Electronic medical records after Google Health’s failure
By Vineeta Vijayaraghavan and Clayton Christensen The opinions expressed are their own.
It may seem that the viability of electronic health records looks dismal after the failure of Google Health, yet in integrated health systems around the country they have been implemented and utilized by patients. In Google’s failure we must see an opportunity to address the fragmentation of our healthcare system and take notice of those health systems that are offering innovative services that help provide better care at a lower cost.
Earlier this month, Google announced that it was closing down Google Health, its foray into personal health records, because it failed to find “a way to translate limited usage into widespread adoption in the daily health routines of millions of people.” Based on 30 years of research, we are firm believers that technology will enable disruptive innovations in healthcare – the types of innovations that will dramatically lower costs, increase quality and improve access to millions. But Google Health was doomed from the start. The obstacle standing in the way of its success was the massive fragmentation of our healthcare system, and its closure signifies the urgent need to integrate healthcare.
Google thinks big. With Google Health, it would have loved to solve the fundamental problems facing consumers – making it easier to schedule appointments and communicate with doctors, allowing patients to manage medications remotely, or even helping them avoid the doctor’s office entirely. Accomplishing these goals would have almost certainly inspired consumers to embrace electronic health records. But to do so, Google needed a fragmented maze of insurers, hospitals and medical groups to also share their data, requiring them to clear complex regulatory and privacy issues to complete the onerous process of bringing their own information online. These organizations do not have the right incentives in place to invest in such an effort, and so Google Health failed.
There is only one way to speed up the process of getting robust health records online, and that is integration. Over the last year, we closely studied seven integrated health delivery systems – which typically contain a medical group, an insurer and a hospital – and found that electronic health records are immensely popular with consumers enrolled in the systems because they solved their most urgent problems.
At one well-known system, HealthPartners in Minnesota, patients can access their online records to schedule an appointment and have all their files automatically available to a new specialist the patient might never have seen before. At Group Health Cooperative in Washington, when patients go in for a blood test, test results have often been emailed to them and added to their electronic health record before they even arrive home.
Even the Medicare population served by some Group Health physicians has embraced electronic health records, contrary to expectations. In fact, some physicians have seen a 50 percent drop in in-patient visits by Medicare patients while retaining the same satisfaction ratings and outcomes. If replicated widely, that result has astounding implications for lowering the cost of care across our healthcare system.
America’s Canadian road trip starts today
By Sally Pipes The opinions expressed are her own.
Today, several of the more popular provisions of the president’s health reform law go into effect. Adult “children” will now be able to stay on their parents’ policies until they turn 26, and insurers can no longer impose lifetime limits on the amount of coverage they provide.
Nevertheless, congressional Democrats are running away from Obamacare as fast as they can.
Late last week, Rep. Gene Taylor (D-Miss.) became the first Democrat to sign a “discharge petition” circulated by congressional Republicans as the first step toward repealing Obamacare. At least five Democrats are running ads touting their votes against health reform. And Democratic candidates have spent three times more on ads criticizing the health overhaul than on ads supporting it.
Their apprehension over Obamacare is warranted. The new health reform law will not deliver the savings the president promises, will cost more than advertised, and will not achieve universal coverage. Instead, the president has placed America on the path toward a single-payer, government-run healthcare system.
Speaking as a Canadian who has experienced socialized medicine firsthand, I urge America not to go down that road.
What the author leaves out is the plain fact that “around the world” whether you live in a capitalist society, communist society, or socialist society you are free to seek the medical care of your own choice, you just have to pay for it. American medical plans exclude all kinds of treatments on a variety of grounds, but mainly because they will cost the insurer too much, which means reduced profits.
Of course a government providing socialized medicine is going to try to keep costs down by rejecting costly treatments. There has to be enough money to go around right? The difference is that an insurer is going to try to make a “profit” not just break even. It is not fair to Americans to sell them “for profit” plans with high premiums and limited care. It is an obvious conflict of interest between the consumer and insurer.
American insurers have been spreading a bunch of baloney about how medical costs have increased so they have to raise our premiums. Do you actually know a doctor or two? Have you talked to them about that issue? Perhaps you should. Or perhaps they are sucking up all the little perks provider to favored doctors by drug companies?
