MIT Enterprise Forum of NYC
Wednesday, 17 November 2010
Reporter/Attendee: Donna Cusano–Editor, North America
Is this a perfect storm for healthcare IT and consumer health? Panel moderator Raymond Falci (Managing Director, Cain Brothers) set out a ‘storm map’—a hospital IT spaghetti chart that represented ‘streamlined process’.
- Business models in consumer health are fractured—whether payors seeking the next gen in disease management; pharmaceutical companies trying to increase falling sales; healthcare providers attempting to measure and manage risk (and will accountable care really work?); and consumers reluctant to pay for anything.
- Prospect areas: Monitoring chronic diseases, other remote monitoring, acute care post-discharge management, member health status and wellness monitoring.
Panel question #1: What are the obstacles and enablers to connected healthcare adoption?
Nick van Terheyden, M.D. (Chief Medical Officer, Nuance): Prior experiments in paperless hospitals in 1990s unworkable because inability to transfer records and information. Current EMRs and tablets take too much time.
Rob Dhoble (President, Diversified Agency Services Healthcare): WebMD in 1990s opened up torrent of information, not always correct. Understanding it is a problem for average person. Video e.g. YouTube the most persuasive (and often incorrect) medium—video is ‘surrogate’ for information needed. People gravitate to ‘authorities’ who make health information simple (Dr. Oz, Dr. Sanjay Gupta)
Rachel Block (Deputy Commissioner for HIT, NY State Dept. of Health): State Health Information Exchanges (HIE or HIX) have been useful in delivering health information; most are getting tools (e.g. EHRs) to doctors. Now emphasis on programs—care coordination, public health, mHealth. Two factors supporting adoption—systems that are patient-centered, policies in standards and payments.
Teo Dagi, M.D. (HLM Venture Partners):
The big question: Do we really know if prevention, monitoring and information (data synthesized) make a difference in outcomes?
Adapting to change: Physicians find adapting to change like connected health very difficult because of the way they are trained: to take care of patients, provide good technical care, take responsibility for patients, not populations. Comparison: NHS short visit system versus longer consult and options in individual care (US). Other questions: current comfort level in technology and transferring skills to technology.
Gopal K. Chopra, M.D. (CEO, Dauphin Health): The system is so broken we have to reconstruct it. IT is colliding with care—‘we built it so that we could bill.’ For instance: we have not figured out how to make data actionable in workflow; we have looming shortages of time (e.g. pediatricians where many doctors are not full time through careers), versus demand (birth rate). Can we succeed in taking healthcare out of the enterprise (hospital)?
Panel question #2: What is the revenue model for advanced technology?
Mr. Dhoble: Accelerant will be the CMS non-reimbursement for preventable readmissions in 30 days in October 2011. ‘Expert patient’ key factor (and can patients be ‘experts’?) Leveraging media to increase learning of healthy behaviors and increase understanding.
Ms. Block: Disincentive in healthcare reform. Health may well become a ‘regulated utility’ that is based on scale. (This was a surprising answer)
Dr. Dagi: Questioned ‘scale’ paradigm. We may wind up with a two tier system like the UK or a ‘shadow system’ e.g. privately paid concierge medicine because ‘scale’ does not work.
Panel question #3: Will EHR adoptions fulfill the ‘vision’ of better quality healthcare in the short term? (Answers here were especially surprising)
Dr. Chopra: There is NO WAY that the January 2011 start of adoption and qualifying for meaningful use works. If he were in private practice, he would run away from it!
Dr. van Terheyden: Systems can’t extract information from the EHR and put into patient records as needed.
Ms. Block: System is in overload because of other demands, such as transition to new coding standard (ICD-10). Meaningful use is a distraction (!)
Mr. Dhoble: All the stakeholders (pharma, imaging companies, etc.) are lobbying for too much to be included.
Dr. Chopra: Right now, we are not practicing ‘clean healthcare’ and EHRs aren’t going to change this.
Dr. Dagi: What is the standard of care? This is a population question not an individual care question. (Not clear from his remarks or my notes where EHRs fit in this comparison, though.)
More on Dauphin Health: After the panel concluded, I spoke with Dr. Gopal Chopra who is their CEO. The early-stage company has designed a system, currently in test, that allows a parent to transmit information on an ill child via phone or web to a ‘virtual resident’ which compiles it and connects to the family pediatrician. Treatment instructions are returned in 10-15 minutes. The call is essentially triaged but speeds response back to the parent. It is in test: their two basic websites are at www.dauphinhealth.com and www.dauphinmd.com.
Not all the questions in the session notes were answered…are they ever?…but an excellent evening (and any event at 30 Rockefeller Plaza is a treat!)