January 30, 2007

The NEPSI Challenge

Physicians who already signed up for the free Web-based e-prescribing software eRx NOW, provided by the National e-Prescribing Patient Safety Initiative (NEPSI), will begin receiving their free software tomorrow (January 31). According to their online FAQs, NEPSI  is a coalition of large corporations led by Allscripts and including Dell, Google, Microsoft, Intel, SureScripts, among many others. NEPSI sponsors are investing $100 million over the next five years to provide free Allscripts’ e-prescribing software to every U.S. physician as a way to jumpstart the use of e-prescribing software, and eventually electronic medical records, to reduce preventable medication errors and overall health care costs. NEPSI says,”We are not trying to lock providers into a one-vendor solution – we have a solution that works with any Electronic Health Record, Personal Health Record or practice management system from any vendor certified by the Certification Commission on Healthcare Information Technology (CCHIT).” For more information from NEPSI, see the press release from earlier this month.

From ”Coalition Offers Doctors Free Electronic Prescriptions,” an article posted two weeks ago on Ziff-DAvis’ eWeek: “The [NEPSI] system will be able to transmit prescriptions electronically to over 95 percent of the nations’ pharmacies. Two of the health insurance companies in the coalition, Aetna and WellPoint, said that they would provide incentives for physicians to write electronic prescriptions. Another coalition member, Sprint Nextel, is offering free pocket PC phones to doctors who sign up early…The initiative is offering a free Web-based system that would instantly check prescriptions for interactions with other medications (powered by a database provided by Wolters Kluwer Health) and would also check how much a patient or plan would have to pay for a drug. Google is providing a custom search engine to help physicians find relevant information for themselves or patients. Patient information will be stored remotely so that it will not be compromised if a doctors’ phone or computer is stolen.” 

This is not the first such effort. The article recalls how, in 2004, one coalition member—health insurer giant Wellpoint—invested $42 million in an effort to provide free e-prescribing software. “Doctors took the free stuff, but did not use it for the intended purposes. Since then, however, health IT evangelists have made large headways to create more positive attitudes toward health IT. ”

That same year, a second e-prescribing initiative involving many of the same NEPSI founders, Cafe Rx, also dissolved. Digital Healthcare & Productivity’s article, Free ePrescribing S/W Initiative Stirs Interest and Debate, goes into greater detail regarding Cafe Rx and quotes several competitors who speculate regarding NEPSI’s ulterior motives, along with replies from Glen Tullman, Allscripts CEO. “Tullman is clear that neither Google nor anyone else will mine data collected as part of the eRx NOW program and use the results for marketing purposes. ‘Patients and physicians will have unique access to all the information…Google will have no access to data we receive as part of the electronic prescribing process.’ Other questions raised about the e-prescribing program focus on accessibility of patient demographics and drug formularies. Notably absent from the list of NEPSI sponsors and supporters was RxHub, a joint venture of major pharmacy-benefit management companies that provides real-time electronic connectivity to patient-specific formulary and drug-benefit information. Tullman acknowledges that many users would have to find a third party to link the prescribing software to existing practice management and billing systems, but says that eRx NOW follows established standards to make the link. ‘We’re happy to interface with any practice management system.’ Tullman also addressed the formulary question by saying that Allscripts has access to eligibility and preferred-drug lists of more than 95 percent of payers nationwide via SureScripts and through the company’s own business relationships. He said that Allscripts was having discussions with RxHub and with practice management vendor Per-Se Technologies—now a part of McKesson due to an acquisition that closed last week—to find ways to pre-populate eRxNOW.”

