First, Dr. Ron Goetzel notes that one of the largest sources of the escalating cost of health care is innovation itself – new prescription drugs and new technology. This backwards incentive is fueled by a complete lack of top down pressure for cost reduction. Innovation has no need to be aimed at reducing costs – and instead seems aimed at increasing care options at additional cost. Until we can provide incentives for innovation of cheaper alternative products and process, the unchecked increases in costs will just fuel innovation not aimed at efficiency.

Second, a great presentation from Goetzel on case studies of employer organized health promotion plans, but sadly the focus was on large American companies with predominantly US-based employee bases. Justifiably, the buzz among attendees turned to how all of these good ideas could practically be applied to small business. The suggestion was made by Goetzel that the same approach used in Massachusetts to service fully insured small businesses for the individual mandate (the Health Connector) could be used to aggregate firms around wellness.

This seems a bit simplistic. The incentives are simply not there. You could indeed crowd-source the employment of wellness across a larger employee population through a cooperative, but you cannot expect all participants motivations to align. Perhaps a model where participation in the connector itself were tied to roll-out of a standard wellness program could work, where participants not wishing to roll out wellness across their company could pay credits to opt out and further incentivize those who do wish to participate could create some efficiencies while employing wellness across a larger but transient employee population.

At HealthCampBoston, the convergence of thought around various challenges facing health care was evident. And this was not the development of a myopic view but a vision of a path through challenges.

To illustrate, I’ll dive into one challenge discussed in one of the sessions throughout the day-long unconference. The challenge was the major one of reporting clinical patient data by providers.  Most people agreed that this is necessary and may soon be required by providers seeking to qualify for economic stimulus funding for healthcare. Yet some providers are disinclined to do so as reporting exposes too much too quickly. Professionals in any field would hesitate at exposing business “tricks” on which they have become reliant. Provider offices faced with a difficult coding systems for billing sometimes place diagnostically inaccurate but monetarily accurate codes into health records for billing purposes, and so some fo these providers are understandably hesitant to have these seemingly harmless shortcuts cut short.

These shortcuts which can generate inaccurate data are not different than the many outside healthcare (just check out banking), but the impact of these shortcuts can be severe to individual patients when it concerns health records, as was evidenced by ePatientDave’s experience. At HealthCampBoston, a realization emerged that different solutions would have to be developed and used in concert to determine what would work best for providers and patients. John Moore suggested a virtual weigh station where patients would validate information before it was added to their PHR as a way to keep bad data out may be needed. Who better to manage one’s data than oneself. Another suggestion was that provider facilities would clean up the data before publishing it. You broke it, you own it. Another idea was to exclude billing data and only publish clinical data to PHRs, but this alone would not solve the problem. A physician noted that sometimes, non-billing related information such as temporary conditions (like pregnancy) were left on a patient’s record indefinitely. The convergence of thought came not from groupthink but from the realization that solutions often did not have to be mutually exclusive and that no single one is an obvious a silver bullet to this problem of effectively publishing and reporting clinical data that could be shared by providers and measured by payers, to align with paying for reporting and performance, which also brings other challenges.

The fact that there are incentives, both publicly and privately funded, aimed at providers which pay for reporting now and that they are being followed by a nascent wave of pay for performance incentives is heartening. The fact that there are now robust PHRs from Microsoft, Google, and others and that data can be electronically signed by the providers publishing this data also makes it more likely that increasingly clean clinical data will be provided for patients. I suggested that given choices, patients will reward providers who can a) publish data to PHRs at the request of patients and b) publish clean and complete data. This might be the best incentive and stimulus of all.

Started in 1990, the Human Genome Project was an early effort dedicated to mapping and sequencing the human genome. The time and money spent to complete a whole sequence of DNA were many years and billions of dollars.

The technology has advanced significantly since then.  For the first time in history, individuals can gain access to their personal genome information through different companies. Now, DNA sequencing can be turned around in months. Depending on how complete of an analysis you want, you can take a look at your genome by paying a fee.

Here are a few options mentioned by Kevin Davies, Editor in Chief of Bio-IT World, at the HBSAB event: “The $1000 Genome: How Routine DNA Sequencing Will Reshape Medicine”:

• 23andMe – $399; analysis is based on genotyping; output: 110 clinical and research reports
• deCodeMe – Complete scan for $985, analysis of 38 conditions. Cardio scan for $195 which covers heart attack and atria fibrillation. Cancer scan for $225 which covers 7 cancers.
• Navagentics – Health Compass for $2,499 which covers 23 health areas. Annual Insight for $499 that includes analysis on 10 common health conditions.
• Knome – $150,000, high-touch service that sequence the whole DNA

If you are willing to “donate” your genome, you can participate in the  Personal Genome Project which will analyze human DNA for free. The data will be published and help with on-going medical studies.