The American doctors I know are not fooled by insurance company rhetoric and are pretty disgusted with the insurance industry. They make decent money and have not seen “their” costs rise. We talk about these very issues. They did not go into medicine to have insurance companies directing patient treatment. If you think that your insurance company has “your” best interest at heart when you have a serious and costly condition, I’ve got a bridge . . .
Get real. A sick person is just a liability in for profit America. Sick and cannot work because you got cancer? Bye, bye employer provided health insurance, you are going to lose your job, and without a job you cannot afford your insurance premiums. Next you will be on disability and then a liability for the rest of us tax payers. And without a job, the government will pay most of your medical because you “will” qualify for state or federal and programs which pay next to nothing to doctors. And you don’t think “that” is socialized medicine?
Healthcare in America is on par with healthcare in Estonia. Seriously. Research the issue. Get a passport. Travel around Western Europe. Actually see and experience the counties you are not familiar with.
Are Dems abandoning healthcare?
By Jane Orient. The opinions expressed are her own.
One of the Obama Administration’s greatest legislative triumphs is already turning sour.
Before passage, Democrats were urged to vote for ObamaCare as a smart political move. In time, they thought, people would come to love the new benefits. “Good policy is good politics,” Obama said.
But “Healthcare reform” passed with zero Republican support and bipartisan opposition. And with midterm elections on the horizon, Democrats who voted “no” are posing as heroes.
Now that we can see what is in the bill – we had to wait until it was passed — people are very unhappy. One of its key backers, Families USA, issued a new message: “The bill isn’t perfect, but we’ll improve it.”
Nor are any of the left-wing groups that pushed for the passage of the bill doting on their healthcare baby. Its godfather, Sen. Max Baucus (D-MT), isn’t bragging about his authorship of “historic” legislation. He says he didn’t even “waste time” reading it, but relied on “experts.”
BGC said: “Health care is not a privilege, it is a birth right.”
What manifesto did you just crawl out of? The rationalization that convinced you of this absurdity must be truly astounding.
The socialization of health care is indicative of old states which have fallen out of economic prowess and relegated their ambition to the construction of social support over the pursuit of advancement and achievement. It’s a sign of the loss of economic willpower, not a benefit of such.
Don’t demonize drug samples. They are crucial to our healthcare
The following is a guest post by Grace-Marie Turner, founder and president of the Galen Institute, a non-profit research organization focusing on patient-centered solutions to health reform.
Medical researchers recently confirmed a link between chronic fatigue syndrome and a recently discovered retrovirus. Armed with this knowledge, some doctors are now prescribing HIV drugs to their sickest patients.
This story highlights how difficult it is for physicians to find the right medicines for their patients. The interaction between a particular drug and the human body is incredibly complex. People react to the exact same treatment in very different ways.
As a result, doctors often rely on samples that the pharmaceutical companies give them so they can determine more quickly if a particular drug is right for that patient. That is good and timely medicine. And every drug the companies give away has gone through years of testing with the Food and Drug Administration to make sure it is safe.
Yet under the new healthcare overhaul law, pharmaceutical firms are required to provide Congress with detailed reports on all of the free drug samples they provide to physicians. Some lawmakers see this requirement as a step toward an outright ban on free samples, making it more difficult for doctors to customize drug treatments for their patients.
But samples serve a crucial clinical role. They allow doctors to learn more about the drug to see how well it works. Also, patients are more likely to start treatment if they walk out the door of their doctor’s office with the medicine they need.
Across the country doctors have testified that samples help them improve patient care. Anand Mehendal, a neurologist in Kerrville, Texas, recently said that he uses samples “to see whether the patient is going to tolerate the drug.” Similarly, the American Medical Association has stated that “samples of prescription drug products represent valuable benefits to the patients.”
As a public mental health social worker for my locality I completely agree with this. The unintended consequences of reporting these samples is huge. Look at it this way- many uninsured and under insured patients we see cannot afford their prescriptions so we give them samples. Now the monetary value of these samples are being listed as a “gift” to the prescribing doctor. As a result many doctors are refusing to give them out in fear of tarnishing their good name. As a further result those patients who relied on samples must now either pay high out of pocket costs, switch to a cheaper and less effective medication, or go without. In the mental health world when a patient goes without that often means they end up in the hospital or even worse- the correctional system. So please people, calm down about samples- in the long run they keep costs way down for everyone.
