Tue, 21 October 2014
In a sidebar to the September cover story I did for Healthcare IT News, I reviewed some of the work of Scot Silverstein, M.D., who has long been chronicling problems with EHRs and other health IT systems. Unfortunately, he wasn't available for an interview in time for that report, but he was last week, so I got him for a new podcast.
Silverstein, a professor of health informatics at Drexel University in Philadelphia, considers EHRs to be experimental and, sometimes, less safe than paper records and would like to see health IT subjected to the same kind of quality controls as aerospace software or medical devices. "Suboptimal system design could lead even careful users to make mistakes," Silverstein said in this interview.
During this podcast, we refer to a couple of pages that I promise links to, so here they are. Silverstein writes regularly for the Health Care Renewal blog, a site founded by Roy Poses, M.D., a Brown University internist who runs the Foundation for Integrity in Research and Medicine. His definitions of good health IT and bad health IT appear on his Drexel Web page.
Podcast details: Scot Silverstein, M.D., on health IT safety risks. MP3, mono, 128 kbps, 33.8 MB. running time 36:59.
1:10 How this interest came about
Mon, 22 September 2014
PALO ALTO, Calif. — I'm out here in the Bay Area, in part because Intel-GE Care Innovations invited me to be one of six judges of its first-ever "hackathon" this past weekend. (Full disclosure: Care Innovations paid my travel expenses, but placed no editorial demands on me.)
On Saturday, I sat down with CI CEO Sean Slovenski to discuss a number of issues in digital health and health reform, but I found myself most curious about CI's new Validation Institute, launched in late June, which looks to bring some truth to some outrageous claims made by entrepreneurs in the untamed world of digital health, telehealth and population health management. I turned on the voice recorder, and this short podcast is the result.
(Sorry for the bit of background noise. We both live in the Midwest, and just had to do this outside on a gorgeous California morning.)
Podcast details: Interview with Sean Slovenski, CEO of Intel-GE Care Innovations, on the company's new Validation Institute. MP3, stereo, 192 kbps, 9.2 MB. Running time 6:38
Fri, 12 September 2014
Health IT vendor Greenway Health recently finished its rollout of a cloud-based EHR to all 8,200 Walgreens stores in the U.S. When I was offered the chance to interview CEO Wyche T. "Tee" Green III about this, I decided to take it a step further.
In all my years of covering health IT, I've never met nor even spoken to Green, so I figured a podcast was in order. After all, I had written a piece for Health Data Management earlier this year about how pharmacies are reshaping themselves as true healthcare companies. (This interview also comes in the wake of CVS Caremark ending its sale of tobacco products and changing its name to CVS Health.)
I also had a lot of questions about interoperability issues in health IT and the many criticisms that lately have been heaped on both EHR vendors for perceived usability problems and the federal Meaningful Use EHR incentive program. The timing couldn't have been better.
Podcast details: Interview with Greenway Health CEO Tee Green, recorded Sept. 8, 2014. MP3, mono, 128 kbps, 25.5 MB. Running time 27:51
1:00 Walgreens rollout and EHRs for "retail health"
Wed, 9 April 2014
Yesterday, Grand Rounds, a San Francisco-based startup that makes an "outcomes management platform" for large employer groups, introduced Office Visits, an online service that helps consumers find "quality" physicians close to home. I've long been skeptical of any claims of healthcare quality or any listing of "best" physicians or hospitals, so I invited Grand Rounds co-founder and CEO Owen Tripp on for a podcast to explain what his company is doing.
He told me that a proprietary algorithm helps Grand Rounds "recommend with confidence" the top physicians among the 520,000 medical specialists the company graded nationwide, based on numerous publicly available data sources and some self-reporting. Of those more than half a million specialists, only about 30,000 meet the company's criteria for recommendation, which shows, at the very least, that Grand Rounds is highly selective.
Based on this interview, I think the product has a lot of potential. It's nice to see ratings based on outcomes data and not squishy criteria like "he is a great doctor," as parodied in The Onion this week ("Physician Shoots Off A Few Adderall Prescriptions To Improve Yelp Rating").
