Donna Shalala, who served as Secretary of Health and Human Services under President Bill Clinton, is urging lawmakers to build broad public support before embarking on any reform. Shalala told the Senate Finance Committee that public support for Clinton's health reform effort in the early 1990s diminished as people with health insurance began to worry about what it would mean for their coverage. Clinton's 1990s proposal also faced staunch opposition from the healthcare industry.
Tenet Healthcare Corp. has reported a first-quarter loss on costs for labor lawsuits. The net loss was $31 million, compared with a profit of $75 million a year earlier when the company benefited from a $92 million tax gain. Revenue gained 6.9 percent from the year earlier to $2.37 billion. Tenet has tried to gain patients by renovating hospitals to attract doctors and insurance plans, and said admissions increased 1 percent. The admissions increase was helped by a severe flu season and an extra day in the quarter, according to a Tenet statement.
The Association of Health Care Journalists recently held its first Rural Health Journalism Workshop at the University of Missouri-Columbia. Speakers at the workshop included Don Sipes, vice president of regional services for St. Luke's Health System and chief executive officer of St. Luke's Northland Hospital-Smithville. Sipes noted that many rural hospitals have suffered and even closed because their patient volume and Medicare reimbursement couldn't keep up with the cost of new medical equipment. He added, however, that telemedicine programs can keep patients in their communities and deliver the same quality of care they would in an urban area.
Kaiser Permanente has announced that all of its 8.7 million enrollees in nine states and the District of Columbia have access to an outpatient electronic health record Kaiser says is the world's largest privately funded EHR. All of Kaiser's 13,000 physicians nationwide now have electronic access to patients' medical records in the system's 421 medical offices and clinics, said Kaiser officials. Kaiser's overall costs for the EHR installation are approximately $4 billion, including $1 billion for maintenance.
Innovation is a word tossed around all too lightly in the healthcare industry. While healthcare organizations and vendors claim that they are innovators, industry analysts point out that healthcare is frequently one of the last sectors to adapt to global change.
Whenever I see the word “innovation” in the title of a conference presentation, I can’t help but to roll my eyes. I’ve seen too many of these monologues turn out to be about implementing the Toyota method, which was once an innovation—for Toyota.
Today I’m in Las Vegas, the city of neon lights and second-hand smoke. I’m here at The Venetian conference center for the Healthcare Globalization Summit. Even though I’m not much of a Vegas guy, I’ve been looking forward to this conference. There are some influential names on the agenda and some people I’ve interviewed for past articles that I’m hoping to reconnect with.
But then I scan the agenda for the day and notice the title of the keynote: “Driving Innovation in a Global Healthcare Marketplace.” After some initial skepticism, I push back my bias and see this roundtable discussion includes some folks who might actually know a thing or two about real innovation, including Bumrungrad Hospital’s CEO, Microsoft's worldwide health director, and Converge Partners’ managing director, health industry.
Here are some of the highlights of their conversation, moderated by Greg Lindsay, a contributing writer for Fast Company magazine who has written about medical travel.
Curtis Schroeder, CEO of Bumrungrad International Hospital, made the point that the barrier of distance for medical travelers might become more of a factor as more and more international hospitals emerge in the market. For instance, if low cost, world class hospitals are available in Mexico or Central America, Bumrungrad would face greater competition based on the proximity of the hospital to the patient.
Simmi Singh, managing director for Converge Partners, said international hospitals have a tremendous opportunity with the creation of global healthcare brands to reach cash rich consumers all over the world—not just in the United States. Schroeder noted that when healthcare was largely local, branding wasn’t important, but agreed that global hospitals on the forefront can develop worldwide brands. Singh said that this only increases the importance of the consumer experience. “People don’t understand quality as consumers … but they can understand the transformative experience,” she said. “While the discussion is about cost moving people around the world, I think the ante has been upped on the patient experience.”
The panelists also had an interesting discussion about the inequitable price of medical devices around the globe. They predicted that the global health movement could flatten the costs for devices in the next several years.
I will be here at the Healthcare Globalization Summit for the next two days and will post any observations I have online. I’m on the company tab, so what I do in Vegas doesn’t stay here. Check back in and shoot me any comments, questions, or suggestions you might have.