The next chapter in reforming healthcare
The following is a guest post by Stephen Davidson, a professor at Boston University’s School of Management and author of “Still Broken: Understanding the U.S. Health Care System.” The opinions expressed are his own.
President Obama brought back the healthcare debate yesterday by telling a White House audience, “I refuse to go back. And so do countless Americans.” Obama drew attention to the consumer protection regulations developed to implement the new law. Given the continuing controversy surrounding the new law and the relentless criticism from its opponents, the president’s remarks highlighted some of the law’s most dramatic early benefits.
Obama’s healthcare address was an early entry in what will undoubtedly be a series of efforts that emphasize how Americans will benefit from the healthcare bill. The political reality is that as the fall elections approach, the administration must continually inform the public of the beneficial effects of the reform so Democrats get electoral credit come midterm elections.
In the meantime, let’s take a take a step back and look at what the bill that was signed into law three months ago promises to achieve.
The new law makes substantial progress toward the kinds of systems found in other developed countries, which is a good thing. Those systems cost much less to run, cover all their citizens, and provide greater patient satisfaction and better health results. Beginning in 2014, America, too, will provide healthcare to almost all its citizens by mandating most Americans to buy affordable coverage. Federal subsidies will help those who cannot afford an available policy to pay both the premiums and cost-sharing amounts required. The result will be that more than 30 million additional Americans will gain access to affordable and comprehensive health care coverage.
Additionally, private insurers will be forced to improve their coverage by allowing parents to cover unmarried children through the age of 25 and by no longer being able to do the following: –refuse to sell to people with pre-existing conditions or other risk factors –charge more to subscribers with pre-existing conditions or other risk factors, with the lamentable exception of age –cancel or refuse to renew policies for people who use services –impose annual or lifetime limits on benefits
Interesting story, since health care systems in most developed countries are flawed, cannot afford the cost going forward, the US has decided to take a system and match the rets of the world. Too bad, it had a great opportunity to move forward.
Now it can join the ranks of the rest of the world as all try to find a solution to health care.
Costs will increase, some current programs will be reduced in coverage and all will pay more out of pocket/taxes, premiums etc.
Better, maybe perception is the reality, but simply paying more does not improve the system or gain efficiencies.
What the U.S. can learn from Aussie health care
By Alan Mascarenhas — the views expressed are his own. This article first appeared onGlobalPost
SYDNEY, Australia — Here’s a damning statistic: Australia spends 8.7 percent of its GDP on health care and covers everyone, irrespective of their employment status. The U.S., meanwhile, spends 16 percent of its GDP on health care — far more than any other industrialized country — yet 47 million of its citizens lack health insurance while millions more are underinsured.
Critics of nationalized health care paint systems such as Australia’s as anything but healthy or caring, with putrid public hospitals that offer little more certainty than a long waiting list. This is a point not lost on Australians, with the topic of hospital waiting lists a perennial hot-button topic at election time.
Meantime, here’s a view of America from Down Under: The U.S. health care debate is at best bemusing to watch, with all those exasperated Americans working up a head of steam in shout fests called “town halls meetings,” most of which resemble a bar room brawl minus the blood. (See related GlobalPost story “Where the healthcare debate seems bizarre.”)
Yes, Australia’s universal health care is a long way from Nirvana. Indeed, it underperforms the U.S. in some key respects. Yet, lawmakers of all persuasions tamper with it at their peril because they know that most Australians would rather die than give it up.
The great strength of the Australian system is affordability and access. In the U.S., publicly funded health care is confined to those over 65 and the very poor, with the remainder purchasing private insurance if they can (usually through their employer). Great swathes of low-income Americans fail to visit a physician or obtain needed prescriptions or tests because of the potential cost.
Thank you for the reasoned commentary, Mr. Mascarenhas. The disagreements of many on the current plans in Congress are far-reaching & multifarious. On one point, most Americans do agree- our healthcare system needs reformation. Here is an excellent article which explains problems with our current system: http://www.john-goodman-blog.com/keeping -score/. Here, the ideas of government subsidies aren’t off the table, but the intent is to increase competition, not cause imbalances for the rich and connected.