At about 18:30, the conversation reminds me of another recent podcast, with University of Rochester neurologist Dr. Ray Dorsey. It turns out that Dorsey is among the 1,000 or so medical advisors to Grand Rounds.
1:00 "Safety" vs. good outcomes
Mon, 24 February 2014
It's time for my annual podcast interview with HIMSS President and CEO Steve Lieber, this time from the Orange County Convention Center in Orlando, Fla., on the day before the official opening of the 2014 HIMSS Conference, rather than in his Chicago office a week or so in advance.
Lieber reiterated HIMSS' position that the federal government should extend the attestation period for Meaningful Use Stage 2 by one year. I wasn't there, but today at the CIO Forum, one of the preconference educational symposia, ONC Chief Medical Officer Jacob Reider, M.D., hinted that there will be an announcement on Stage 2 flexibility, possibly Thursday morning at a joint ONC-CMS town hall. That session will feature CMS Administrator Marilyn Tavenner and new national health IT coordinator Karen DiSalvo, M.D. I've never heard either of them speak, and now I'm excited to be covering that session.
We also discussed other aspects of healthcare reform, trends in health IT and expectations for HIMSS14. Of note, on Monday morning, HIMSS and two other organizations will announce a new initiative on "personal connected health."
Near the end, I reference the podcast I did last week with Dr. Ray Dorsey about remote care for Parkinson's patients. For easy reference, here's the link.
This is, I believe, the seventh consecutive year I have done a podcast with Lieber at or just before the annual HIMSS conference. Another interview that has become somewhat of a tradition won't happen this time, as Athenahealth CEO Jonathan Bush is not making the trip to Orlando this year.
Podcast details: Interview with HIMSS President and CEO Steve Lieber, Feb. 23, 2014, at HIMSS14 in Orlando, Fla. MP3, stereo, 128 kbps, 36.2 MB. Running time 39:35.
0:40 "It's time to execute."
Wed, 19 February 2014
Two months ago, I interviewed neurologist Ray Dorsey, M.D., co-director of the Center for Human Experimental Therapeutics at the University of Rochester, for a story I wrote based on a study he led. He had a lot of interesting things to say and, unlike so many other physicians, was aware of multiple system atrophy, the disease that killed my dad in 2012, so I decided to have him on for a podcast to describe how he is using off-the-shelf telehealth technology to expand access to care, improve patient satisfaction and reduce costs.
The study focused on Parkinson's disease, as does a new study Dorsey is leading through http://connect.parkinson.org, but Dorsey sees this technology as promising for treating autism and Alzheimer's disease as well.
We, of course, discussed cross-state licensure holding back wider use of remote care, a subject that is very much in the news right now. In fact, Health Data Management just published a story I wrote about, in part, the launch of the Alliance for Connected Care. This group, headed by three former senators and including CVS Caremark, Walgreens, Verizon Communications, WellPoint, Welch Allyn, Cardinal Health and telehealth companies HealthSpot, Teladoc, Doctor on Demand, MDLive and GE-Intel Care Innovations, is advocating for regulatory changes to expand remote care.
Podcast details: Interview with University of Rochester neurologist Ray Dorsey, M.D. MP3, mono, 128 kbps, 16.3 MB. Running time 17:54.
1:30 Telehealth to expand access to care for people with chronic diseases
2:00 Shocking numbers about Medicare beneficiaries with Parkinson's who don't have a regular neurologist
2:45 Lack of reimbursement for telehealth even though it costs substantially less than in-person visits
3:38 Incentives to provide care in "high-cost, relatively unsafe environments"
3:58 Insurers "are never going to lead the way" in terms of innovation
4:40 Previous study funded by PatientsLikeMe, the Verizon Foundation and Medtronic funded his study
5:40 Findings of that study, and advantages of remote care
6:25 Telehealth to increase access to care, improve patient satisfaction and reduce costs
6:50 New study on "virtual house calls" about to launch in collaboration with Patient-Centered Outcomes Research Institute (PCORI)
7:37 Low-cost, off-the-shelf technology
9:45 Registering for PCORI study
10:40 Cross-state licensure issues, including new Alliance for Connected Care
12:10 Parameters and goals for new Connect.Parkinson study
13:35 How technology is creating care opportunities for "anyone, anywhere"
14:10 Dealing with the newly insured and with special-needs patients
15:50 Savings from preventing falls and other dangerous conditions
16:10 Enrollment for Connect.Parkinson
16:42 About the Center for Human Experimental Therapeutics
Fri, 1 November 2013
Two weeks ago, I picked apart a terribly misleading, ideologically steeped Fox News story that wrongly linked the initial failure of the healthcare.gov Affordable Care Act insurance exchange to the Meaningful Use EHR incentive program. Among my many criticisms was the reporter's apparent confusion between an actual EHR and My Medical Records, the untethered PHR offered by MMRGlobal.