Personally, I have not yet decided to get my DNA genotyped or sequenced yet. I am not sure my primary care physician is ready for the amount of data and the type of data that I would get. I am not sure I am ready to know about my health risks. However, I understand the benefit of preventative health measures and I have been told that learning more about myself – what health risks I have – may lead to life changing decisions – devoting more effort to discovering the cure for MS, for example.

I am excited about what’s possible. I hope to continue learning about this space and look forward to this being even more accessible and mature.

Of the interesting topics discussed during Thursday night’s Transforming Healthcare Summit 2009, I found a few simple words to be the most intriguing – “certified” and “meaningful use”. These are of course the terms used in the recently signed Health Information Technology for Economic and Clinical Health (HITECH) Act, to determine if a provider’s EMR implementation enables them to collect their share of the $19.2 Billion stimulus.

A quick Google search shows the immense interest and opinions this specific subject has invoked since the Act was published in February.  First around the topic of certification and what deems a “certified” EMR.  Although CCHIT is the nationally recognized certifying body for EMR implementations, there seems to still be a question within the HITECH act as to what will deem a certified EMR. Of course this provides an opportunity for anyone and everyone to voice their concerns with the CCHIT and its current certification requirements. The major arguments I’ve read point to the certification’s discount of system usability and the lack of any tie to outcome measurements.

Secondly there’s the term”meaningful use” which is also yet to be defined to a majority’s satisfaction.  The world is not short on opinions and businesses are doing what they can to capitalize on the current ambiguity.  In fact a google search of “HITCH Act, meaningful use” will often provide sponsored links to no less than three companies, one consistently by Watertown-based, athenahealth, offering “…The Facts About The HITECH Act What It Means For Your Practice”.  If you follow the link, athenahealth basically explains how providers can get their piece of the pie, and how athenahealth’s suite of software products, can help.  Athena also subtly announces that they will alter their application’s capabilities in places where it doesn’t currently meet the requirements laid out by the HITECH Act. “..we are prepared to update athenaClinicals with new measures, and assist physicians in program enrollment, submission and performance optimization.”  Hmm, think Jonathan Bush sees $$?  But his developers are currently trying to hit a moving target of requirements.

The unfortunate reality is that it’ll take too long to develop a new certification criteria, certify new software packages and implement them by 2011 – the deadline indicated by the plan’s Meaningful use Timeline. So, are there incremental changes we can make, that add significant value to the certification criteria, but do not force us to start from scratch?

Contribute to the debate:  A recent emrandhipaa.com poll asks whether the current CCHIT certification should be the one used by the HITECH act? I’d argue a third option should be included – “Update CCHIT Certification with latest metrics in usability (proficiency and process cycle time reduction) and measured outcomes (patient health, subscription accuracy, billing accuracy).”

What do you think?

In reality, the most value that the HITECH Act is providing the health care industry at the moment is the buzz it’s creating. Perhaps due my recent baptism into the world of HIT blogging or the facts-of-life living in the Northeast, but it feels as though there’s more thought, opinion and open discussion occurring around these topics today than ever before. My hope is that the buzz is infectious and pushes decision-makers to become more educated on the value of utilizing technology to bring value to the industry and not just to dip into the Administration’s cookie jar (for what will end up being significantly less % of overall revenues than you may initially think). I also hope that these questions, left open by the HITECH Act, don’t discourage progress; discourage providers from implementing an EMR or other system which they will find out will not meet all the criteria laid out by HITECH in order to collect on the Act’s incentives.

Of course the best thing that could happen during this next 9 months is the general acceptance that information availability is *the* enabler for patient-centric health care to flourish and the first provider system to master and coexist in an environment driven by information exchange and availability will be the winner with patients and board members alike.

Change has been on the agenda for a long time in the healthcare industry, but change has been slow to come and implementing change has been fraught with pitfalls along the way.  The Obama Adminstration is giving all indications that addressing this need for change in healthcare is going to be front and center among the key challenges that will be addressed over the next four years.   Since November 4th, much attention within the industry has been given to the question of whether President Obama would still be able to tackle this problem given the issues with the broader US economy.  The industry waited with bated breath to see what investment would be made in healthcare as part of the stimulus package that the President challenged Congress to create.

With the stimulus package signed into law on Tuesday February 17th, it finally seemed that those who had been waiting to see what would transpire could now shift gears and begin the work mapping out the road ahead.  There is much to be done, and there are still many, many more questions than there are answers, but after several months of “wait and see”, it is clearly time for those most able to move the ball forward in healthcare to come together and begin the hard work that lays ahead.  While the Summit of course cannot in and of itself boast to have started the ball in motion, it may prove to be an effective call to action for those of us who have been forced into playing a waiting game over the past three months due to the state of the domestic and global economy.

