Next Things First


Wal-Mart to Sell EMRs (Wait … What?) by charlottegee
March 11, 2009, 2:34 pm
Filed under: electronic medical records, health it | Tags: , ,

“We’re a high-volume, low-cost company,” said Marcus Osborne, senior director for health care business development at Wal-Mart. “And I would argue that mentality is sorely lacking in the health care industry.”

According to the New York Times, Wal-Mart “is striding into the market for electronic health records:”

The company plans to team its Sam’s Club division with Dell for computers and eClinicalWorks, a fast-growing private company, for software. Wal-Mart says its package deal of hardware, software, installation, maintenance and training will make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half. … The Sam’s Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates. Wal-Mart says it had explored the opportunity in health information technology long before the presidential election. About 200,000 health care providers, mostly doctors, are among Sam Club’s 47 million members. And the company’s research showed the technology was becoming less costly and interest was rising among small physician practices, according to Todd Matherly, vice president for health and wellness at Sam’s Club.walmart

The Wall Street Journal Health Blog adds: “Wal-Mart has been getting more deeply involved in health care in recent years, drawing a lot of attention for its $4 generic-drug program. It has improved its image in health after drawing criticism for offering stingy health benefits.”

And from Chilmark Research’s blog:

Wal-Mart/Sam’s Club has no credibility, no brand, no nothing in the technology solutions market. Hell, they don’t even have a Geek Squad. … if it were our money, we would go with an HIT specific solution provider who has a few years under their belt installing, training and servicing fellow physicians. Wal-Mart brings none of that to the HITECH gold rush.

What do you think?

A. Wal-Mart: A Study in Cool (Health Care Innovation)
B. Wal-Mart, WTF?
C. Whatever, Wal-Mart. We need to go back to the drawing board and completely rethink HIT before it gets out of hand. (One doctor close to us asks: Where’s the “Apple of EHRs”?)

Posted by CharlotteGee

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Overheard: Health Affairs and HIT (Take Two Aspirin and Tweet Me in the Morning…) by charlottegee
March 10, 2009, 5:54 pm
Filed under: consumer engagement, health it, innovation | Tags: ,

If you haven’t heard, Health Affairs has devoted a chunk of its March/April 2009 edition to “stimulating health IT.” Today Health Affairs held a briefing on health IT, featuring a whole slew of experts, and the event was covered live on Twitter. One of the articles in this latest edition, and of course much of today’s discussion, touched on Web 2.0 in health care: “How Twitter, Facebook, And Other Social Media Are Reshaping Health Care.”

One observer: “The fact that Health Affairs – the leading health services journal – is spending ink on this stuff now is a big deal.”

And in a recent conversation, we overheard a leading NYC-area orthopedic surgeon say:

[Health Affairs is a] great journal and hell-bent on meaningful reform and innovation. Their writers are wonderful and insightful – and wouldn’t waste their readers’ time if they didn’t believe this is the next wave. Now you can no longer poke fun at me as I “tweet”… or engage. Patients get it, the “well”: public gets it, the press is starting to catch on…. but most docs are woefully ignorant of the changes taking place. I tried to gather support through the medical executive committee to put together a platform so the docs at [hospital name] can be*available* to their patient base… and you would have thought I asked each and every member of the committee to pose nude. They think that only teenagers are using this technology. We still have a ways to go… There are few companies that enable the physicians to adopt this type of wide-reaching and wide-ranging communications platform and docs still feel they simply don’t need to engage consumers like this….yet.

Posted by CharlotteGee



Attention Pacific NW Health Care Innovators: innovateHealth Update by charlottegee
March 8, 2009, 11:32 am
Filed under: innovateHealth, innovation, seattle market | Tags:

Here at Next Things First, we’re happy to report that the second innovateHealth* event, held on March 3, was a “standing-room-only” success. The event featured Rebecca Williams, RN, JD, of Davis Wright Tremaine and Michael Burcham, a seasoned health care entrepreneur and instructor at Vanderbilt. (Faultline Ventures, Clarity Health Services and iMedExchange have organized innovateHealth’s inaugural events.)

Topics for this meeting included the implications of the recent stimulus legislation on health care services and technology companies and entrepreneurial opportunities amidst the market chaos.

Read more:

And … Save the Date for the next innovateHealth event: The First Annual Capital Meets Innovation Summit on May 12, 2009

* What is innovateHealth, you ask? Well, it’s a newly formed, fast-growing group of health care services stakeholders from the private and public sector focused on driving innovation in the health care industry and building awareness of the health care services and technology cluster in the Pacific Northwest. innovateHealth both connects our members within in the cluster and connects the region to the larger national and global market.

Posted by CharlotteGee



More on the Value of Care (Hint: It Varies Widely) by charlottegee

“Value is the watchword in today’s economy, and health care cannot be the exception.” – Hal Andrews, CEO of Data Advantage

Back in December, we featured a guest post by Hal, where he wrote:

VBP [value-based purchasing], in some form, is headed to a hospital near you. Hospitals have always ultimately adapted to changes in the financing of healthcare, but usually reluctantly and slowly. Value can, and will, be defined for healthcare, and CMS is leading the charge. History suggests that private payers will not be far behind. If you don’t know your value proposition today in comparison to your peers, time is not on your side. If you don’t join the discussion of how value should be defined, others will fill that void.

That post continues to see quite a bit of traffic. … Google searches for “value-based purchasing” remain high. And the information available on value of care also continues to build: According to the latest edition of the Hospital Value Index™, a study that looks at quality, affordability and efficiency, and patient satisfaction at more than 3,000 hospitals, the value of care offered to hospital patients can vary by as much as 40 percent across the United States. (Data Advantage developed the Hospital Value Index™.)

