Diet and Nutrition. Natural Health, and Healthy Living

Yesterday we tried to put EHRs into perspective. They're important, and we can't effectively move health care forward without them. But they're only one of many important health IT functions. EHRs and health IT alone won't fix health care. So developing a comprehensive but effective national health IT plan is a huge undertaking that requires broad, non-ideological thinking.

As we've learned so painfully elsewhere in the economy, the danger we face now in developing health care solutions is throwing good money after bad. We don't merely need a readjustment of how health IT dollars are spent. We need to reboot the entire conversation about how health IT relates to health, health care, and health care reform. To get there, we need to take a deep breath and start from well-established and agreed-upon principles.

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Kibbe & Klepper are back with an update to their pre-Christmas piece on EHRs and the forthcoming Obama Administration's investment policy towards them. Lest you think that this is just a small group here on THCB and fellow traveler blogs shouting to each other, I'd point you towards the Boston Globe article about their previous "Open Letter," which shows that this discussion (and a similar piece on THCB from Rick Peters) appears to be being taken very seriously. As it should--Matthew Holt

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In last week’s NEJM, physician-author Abraham Verghese paints a disturbing picture of a medical world in which technology has morphed from tool to object, the patient relegated to a supporting role. To me, Abraham has nailed the diagnosis but not the treatment.

I had the distinct pleasure of getting to know Abraham when we both served on the board of the ABIM (actually I came to know his work 15 years earlier, when I reviewed his bestselling book, My Own Country, for the NEJM). Abraham is a romantic and a traditionalist, and in last week’s New England Journal piece he poignantly lays out a problem he has fretted about for years: namely, that information technology is dehumanizing the practice of medicine. Describing rounds with his ward team at Stanford, his new academic home (he was recently recruited there from the UT-San Antonio), he recalls:

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As we inevitably do this time of year, we prognosticate about the new year. This time around, it's a toughie: there are too many uncertainties that preclude us from doing a straight-line forecast for 2009, especially in health and health care.

Here are some trends and wild cards to keep in mind for 2009: the year of managing risks.

How will the macroeconomy play out against health care in the new year? Keep in mind the Kaiser Family Foundation's metric on unemployment: an increase of 1% unemployment leads to 1.1 million uninsured, and 1 million more people added to Medicaid. This was the math that worked in 2007-8. The metric will probably change in 2009 as Governors struggle to balance budgets while providing medical services, education, and safe streets to citizens. The National Governors Association, and the individual state heads, have all warned that Governors will inevitably cut services in 2009 and into 2010 if tax receipts continue to decline.

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There are some folks in Washington who have made statements that we should delay investments in EHRs because current vendor products lack the functionality needed to support a coordinated healthcare system. Others have said that we lack the standards or security framework to implement interoperability. Here are my thoughts.

Take a look at the successes in Massachusetts and New York with commercial EHR products. We've implemented eClinicalWorks, which includes decision support, e-prescribing, administrative transactions with payers, clinical summary sharing across the community, and quality measurement (all the National Quality Forum high priority measures). It's web-based, using a service oriented architecture in a cloud computing environment. By implementing this product at BIDMC, we're meeting all the payer guidelines for delivering appropriate, coordinated, high value care. Vendor products from Epic, Allscripts, NextGen, GE, Meditech, eMDs, MedSphere, and other CCHIT certified vendors have similar features.

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This is a modified post from one I wrote in Nov of 2007. I report this as a part owner of a small business whose costs are increasing every year while revenues are decreasing.

Therefore, I present to you all the new, improved EHR: Effective Hourly Rate.

With the absurdity of bailouts and the apparent transition from a constitutional republic to an elected monarchy, let’s see if the powers that be require us to ‘move from a 20th century economy to a 21st century economy’--- by making the change from the worthless concept of ‘wages and tips’ on the W-2 to the concept of ‘total compensation’.

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The concept of participatory medicine is taking hold, fueled, at least in part, by what we see as two complementary forces, these being the patient-centered medical home (PCMH) and Health 2.0. Health 2.0 is very much a grass roots phenomenon, dominated by a small but significant group of patients who are testing the hypothesis that the wisdom of the crowd can rival the wisdom of physicians. The PCMH is a concept, not new, but gaining tremendous traction in the provider sector now as a best-try effort by some providers to be truly patient centric in their approach. The two should be complementary and mutually self-supporting. One might even suggest their respective champions should be collaborating right now, when the scent of health reform is in the air in our nation’s capital. But they are not. Lets examine why and explore ways in which to create a natural bridge between these two concepts and their champions.

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One of the most remarkable people I’ve met this year is Dave deBronkart, better known as ePatient Dave (fourth from left on top of the e-Patients.net blog). Dave has had a remarkable recovery from cancer and has probably used as many Health 2.0 tools as any patient.

I got the chance this week to talk at length with Dave and his GP Danny Sands. Danny is not only a practicing doctor in the BIDMC system in (Boston, yes that one with the blogging CEO and blogging CIO!) but also the Director of Medical Informatics for Cisco (FD, Cisco is a Health 2.0 sponsor and I’ve done consulting work for them in the past).

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A health care Marshall Plan -- $50 Billion stimulus to get electronic health records (EHRs) in every doctor’s hands or $50,000 to each physician -– what an incredible marketing job.

Detroit, are you listening? Stop whining to Congress that you need a bailout. Tell them you want to be the new alternative energy Manhattan Project, get the money, and then keep building SUVs and flying around in corporate jets.

To Congress, Daschle, and Obama, please don’t do this. Our industry, health care, combines the worst of the Big Three automakers with the worst of the hubris, dishonesty, and failure of the public trust of Wall Street. Please do not bail us out.

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A health care Marshall Plan -- $50 Billion stimulus to get electronic health records (EHRs) in every doctor’s hands or $50,000 to each physician -– what an incredible marketing job.

Detroit, are you listening? Stop whining to Congress that you need a bailout. Tell them you want to be the new alternative energy Manhattan Project, get the money, and then keep building SUVs and flying around in corporate jets.

To Congress, Daschle, and Obama, please don’t do this. Our industry, health care, combines the worst of the Big Three automakers with the worst of the hubris, dishonesty, and failure of the public trust of Wall Street. Please do not bail us out.

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