CHICAGO—It's becoming a tradition, sitting down with athenahealth Chairman, CEO and President Jonathan Bush for a podcast during the annual HIMSS conference. If you missed the original in 2007 or the sequel in 2008, you missed a whole lot of fun. If you happened to catch either or both of those, you know you're in for some more entertainment, and perhaps even some enlightenment. We get awfully intellectual this time.

By the way, this one is rated PG-13 for language, but the kiddies wouldn't understand the topic anyway. Enjoy.

Podcast details: Interview with athenahealth's Jonathan Bush at HIMSS09. MP3, stereo, 64 kbps, 16.6 MB, running time 36:11
1:45 Thoughts on "meaningful use"
2:25 Maybe accelerate PQRI?
3:30 Why EHR implementation has failed so far
4:40 David Ricardo and physician transcription
4:35 Let primary care physicians be the disruptive force
5:30 Lessons from "House"
6:15 Rethinking medicine
6:50 Micromanagement by the government and thoughts on scope of practice
7:50 Practice models that work
9:05 Data that help manage populations
10:05 Lobbying in Washington and qualifying for stimulus money
11:15 Medicare audits
11:30 HIMSS membership and "defensive" business management
13:00 Software-enabled service vs. software vs. ASP vs. software as a service
14:30 Examples of software-enabled services
16:45 Why standalone software is dying
17:15 Uninstalls of other products
18:15 How the stimulus has affected the company
21:20 "Aggressive stance" of Medicare
21:40 Many things happening at once
22:40 Unintended consequences of government actions
24:50 Entitlement spending and end-of-life care
28:30 Potential similar problems with stimulus and a return of the "plutonium sneakers."
29:20 Decision-makers who have never run a practice
30:00 Hopes for David Blumenthal as national coordinator
30:30 Thoughts on comparative effectiveness studies
31:20 Concerns of HIT industry: "Don’t make what I’ve been doing for years illegal."
31:50 Different needs for different doctors
32:35 New standards on data mining and patient privacy
34:20 The example of General Motors

CHICAGO—For the second year in a row, I had a long, detailed chat with HIMSS CEO Steve Lieber before the start of his organization’s annual conference. This time, I was able to meet him in his downtown Chicago office last week since the 2009 conference is a home game for both of us.

Clearly, the focus of the HIMSS conference and of this podcast was on the economic stimulus that will send billions of dollars into the health IT sector next decade, but there is plenty else going on in healthcare technology and in the economy as a whole. Enjoy the podcast—and don’t be surprised to see a small army of Epic Systems employees at the conference. The company is busing nearly 800 people down from Verona, Wis., less than three hours away.

Podcast details: Interview with HIMSS CEO Steve Lieber on the 2009 HIMSS conference, recorded April 1, 2009. MP3, 64 mbps, 25.5 MB, running time 55:47.

0:20 Immediacy of health IT with passage of ARRA
1:20 Healthcare vs. the economy in general
2:15 Timing of the stimulus money
3:45 Thoughts on "meaningful use"
5:25 Input from HIMSS membership on shaping regulations
7:00 Upfront expenses for back-end stimulus payoff
7:40 Shifting of priorities
8:30 Financing issues
9:03 The Illinois example: Paying down Medicaid backlog with non-IT stimulus funding
10:50 Current leadership vacuum at HHS
11:35 Interagency committees formed within federal government
12:15 Thoughts on David Blumenthal
13:05 Thoughts on John Glaser
13:40 Why President Obama might have made the change at ONC
15:20 First hospitals reaching Stage 7 on HIMSS Analytics EMR Adoption Model
16:15 State of EMR adoption as it relates to ARRA incentives
17:15 EMRs for physicians
18:24 Watch vendors for clues on physician adoption
19:00 Change in the environment with ARRA
19:50 Other cultural barriers to adoption
20:45 HIMSS will provide case studies and how-tos on adoption for physician offices.
21:30 Workflow change
23:18 Changes to HIPAA and consumer attitudes toward data confidentiality
25:25 Treating healthcare data like financial data
25:55 Certification of health IT
27:25 Standards and the work of HITSP
29:10 How to improve HITSP process
30:10 Certification and favoritism
31:40 Why it would be a mistake to replace CCHIT and HITSP
32:30 Relationship between HIMSS and CCHIT
34:00 Complaints about CCHIT
34:43 Assessment of certification to date
36:12 Tying practice management and EHR software together
37:25 Relationships between ambulatory and hospital data
37:37 Stark EHR exemption
38:40 Medicare e-prescribing incentive
40:15 Expectations for attendance at HIMSS conference
42:20 Economic impact on exhibitors
42:05 Meditech and Cerner skipping conference
44:15 Estimate that conference will generate $4 billion in HIT buying
45:20 Effect of Chicago location
46:30 Healthcare hub in Chicago and Midwest
47:35 New conference programs related to the stimulus
48:25 Transition from Robert Kolodner to Blumenthal
49:30 Creating "different worlds" within the conference
50:30 Meeting with CBO and expectations for actual HIT spending
51:15 Education at HIMSS conference
51:50 Interoperability
52:30 Some drop-off on consumer focus because of magnitude of stimulus
53:15 Partnerships between enterprise and ambulatory vendors
53:30 Keynote speaker Alan Greenspan and "irrational exuberance"