To hear about the content of the discussion on the summit, I suggest reading my colleague’s blog article here

Everyone came with something important to contribute to the summit and with a mission to take away new perspectives as well. The networking before the night’s speakers and the panel was a good time to meet people and share expectations about the event. Most revealing for me was how connected so many industries are to healthcare. It is reflective of the relative size of healthcare expenditure in the GDP.

Steve Wardell, the head of the HILForum, which organized the event, started his talk with some level setting. By doing a quick poll, he demonstrated that most of the people at the symposium work towards improvement in treatment outcomes for patients and also to reduce the costs associated with healthcare. There is a lot more to gain for everyone involved if these two goals, which are not mutually exclusive, are kept in clear focus. This was the best start for what is almost always a heated debate. I say almost because despite the few points of contention that came up, there was a general consensus in what needed to be done and where most of the waste in health care delivery was happening. There was also widespread acknowledgment of what has been working well – social networking amongst patients – through little or no industry help at all.

One observation as to the biggest problem that needed to be corrected was that Medicare, as it exists today, has inadvertently rewarded specialization for physicians and has discouraged the practice of primary care. Where the population of physicians was about evenly split about 50/50 forty or so years ago, it is now heavily skewed towards specialists and away from primary care practitioners. Charlie Baker of Harvard Pilgrim also made the point that this skewing had taken place gradually but consistently and that undoing this change might also have to happen at this pace. The correction to the rewards and incentives to improve what providers did was a generally agreed-up point.

Another panelist, Jonathan Bush of Athena Health, dramatically made the point that there is a need for pragmatism in addressing health care cost issues, and that without it, the result may be passing along the burden of high costs of healthcare to the generations to come. Both Charlie and Jonathan believe that incremental changes were happening in the right direction and that incentives were helping and would continue to help. The health IT budget in the stimulus was one big incentive, that might trigger the flow of health data which could then be measured by the right authorities, both private and public, in order to improve quality, determine comparative effectiveness, and reduce costs. There was general agreement on this point as well.

A physician in the audience raised the point that she spent a significant amount of time trying to determine if her patients were being compliant with their prescriptions for recovery after being discharged, and that if this time could be saved by making it easier for her to follow up on her discharged patients, it would be worth spending the additional time to use electronic prescription systems (ePrescriptions) as opposed to continuing to write them by hand.

The other panelists were John Glaser and James Roosevelt of Partners Healthcare and Tufts Health Plan respectively. They contributed a wealth of perspective and balance to the issues as well. James Roosevelt was the keynote speaker and his message was that all stakeholders needed to be ready for compromise in order to accomplish change. John Glaser touched on an item that everyone agreed on – what does “meaningful use” mean? It is language included in the recently passed bill that is the qualification for a medical practice to receive some of the stimulus funds, but the exact definition of what that is still has to be clarified. Jonathan Bush made the point that everyone was contemplating – that “meaningful use” will be different for providers, insurers, and patients.

A patient named Dave also brought into perspective another dimension into the conversation when he asked about what was fair for patients who had rare enough conditions that did not attract the industry to accommodate their needs to improved flow of information. A panelist thought that even though a company may be more incentivized to target a larger potential pool of consumers than a smaller pool that might have a rare condition, it might be that through improvements targeted at a larger pool of consumers, a smaller but different group could benefit as well. These would be incremental changes in the right direction.

There were also many ideas from entrepreneurs which were more optimistic in the accomplishment of major impacts, even if from seemingly small and minimally disruptive changes in the delivery of care. David Williams logged perspectives from several CEO’s on his blog. Among those pushing innovation, there remains optimism that big changes can happen fairly quickly if the right solution were matched to the right opportunity.

6:29 pm: Meet and greet just ended. Lots of people and ideas. About to start with tonight’s speakers

7:20 pm: Panel is very lively. Discussing the top pritities for reform that am incoming secretary of HHS should take on

7:55 pm: Live questions from the audience about how comparative effectiveness results for treatments will loop back to treatment coverage

8:13 pm: Question about impact and support for patient online social networking and supporting this trend

8:18: An interesting question is on table now about role of open source software in electronic health data interchange and interoperability. Response generally was that it is the data which would matter – that is what needs to move freely

8:37 pm: A physician proffered that a potential significant area of cost savings would be the ability for a physician’s office to follow the compliance of a discharged patient to their prescription for recovery. The panel agreed violently

9:18 pm: networking session afterwards is lively. A lot happening.