I attended the 6th Annual World Healthcare Congress (www.worldcongress.com) this past week. So I will share some of my notes from the conference. Next week, I will share some of my interviews with participants:
Tuesday April 14, 2009
The first keynote discussion of Dr. Dora Hughes (HHS), Mr. Bruce Bodaken (Blue Shield of CA) and Dr. John Kingsdale (Commonwealth Health Insurance Connector Authority) brought some critical insight. Particularly, Dr. Hughes talked about President Obama’s 8 principles of Healthcare Reform. The President’s intent is that any plan must abide by these principles. These principles are:
- Protect Families’ Financial Health
- Make Health Coverage Affordable
- Aim for Universality
- Provide Portability of Coverage
- Guarantee Choice
- Invest in Prevention and Wellness
- Improve Patient Safety and quality
- Maintain Long-term fiscal sustainability
This is pertinent for even the Health IT community because the principles set the paradigm. Health IT solutions should always point back to the eight principals for justification.
Dr. Hughes interestingly enough also reinforced the point that there is no exact Administration plan. The healthcare plan is meant to be a collaborative effort. Other speakers reinforced the need for bipartisanship in the reform effort. Personally, this “group effort” bodes well for Health IT since it enjoys bi-partisan support.
Other items that were mentioned were pay-for-performance and community health ratings. This trend emphasizes the need for data so Health IT solutions should have data research components.
Overall, this presentation has relevance for the Health IT community.
The second keynote discussion included Angela Braly (Wellpoint), Carl Camden (Kelly Services) and Mark McClellan (Brookings Institute). Mr. Camden cited the large amount of uninsured being sole proprietorships, i.e., freelancers. He discussed how a lack of insurance becomes an impediment to start a new company.
While his emphasis was on the need to provide insurance to those individuals, I think there is relevance to Health IT. Small-businesses owners should be a target audience for Health IT vendors, specifically, PHRs. These individuals are likely to be uninsured or underinsured. An inexpensive PHR will allow for a record of care that may become sporadic during periods of low insurance coverage. Thus, a PHR becomes a stop-gap measure until a better insurance can be implemented.
Dr. McClellan is proponent of pay-for-performance as well as insurance mechanisms that encourages cost-effective treatment. Again, Health IT would be the underpinning of his reforms. For example, a robust e-prescribing system could encourage the purchase of generic drugs.
This was a very insightful discussion.
The third keynote discussion included Jim Clifton (Gallup), Jim Guest (Consumers Union), Newt Gingrich, and Regina Herzlinger (Harvard Business School). This discussion talked about consumer behavior and its importance in good health. This leads to 2 questions how do we change culture to better utilize Health IT and how can Health IT change culture?
The hazard exists that we will have Health IT, specifically PHRs, but consumers will not use them. Speaker Gingrich talked about a Southern Georgia town where the male population would only routinely get their blood pressure checked in the local barber shop. It was an environment where they felt comfortable. Perhaps, Health IT stakeholders must begin to think about such cultural solutions to ensure full use of Health IT.
For the second question, again, I refer to Speaker Gingrich’s thoughts on changing the culture. He argued for positive incentives for better behavior through transparency and metrics. Health IT could help with the development of these incentives by collecting the data to create and validate performance metrics.
This panel demonstrates how Health IT is critical to healthcare reform.
The fourth keynote dealt with market forces. The panel included Steve Burd (Safeway), Newt Gingrich and Gary Ahlquist (Booz and Company). The question of Health IT actually came up in the discussion. The question was how to assure adoption and interoperability without bureaucracy. Speaker Gingrich advocated that the government set out requirements on interoperability and use and perhaps, provide some subsidy. However, he said that government must not dictate the exact technology. Such a dictate would freeze technology in its infancy. I must admit I agree with this position.
Wednesday April 15, 2009
The first keynote of the day was on sustainable healthcare. The panel included Nobel Laureate Mohammed Yunus (Grameen Bank and Grameen Health_Bangladesh) and Frank Rijsberman (Google). Mr. Yunus provided a holistic view of healthcare reform in the developing world. He talked about the need to raise income of the poor, improve nutrition and sanitation and increasing access to healthcare providers. In terms of Health IT, Dr. Yunus talked about leveraging cell phones. Cell phones are the source of internet access for the poor in the developing world. Dr. Yunus is working with GE to find ways to improve healthcare utilizing cell phones. Personally, I feel that this initiative needs to be monitored closely since it may be the source of global best practices for low-cost Health IT.
Mr. Rijsberman discussed Google initiatives to distribute healthcare data. He discussed aggregate data such as the spread of flu and individualized data such as finding a nearby dentist. Additionally, this data could be delivered through web-enabled cell phones. The ultimate result would the efficient allocation of resources, i.e., placing the time, money and effort in the necessary areas.
For me, this discussion emphasizes that the “pipeline” for the information can be rather “low-tech.” What is far more important is collecting the data from users, from patients, etc.
The second keynote was about patient education. The panelists were Dr. Daniel Vasella (Novartis), Dr. Peter Salgo (Second Opinion, PBS) and Marilyn Carlson Nelson (Carlson Companies).
Dr. Salgo made some interesting points. He talked about discussing risks in health. He said that statistics must be presented in very easy-to-understand ways. More importantly, he discussed incentives for patients to educate themselves. For example, viewers of Second Opinion can receive CME credits. Perhaps, a similar program could be set up for the utilizing Health IT, specifically, PHRs. PHRs could have an online health education component. Users could receive credit of some sort for utilizing the PHR in general and the educational component specifically.