As regular readers know, I was fortunate enough to be invited by the Rockefeller Foundation to Bellagio, Italy, last week for the third of four weeks in a series of conferences called Making the eHealth Connection. The goal was for a small group of technology and healthcare informatics leaders to come up with actionable ideas to use IT to improve the health of people in the developing world.

The week I was there focused on electronic health records and mobile health.

While I was in Bellagio, I interviewed Judith Rodin, Ph.D., president of the Rockefeller Foundation (and former president of the University of Pennsylvania), and Ariel Pablos-Méndez, M.D., managing director of the Rockefeller Foundation and the head of health programs. Unfortunately, there was an echo in the room that found its way onto the recording. And unfortunately the battery ran out of my recorder before I got done chatting with Dr. Pablos.

We also take a while getting into the discussion about IT, but I still think it’s an interesting interview.

Podcast details: Interview with Judith Rodin, Ph.D., and Ariel Pablos-Méndez, M.D., of the Rockefeller Foundation. Recorded July 29, 2008, in Bellagio, Italy. MP3, mono, 64 kbps, 14.5 MB, running time 31:41.

1:05 Rationale behind the conferences
1:55 Harnessing the beneficial aspects of globalization to fix the negative effects
2:50 Why e-health in the developing world?
5:00 Affordability, accessibility and quality of care
5:28 "Leapfrog" strategy for bringing technology to underserved areas
6:50 Market opportunities from public-private partnerships, even in poor countries
8:02 E-health as a remedy to globalization of diseases
10:30 Bold, actionable ideas
12:22 "Game-changing ideas" from previous Bellagio conferences
13:15 Welcome to Dr. Ariel Pablos-Méndez
14:05 The foundation’s current attempt to strengthen health systems and long history of creating global programs
15:15 Breaking down the silos of health programs in developing countries
16:05 Worldwide concerns go beyond HIV/AIDS
16:40 Problems with access to care, and the role of telemedicine
17:10 Problems with affordability and efficiency
18:20 Good health at low cost
19:15 Theory that the future will be about more health for the money rather than more money for health
19:45 Current Rockefeller Foundation health programs: access
20:35 Role of the private sector in health systems in developing countries
22:45 E-health in the developing world
23:50 Challenges and opportunities in e-health
24:55 Interoperability issues with legacy systems
26:20 Technology transfer from U.S. institutions to Africa before legacy systems become a problem
27:34 Why the timing is right for IT and for these conferences
28:10 Needs: collaboration, agenda setting, capacity building, evidence, applications
30:00 Bold ideas: British NHS and a system in Sao Paolo, Brazil, sharing code with South Africa and developing a framework strategy for e-health

 

I love the annual Association of Medical Directors of Information Systems (AMDIS) Physician-Computer Connection. It's a chance to hear some of the smartest people and most accomplished people in healthcare, namely medical informaticists, in a small, informal setting. This year's event, held last week in beautiful, laid-back Ojai, Calif., featured an appearance by Robert Kolodner, M.D., the national coordinator for health information technology.

After Dr. Kolodner's presentation—more of a Q&A with his peers in medical informatics—he graciously sat down for an audio interview with me. Here is the result.

Podcast details: Robert Kolodner, M.D., on the national health IT strategy. Recorded July 16, 2008, in Ojai, Calif. MP3, stereo, 64 kbps, 14.3 MB, running time 31:24.