In that post, I said, "I haven’t seen a whole lot of evidence that MMRGlobal isn't much more than a patent troll."
Bob Lorsch, CEO of that company, posted in the comments that I should put my money where my mouth is and interview him. (I had interviewed Lorsch before, but never wrote a story because of my longstanding policy of not paying attention to untethered PHRs since none that I know of has gained any market traction, despite years of hype.)
As this podcast demonstrates, I took Lorsch up on his offer. It was at times contentious, in part because I challenged many of his statements in the Fox story and to me, and in part because he challenged some of mine.
He asked me a pointed question, whether I still thought he was a patent troll. Based on the fact that MMR actually earned patents on a product it actively markets and didn't just purchase someone else's patents for the point of suing others, it's hard to conclude that he is a patent troll.
Investopedia defines patent troll as:
"A derogatory term used to describe people or companies that misuse patents as a business strategy. A patent troll obtains the patents being sold at auctions by bankrupt companies attempting to liquidate their assets, or by doing just enough research to prove they had the idea first. They can then launch lawsuits against infringing companies, or simply hold the patent without planning to practise the idea in an attempt to keep other companies productivity at a standstill."
By that definition, MMR is not. I still don't think an untethered PHR is a good business model, a belief supported by the fact that publicly traded MMR is a penny stock, currently trading at less than 3 cents per share. I have said that patient engagement, called for on a small scale by Meaningful Use Stage 2 rules, could change the landscape for PHRs—with a better chance in pediatrics than for adult populations—but it certainly will take a few years.
I stand by my original statement that the Fox News story did health IT a huge disservice by latching onto one problem and trying to tie it to an unrelated issue simply because it fits an ideological narrative. As for MMR, well, take a listen and then judge for yourself. It's a long podcast, but I went through the trouble of breaking it down by discussion point so you can skip around as necessary.
Podcast details: Interview with Bob Lorsch, CEO of MMRGlobal, recorded Oct. 18, 2013. MP3, mono, 128 bps, 49.5 MB, running time 54:07
2:03 About My Medical Records
3:26 Why he believes his product is better than traditional EHRs
5:00 My skepticism of untethered PHRs
6:28 Lorsch's interview with HIStalk from February
6:40 MMR's user base
8:00 Why he thinks MMR could facilitate health information exchange
9:40 Health information exchanges vs. health insurance exchanges
10:15 Patient-centered HIE as an alternative to multiple patient portals
12:20 Physician trust of patient-supplied data, and other workflow issues
15:05 Emergency use case
15:50 How MMR is different from other PHRs
16:32 "Last mile" of connectivity
18:17 His assertion in Fox story that patients lose control of health information and privacy under ACA, despite HIPAA
24:15 MMR carries cyber liability insurance
25:00 Scope of MMR's patents
26:45 "Likely" infringement of patents
27:45 Lawsuits and licensing
29:30 Patent troll?
31:10 Negotiations with WebMD and others
33:00 MMR's reputation
35:00 "We build and sell what we have intellectual property rights to."
36:25 Other vendors ignoring patients?
36:50 Standardization in health IT
38:38 MMR's low stock price
39:20 Patient engagement boosting PHR use?
