Neil Versel's Healthcare IT Podcasts

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
3:05 His blogging
3:45 His 11 points demonstrating why he believes the FDA should be concerned about health IT risks
5:00 IOM, FDA and ECRI Institute statements on health IT safety
5:50 Comparing EHRs to medical devices and pharmaceuticals
8:35 Lack of safety testing in health IT
9:25 Issues with EHR certification
10:00 Safety validation of software
10:35 EHR's role in Texas Health Presbyterian Hospital's initial discharge of Ebola patient
11:50 EHR failure causing medical harm to a close relative
13:10 Poor design vs. poor implementation
14:35 Who should regulate?
15:55 Billions already spent on EHRs
16:45 Threat of litigation
17:40 "Postmarket surveillance" of "medical meta-devices"
18:50 EHRs now more like "command and control" systems
19:30 Movement to slow down Meaningful Use
20:17 Safety issues with interoperability
21:40 Importance of usability
22:30 His role at Drexel
24:18 "Critical thinking always, or your patient's dead"
25:05 Lack of health/medical experience among "disruptors"
29:30 Training informatics professionals and leaders
31:15 Concept vs. reality of "experimental" technology
32:50 Advice for evaluating health IT
33:55 Guardians of the status quo
35:10 Health IT "bubble"
36:10 Good health IT vs. bad health IT

Direct download: Scot_Silverstein.mp3
Category:podcasts -- posted at: 1:44am CDT

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

 

Direct download: Sean_Slovenski_-_Care_Innovations.mp3
Category:general -- posted at: 2:24pm CDT

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"
3:20 Future expansion to Walgreens Healthcare Clinic locations
4:15 My own experience with lack of interoperability at a CVS MinuteClinic
5:30 Achieving EHR interoperability
7:30 Frustration with slow progress on Meaningful Use
10:30 Data liquidity
12:30 Update on CommonWell Health Alliance
14:25 Addressing criticisms that vendors are hindering interoperability
16:30 EHR usability
18:10 Greenway Marketplace app store
22:15 Patient engagement and slow start to Stage 2 Meaningful Use
24:10 Dealing with the rise of consumerism in healthcare

Direct download: 140908_Tee_Green_-_Greenway_Health.mp3
Category:podcasts -- posted at: 2:55pm CDT

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.


Podcast details: Interview with Owen Tripp, co-founder and CEO of Grand Rounds. MP3, stereo, 128 kbps, 23.8 MB, running time 26:04.

1:00 "Safety" vs. good outcomes
2:20 "Downright terrifying" facts about choosing doctors
4:15 Story behind Grand Rounds
5:30 Algorithm for measuring physician quality that he says has shown about a 40 percent lower rate of mortality on common cardiac procedures
7:10 Data sources, including some self-reporting
8:35 Care coordination services Grand Rounds provides for patients
9:50 Why the direct-to-consumer market is so difficult in healthcare
12:00 Care teams
14:00 Availability and scope of service
16:15 When patients should travel for care and when they should not
18:15 Elements of telemedicine
19:35 Importance of asynchronous communication
21:45 Target market and why he sees the $200 fee as a bargain for patients
23:35 Managing patient records and other data
24:35 Company goals

Direct download: Owen_Tripp_-_Grand_Rounds.mp3
Category:podcasts -- posted at: 3:54pm CDT

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."
1:40 Challenges for small hospitals and small practices
3:10 New ONC EHR certification proposal and continued questions about Meaningful Use Stage 2
5:00 Prioritizing with multiple healthcare reform initiatives underway, including proposed SGR repeal
6:30 Surviving ICD-10 transition
7:35 HIMSS' position on MU2 timelines
9:05 Remember "macro objective" of Meaningful Use
10:00 Letter to CMS from organizations not including HIMSS calling for what he says are "very vague" changes to MU2 criteria
11:40 Things in MU2 causing providers fits
13:05 Fewer EHR vendors certified for 2014, but more HIMSS exhibitors
15:00 What this means for providers who bought products certified to 2011 standards
17:20 Progress on Meaningful Use so far
21:00 Looking toward Stage 3
22:42 What healthcare.gov struggles might mean for health IT
25:35 Other aspects of the Affordable Care Act being lost in the public debate
27:10 Political considerations related to health IT
29:40 Patient engagement and new HIMSS exhibitors
32:20 Why healthcare spending and provider shortage forecasts don't account for efficiency gains made from technology and innovation
35:10 Demographic challenges for healthcare
35:45 Shift from hospitals to ambulatory and home care and consolidation of provider organizations

Direct download: Steve_Lieber_-_HIMSS14.mp3
Category:podcasts -- posted at: 11:12pm CDT

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

 

Direct download: Ray_Dorsey_140218.mp3
Category:podcasts -- posted at: 3:36am CDT