January 10, 2007

Apple bites into the telecommunications market

Filed under: — mlazoff

Not to be outdone by the Consumer Electronics Show in Las Vegas this week, San Francisco’s Macworld Conference and Expo has its own attention-getting promo that might be of interest to physicians with smartphones. According to a Personal Technology article in today’s Washington Post, “[t]he iPhone, which should be available through Cingular Wireless in June, pending approval by the Federal Communications Commission, would be priced at $499 for a 4-gigabyte model and $599 for an 8-gigabyte model. The device will run the Mac OS X operating system and a full version of Apple’s Web browser, Safari.” Features include three built-in sensors related to its touchscreen functionality. It will have a battery life of five hours of talk time, video playback or Web browsing and 16 hours of audio playback. ”Companies have tried for years to build a slick, intuitive device that does everything Apple is promising with the iPhone. But this gadget class is still largely the realm of early adopters — consumers who latch on to new technologies.” The 4.8 ounce, half-inch thick iPhone will not be for sale before June.

January 8, 2007

A Trio of Windows-based Treos

Filed under: — mlazoff

Last month, PC World PDA/cell hybrid reviews published a short comparison on the two new Windows-based Treos from Palm.  Both Verizon’s Treo 700w and the newer Sprint Treo 700wx are laden with multimedia features typical of other mobile devices that run Microsoft Windows operating system (OS). Verizon and Sprint subscribers who prefer Palm OS can choose Treo 700p. All Treo 700s uses CMDA network’s high speed EV-DO technology.

Cingular users can purchase Palm-based Treo 680; no need for the ”p” subscript as Palm OS was the only Treo available to Cingular subscribers—until today’s release of the Windows-based Treo 750, which also takes advantage of new broadband speeds comparable to the Treo 700. Treo 750 was previewed by PC World yesterday at the hugely promoted Consumer Electronics Show

T-Mobile subscribers who wish to purchase a Treo through a service plan are out of luck—though T-Mobile, like Cingular, uses the GSM network, so subscribers should eventually be able to purchase the unlocked version of Treo 750 at the full retail price through Palm (or eBay), just as they did with the Treo 680. Alas, no word yet on a high speed Palm-based Treo for GSM-network users. 

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.”

January 1, 2007

Privacy Rites

Filed under: — mlazoff

Spread of Records Stirs Patient Fears of Privacy Erosion made Page One of The Wall Street Journal’s December 26th issue. The article opens with the story of a middle aged tax attorney who was denied accident disability benefits based on information her insurer obtained through her medical records–specifically, psychotherapist’s notes allegedly documentating travel and work-related activity that conflicted with her claim. 

According to the article, neither state nor federal law currently safeguards the privacy of confidential information in electronic medical records. ”[Health Insurance Portability and Accoutability Act] HIPAA’s principal goal was to ensure that people could change jobs without losing insurance coverage for pre-existing medical conditions. When employers and insurers complained about the added cost, the federal government pledged to make it easier for medical providers, insurers and others to swap medical information electronically, potentially saving as much as $30 billion over a decade. To assuage concerns of privacy advocates, Congress authorized the Department of Health and Human Services to draft privacy regulations. The final rules allow health insurers and medical providers — including doctors, pharmacies and hospitals — to disclose medical information for “treatment, payment and healthcare operations,” among other situations, without specific patient permission. But they aren’t supposed to send any more records than necessary for nontreatment purposes.”

The article goes on to describe other examples of unexpected disclosures: how one hospital’s collection agency had detailed information from the medical records of an uninsured patient; how patients diagnosed with borderline diabetes received unsolicited marketing materials from their medical providers. “The federal rules allow patients to ask doctors, other medical providers and insurers not to share records with certain people, groups or companies. But medical professionals and insurers can ignore such requests” if, for example, it is technically unfeasible or if the request would incur addtional costs.  

However one feels about the examples provided in this article, the assurance of confidentiality is at the heart of patient care. From the Health Care Renewel blog, see Another Electronic Medical Records Horror Story by Scot Silverstein, MD, director of Drexel University’s Institute for Healthcare Informatics. All three letter responses to the article as printed by the WSJ are available on the nonprofit organization Patient Privacy Rights Web site.

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