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Readers Write

Gary Baldwin, for HealthLeaders News, November 27, 2007

Thanks for all the great feedback and correspondence to HealthLeaders IT. My recent critique of the HIMSS08 keynote speakers drew the most heated correspondence. Curiously, readers within the industry praised me, while those outside healthcare took me to task--some in unprintable ways! Typifying the first group was Brian Patty, MD, the chief medical informatics officer at St. Paul-based HealthEast Care System, who writes: "THANK YOU, THANK YOU, THANK YOU. What a great (and brave) article; wish I had written it!" At the other end of the spectrum is Chuck Fisher, who runs a catering business in Memphis. His lengthy response is included. I'd be curious to hear your thoughts to his contention that the industry's own people are responsible for current problems. Also included are other letters responding to my most recent columns.


Perhaps HealthLeaders Media should reconsider your position and make you Social Commentary Editor. You may, or may not, have some expertise in technology, but your criticism of the keynote speakers list at HIMSS08 shows me that you do not understand the economic issues facing the healthcare industry on a macro level.

The advent of "consumerism" in healthcare is creating monumental change. Your own publication has multiple references to hospitals, physicians and insurance companies being forced to disclose pricing information that has been previously unavailable to the consumer, which presumably will cause behavior changes. So rather than waste time on social drivel, you should look at why HIMSS08 is having these evil "rich, white, men" as keynote speakers.

Steven Levitt. Instead of worrying about something he said regarding abortion, why do you not tell your readers that he is a star in the field of Price, or Game Theory? This is the branch of economics that uses mathematics to predict the behavior of market participants based on what behavior other market participants exhibit. So let's think, how might a CIO benefit from an economist showing her (for your sensibilities) how to build a computerized mathematical model to predict consumers' behavior in response to a provider changing pricing?

As for those evil, white, rich guys, Eric Schmidt and Steve Case, why would any CIO or information systems person want to hear from them? Could it have to do with the government's push to have electronic patient records available? Google Health has announced their "Weaver" project, an electronic medical record that will be available to the consumer soon.

It will allow the patient to access medical records anywhere that there is a computer. Revolution also has a similar product. However, the product that Revolution has which is the most impressive is ConnectYourCare. Just ask ExpressScripts who just bought it. ConnectYourCare is a consumer directed health plan that offers a front end screen for health information, customer service, HSA and HRA administration.

They are not an insurance company, they overlay their services on an insurance company's high deductible health plan. If the health insurance gets too expensive, the consumer moves from one carrier to another without interrupting the continuity of the parts with which he interacts (customer service, etc.). These guys might lead an "industry" person to think outside the box. Schmidt and Case did, and they were rewarded for it.

The government employees. Since the government controls so much of the healthcare dollars now, and the politicians want to increase the percentage, isn't direction from government helpful to the people that must build the interfaces? I certainly think so. Thus we have the Secretary of HHS and the national coordinator of healthcare information technology (that might just tie in with the rich white guys too). Then there is Senator Frist who held one of the highest positions in government as Senate Majority Leader.

These guys may have some of the insight that information systems people will be dealing with in the future. You say, correctly, that none of these people work in a medical practice or hospital and you further say that this is a beleaguered industry. The people that work in medical practices and hospitals are the ones that put the industry in the predicament that it is in now. It seems that new ideas cannot hurt the industry. Look at the automobile industry and General Motors in particular.

This is a business that knew how to do everything and did not need help until they almost went bankrupt in 1992. GM brought in John Smale (retired CEO of Proctor & Gamble, a consumer brands company) to save the company. Smale did not know anything about the car business, but he knew consumers (Google and AOL). This group of keynote speakers may not work in the industry, but they know consumers.

If the healthcare industry does not get to know consumers, it will become more beleaguered. Stop your social commentary and look at the facts: HIMSS08 is putting a slate of speakers out there to help foster thinking in the IT infrastructure that can help save the industry. Chuck Fisher
Managing Partner (and informed consumer)
Just In Thyme Catering
Memphis, TN


EMR: A new standard of care?

The EMR Pushback article is well done. I look forward to your technology contributions, and use your work in my Capstone class for MHA students. I'm curious. You note in the "Taking the Plunge" sidebar that the Hedges Clinic claims it is paying less for malpractice insurance after implementing an EMR. Do you believe this is a pattern or practice for malpractice insurers to discount their annual premiums if a hospital or physician practice can present evidence of an operational EMR system? Will an operational EMR system become a new, higher standard of care? Will those providers who don't have an EMR system pay higher malpractice premiums, and be more vulnerable to malpractice claims?

