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Day One: eHI Conference

by John Moore | December 04, 2008

8:15am After the formal introductions, Karen Davis, head of The Commonwealth Fund has taken the stage.  She’s beginning with the slides we have all seen (that is those of us who attend these events), unsustainable growth in spending, not getting what we paid for, etc.  Their “National Scoreboard” has found quality slipping 1n 2008 from last survey in 2006.

Think we’re bad?  Canadian adoption of HIT in primary practice is half that of the US (8% vs 19% in US).  At least according to their survey.

Commonwealth has found in their surveys that physicians who adopt HIT and get comfortable using, actually find, or at least believe, that they can provide better care than before.

Karen has now begun talking about the Danish national HIT system (she was just there).  Fascinating what Denmark has done.

  • 98% adoption of physician use of HIT & eRx
  • Physicians are reimbursed $7 (probably 5 euros) for each email thy respond to.
  • Have established a master HIE for the country where every bit of health documentation related to a consumer is put and can be accessed via a Master Patient Index (MPI), via the Web.  All information is digital, fully searchable and get this, Controlled by the Consumer!  The consumer can see who has reviewed their records (audit trail) and determine who has access to their records.  As an added privacy feature, physicians must always (except in break the glass emergency) click a check-off box stating that the consumer has granted them access prior to viewing a record.  Sounds like a pretty sweet set-up.
  • To close the loop on eRx, the system also connects to pharmacies for them to upload when scripts were actually filled.
  • Took Denmark 10 years to put this together.

Now circling back to what we might see in terms of healthcare reform with the new administration.  Nothing new here.

9:45am We now have a panel of various legislative aides who will talk about what they see coming in the future. First aide, for Enzi?, stated that they have put up all sorts of HIT bills, all to go up in flames.  Hopefully for the future. One aide stated that their boss, Congressman Barton (R-TX) has had his records breached twice, so he is extremely concerned about the privacy issue.  Big challenge for him is how do we privacy for health records and who ultimately has control of the records.  In this case, the Congressman believes the consumer should have ultimate control.

Odd all this talk about privacy – amounts to nothing without enforcement.

Rep. Sheldon (D-RI) is a freshman and very keen on HIT issues.  Surprisingly, not a big fan of P4P programs to fund HIT adoption, at least P4P that focuses on individual docs, would rather see P4P focus on communities of care.  Likes the old Land Grant funding model.  This was used oh about a century ago for supporting agricultural sciences and led to all those state universities that have an A and or M in them, e.g, Texas A&M.  Honestly, don’t see this going anywhere, but good to see some new thinking.

So far, about a third of the aides have made statements, no one has mentioned the consumer (other than the privacy statement) and what their interest is in HIT.  All about the physician – extremely myopic.

Attendee composition is almost the antithesis to Health 2.0.  Few computers are open (or even here), lots of “suits”, mid-forty and up, stiff.  About 100 in attendance.

Kennedy aide’s comments quite short and sweet, their focus is on three main areas, coverage, quality and prevention, putting together legislative teams to address them: .  Kennedy aide went on to state that the challenge of healthcare reform will be in containing all the add-ons which various legislators will add to any major legislative act.

During the Q&A, one of the aides stated that ~60% of residencies are done in VA hospitals where they get to use the “state-of-the-art” EMR, VistA and how we need to extend such tools in the general healthcare space.  A physician got up and asked the aide: “Have you ever used VistA?” infering that it was hardly state-of-the-art, and aide admitted “No” and audience got a good chuckle.

Really exposes a key issue:  Those that are creating the legislation just skim across the top of the issues/challenges without digging deeper.

10:00am Next panel has a Who’s Who of HIT folks such as John Glasser (AHIC and Partners’ CIO) Marc Overhage (Indiana HIE), J&J rep, AMA rep, etc.  Panel is to get their views on healthcare reform and role of HIT.  Hopefully better than the last panel.

Beyond no free WiFi at this event – just don’t see how any conference organizer worth their salt would not provide such – can’t find a power plug and begining to run low.  Frustrating. May have to come back later, revert to pen and paper.  Possibly twitter, john-chilmark

Panel agreement that HIT now has strong visibility on the hill and that we have come a long way – it is being discussed.  Big challenge though is how do we get value out of HIT. Currently, there is no solid evidence that HIT lowers costs (CIGNA’s CMO asked Jon White of AHRQ if there was such evidence, Jon responded no, not today).  Belief is that such benefits will accumulate and be realized in 7-10 years time.