Obama’s troubles with healthcare
– Peter Morici is a professor at the Smith School of Business, University of Maryland School, and the former Chief Economist at the U.S. International Trade Commission. The views expressed are his own. –
Healthcare reform is in trouble, because President Obama and congressional leaders are not adequately addressing issues that trouble many Americans.
House of Representatives Speaker Nancy Pelosi and Health and Human Services Secretary Kathleen Sebelius caution Americans to ignore terrorist claims about death panels. Reasonable enough—unseemly critics on both the right and the left seek to stir up unwarranted hysteria.
Sebelius defends end of life counseling from physicians as a benefit families need when facing difficult treatment choices for elderly relatives. However, what worries people is such counseling in the context of government rationing.
All health insurers ration care—private insurers in the United States and government-run health services in Canada and Europe face tough choices and limited resources. U.S private insurers generally don’t deny or delay critical care that could cause death—officials implementing such a policy would land in jail.
Foreign public systems are noted for long waits for specialists and critical procedures like hip replacements and bypass surgery. In Sweden, for example, delays result in suffering and deaths that would not occur in the expensive, but more humane, U.S. system. No one is held accountable, the elderly are particularly vulnerable, and that is euthanasia, de facto if not de jure.
President Obama promises Americans they won’t lose private health insurance if they want to keep it. However, legislation moving through the House requires businesses to pay an 8 percent payroll tax if they don’t provide healthcare and creates a government-run alternative to private insurance. Moderate senators would like to create non-profit cooperatives instead but to gain support from liberals in Congress, those non-profits would operate much like government agencies.
Prof Morici is ignoring the real facts that the process is being blocked by every Republican in Washington. Also all the conservative radio hosts are daily condemning anything Obama is trying to do to help the country.
The system won’t be perfect. The businesses should get all employees into the public option. It is cheaper and easier for them to do that. The public option is necessary.
Other factors are changing the system from fee per procedure and emphasis on preventive healthcare.
End of life is an arguing point. The reality is senior face this every day. What to do-go to nursing home and suffer neglect and abuse, stay at home and get worse health,opt for some type of assisted suicide if terminally ill, and all related to finances.
Vineeta,
There are, of course, a bazillion different reasons why a given idea might or might not work in practice, with much of that most immediately having to do with the skill (or not) of the entrepreneur bringing it to market.
In that regard, rather than become fixated on the idea that “the reason’ for failure is due to the fragmented condition of our health care system, one must take the perspective that Google Health failed because it did not take the fragmented condition of the health care system into account – and while there’s only a subtle difference in those words, the difference in meaning is anything but.
Said another way then, the responsibility to develop a business proposition which drives critical stakeholders towards adoption lies with the entrepreneur and not the other way around. Clearly that did not take place for this initiative and as such, the project (in its current form and under this particular sponsorship) died a predictable and poductive death. That isn’t to say that a universal medical ID won’t ever come into existence, it only means that that it’s not going to come about in this particular form at this particular moment.
On what remains in the discussion, I’d challenge the assertion that integrated health systems are necessarily ‘better’ than modular systems. Whereas integrated systems can be configured for optimal overall cost at a given point in time, such efficiencies can be developed in a manner which detract from other stakeholder priorities – and since existing integrated health care systems have not come to dominate the health care industry despite having had a longstanding opportunity to do so, I’d suspect that such may be the case here.
So while it could be that we’re all being held hostage by one or another monopolistic element within the existing system, you and I both know that once an appropriate disruptive innovation becomes deployed AND adopted, elements such as these will fail and fall by the wayside of their own weight – and the next era of healthcare management methodology will take its place.
On that basis – what has transpired is just another of the failures needed to guide providers towards convergence on a method or means that will actually work well enough for a enough people such that it has the opportunity to become improved and eventually assume the dominant role in the way health care is managed and maintained. Until that time, we can (and should) surmise and experiment, but only the market can dictate which approaches will be sufficient to initiate the eventual (and inevitable) departure from the incumbent system.