Saturday, January 14, 2012

Welcome to 2012!

Wow… I am officially in awe of all bloggers who can post once a day, once a week or even once a month at this point.  I have clearly fallen off the horse - but am saddling up again for what looks to be an amazing 2012!   Yeah, I've been a bit distracted - helped start up a new HIT company (more to come), am working on a book highlighting the intersection of HIT and Innovation, and am juggling all the regular doctor and CMIO type of things.  BUT - no excuses… I've got to find some time to get my thoughts down!
I actually have a couple of blogs half-written in emails to myself, but I'm going to start with something more current… my take on various stories from one of my favorite blogs - HISTalk.  In their recent blog, they mentioned the following three stories (among others), and I thought each had some major importance so I want to highlight them and give my 2 cents:
First, Meaningful Use (MU) Attestation
CMS has provided the database for the statistics on numbers of physicians who have currently attested for MU.  Modern Healthcare did a nice breakdown in their story on it:
·    For Ambulatory:  Epic was the EHR of choice for 6,045 physicians and other eligible professionals, grabbing a 28% market share of the eligible-professionals segment, a slice larger than that of the next four vendors combined.  Those others in the top five, in rank order, are eClinicalWorks, 1,847 (9%); Allscripts, 1,449 (7%); Athenahealth, 1,158 (5%); and Community Computer Service, 999 (5%).  These top five vendors claimed 54% of the market of early adopters and meaningful users.  The top 10 vendors also claimed 71% of the incentive payments thus far.  But it's still a wide-open market.  The database lists 217 EHR vendors as having products that had been used successfully by at least one eligible professional to either achieve meaningful use or receive incentive payments under Medicaid.  Of those 217 developers, 131, or 60%, had 10 or fewer installations.
·    For Acute Care (Hospitals):  Epic also led among hospitals that received federal incentive payments for using a complete EHR, but the privately held company was not nearly so dominant in this indicator of the hospital IT market as it was in the EP segment.  According to federal data, there were 627 hospitals that have been paid using complete EHRs developed by 22 different companies or organizations.  Of them, 165 were Epic customers, 26% of that niche.  Ranked second was Computer Programs and Systems, commonly known as CPSI, used by 140 hospitals (22%), followed by Cerner Corp., 71 (11%); Healthland, 54 (9%); and Meditech, 47 (7%).

Mr.HISTalk said the following:  Here’s a point/counterpoint issue to mull over.  Inga and I disagree on the value of CMS’s attestation statistics.  Inga thinks the percentage of each vendor’s customers that have attested is a good benchmark, so she did lots of spreadsheet work to compare vendors and to assume that varying percentages among them must be reflective of product capabilities and ease of use in meeting Meaningful Use requirements.  I said the information is useless for that purpose since it’s more reflective of unmeasured customer demographics and buying criteria than anything else and that it would be wrong (not to mention statistically indefensible) to use the CMS figures to infer that vendors with a higher percentage of successfully attested users have a better product for earning Meaningful Use money.  Feel free to take sides.  One thing’s for sure: vendors who massage the data into slick marketing collateral won’t be footnoting their handouts with statistical disclaimers.

Here was my response:  I'm siding with Inga on this Point/Counterpoint… although the numbers are not perfect - they should provide value in two ways:

1. Totals. A general idea about the total number of real EMR users.  I’m sick of the vendors each claiming to have 50-100K users.  Sorry - there are only about 600K total active doctors… and only 25% using EMRs – so you are all splitting about 150,000 docs at best right now.  Although this initial data is a good start, I think very soon we will get a much better idea of how many docs are attesting with each vendor (since many are waiting until end of 2011) and then at least the general proportions will be easier to assess… will it be EPIC with 30%, and the next tier of 5-6 vendors at 5-10%, and then 210 more with under 1% each… or will we see a surprise pop up somewhere?!??!

2. Successes.  Fair enough – it is possible some EMR vendors will have a higher percent of attestations because they are better at implementation, etc… but hey - that’s OK, I think that is a key indicator too… and am fine if that “biases” the numbers.  But they are still valuable.

Second, Most Online Diabetes Management Tools are Ineffective
CMIO Magazine did a nice summary of the JAMIA study.  It turns out that over 75% of the time - the tools were NOT clinically useful or usable (or said another way- they were only useful and usable 25% of the time).  But perhaps more importantly was the second finding which is that patients just don't use these tools consistently.  Hey - that should be a surprise!  Yet it may shock or offend some in the "consumer empowerment" community who keep saying patients want more tools to use online.  While I think a subset do want these, it is just not the majority.  Unfortunately, the reality is that any tool or business model that relies on behavior change is a really tough sell.  Patients have shown for a very long time how resistant they are to change, and just having a website or app telling them what to do is not going to make that magically happen.  I do look forward to the next slew of websites claiming to have that "secret sauce" that will make patients change (e.g. games, rewards, social interactions), but think that the vast majority of folks who try to crack that code don't fully understand human behavior, especially as it relates to health.  It is much more complex than buying stuff online, banking and Facebook... but I do think we are getting better - and a well researched article like this will help us continue to move in the right direction.
Finally, "Smart Contact Lenses Keep Eye On Your Health"… Sensors are here baby! 
This news story asks "What if the lenses could look inside of you to diagnose, monitor and even treat disease? Sound far-fetched?  Well, it may not be too far away… The new generation of contact lenses is being called “smart lenses”, and they are packed with circuits, sensors and wireless technology – all designed to "keep an eye on your health".   It is indicative of a big and growing trend towards ubiquitous biomedical devices, especially involving sensors, which we will be hearing more and more about in the months and years to come.   Of course, it pairs well with the other big trend around big data - because this many sensors are going to need some major analytics to make them useful. 

Bottom line - there is so much amazing change and innovation going on in healthcare, cannot imagine a better industry to be in for the next few decades!!!

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