Next Things First

A Physician’s Reaction to the New York Times’ EMR Story (From Howard Luks) by charlottegee

The NY Times ran another piece* on the potential benefits of an EMR platform. I’m not sure who was *behind the story*… but I disagree with a number of the statements and premises of their article.

I have blogged about this topic often enough … here, here and here.

I am not against technology. As a doctor, I am against  *shouldering the burden* and *paying a fortune* for technology that will probably not enable my patients, will not materially affect my business, and as currently designed will not reform health care or the practice of medicine. EMRs, as currently available today, are in their infancy. They are, for the most part, very poorly engineered, very expensive, and do not allow me to share patient data with hospitals, RHIOs, etc.

(image from California Physician)

(image from California Physician)

Physician innovators should have taken the lead on EMRs … but we didn’t. We should have been involved at all levels of the platform’s build-out, but we weren’t.

Who benefits MOST from an EMR, and the sharing of knowledge, tests and procedural data … ? *Nope* … it’s not the patient … but the managed care industry!!! *If* technology such as an EMR platform decreases the number of duplicated procedures, the managed care industry’s profits rise. *If* they need fewer FTEs to handle electronic claims, their profits rise.

Do you think they will decrease their premiums if their costs go down???? Nope. Look at the airline industry. Gas/fuel are at four-year lows … yet we are still paying a fuel surcharge!

So, if the MCOs are going to benefit the most …WHY SHOULD THE DOCS, many of whom are already operating on a very fine margin, SHOULDER THE ECONOMIC BURDEN of purchasing, rolling out and maintaining an EMR system that most relevant research shows they probably will not like in the first place????

“This requires the usual leap of faith that knowledge will yield good things — better care, doing things smarter and, yes, saving money in the long run.”*

Leap of faith??? I’m not jumping out of a plane and relying on a parachute opening. Design a platform I like, align the interests/economic burden of those who prosper from the IT expenditure, make it economically feasible, make the systems inter-operable, the data actionable and computable and I will be the first one to sign up.

“We have to restructure our medical culture,” he said. “We have to promote a culture that believes in the evidence and is trained in analyzing the evidence. It’s the only long-run answer to the challenges we face in health care — evidence-based medicine.”*

This has nothing to do with evidence-based medicine (EBM). Whenever possible, I have been practicing EBM for years. The problem is that we do not have enough evidence. Without interoperability, currently available EMR platforms will not lead to a plethora of EBM data.

There has to be a better way … another reason why the Obama administration needs to fund the health care venture capital sector to allow for disruptive innovation in a space clearly in need of a new way of thinking.

In addition, this clearly points to the need for physician thought leaders to be actively involved in the innovation process.

Submitted by Howard J Luks, MD


On Vacation – Back Soon … by Rob Coppedge
December 23, 2008, 12:00 pm
Filed under: Uncategorized

We are on a short year-end break …

We greatly appreciate all your support as we launched the blog this year! We are looking forward to more spirited discussion (and perhaps even finding some solutions to the health care and venture capital messes) in 2009.


Rob, Charlotte and all of us at Faultline

Venture Capitalist to Run the SBA by Rob Coppedge
December 19, 2008, 12:51 pm
Filed under: politics, start-ups | Tags: , ,

For those who aren’t following the Obama Administration Cabinet Appointment Ticker, the story is out that a venture capitalist will be appointed SBA Administrator.  In the context of all our recent posts on the challenges facing small businesses, this could be a good sign that the new Administration is going to try to stimulate the early stage market.  The Sun is out again and we are trying to find good news to report.

Mills is a venture capitalist and a founding partner of the New York-based equity firm Solera Capital. She has been an adviser to Maine Gov. John Baldacci on economic matters. She’s also president of the MMP Group in Brunswick.

Posted by RobC

Web 2.0 Basics for Marketers, Part 2 (From Tobin Arthur) by charlottegee
December 19, 2008, 12:47 pm
Filed under: marketing, web 2.0 | Tags: ,

Yesterday I talked about why people are using Web 2.0 tools more and more. Once marketing teams within companies come to grips with the fact that Web 2.0 is part of a larger societal shift rather than a fad, the justification for embracing Web 2.0 as central to marketing efforts is easy. However, just as the Internet has affected societal shifts, marketing departments have a shift to undergo of their own.

Companies with old secure brands tend to want to control everything said about their product, etc. HP was one of the first Fortune 100 companies to embrace the fact that if people are going to talk badly about you, it’s better for you to be engaged in that discussion and not hiding from the fact that they exist. So, they opened internal corporate blogs to the public and let their employees dialog. Open discussion may bring out blemishes … but any company that thinks that avoiding Web 2.0 technologies allows them to maintain “control of their brand” is fooling themselves. Customers will talk whether we embrace it or not, so better to join the conversation and embrace the feedback – the good and the bad.

With more and more of people’s time being spent online, and especially on social networks, companies have to be engaged or they risk corporate death. The shift in people’s time spent online versus newspaper, television or radio is significant. Smart companies are responding accordingly.

Once a marketing team decides to get serious about Web 2.0 initiatives, someone needs to lead the effort. If the person leading the effort is older than 35 years of age … find someone else to do it. The best Web 2.0 models deployed to date have been targeted to younger audiences, so a younger person will have more context for how to introduce the value of Web 2.0.