0:40 Background on national health IT strategic plan toward interoperable electronic health records
3:35 Goals of the plan
4:08 Distinction between "health" and "healthcare"
5:25 Explanation of "patient centeredness"
6:20 Physicians’ role in promoting patient centeredness
7:30 IT’s role
8:50 Population health
10:40 Why physicians should care about national IT strategy
12:55 Making the issue personal
13:35 Financial incentives for technology adoption
14:37 Incremental advances
16:18 Medicare e-prescribing incentives as one step in a series of improvements
17:30 Convincing healthcare organizations to cooperate
18:08 Greater public awareness about electronic health information
18:32 Privacy and security concerns, and coming framework
20:50 Convincing doctors to share data
22:10 Trial National Health Implementation Network implementations
22:55 Where physician IT leaders can make a difference
24:06 AHIC successor
25:25 Complexity of healthcare in the U.S. and abroad
27:18 Profound workflow changes from IT and maximizing skills of healthcare professionals
29:06 Possible effects of 2009 administration change
30:15 Health IT’s fundamental role in healthcare reform

The just-completed Towards an Electronic Patient Record (TEPR) conference featured the unveiling of the TEPR Cell Phone Project, an eight-month effort to study and prove the efficacy of the mobile phone as a hub of interoperability in healthcare. (You can read my Digital HealthCare & Productivity story about the project here.)

The Medical Records Institute, which puts on TEPR, is partnering with AllOne Health Group, a Wilkes-Barre, Pa.-based health and wellness services provider, to conduct this test of bottom-up, consumer-controlled health information exchange. The study begins June 1, and results will be released at TEPR 2009 next February.

During Monday’s TEPR Cell Phone Project press conference, I peppered AllOne executives with some tough questions about their plans, and was not shy about voicing my skepticism about personal health records. In a rare show of tact on my part, I did so without offending anyone. In fact, Frank Avignone, director of business and sales development for AllOne Health subsidiary AllOne Mobile, agreed to join me the following day to record this podcast.

Podcast details: Interview with Frank Avignone, director of business and sales development, AllOne Mobile, about the TEPR Cell Phone Interoperability Project. Recorded May 20, 2008. MP3, mono, 64 kbps, 10.8 MB. Running time 23:37

0:54 Background on the company and its technology
2:00 Interoperability study
3:30 Metrics being measured
4:00 Convergence of Dossia, Google Health and Microsoft Health Vault, and the subtle differences
5:50 Technology behind AllOne Mobile Health
6:49 Phone requirements and registration process
8:25 Continuity of Care Record
8:50 Why consumers might accept this technology
10:25 Data input options
11:50 Provider access to data
12:37 Workflow considerations
14:10 Pragmatic approach to uptake
14:35 Logistics of the study
16:25 Study participants
17:30 Mobile phone carriers
19:30 ROI for end users
21:00 Marketing strategy
22:18 Study goals

For me, the highlight of HIMSS ’07 was my podcast interview with Jonathan Bush of athenahealth. It was so much fun, he agreed to sit down with me again at this year’s HIMSS conference. I’m hoping this can become a regular occurrence. We get full of ourselves at several points and get way off topic at times, but it was taped on the last morning of HIMSS and everyone’s a little loopy by then. Even the technical glitch—my microphone being off for a few seconds—didn’t affect the outcome, other than to provide a good laugh or three.

Podcast details: Interview with Jonathan Bush, president and CEO of athenahealth, recorded Feb. 28, 2008, in Orlando, Fla. MP3, mono, 64 kbps, 18.9 MB, running time 41:17.

0:35 The cult of Mr. HIStalk
1:25 Is Cerner pulling out of HIMSS?
2:25 Disruptive technologies
2:50 Why software is dead
4:25 Why other companies still sell software
6:30 The "dead zone" around the Orange County Convention Center
8:15 Chief athenista Todd Park and future plans for the company
10:15 athena’s lingo
12:10 Success of eClinicalWorks based on selling software
14:10 Google Health, the next Segway?
16:05 Google Health vs. Microsoft HealthVault and other PHRs
18:00 Why existing PHRs are not much better than Microsoft Word
19:00 How athenahealth could help with PHRs
20:40 PHRs need something to do
21:15 Could Google give doctors leverage with health plans?
23:55 Trust issues
24:45 Risk vs. reward for sharing health information
26:05 athena’s API for linking to PHRs
27:25 Why e-commerce works in other industries
28:35 What doctors need
29:25 Carrot vs. stick: cash, options or control
31:10 Opportunity for doctors to take back disease management from payers
33:00 How to reach physician practices
33:40 Targeting smaller practices
34:55 Opportunities with enterprise customers
36:15 Partnership with Eclipsys and the seeds of RHIOs
39:40 Slight technical glitch, and concluding remarks

ORLANDO, Fla.—Here’s a podcast that’s been a year in the making. Actually, it was a year plus an hour and a half. Last year in New Orleans, I had a lively, hour-long conversation with HIMSS President and CEO Steve Lieber that was supposed to be for a podcast, but the recording didn’t work.

On Saturday, I showed up at the appointed hour for another sit-down with Lieber, and realized I’d forgotten my recorder back at my hotel, so we rescheduled for about 90 minutes later. Well, the third time was a charm, and the result is this podcast, a lively, half-hour-long conversation with Steve Lieber, just ahead of the opening of the annual HIMSS conference.