Helped by active government support, a boom in cosmetic surgery and a pool of experienced surgeons, South Korea wants to surpass Singapore, Thailand and India to become Asia's new medical tourism hub. The South Korean government is stepping up efforts to win parliamentary approval of a bill that would legalize profit-oriented medical brokerages linking hospitals and patients. But even without local insurance benefits, foreigners find high-quality services cheaper than in the United States or Japan, said South Korea Health Minister Kim Soung-Yee.
More than 1 in 4 workers earning at least $60,000 a year went without insurance in 2006, and such workers are too well-off to be eligible for medical assistance. They can, however, often wring tens of thousands of dollars out of hospital "rack rates" by going abroad for treatment. Estimates on the number of those who are leaving the United States for surgery range from an ultraconservative 5,000 to 500,000 annually if minor procedures are counted. Some employers and big insurers are so intrigued by medical tourism that they're beginning to look for signs that they should start covering it.
The U.S. is facing a crisis with the quality, disparity and cost of our healthcare services. We have a fragmented healthcare delivery system that functions with silos of data.
Creating a cohesive healthcare system is exactly what we need to meet the common objective of delivering high-quality, cost-effective, and timely patient care. Luckily, we have a model to follow directly to our north: Canada.
In Canada, the 14 federal, provincial and territorial Deputy Ministers of Health—as well as regional healthcare authorities and other healthcare organizations and information technology vendors and suppliers—are all working together toward a common goal: to provide 50% of Canadians with access to a secure electronic health record by 2010.
How does a country with more than 33 million people come to an agreement and move forward with a country-wide healthcare IT system? Easy—in Canada, the healthcare IT infrastructure functions like a business unit. To move forward with EHR adoption, this representative group did research, made a decision, secured funding, and began implementation.
Here in the U.S. we don’t make decisions nearly this quickly. We’ve been churning over patient identification, for example, for more than a decade. Churn costs money; churn costs development time and effectiveness; ultimately, churn costs lives. Let’s take a lesson from our northern neighbors and get the job done.
Following Canada’s lead
Spearheading the initiative is Canada Health Infoway, Inc., an independent not-for-profit organization that invests with public partners across Canada to implement and reuse compatible health information systems.
One of the first steps in implementing this nationwide project—and one of the most pivotal aspects of its success—was to create a common blueprint, or electronic health record “info-structure.”
This blueprint includes:
Client registry systems, similar to enterprise master person indexes and record locator services that commonly support regional health information organizations (RHIOs) in the U.S. domain repositories
A longitudinal record service, to coordinate data across multiple domains and registries
Standardized common services and communication services to sustain privacy, security and overall interoperability
Standardized information and message structures and standardized business transactions to support information exchange
In this model, each info-structure interoperates with others in a peer-to-peer manner through the Health Information Access Layer (HIAL). The data-sharing journey begins and ends with the HIAL.
Watch and learn
Let’s learn from Canada’s success and follow a business-model approach.
First, of course, let’s have a blueprint. Second, let’s invest wisely and strategically—and measure results to monitor that investment. The Canadian government invested $1.6 billion in the initiative. The government entities knew they needed to see value from their investment, so they funded a small number of targeted areas rather than spreading their investment across a range of initiatives.
The Canadian government also demands results. Each year, Infoway is accountable for reporting status and success metrics. Again, this mirrors the way a business unit would operate.
Third, no churning. Period. Let’s make decisions and start to move.
Ron G. Parker, Director of Architecture within the Solution Architecture Group at Infoway, added this advice: “It is important to invest in a structured collaboration model that ensures all key stakeholder communities are represented in the process of standardization.”
He explains that standardization of business processes in any industry requires a three-level simultaneous “sell”: To the executive decision makers/sponsors, to the people with the industry domain expertise, and to the people that implement the business processes directly.
“Only if everybody in this ‘stack’ knows the other groups are good-to-go, can you have success,” he says.
I love Canada. I just don’t want to move there. (In fact, I’d like to retire in Montana.) My hope is that we’ve got a nationwide healthcare IT system in place by that time. Needless to say, the clock is ticking. Can’t we follow someone else’s lead?