The fact of the matter is that consumers are talking about your products or services. Companies that decide to engage in the conversation are setting themselves up for success while those that stick to the comfort zone of their old-school marketing programs and ignore the conversation are losing ground without any say in the matter.

web-marketing-bSubmitted by Tobin Arthur
CEO of iMedExchange

Running on Empty by Rob Coppedge

The snow storm that has left Seattle immobilized (the schools were closed a day *before* the storm, just for good measure) has created the perfect  cold, wintry environment to read the just released National Venture Capital Association survey.  It confirms the icy predictions we’ve been making over the past month – things do not look good for start ups and early stage companies in 2009. In fact, for those that will need the capital markets, things look quite bad.

Respected Seattle business journalist John Cook comments on the NVCA report:

I’ve been informally conducting my own survey of VCs, lawyers and entrepreneurs around town.  The message I am hearing is not pretty, with one VC saying that nearly everyone is hunkered down. Long-time tech entrepreneurs such as The Cobalt Group’s John Holt and Jobster’s Jeff Seely have told me recently that it is about the worst economic environment they have seen.

The general feeling is that the capital markets may be shut for another 12 to 18 months, meaning that startup companies will have to learn to exist on the fumes of their previous venture rounds or get to profitability sooner than anticipated.

Running on fumes… Wow. I made the mistake of using that line with several start up CEOs recently and they almost took my head off. “What do you think we’ve been doing?” “We don’t have any fumes left… we ran out in the third quarter”.

A 70s Flashback for Start Ups

Running on Empty: A 70s Flashback for Start Ups

Without access to capital many of these early stage companies won’t make it to the next gas pump. Unfortunately, with news like this NVCA survey and  Coller’s Global LP Barometer, it doesn’t sound like the capital markets are going to show any sympathy.

Sure, there may be bigger problems out there.  But when billions of dollars are spent to bail out industries that  need to shed jobs, it is troubling to see the innovation and job creation engine of our economy seriously threatened by a lack of relatively small amounts of capital (mere rounding errors to the Treasury’s bailout accountants).

Posted by RobC

Holiday Pink Slips: Aetna Layoffs and More by charlottegee
December 18, 2008, 1:04 pm
Filed under: economy | Tags:

Yesterday’s news that Aetna is laying off around 1,000 people, or less than 3% of its workforce, coupled with a variety of other cuts in the works (See: Boston Medical to cut staff, services / Hospitals and nursing homes staggered by state budget cuts, Officials expect layoffs, closures / NY Governor’s Budget Slashes School Aid and Health Care Spending / Austin Regional Clinic cuts 60 jobs, closes Rundberg Lane clinic)—brings to question whether health care is indeed recession-resistant, as we so often hear. Or, perhaps it’s just that certain business models/organizational structures/policies are not immune … you know, only the strongest (smartest?) survive.

At any rate, it’s never a good thing to read headlines about layoffs and budget cuts, and it’s especially scary in the health care industry, as it has the potential to affect so many people on such a personal, basic level.

Our eyes are a-watch on 2009 and the changes and challenges and (we hope) good things a new year, a new administration and a new way of looking at health care can bring.


Posted by CharlotteGee

Web 2.0 Basics for Marketers, Part 1 (From Tobin Arthur) by charlottegee
December 17, 2008, 9:17 am
Filed under: marketing, web 2.0 | Tags: ,

web-marketing1In the 12/15/08 edition of the Wall Street Journal, there is a solid overview of The Secrets of Marketing In a Web 2.0 World. There has been a lot of chatter recently about the fact that many Web 2.0 companies, including leaders like Facebook and MySpace, are struggling to find their economic bearing. Part of the problem stems from the fact that marketers look at Web 2.0 as another gadget to “game” the end user. This misses the point, and will continue to result in missed opportunities.

To understand the economic power of Web 2.0, one must understand why people embrace Web 2.0 tools in the first place:

  1. The primary benefit of Web 2.0 is that it creates a platform for more seamless communication or exchange of information. Professionals (at least most of them) house lots of latent “tribal knowledge” that can be of great benefit to colleagues. Web 2.0 technology can free that knowledge to the advantage of the community members.
  2. In addition, with people as busy as they are these days, it’s difficult to nurture relationships. Social networks allow people to stay connected, even if it just means an occasional note or knowing what someone is up to at any given time. When you are able to connect in person, you have deeper context for the gap since you last met.

Understanding the drivers to Web 2.0 adoption is critical if marketers are going to figure out if and how to engage in these communities. Marketing needs to be a part of the conversation that happens naturally within Web 2.0. If marketing feels like it’s “selling” or gaming the users, they will reject it and no one benefits.

At iMedExchange, we always work with the understanding that our members – our physicians – are first. If what we do is in their best interest, they’ll be more productive users and offer us their trust. And the sponsors and advertising we bring in, with the advisement of our physician advisors, can enhance their overall experience. When a Web 2.0 company’s business model is not in line with the members’ best interest, they’re set up for an inevitable, fundamental struggle to maintain happy members.

Tomorrow I will post a follow-on entry with additional thoughts for marketing on the web …

Submitted by Tobin Arthur
CEO of iMedExchange