Just a couple of the study findings:

  • The median Hospital Value Index™ score declined more than 8.5 percent since June 2008.
  • Hospitals in the Northeast (also known as CMS Region I) have hospital value scores some 40 percent better than those in the Southwest (CMS Region IX). The sharp contrast between Regions highlights the complexity of measuring value. For example, some hospitals provide similar quality at a lower cost, while others provide higher quality at a similar cost.

More here (PDF).

In the announcement, Hal noted: “We found that the delivery of high value care is widely divergent across the country, among regions, and even among markets. Measuring value in healthcare is more complex than measuring solely quality or cost and represents a significant challenge for every stakeholder who wants to improve healthcare.” We talked with Hal to get a little more perspective on what all this means. hcvalue

1) Explain to someone who doesn’t know anything about how health care works (say, someone who just goes to the doctor when he gets sick) why your findings are important?

In some ways, consumers and employers have operated under the assumption that “priceless quality” in health care was OK. As consumers increasingly become responsible for shouldering more of the cost of healthcare, we believe that value will become as important in health care as it is in other buying decisions.

Obviously, for matters of life and death, a value analysis will place more emphasis on quality than price; at the same time, for basic health care, like blood tests or X-rays, we believe that understanding the relationship between quality, price (what is charged), cost (what is paid) and patient satisfaction will become more important.

2) I’m a little confused. The data shows that quality scores “significantly” declined since June 2008, but “patient safety, patient satisfaction, and affordability and efficiency scores showed improvement across virtually all hospitals.” How does that work?

The Index is a composite number that moves depending on the number and weight of variables. The most recent Index included information about mortality that was not available in the first Index, and including mortality in our calculation of quality offset gains in other elements of quality.

3) How can hospitals, and health care in general, take this data and use it to spur innovation in care? Given the news that came out recently about 50 percent of hospitals being unprofitable in 3Q 2008, there’s little cash on hand to pay for staff or facility improvements or IT or anything. Give one example of what a hospital CEO might do to improve her hospital’s value rating, now that she’s seen this variation in value.

Any unprofitable business should perform an internal and external analysis of its performance. Benchmarking is the starting point in this analysis – a hospital should analyze what service lines are unprofitable (internal) and then compare that to its peer group (external) to understand where the opportunities for improvement are. In anticipation of CMS’s proposed Value-Based Purchasing, every hospital should have a clear understanding of how it compares to the benchmarks that CMS will use.

4) How does all this fit in with the current political landscape, with the idea of larger health care reform in general?

CMS first proposed Value-Based Purchasing in the fall of 2007, at the peak of the stock market. Even then, it was clear that “priceless quality” was not sustainable. In the current economic environment in which value is the watchword, healthcare can no longer be the exception.

5) Will having this kind of information at their fingertips drive people to, well, drive to other areas of the country to get care?

We have found wide variance in value across the country, within regions, and within individual markets. Value is different to everyone, and we would hope that people would use the information to make decisions that fit their own personal needs.

Posted by CharlotteGee



Gupta Out; Doesn’t Want to Stop Performing Brain Surgery by charlottegee
March 6, 2009, 9:23 am
Filed under: politics | Tags:

ac_guptaCNN’s Sanjay Gupta is officially out of the running for the Surgeon General position, as of last night. From the Washington Post:

Speaking on “Larry King Live” hours after news of his decision broke, Gupta said he did not want to stop performing brain surgery, leave his television career or spend extended time away from his family….

He said the surgeon general “has to have a little bit of a higher profile. Whoever takes this job has to be out there really advocating the issues of public health. At no time is it probably more important than right now, as we’re dealing with health-care reform. These issues really go hand in hand.” …

An administration official said last night that Gupta “was under serious consideration for the job of surgeon general. He has removed himself from consideration to focus more on his medical career and his family.”

Gupta, who was once named one of the “sexiest men alive” by People magazine, was never officially named to the post and continued to report for CNN. Sources said the medical journalist told CNN executives that he wanted to devote more time to his medical practice and to his duties at the network.

Posted by CharlotteGee



Are we asking too much from Angels? by Rob Coppedge
March 2, 2009, 8:03 pm
Filed under: Uncategorized

I have a feeling we are going to be posting a lot over the course of the next few months on the unsustainable pressure on angel investors – but for now, let’s celebrate the fact they are stepping up to the plate when the guys getting paid to do the job shy away.  John Cook writes this today in TechFlash:

Despite the struggles in the economy in the latter half of 2008, members of the Alliance of Angels still invested near record totals last year. The Seattle angel group said today that its members invested $6.4 million last year, a 64 percent increase over 2007 and the second highest investment total since the organization was founded 11 years ago.



innovateHealth – Tomorrow Night by Rob Coppedge
March 2, 2009, 5:56 pm
Filed under: Uncategorized

For those in Seattle – or those who are looking for an excuse to hop the next flight – check out the meeting of innovateHealth tomorrow night. We will be joined by Michael Burcham (Paradigm Health, Theraphysics) and will be discussing the opportunities for innovation created by the Obama administration’s health care reform plans and the bottomless cratering of the economy.

It will be a great chance to see all those folks who you had no idea were working in health care too and to strike up a vigorous debate about health care issues without embarrassing yourself in front of your friends.

RSVP to events@innovate-health.org.

InnovateHealth blog: innovatehealth.wordpress.com