it comes to various outcomes. And I think this is quite pronounced as we start thinking about the genomic world, where you have so many genomic risks, like, you know, you might have heart disease in the future, or you may have breast cancer, or you may have memory loss. And you have to decide if you’re going to act on that 20 or 30 years in advance. This question about whether we are going to move beyond the promise and actually make the health care industry centered on that, which is profoundly disruptive to the established interests that rely upon a very high volume of hospitalizations, or bouncing patients around, and churning patients a lot because we can’t quite create integrate care processes around them, you know, that’s disruptive. And I think that’s a debate about how far the industry will come towards focusing on patient control and consumer choice. And so you could think about that as either happening or not.
           Secondly, and I think apart from that, there’s a debate about the role of government. We’re sitting in a hybrid system now. Government intrusion in private sector, or participation — neither one is dominant and neither one has the leverage to make it cohesive. The industry can’t do what it’s done in other industries, which is squeeze out the inefficiencies and create, really, a seamlessly integrated experience. Look at the financial sector, elsewhere. Nor can government do this because it doesn’t have control, and I think it has a lot of conflicts of interest with respect to how to make health care work versus the Medicare Trust Fund be solvent. And so you see kind of that being … now sitting at a point of maximum agony. I think that’s going to flip one way or the other. So we could have a very government-controlled system that’s consumer responsive or a government-controlled system that is quite provider-driven, and we could have a private-sector system that’s one or the other.”

November 24, 2006

It was a very good year (in-review)

Filed under: — mlazoff

American Medical Informatics Association (AMIA) 2006 Year in Review groups selected articles on medical computing that were published this year in major medical journals by topic, with links to PubMed abstacts. This wonderful resource was created by Daniel Masys, MD chairman of Vanderbuilt University Medical Center Department of Biomedical Informatics and was taken from Dr. Masys’s presentation at a recent AMIA Symposium; his slides can be accessed online as well.

September 14, 2006

Capitali$m by Remote Control

Filed under: — mlazoff

The Business section in last Saturday’s New York Times included Remote Control for Health Care, an article describing the competition among companies betting on the future of remote-control medical technology. Examples of such technology include implanted heart devices for arrrhythmias, electronic beds that weigh, a handheld blood pressure device that plugs into a telephone, and a subcutaneous catheter for blood sugar monitoring. Companies compete for the technology itself; what the technology measures (for example, three companies have competing views on the best sign for impending heart failure); and on the data collection services run by the device companies and independent monitoring services that interact wirelessly with these devices, for data storage and to communicate the data to physicians and patients. The article notes that “[a] Veterans Affairs study that followed 70 patients over three months found that remote monitoring of their heart implants freed up eight days of time doctors would otherwise have devoted to office visits.” Still, the article describes healthcare practitioners concern over uncompensated time spent analyzing each patient’s data, and an increased risk of malpractice, should the data collection services fail to notify them of warning signs. The optimistic article closes with the same patient that opened the article: a 42 year old woman with chronic heart and kidney problems. “Mrs. Huntoon says longer stretches between hospitalizations would be enough of a life change to make her happy. She says she hopes her doctors can add remote monitoring of her potassium levels to her routine, thus increasing the chances of stabilizing her unreliable heart. The hospital employees know her so well they treat her like family, Mrs. Huntoon said. ‘But I don’t want to be a part of that anymore.’”

August 21, 2006

Telebiopsy report

Filed under: — mlazoff

A recent press release from Kansas University Medical Center describes how surgeons in the OR are teleconferencing with pathologists in their lab. “The system uses two computers equipped with cameras, an intranet connection and high-quality video conferencing software to create a virtual connection…surgeons can send a tissue sample to the lab and communicate from the OR as the pathologist examines the sample under a microscope. In fact, surgeons can see both the pathologist and the microscope slide on the computer screen, making the process truly interactive.” The press release describes this as an “innovative system,” but is this really not being done elsewhere in 2006? (Thanks to HIStalk, who notes, “That’s one of those ‘why didn’t we think of it earlier’ ideas that’s cool, easy, and cheap.”)

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