Lorraine Fernandes is VP, Healthcare Industry Ambassador at Initiate Systems. She frequently on topics such as RHIOs, health data exchange, patient identification issues, and best practices for master person index (MPI) cleanup. She serves on committees and workgroups for HIMSS, AHIMA, and Health Initiatives. She can be reached atlfernandes@initiatesystems.com.
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Time to open up the mailbag and acknowledge some of the great letters I have received. My article, “Say What?” easily drew the most mail since I began writing this column. I thought the column might irritate people in the PR biz, but they enthusiastically supported me. “Although I’m in the profession, I’m embarrassed by the examples you posted; you would think people in communications would write in English,” wrote Stacy Brucia of the Hodges Partnership. One fan, Beth Friedman, even sent a Web site that lets writers weed out the “bull.”
I run a PR firm specializing in healthcare, and I used to be a writing professor at BU. I agree with you wholeheartedly. And doesn’t the word “unique” drive you crazy?
Gary Woonteiler
President
Woonteiler Ink
As a long time writer of press releases for startup tech companies, who spent a number of years in network security–first I sighed with relief that my last release wasn’t in here, but then I considered sending you a hyped-up, jargon-filled release to see if I could get covered in your column. Good read–thanks for the laughs.
Tamyra Hyatt
Director of Marketing
StatCom
Claims Quagmire
My take on the tangled state of claims processing drew this heated response, from one reader who asked not to be identified. While I am not in a position to “take sides” on the payer’s role in this, I will say that getting health plans to talk–on most topics–can be very frustrating. I had some notable exceptions in my article, fortunately, such as Dave Boucher, vice president of healthcare services, BlueCross BlueShield of South Carolina. Boucher referred to the “black hole” of claims. Our May issue, which includes part 2 of my claims series, examines how BCBS of SC is attempting online, real-time claims adjudication for providers. It is looking to at least curtail some of the intermediary action that seems to drive everyone nuts. But I would be glad to hear from other payers and clearinghouses out there as well, particularly in response to this letter:
Just look at the history of how payers have complicated the claims transaction environment every time we have tried to implement standard transactions:
UB92; each payer corrupted the implementation guidelines for various fields in the claim within weeks of implementing this claims format.
HIPAA v4010; most payers corrupted the implementation guidelines again for various claims fields. We can only hope that the new v5010 will become more of a “standard.”
A single payer model (Medicare) would significantly simplify the claims environment. Supplemental insurance would add more complexity but those costs could be pushed back at the payers providing the supplemental insurance. Also, if you don’t follow protocol you go to jail; that is a great incentive to follow the rules and standards!
The payers are the major problem children for the claims environment no ifs ands or buts about it. But, good luck in dis-intermediating them any time soon – they have a great deal of power over Capitol Hill.
Name withheld by request
Data Sharing
Several people wrote in response to my essay, “On Carts and Horses.” They raised additional points about why regional data efforts, while a good idea, may be a while in coming.
I read with interest your article “On Carts and Horses” in the April 8 issue of HealthLeaders Media IT online and had previously read the essay in Health Affairs, “The State of Regional Health Information Organizations: Current Activities and Financing,” which you cited.
While I agree with your assessment that the chances for a sustainable data exchange model would improve if local hospitals and medical groups first got their own IT houses in order, it still seems to beg the question “how”?
A clear revenue model to support data exchange efforts beyond enabling legislation, Stark safe harbors and grants has not emerged. Hospitals and large medical groups already struggle financially and small physician practices that still account for more than half of the nation’s providers are even worse off. While serving the greater good – improved patient care – by investments in EMRs and other enabling technologies is an interesting argument, a clear ROI for hospitals and physician practices is not in sight.
Fortunately, the nation’s health plans are emerging as the drivers of successful and sustainable patient information-sharing networks that can serve as the foundation for the future of Web-powered healthcare. Payers are natural economic sponsors for information-sharing technologies that benefit patient care. They have the financial resources and the physician networks to deliver these technologies with considerable economies of scale and accrue significant financial benefits justifying their investment.
Along the way, hospitals and physician practices also benefit.
Health plans are also the source of critical and actionable data that better reflects the care received by patients than individual providers could easily reproduce. For example, a provider may document a prescription, but payer data can document it was filled as well as all the other prescriptions written and filled for that patient.
