Enoch Choi, moderator
EHR Electronic Heatlh Record = EMR Electronic Medical Record + PHR Personal Health Record
Matthew Holt
Lawrence Wong
Adrian Enrique Meneses
Daven Grasof
Tony Gentile
Johannes Ernst
Rene Chin
Indu Subaiya
Neil Henry
John Morgenthaler
Jack Higgins
Johannes: the disruptive part
Asof: Oracle: Set of views; security permissions to various users of the same information: provider VS patient
Neil: It might be useful to have a vocabulary (I'm certain one exists) to talk specifically about sections of PHR data that come from: an office visit; a filled prescription; a lab test; a diagnosis;
Matthew: EMR vs PHR, PHR has been more adopted rapidly based on computer savviness of patients rather than providers.
Adrian: patients use the PHR very differently than EMR use by physician that is very fixed and codified. PHR use is lifestyle oriented
Matthew: i'm talking about the data and how it's viewed
Adrian: EHR: Epic/Cerner: horrible thousands of fields that don't mean anything to consumers. Patience of Job to complete the fields, so providers don't complete them. Usability is key for much use.
Johannes: Who's the beneficiary? The problem is best solved for that patient, based on their education. My problem is that i want my buddy to see a lab result, that's not my providers problem.
Indu: Look at what's happened in Banking. Intuit is consumer centric. I'm at B of A and can download that to Quicken. It's a model how PHR could be. My question on the wiki: jump to the issue of financing, who pays for it.
Enoch: build a great product, someone will fund it, or acquire it. Lots of problems using EOB data since it's late, duplicative from many providers, you won't find the PCP wanting to clean this up. It needs to drive from the physician's up-to-date record of the problems & meds if the patient will have trust in the services and decision support offered to them.
Johannes: How expensive is it to build? More than the model of blogging software? Why can't it be that simple
Matthew: EHR more complicated than blogging software. Danes all have EMR. IBM designed a comprehensive system for them. We don't in the US, and most providers don't use EMR. KatrinaHealth.org is an example of collecting PBM, retail pharmacy, HMO & VA records into a web based record. Epic has complicated workflow, very high licensing cost per seat.
<20% providers using EMR.
50% Physician transcription
? Consumer data
the following 3 are from employers and health plans:
a. 60% Lab claims / result
b. 80% Med/hosp claims
c. 40% claims
Johannes: consumer pricing very different. For example Nokia had a conference: Brailer was there. Where are the mobile products.
David: glucometer in cell phones
[Neil: (post session edit) I have had some experience (several attempts; a few successes) in launching blood glucose monitors embedded in cell phones and PDAs. The bad news is that the product platform cycles on cell phones are not long enough to make this a viable opportunity. The best organizations in the world can move a medical device like a BG monitor through FDA to launch in 9 months; cell phone forms lifespans are between 12-18 months. Bluetooth provides a great opportunity to leverage the WAN capabilities of the phone and upload results to a web-based application for education & analysis by patients and clinicians.]
Johannes: not monitoring
Asif: my background is in math. i have a private company in practice management, what can you do in terms of data mining and predictive analysis? Eg. weight, drop in it, create alerts to inform patient to schedule a visit. I'm more interested in taking the billing data to create alerts. More involvement between patient-provider makes better health.
Enoch: Physicians may not be excited to call because we don't get paid for it
Johannes: data that provider about patient is very bad
Neil: Health Hero, (Redwood Shores, CA) www.healthhero.com disease management via proprietary embedded platform via wireless 'interventions' (via SMS or other text service) for several chronic diseases.
Matthew: most very ill are very old, don't use technology well
Adrian: it'll change
Neil: The average age of diagnosis for T2 diabetes is now <50 and moving lower.
Matthew: have to realize providers don't get paid well for disease management.
Neil: Right, but where do you start? We know that face-to-face consults are reimbursed but they are not 'economical' in terms of access or scale. Don't we have to build systems that allow clinicians to more efficiently deliver education and care and use the results (positive health outcomes, lower ER use, quality of life surveys) of these systems to drive changes in what is reimbursed.
Indu: payers are building dashboards of information about a particular members health. IT's not consumer facing. It's to help providers do disease management. This is only a segment. I'm 32, i've switched employers 4 times, i work for myself, i've had 15 doctors, i need something portable. Patients will
Johannes : Interesting and disruptive
Matthew : what will patients do? they won't enter their own data. PHRs can
Lawrence: reimbursement is procedure based. need reorientation
David: the premise is that future is buyer is in a fragmented system. Medicare is a single payer system which is more efficient. Can we look that that for source of opportunity for incentives? Elders can be difficult to engage in using technology, but look forward to many more becoming web-savvy and willing to do self-paid. We have a completely fucked up system, you never know what you're going to pay, shifting costs.
Johannes : I'll throw my hat into the free market as an entrepreneur
Indu: I'll pay for my parents. I'll pay to make to make the problem go away.
David: Search
Tony: 50% of health searches are for a loved one
Matthew: PHR users are either seeing provider's data entered into EMR, or insurer's data
Johannes: where are the completely different models of getting to the data?
Adrian: Make a focused Medication errors product
Tony: PHR's won't be paid for by the patient. I want it for free. I'll pay for services built on top of that data. Consider data from EOBs or glucose monitor into data repository, especially for chronic disease management. Billing data is 3 months late. Standards will be set, and services will be built to compete.
Adrian: are any of these open?
Tony: the existing plans are misguided: they're concerned about service provision; consumer focused companies are trying to build the services
Matthew: JD Heineke & Markle in Oregon: Walmart & Intel are announcing a PHR next week: open portable data store of claims, others can add their own data stores, then build services on top of that.
Johannes: aren't employers interested in portability?
Matthew: Theoretically if you moved employment from Intel to Walmart, you could port your data.
Neil: Let's say that employers may have an interest in advancing the use and utility of a PHR (as opposed to Plans, who may have a contra-interest).
Matthew: Absolutely
Enoch's wrapup: We chatted today about what's interesting and disruptive about open data sources, build services that will be funded by users/business beneficiaries.
Indu: What future conferences are available?
Enoch: HealthCamp will reconvene in spring 2007 at Kaiser's Hospital of the Future. CDHCC will meet in Wash DC Dec 11-14, 2006, where I'll speak on Healthcare Blogging, which I do at Healthline. Bloggers meet up at HIMSS 2/07 in New Orleans, email Matthew or Enoch. No BarCamps yet on the schedule thru 8/07.
