The HIT Transition Weblog

Prepping for CCS

Last fall, I reported about how much fun I had at the Collaborative Communications Summit. Not "fun" as in golf outings and spa appointments, but "fun" as in meeting some really interesting and influential people, and being surprised at just how much some executives at the top tiers of the healthcare industry actually know about health IT. But CCS is not just about IT, it's about IT-enabled healthcare, which is a different spin from the typically techy-wonky conferences I traditionally attend.

And I didn't just like it enough to go back; I liked it enough to help make the next one happen. [Disclosure: HITTG is a media sponsor for this event. But we don't sell blog endorsements to anybody.]

Multisyllabic Session Title #1
On Tuesday, I'll be moderating a session called, "Unified Vision with the Consumer and Provider through HIT." I've got an incredibly qualified -- and incredibly broad -- array of panelists:

• Carolyn M. Clancy, MD, Director, Agency for Healthcare Research & Quality
• Michael E. Singer, President, Revolution Health Investments, Revolution Health Group
• George Chedraoui, Global Well-being & Health Benefits Leader, IBM
• Grad Conn, Senior Director, Health Solutions Group, Microsoft Corporation

And before you jump to any conclusions, no this is not a PHR vs. PHR smackdown with a government referee. First, you should note that Mr. Chedraoui has a largely HR perspective -- he's on the boards of both the Leapfrog Group and Bridges to Excellence, recently serving a term as the latter organization's chair. So he's bringing IBM-as-employer mojo, not just IBM-as-programmer-to-the-world. And I don't expect Conn is showing up just to shill for HealthVault, since Microsoft's entire health sector -- personal and enterprise -- reports to him.  Singer has a doctorate from the London School of Economics, which means I will probably buttonhole him first and ask if he's ever met Mick Jagger. I think he's working on some sort of portal these days. Singer, that is.

Taking the Moderation out of "Moderator?"
And, just to make sure the conversation is lively, I've given them all a daunting task.

"Engage me."

As a tough-but-interested, enthusiastic-but-skeptical, chronic-conditioned-but-disclosure-averse patient with a checkbook, I could be your best -- or worst -- customer. 

Engage me.

(And yes, I will be nice. I promise. After I set up the challenge.)

Multisyllabic Session Title #2
As if that isn't enough fun, I get to host the second day's "High Performance Leadership" session. This is the slot made famous by last year's CEO roundtable, where athenahealth's Jonathan Bush, Allscripts President Lee Shapiro, Andrew Eckert, CEO of Eclipsys, and Jeff McCaulley, CEO of Wolters Kluwer Health made such an impression on me, I wrote it up as a TV pilot, which was eventually re-cast and optioned as an animated short for the HIMSS conference.

Can we outdo that august assemblage this year? Looks like we'll give it a run. Here's our roster.

• Duncan James, Group President, Health Systems Market, McKesson Provider Technologies
• Oran Muduroglu , CEO, Healthcare Informatics, Philips Healthcare
• Graham Hughes, MD, GM of Product Strategy, GE Healthcare IITS

Like last year, it will be short prepared statements (keep your PowerPoints in their holsters, please, gentlemen!),  followed by a lively Q&A from the assembled C-suiters and opinion leaders in attendance. Last year, the atmosphere by the end of the second day was both congenial and charged with energy. There weren't any yawners or whiners in the group, and you could actually see ideas being connected by people who were very much able to take the next step and make something happen.

Why Wait Until Nomination Time? Let's Get Partisan!
Oh, and if that wasn't enough, the organizers have got healthcare policy advisors for all three presidential candidates to agree to show up at the same time for a pleasant little chit-chat.  I thought they were really reaching when they said they would set aside time for such a forum, but they pulled it off. I guess you'd have to call that a coup.

Just got the lineup today, so it might not be posted on their website yet.

• Tom Miller, Healthcare Policy Advisor Senator McCain
• Chris Jennings, Healthcare Policy Advisor, Senator Clinton
• Dora Hughes, Legislative Assistant Senator Obama

They were too smart to put me in with that crowd. Instead, eHealth Initiative's Janet Marchibroda will get to wear the zebra suit and blow the whistle if they get out of hand. Janet's much more diplomatic than I am, so I think they'll play nice. I'd hate for her to have to pull out a Yellow Card.

But Seriously
I probably said "fun" too many times to say, now, that it would be a wise investment of your time and energies to roll up for a conference that's barely a week away. But if you're in the DC area -- or are looking for a good excuse to be in the DC area -- you might want to check it out. Monday and Tuesday, May 5 and 6 at the Mandarin Oriental.

Marty's HIT List 2008

Here's my official list of prognostications for 2008.  In 2006 and 2007, I didn't call them predictions, so I probably don't deserve any credit if anything I said came true.  If you agree -- or not -- you can give me your own scorecard by clicking here.  Give your feedback by January 23 and I'll post the results (and any interesting comments) in a blog at the end of the month. As far as we know, we're the only industry analysts that give you, our valued reader, this critical "You're Full of..." HIT response tool.