Podcast details: Interview with Steve Lieber at HIMSS ’08. MP3, mono, 64kbps, 13.8 MB. Running time 30:10.

0:30 Expected attendance of 27,000+
1:15 Greater attention on technology in healthcare
1:45 Growth on clinical side
2:50 More interest from non-IT executives
4:00 E-prescribing as an example of IT crossing disciplines
5:45 Multiple opportunites for improvements in prescribing and medication administration
6:30 Continuing problems with access to capital
8:50 Prospects for Medicare payment reform
10:07 Health IT in the presidential campaign
11:15 Health IT debate remains largely nonpartisan.
12:40 Progress among private payers in reimbursement for quality
14:00 More focus on disease management than quality per se
14:40 Slow adoption of personal health records
15:42 Suitability of PHRs for chronically ill
17:30 Kids may be first major PHR constituency in general population.
18:05 Google, Microsoft and Revolution Health in healthcare and HIMSS keynotes from Eric Schmidt and Steve Case
20:00 Movement toward home health
20:40 HIMSS strategic interest in medical devices
21:40 HIMSS branching out as an association
22:30 Interoperability of financial and administrative information
23:10 Working for universal set of quality measures
23:35 Globalization of HIMSS
26:00 Standardization beyond the U.S., e.g., Snomed
27:00 Highlights of HIMSS conference: Interoperability Showcase
28:00 Public meetings at HIMSS, including AHIC
29:03 International registration

From the Department of Better Late Than Never comes this podcast with Nick Jacobs, CEO of Windber Medical Center in Windber, Pa., who's well known in some circles for being perhaps the first hospital chief in the country to write his own blog.

Nick's Blog has been around since May 2005, and Jacobs also contributes to Hospital Impact and to the World Health Care Blog. Paul Levy at Beth Israel Deaconess Medical Center in Boston has been writing his blog since August 2006. (I've got them both beat, as my blog dates to May 2004. But I am not going to brag until I get the kind of traffic that HIStalk does. That blog, which I've heard referred to as the "National Enquirer of health IT," recently passed 1 million visitors. I'm still looking up at 30,000.)

Speaking of historical records, I've been sitting on this podcast since September, when Jacobs was in Chicago for the third Healthcare Blogging & Social Media Summit way back in September. I've got an even older recording in the podcast pipeline, and who knows when I'll get to that? I did write about Jacobs in Digital HealthCare & Productivity in early October, but now you can hear what he's all about.

Podcast details: Interview with Nick Jacobs, CEO of Windber (Pa.) Medical Center. MP3, mono, 64 kbps, 9 MB. Running time 19:34.

0:49 Genesis of the blog
2:02 How blogging helps a small hospital compete with larger hospitals
2:50 His message
3:45 Early blog posts and how he started taking more risks
4:50 Motivating employees via the blog
5:40 Keeping local mass media honest
6:40 The global reach of the Internet: “You can never be a prophet in your own home town.�
8:00 Why other hospital CEOs don’t blog
9:20 Being the first to take the plunge
10:00 Why healthcare is so slow to turn to IT
10:40 Windber’s cancer research for the military
11:30 National recognition and local indifference: “reverse urban snobbery�
12:30 Transparency in healthcare
13:45 Flaws in public reporting requirements
15:30 High tech at small hospitals
16:20 Using the Internet to build a reputation
17:30 Market challenges for a small hospital
18:04 The future and his passion for change in healthcare

SAN FRANCISCO--Dr. David Brailer is a very popular man these days. Having $700 million of Other People’s Money to invest, as his company, Health Evolution Partners does, tends to do that. At the Health 2.0 Conference today, it took an hour and 15 minutes for him to fend off the suitors and finally sit down with me for this brief but lively podcast about his new venture and about the current state of health information technology in America. I think it was worth the wait.

(Everyone else is blogging this event live. I can’t keep up, so thought I’d try something different.)

Podcast details: Interview with Dr. David Brailer on Health Evolution Partners and progress in health IT. MP3, mono, 64 kbps, 4.5 MB. Running time 9:53.

0:34 Investment strategy
1:05 Surprise since he started the fund
1:40 About the company
2:25 Why he’s not looking at biotechnology
2:55 Health 2.0
3:35 Investing through venture partners
3:45 Assessment of national health IT adoption
4:35 Health IT hasn’t become politicized
5:05 Tough issues still unsettled
6:13 RHIOs
6:50 Shakeout in health IT (and interruption from siren outside the window)
7:50 Advice to people involved in RHIOs
8:08 Personal health records and consumerism