WirelessDoc

"Consumer-Directed Health Care: a 360 degree view"

This is the working title for a book by Kim Slocum, a healthcare policy consultant who comes from the biopharmaceutical industry. He was part of the panel in a Webinar yesterday produced by Healthcare IT News and sponsored by IBM Global Business Services, as part of their Healthcare 2015 initiative. (2015 is the year they propose that "healthcare systems around the world will become unsustainable" if major changes are not implemented soon.)

During the prepared section of the Webinar, these experts presented the current thinking in the technology, 3rd-party payer, clinical, and biopharm sectors. But, it was during the open panel discussion that consumer-directed health care (CDHC) topic was addressed. Kim was well prepared and had plenty of statistics and observations, and it stemmed from the research he had done for his upcoming book.

I called him immediately after the Webinar was finished, and enjoyed hearing even more ideas. For his book, he collected the studies that he considered to be the least biased or tainted with conflict of financial interest by looking for the work done by "voyeuristic eunuchs." (I guess this is the same of "disinterested parties" but what do I know about publishing.) His sources include the Kaiser Family Foundation, the Commonwealth Fund, Harris Interactive, and the Health Affairs journal.

I won't get to all the points he mentioned both in the Webinar and our phone conversation in this post, but I will touch on them as I blog more on this topic.

One factor to consider with CDHC is how the consumers will use resources to make important decisions about their health care. Kim cited an article produced by the Hastings Center called "How Do Patients Know?" In essence, patient want to speak to a doctor to get their information. As Kim put it during the Webinar, the US isn't about to send its 300 million citizens to medical school. Compounding this, he said, is that the average American has a high school education, and 50% are health illiterate or health innumerate, having a reading level of grade 6-8, while most healthcare communication is written for grade 12.

There is a concept called the Medical Home (pdf file) that seeks to pair individual patients or families when possible with primary care physicians as their guides so that they people can have a strategy for longitudinal care rather than addressing isolated bouts of illness.

However, there is still the need for funding, clear of support by commercial interests, to produce all this medical media written in a very simple and clear manner. Slocum calls this "iPod health care" with "libertarian paternalism."This metaphor is meant to describe a system where people have access to simplified information which will be easy to navigate and understand, but won't require any special knowledge or preparation. If anyone seeks a deeper understanding on a particular topic, he or she will be able to augment their knowledge.

This “libertarian paternalism” is all about protecting those who do minimal research—a kind of benign default—but they will have the freedom to seek more data to personalize their medical care if they chose to do so.

Andy Kessler's "The End of Medicine : How Silicon Valley (and Naked Mice) Will Reboot Your Doctor"

Link: Amazon.com: The End of Medicine : How Silicon Valley (and Naked Mice) Will Reboot Your Doctor: Books: Andy Kessler.

Just a quick post about this book. One of the themes in this book is that while it might seem that advancing technology will allow a diagnosis to be made by a machine, patients will still want the personal contact they have with their physicians.

In some cases, keeping clinicians in the background could be desireable as in the case of tele-hospice.

Hmmm...I think he might have wanted to use the term "nude mouse."

First Nationwide Health Information Network Forum

A post was made on the Health-IT listserv about this event:

June 28-29, 2006
National Institute of Health's Natcher Conference Center in Bethesda, MD

Purpose:
The purpose of the Nationwide Health Information Network Forum is to identify and catalogue the list of functional requirements that will frame the development of a Nationwide Health Information Network. While other processes continue to explore the policy determinants for nationwide health information exchange, the development of functional requirements will focus on the critical technical components of architectures to support a Nationwide Health Information Network.

The identification of functional requirements will lead to the foundational specifications of the next phase of Nationwide Health Information Network development. In addition, the functional requirements will provide a framework for the Health Information Technology Standards Panel's efforts to define implementation level guidance in their interoperability specifications, and input for the Certification Commission for Health Information Technology's compliance certification criteria that address the infrastructure or network components through which EHRs interoperate.

Overview:
As a key element of the Administration's health information technology strategy, the development of a Nationwide Health Information Network will provide the foundation for an interoperable, standards-based network for the secure exchange of health care information.

On June 28 and June 29, 2006, a forum to address the functional requirements of a Nationwide Health Information Network will be held. The Nationwide Health Information Network Forum will be open to the public and include participants in key processes supported by the Office for the National Coordinator for Health Information Technology (including the four consortia developing prototype Nationwide Health Information Network architectures, the Health Information Technology Standards Panel, the Certification Commission for Health Information Technology, and the Federal Health Architecture) and key representatives from other public, private, and non-profit health information technology stakeholders.

The Nationwide Health Information Network Forum will be structured as an interactive discussion with facilitated breakout sessions to illuminate the technical components of a Nationwide Health Information Network.

Attendees will have an opportunity to participate in two series of breakout sessions:

• focusing on categories of "functional requirements" (i.e., security, data transmission and transformation, information location, etc.)
• focusing on the "core" system components and the requirements of "edge" applications that will be participating in the exchange of health information technology.

Audience:
Representatives from public, private, and non-profit health information technology stakeholders who can contribute to the consideration of functional requirements.

You can get the logistics from the Web page this comes from.

   

National Health IT Week

I don't think this National Health IT Week is so much about all sectors of medical informatics as it is about public access to online resources to promote wellness programs or just healthcare policy in general. (I could be wrong.)

There is a National Health It Day event planned, with Senator Kennedy, Newt Gingrich, Drs. Brailer and McClellan speaking. But it is also interesting to see IBM represented by their Director of Wellness. There is a push by major companies to seek to drive down healthcare costs by providing their employees with online resources to help them self-monitor their lifestyles and be compliant with the usually recommended screening modalities.

Here's one of the sessions:

Driving Down Healthcare Costs – Purchasers Who Are Innovating:
      UPS, IBM, Pitney Bowes, and General Motors – together represent a sizeable percentage of the US workforce.  Each of these firms are working to decrease the cost of care  while simultaneously improving the quality of care.  Learn about their work in outcome-based  benefits design, employee incentives, pay for performance, and pay for use.

I really don't know about the "One Voice. One Vision." thing either. There is certainly bipartisan support for these initiatives as evidence by the press conferences you've seen with Hillary Clinton and Newt Gingrich or Bill Frist.

This photo with Hillary Clinton and Bill Frist marked their announcement of Health Technology to Enhance Quality Act of 2005. Not to overstate the obvious, but the main stumbling block is not securing this unified political will, but to ensure that the funding is available for hospitals and clinics to invest in these systems upfront in order to realize the benefits and savings that will come over time.