42:00 Interest from WellPoint
42:48 Payers building trust with PHRs
44:18 Other features of MMR's PHR
46:45 Segmentation of sensitive parts of medical records
49:08 Putting me on the spot
50:35 His objective in asserting patent rights
51:15 MMR's issue with Walgreens
52:25 Revenue sharing vs. licensing
Wed, 2 October 2013
Friday is the last day on the job for departing national health IT coordinator Dr. Farzad Mostashari, who is stepping down after four years with the Office of the National Coordinator for Health Information Technology, including the last two years as head of ONC.
I was in Washington two weeks ago and stopped by the HHS headquarters for ONC's Consumer Health IT Summit, the opening event of National Health IT Week, and got a few minutes with Mostashari. (I suppose that was good timing, because I imagine the government shutdown that took effect this week would have canceled the summit and even prevented me from entering the Humphrey Building.) I had the recorder rolling for a brief chat, which lasted less than 15 minutes before Mostashari's handlers ushered him out to his next appointment. But I did get something.
The interview actually goes on a bit longer than what's on this track, moving on to a discussion about Food and Drug Administration guidance on mobile medical apps. (You can read about that in this story I wrote for MobiHealthNews.) As it turned out, the FDA issued its final recommendations Sept. 23, which also happened to be the same day new HIPAA regulations—modifications called for in the HITECH Act—took effect.
I might get another chance to talk to Mostashari at the College of Healthcare Information Management Executives annual conference at the end of next week, after he officially leaves government service and is allowed to discuss his future plans and perhaps be more candid about his tenure; CHIME has confirmed to me that he will keep his speaking slot. For now, enjoy this short interview.
Podcast details: Interview with outgoing national health IT coordinator Dr. Farzad Mostashari, Sept. 16, 2013. MP3, stereo, 128 kbps, 7.1 MB. Running time 7:44.
Fri, 1 March 2013
Once again, as has become custom, I sat down with HIMSS CEO Steve Lieber at the organization's Chicago headquarters the week before the annual HIMSS conference to discuss the conference as well as important trends and issues in the health IT industry. I did the interview Monday.
Here it is late Friday and I'm finally getting around to posting the interview, but it's still in plenty of time for you to listen before you get on your flight to New Orleans for HIMSS13, which starts Monday but which really gets going with pre-conference activities on Sunday. At the very least, you have time to download the podcast and listen on the plane or even in the car on the way to the airport. As a bonus, the audio quality is better than usual.
Podcast details: Interview with HIMSS CEO Steve Lieber about HIMSS13 and the state of health IT. Recorded Feb. 25, 2013, at HIMSS HQ in Chicago. MP3, stereo, 128 kbps, 46.0 MB. Running time: 50:17.
1:00 Industry growth and industry consolidation
Fri, 15 June 2012
Did you happen to catch my story in MobiHealthNews on Thursday about Carrie Handley, the IT consultant-turned-cancer patient? She got frustrated with first a misdiagnosis and then the hassle of lugging around a binder full of paper records that she had to go to multiple sites to collect to assure continuity of care during her treatment and surgeries. So Handley digitized all her records.
Initially, she transported the information on a USB drive, but that got lost in a doctor's lab coat. Then, her son brought over an iPad. The tablet provided the right balance of portability and shareability. In this interview, Handley, a resident of Waterloo, Ontario (you know, the home of BlackBerry maker Research in Motion), describes the process and shares her thoughts in general on mobility in healthcare.
We wouldn't have connected if she hadn't read my tribute to my dad last month. After reading Handley's story in the e-mail she sent me, I knew we had to do this podcast to help spread the idea that communication can help foster the kind of patient-centric care that eluded my dad, that initially eluded her and that probably eludes millions of people every year.
This Sunday is Father's Day. I miss my dad terribly. But I take comfort in knowing that I'm doing a small part to raise awareness of multiple system atrophy (MSA) -- the rare neurodegenerative disease that killed him -- and perhaps advancing the cause of patient safety ever so slightly.
Podcast details: Interview with health IT consultant and cancer survivor Carrie Handley about mobility in healthcare. MP3, mono, 128 kbps, 26.7 MB. Running time 29:13.