Dr. Salgo did cite a problem with the internet in that there is too much unfiltered information. Ms. Carlson cited reputable websites. So these are valid points to consider.
Again, this was another good discussion.
The final discussion of the day dealt with population health. Dr. Karen Davis (Commonwealth Fund), Randel K. Johnson (U.S. Chamber of Commerce) and Dr. Reed Tuckson (UnitedHealth Group) made up the panel. Dr. Davis reviewed various metrics of population health across nations. Apparently, EMR/Health IT adoption is at 28% in the U.S. versus 98% in the Netherlands. More importantly, only 30% of U.S. physicians have pay-for-performance incentives. Dr. Davis cited Denmark as good example of EMR utilizations. Denmark has a single Health Information Exchange for citizens’ data. This data can be accessed by a physician through a portal.
Thursday, April 16, 2009
The first discussion panel of the day focused on prevention. The panelists included Dr. Will Cavendish (NHS_UK), CAPT Bradley Perkins (CDC) and Cory Billotti (DOW). CPT Perkins discussed Health IT. The Alliance to Make U.S. Healthiest of which the CDC is a partner has as one of its tenets: to catalyze Business Opportunities. Health IT is one of those opportunities. CAPT Perkins discussed DOSSIA, the non-profit sponsored by Walmart, Intel. He stated that DOSSIA’s model is to establish PHR use as a public utility and then build the business space outward from there. He also discussed the CVS/Google partnership to make CVS customers’ prescription data available on Google Health to those customers. CAPT Perkins also said that we could expect PHR use to be at least 40-60%, which is where online banking use levels currently are.
Overall, this discussion was insightful even thought the focus was not Health IT. I thought that Health IT was placed in the proper context as a tool for better health outcomes.
The second discussion focused on Healthcare IT Infrastructure (and I hope that I can capture everything that was discussed). The host of the discussion Dr. William Winkenwerder expressed the role of Health IT infrastructure well. He called local Health IT the “muscles” of the system and the infrastructure as the “nervous system.” Both require care and nourishment through a “circulatory system.” This was an excellent analogy.
The first panelist was the deputy director of the Office of the National Coordinator. She expressed that the stimulus infusion of resources would lead to a tipping point in Health IT implementation. She pointed out an interesting point. The $18 billion dollar allocation to CMS is actually a net cost; the actual outlay is $30 billion. She said that the necessary workforce does not exist for Health IT does not exist but the stimulus includes partnership funding with academia to close this gap. There was great money to the states to create Public-Private Partnerships that map to the federal plan. She mentioned the National Research Center and its extension centers. And she talked about meaningful use. She said that there will be much discussion to include a public meeting Apr 28-29. She said that any meaningful use must be outcomes-related. When asked about the role of government, she alluded to the Economic Advisory Panel, which solicited opinions from stakeholders and she did not rule out mandates.
George Halvorsen of Kaiser talked about health outcomes and Health IT. He said that there were ½ trillion dollars in avoidable health events. Health IT allows for the collection of the necessary data to mitigate these costs.. He mentioned that the medical community gets the treatment of asthma right only about 46% of the time. Health IT could improve this outcome. He said the one requirement for Health IT is that it must be “plug and play.” When asked about the role of government, he said that government should facilitate the use of Health IT by clearing away obstacles. When asked about security, he said that the electricity grid must be protected as well as the Health IT network. At this point, it is difficult to criminalize Health IT penetration because we do not know how the information would be misused.
Dave Merrit of the Center for Health Transformation mentioned how the previous administration did make great progress for Health IT by helping set up the governance standards. He said that there are three phases in Health IT implementation. First, EMRs must be deployed. Then, the connective infrastructure must be created. Then, interoperability must be established. His concern was that paperless siloes might replace paper siloes. He said if those siloes are broken then Health IT could be used to collect and analyze information and provide those findings to the right stakeholders. Best practices could be established and policy could be based on those best practices. The end result is evidence-based medicine. He said that possibly $1 trillion of waste possibly could be eliminated. He mentioned Intermountain as a success story. He also discussed administrative waste: 90% of medicare claims is paper-based; 70% of claims remittance is paper-based; and 60% of eligibility requests are paper-based. He said that Health IT could go beyond the clinical and improve the administrative side of healthcare. For Mr. Merritt, he said the role of government is to assist with the infrastructure. He equated the NHIN with the Eisenhower highway system.
David Cerano of Microsoft said that Health IT’s biggest competition is not among vendors but against paper records. He also differentiated between the patient (person receiving care) and the consumer (the person overseeing the transaction of healthcare delivery such as a caregiver). For Microsoft, meaningful use means that the consumer is included in the interchange and that data is separated from applications. Mr. Cerano also mentioned that the presentation of data in a meaningful way is essential. He concluded with Microsoft’s goals being to liberate data, empower people and connect care.
Overall, this was an extraordinary discussion.
There also was a presentation by Dr. Don Yansen of Click Health. Click Health is pioneering the use of cell phone cameras in telehealth. Basically, community care workers could use cell phones cameras to send pictures over the internet to doctors for diagnosis. The intent is to leverage the internet to bring high-quality care to poor and underserved areas. Click Health is using micro-finance to purchase the phones and the system is entirely digital. Click Health has projects or will have projects in Bangladesh, Botswana, Uganda, Nepal, Haiti and Philadelphia (in conjunction with the University of Pennsylvania).
I found this discussion fascinating since it reinforced the theme of “low-cost” technical solutions to healthcare.
Posted by healthitpolitics 
Posted by healthitpolitics 
Posted by healthitpolitics 