Although fierce competitors, health plans have figured out that it is possible to preserve competition, create real operating value for themselves and the provider community while at the same time creating the nation’s largest clinical and financial health information exchange that now reaches over 400,000 physicians.
Michael L. Hodgkins, MD
Chief Medical Officer
NaviMedix, Inc.
Thank you for your excellent editorial, “On Carts and Horses.” Having been a part of the California CHIN (Community Health Information Network) in the late 1990s, what has been happening in the RHIO movement oddly sounds all too familiar, if not almost an exact replay. Security, a patient identifier and immature technology were major hurdles back then. Also, as you pointed out, politics was the coup de grace of that early effort…we were way ahead of ourselves too.
Today it’s RHIOS and everyone tried to sell one like they were selling a super highway—tough to do when the medical community only sees, wants or can afford a cow path. Your editorial also reminded me that nobody really wanted to buy a CHIN in the late 90s…anybody wanna buy a RHIO?
Thanks again. Really enjoy your thoughts; you’re a great writer.
Jim Bloedau, founder
Information Advantage Group
San Francisco, CA
You probably know that the RHIO idea has been recycled (under various acronyms) repeatedly since the 1980s. The general problem is that almost none of the clinical information networks (and perhaps absolutely none) have adequate economic benefit to cover the cost. Sharing information is of little use unless there is a business objective to 1) frame information requirements, 2) circumscribe a set of processes, and 3) achieve a competitive advantage (in cost, quality or both). In many networks we are actually asking competitors to share information. Go figure.
Tim Breaux
Principal
Intercase
Thank you for drawing attention to the political roadblocks that stand in the way of the next level of progress in swapping personal health information electronically, and in particular the obstacle of reliable identification (On Carts and Horses, March 2008). True, focusing on a RHIO before electronic record systems mature among would-be partners in a RHIO is a problem just the same as it was in the mid-‘90s with CHINs. The movement to a connected system of health information calls for a lot of advance work that plays out in frustrating ways. It seems that every step of progress, every bashing of a barrier, brings the next under-anticipated obstacle into view.
Two decades ago, converting paper charts into a usable computerized form was considered a challenge for the age, and the advent of the electronic medical record truly was a big step forward. But the medical-group or hospital-organization focus of an EMR eventually exposed the lack of patient focus in electronic record-keeping. It was for the benefit of health professionals, at a time when those in healthcare saw the wisdom of making the electronic record a force for managing health and promoting wellness by tracking all available data and encounters on a patient. Once the need to aggregate data from many sources into one electronic health record was recognized, the next barrier ahead was how to do that. In mid-2004, I covered the advent of that problem as a reporter in the aftermath of the Office of National Coordinator’s four-pronged “framework for strategic action.” The typical reaction I got to the urgency of interoperability was, “Huh?” But in a few short years the challenge of interoperability is high on the priority list because of that push for a patient-focused EHR.
The ONC and many public-private partnerships are hard at work bringing down the interoperability barrier, as if it’s the final obstacle to achieving e-records and connecting networks. But when all the pieces of a patient-focused record become available to be aggregated for the benefit of a care professional, how does that happen when a patient is identified in many proprietary ways in source records systems, and identity can’t be precisely determined? This is the next barrier that will come into view as interoperability becomes ably addressed. The typical reaction, like interoperability four years ago, may be, “Huh?” But without a unique identifier, the margin of error in aggregating records may not be acceptable.
Since the HIPAA controversy of a decade ago, the issue of a unique health identifier for individuals has remained a political problem and still hot to the touch. But that doesn’t make it any less a problem. Left unresolved, the marathon effort for data exchange--in RHIOs or by any other method--will not have crossed the finish line.
John Morrissey The National Alliance for Health Information Technology
Chicago, IL
An exoskeleton robotic suit developed by Japan's CYBERDYNE, Inc. may help workers lift heavy loads and patients move damaged and prosthetic limbs. The company created the Robot Suit Hybrid Assistive Limb exoskeleton to help train doctors and physical therapists, assist disabled people, allow laborers to carry heavier loads, and aid in emergency rescues. The suit weighs 50.7 pounds and is powered by a 100-volt AC battery.