Key imperatives of panelists:

  • Glasser – Continue to fund CCHIT, ONC and AHRQ (and although he didn;t say it, AHIC 2.0).  Figure out how do we use CMS to set examples and motivate change.
  • Weber – (Business Coalition rep) No single national solution.  Medicare needs to harmonize at the local level, which they do not see occuring today. Medicare needs to open up, join payment reform strateiges, open up their data, become more flexible.  CMS is so huge, really can’t get anywhere without their involvement.
  • Overhage – Whatever is done needs to be incremental (you mean it isn’t already?).  90% of healthcare costs are spent directly on wages, thus any savings may directly affect jobs, thus move slowly, methodically to minimize transition. Think through how you will leverage existing infrastructure.
  • Steven (from AMA) – Get DEA on-board to let physicians eRx and let’s be honest with adoption as in 2005, one third of states did not allow eRx and now in 2008 it has all of the sudden become a mandate.
  • Richardson (J&J) – Find regions where things are moving quickly ahead and devote energies/resources there to develop best practices.
  • Kang (CIGNA) – Address the patient privacy issue.  Sees it as a “process” issue and that is unlikely to be solved through legislation. Get HHS/CMS to push for a move from payment based on visits to payment based on outcomes.

12:00pm Luncheon Speaker, John Tooker who spoke about AHIC Successor, or AHIC 2.0.  Pretty poor presentation, incredibly boring and text heavy slides, no real value pointed to as a result of AHIC work to date – just a lot of hand waving.  Yikes, if this is representative of what AHIC 2.0 will be, time to close up shop NOW!

1:00 pm Engaging Consumers Session:
American Heart Assoc (AHA) – Courtney gave overview of all that AHA is doing.  Go Red initiative, targets women to take better care of themselves.  Partnered with Revolution Health for Go Red, online community for women, 600+/day interacting.  They see 2M views/month at main AHA site. Recently launched a consumer education on PHRs, how to select, etc. only 15K visitors to date, still pretty crude.  Also have a section on main website dedicated to educating public on broader Health IT issues.

For youth they’ve created www.healthiergeneration.org

Doing a lot of outreach via churches, which has been extremely successful in the South.

Second presenter is from Healthwise, one of their SVPs, Leslie Kelly Hall.  Healthwise has seen very healthy, rapid growth, now at 220 employees, 400K+ pages of content.

Healthwise works closely with Information Therapy and jointly filed comments to CCHIT regarding certification standards for PHRs stating that content must be a part of a PHR and thus a part of certification. They believe this will provide sense of context and future care – prevention.  Sounds self-serving to me.

Gave a nice demo of a diabetes eduction piece they developed that folded education, survey questions etc to create a specific plan for a given consumer.

2:30pm, BCBS Assoc, CEO to talk about comparative effectiveness, at least that is how they introduced him.  Began by stating what we need is clear leadership on where we want healthcare to go as a country.  Oh boy, I bet this is said with each new administration and I bet each new administration believes they bringing clear leadership but get completely bogged down in the political morass that is healthcare today, a morass that payers like BCBS help to create and sustain.

BCBS has a new initiative across all plans called Blue Health Intelligence (bhi).  Claim employers are already using it to help structure plans that are appropriate for their specific populations.  Sounds more like a way to keep employers tied to BCBS plans vs competing plans ala UNH, Aetna, etc.  Not necessarily a bad thing, but question how objective they can truly be.

In strong support of Comparative Effectiveness Institute (CEI).  BCBS believes that roughly 30% of healthcare spend is wasted an areas that this Institute would address.  See it as public-private entity.  Estimate cost: $500M/yr.  Savings $338B/yr (number from The Commonwealth Fund).  Not just about lowering costs but also about improving quality.  Baucus proposal has the CEI concept within it.  Could Obama get behind this?

Want 100% of all BCBS members to have access to a PHR by 2010.  Claim that they are currently at 75% of BCBS plans now offering a PHR to their members.  Gave an example of Anthem and their PHR.  Funny he should use Anthem.  As a member of Anthem, Anthem has never, in my several years of coverage mentioned that I have a PHR.  Doesn’t do a whole lot of good if you don’t tell anyone.  Anthem is not alone, pretty common situation across all payers, most do an absolutely terrible job of consumer education as it pertains to PHRs.

Out of power, reverted to twitter.

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