Thanks for your reflections on these questions.

Michael O. Bice
Adjunct Professor
Department of Health Services Research, Management and Policy
College of Public Health and Health Professions at the University of Florida

Gary's response: Glad to be of service, Mike. Here is what my source, Mike DeMaertelaere, DO, told me about the malpractice discount: "The discount is 2 percent just for having the EMR and then a extra 5 percent if it helps up meet all their documentation guidelines. The discounts don't go into effect until the next billing cycle and that will be after the New Year. Your readers may find this interesting. A benefit of EMR that we are finding is that we can access our patients' records from home on the Internet (password encrypted, of course).

When doctors are on after hours call we can look up patients medicines, allergies and even document the phone call in their chart right from home. It's an upside to EMR that we did not think of when we started this project."

I'm not aware of other malpractice carriers offering these malpractice discounts for technology, although a handful of health plans are stepping up to the plate with incentive programs. However, if you consider what Dr. D. is saying about the improved access to data, I think it is only a matter of time before we see increased insurance industry participation.


Unintended Consequences

Thanks for airing this very important issue. I've been at the EMR implementation business for a long time. A twist that I've often thought about is how much we have focused on eliminating the "bad" things about paper but have overlooked the importance of not eliminating the "good" things about paper--e.g., the doctor's example of eye contact, being able to scribble cryptic notes in the margins for the nurses' eyes only, being able to use linguistic short-hand unique to a team... In my opinion these are just a few examples of physicians intuitively or explicitly understanding that the cost of losing the good exceeds the benefits of fixing the bad. Yet I find it very rare when a design team starts with the understanding that "paper processing" is not all bad. I very much enjoy your newsletter. Steve Rushing
Vice President, Health Services Industry
Northhighland
Atlanta, GA


Device Dilemma

I caught your article regarding EMR interoperability with devices. My company, Full Spectrum Software, is a software development and testing company specializing in the medical and scientific industries. Over the past two years we've seen a marked increase in the interest our clients have in providing interfaces to EMR systems. One driving force is that hospitals and clinics are starting to require this of the devices. That's a big motivator as sales do drive functionality as much as emerging technologies. Clearly the labor costs involved in transcription are being noticed from a business perspective. As the device manufacturers development efforts are largely driven by sales, providing connectivity is making its way onto the "must have" feature list.

Thankfully, providing XML interfaces has become much simpler given the tool available to developers. Standards such as HL7 and DICOM are also making development easier as many systems can understand the data formats described therein. Microsoft is, in fact, moving forward with tools and schemas to help standardize health related data.

One area that Dr. Goldman remarked about is the service life expectancy of devices. Hospitals won't look to replace devices that are in service unless there's a compelling business case or quantifiable patient risk in continuing to use the device. Device manufacturers may provide system updates for some devices but others that are functioning as designed may not ever see updates for EMR integration. Those legacy systems and devices will slow the shift to integrated systems and ultimately in improving patient care. I look forward to reading more of your work.

Andrew Dallas, President
Full Spectrum Software, Inc.
Framingham, MA


800-Pound Marketing Gorilla

When U.S. News started this in the 90s I wrote an article that was published in the Journal of Patient Account Management that was a bit scathing--asking hospitals to wake up and smell the coffee. How can a general magazine rate hospitals? Here we are some 12 or so years later and the list is actually used by the hospitals as marketing collateral. What in the world are we doing here? Perhaps U.S. News filled a void--perhaps HealthLeaders magazine should have a list. I know that the HealthLeaders' list would be more valid. But as it is, the 800-pound gorilla in PR for best hospital lists is USNWR today, and like it or not, we may be stuck with it.

John Casillas
Chair, Medical Banking Institute
Executive Director, Medical Banking Project

Your article is well done. Much like the architecture profession is forcing itself to provide more rigor and research oriented approaches to design; our woeful U.S. general press has become the new National Enquirer in many areas and needs desperately to follow us. Are we following the poor example of England's popular press? It is all about sensationalism. Even U.S. News & World Report has an air of superficiality that creates all kinds of buzz over virtually non-tested data. Just wanted to share my thoughts, and suggest perhaps a more in depth critique of these silly rankings.

David M. Jaeger, AIA
Principal, Architectural Design
Harley Ellis Devereaux
Southfield, MI

Gary's response: Here at HealthLeaders Media we are pretty cautious about the ranking business, but we do honor those who make contributions.


Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at gbaldwin@healthleadersmedia.com.

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