PHR-as-a-Verb and Kibbe's Sparse Information Model

I caught the end of yesterday's NPR report [partial transcript, with audio link] on Personal Health Record technology, and fell into a pit of despair with the realization that HealthFault's ad-sales-driven, bigger-better-silo model was taking hold of the media's imagination.  On the same show, the Medical Data Bank concept got a plug, too, which is a slightly different model: A data-sales-driven, smaller-lousier-network model.

The conventional HIT approach seems to be building PHR as a personalized version of the oh-so-successful standards-based EHR that's in use in 98% of all healthcare facilities today, and allows for the seamless interoperable communication of key health data between any two providers, even those who work in different buildings. A big, fat chart the patient can hide in their own personal virtual drawer.  Call that the software-sales-driven, personal-fantasy-record model.

A much more hopeful scenario is offered by David Kibbe on the Health 2.0 blog.  Kibbe's thought processes seems to point to the "PHR as a verb" concept that I alluded to a couple weeks back.

HL7 Ballots PHR Model

Standards Development Organization HL7 is getting some press for releasing its Personal Health Record functional model for ballot.  Skip all the press release reprints you may be seeing, the definitive article is in Digital HealthCare and Productivity.com, a mouthful of an online journal if I ever swallowed one.  The author is blogger Neil Versel, who may have actually landed a paying editorial gig.  Neil connects the dots on HL7's pact with America's Health Insurance Plans, to migrate their formative PHR standards effort into HL7's process.

PHRing Like a Kitten
I'm encouraged by the development.  I've tried to stay away from the PHR theme park, but have been drawn in by the bone-headed way some major players were starting to push their free-standing "solutions."  PHRs were mentioned in every other presentation at last week's CCS conference, and I came away with a rant beginning to bubble its way into my forebrain. 

The first line of that rant would begin: "PHR is a verb, you knuckleheads!"

Social Contracts Signed with Disappearing Ink
The next part of the rant says something about the average length of enrollment in a private health plan and the average time an employee spends on a particular payroll.  Let's just say those two numbers do not bode well for the plan-based and employer-sponsored PHR silos we see propagating across the marketplace. 

What kinds of "critical information" would you store in a file cabinet that would self-destruct in three years?

More PHR Bads

Click to view the HIT Bottom animated cartoon "HealthFault from Microsoft" >>

Patient Health Records are, in their current incarnation, such a bad idea, that I thought I had put enough bullets in my previous post about Microsoft's HealthVault.  And I definitely pulled some punches in my perspective on the likely impact of Wal-Mart's retail clinics on the healthcare industry.

Now more stuff is beating its way back into my forebrain, and, as usual, the bat is wielded by Mr. HIStalk's well-sourced blog. (Smacked again by my partner, who just posted the "HealthFault from Microsoft" animation at HITCHtv.net.)

I Left My PHR at the Office
One thing I left off the list of bullets is that when PHR is tied to anything temporary -- like, say, an employer or a health insurance plan -- then there isn't a heckuva lot of incentive for patients to maintain the data over time.

And maybe that specific critique doesn't apply to Microsoft -- unless you work for them -- but then the trust issue echoes down that cheeseless PHR tunnel.  The two people you most don't want to know what's wrong with you are your boss and your insurance agent -- lest you give them a legally-defensible reason to kick you out on the street.  Welcome to employer-based healthcare, Mr. 48-Million-and-One!

The third person?  Mr. Gates, I presume.

Speaking of Trust Issues
Wal-Mart has been pushing PHRs as a key member of the employer-based Dossia initiative.  And, even as Dossia membership expands, its developer, Omnimedix, has taken a walk.  One issue may be the viability of the underlying concept: Omnimedix CEO J.D. Kleinke, opined “We don’t believe a system that is developed and operated by employers will be trusted by employees.”

There also seems to be some concern about being paid.

The quote I liked the best came from another software vendor.  I'll just insert my editorial comments in square brackets.

What's Wrong with Microsoft HealthVault

This isn't a blow-by-blow product review of Microsoft's just-released HealthVault Personal Health Record (PHR) portal.  I'd have to share some personal health information with Microsoft to test the new site out, and I'm about as enthusiastic to do that as I was to put my checking and credit card account numbers into Microsoft Wallet.  Remember Microsoft Wallet?

Part of the geewhiz about MSHV is that it protects patient privacy, sort of ("We do not use your health information for commercial purposes unless we ask and you clearly tell us we may.")  According to Dr. Deborah Peel of the Patient Privacy Rights Foundation, "Microsoft is setting an industry standard for privacy." (link)

Um, no.  They may be setting an example, but they are not even close to setting an industry standard.  And that's the biggest part of what's wrong with HealthVault -- and it's the same thing that cripples all the competing PHR silos being erected across the country.