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Wednesday, January 7, 2015

San Francisco: Health 2.0 WinterTech Conference

Health 2.0 WinterTech: The New Consumer Health Landscape
Join us this January for the first ever Health 2.0 WinterTech as we explore emerging platforms, products, players, and partnerships in the rapidly evolving consumer health ecosystem. With the entry of technology giants into the digital health space, we are seeing shifts in the start-up landscape as well as new opportunities for investors, retailers, employers, providers and policy makers as all sectors adapt to the rising trend of the digitally connected and engaged health consumer.

WinterTech will take place in San Francisco’s financial district during the nation’s leading investment mecca, JP Morgan Week. Come hear how emerging technologies and partnerships across sectors are ushering in a new, tech-fueled era in the global health and wellness economy.
Agenda and registration link.

Gonna be an interesting week next week. I have dinner with athenahealth's Jonathan Bush next Monday, and, if they approve my press pass, I'll cover this Health 2.0 event. The annual conference last fall was excellent. Just like the year before. And, the year before that.

apropos of the topic,


Getting first-rate health care will always be quite different from ordering something from Amazon. We’re talking about the most precious part of life— one’s health— not buying a book. But the common thread is the power of information and individualization. We are embarking on a time when each individual will have all their own medical data and the computing power to process it in the context of their own world. There will be comprehensive medical information about a person that is eminently accessible, analyzable, and transferable. This will set up a tectonic (or “tech-tonic”) power shift, putting the individual at center stage. No longer will MD stand for medical deity. What have been dubbed the six most powerful words of the English language—“ The doctor will see you now”—will no longer be true. Indeed you will still be seeing doctors, but the relationship will be radically altered.

Topol, Eric (2015-01-06). The Patient Will See You Now: The Future of Medicine is in Your Hands (p. 5). Basic Books. Kindle Edition. 
Stay tuned. I just got it. I just finished this one (below), which maps to the topic of an earlier post.

Just a tad of disappointment with "The Art of Medicine." The phrase "art of medicine" appears 84 times in the book narrative, without ever once coming down precisely on a firm definition of the phrase.
The emphasis laid on the sciences as prerequisites for medicine ... may tailor the dominant character that emerges. To advance the art of medical practice ... more emphasis likely needs to be put on teaching the humanities — history, philosophy and the softer social sciences. “These are intellectually expanding domains for people on their own professional journey and helpful ways of looking at the world and life. By exposing students to other streams of knowledge, they may begin to see the possibilities of learning in other places.

Ho Ping Kong, Dr. Herbert; Posner, Michael (2014-06-01). Art of Medicine, The (Kindle Locations 3196-3200). ECW Press. Kindle Edition.
 I'll elaborate in bit. It may take a separate post.

New at THCB:
Computers Replacing Doctors, Innovation and the Quantified Self: An Interview with Atul Gawande

... I began by asking him about his innovation incubator, Ariadne Labs, and how he decides which issues to focus on.

Gawande: Yeah, I’m in the innovation space, but in a funny way. Our goal is to create the most basic systems required for people to get marked improvements in the results of care. We’re working in surgery, childbirth, and end-of-life care.

The very first place we’ve gone is to non-technology innovations. Such as, what are the 19 critical things that have to happen when the patient comes in an operating room and goes under anesthesia? When the incision is made? Before the incision is made? Before the patient leaves the room? It’s like that early phase of the aviation world, when it was just a basic set of checklists.

In all of the cases, the most fundamental, most valuable, most critical innovations have nothing to do with technology. They have to do with asking some very simple, very basic questions that we never ask. Asking people who are near the end of life what their goals are. Or making sure that clinicians wash their hands.

Once we’ve recognized the recipe for really great performance, the second thing we’ve discovered is that our most important resource for improving the ability of teams to follow through on those really critical things is [sic] data. Information is our most valuable resource, yet we treat it like a byproduct. The systems we have – Epic and our other systems – are not particularly useful right now in helping us execute on these objectives. We’re having to build systems around those systems.

The third insight is that, for the most part, the issues have less to do with systems than with governance. The people who are buying these systems, installing these systems, and determining how they’re to be used… What are they responsible for? What are their objectives? We’re having to figure out how to get quality and outcomes higher on the list of priorities of everybody running health systems.

Our dumb checklist, or our incredibly sophisticated predictive analytics algorithm, or that incredibly expensive EHR system… none of those change that fundamental failure – the failure of governance. And none of them can, no matter how you design them...
Yeah. Some of this fits with "the art of medicine" as well as the whole "data uber alles" thing.


I guess I need to study Jonathan Bush's book, given that they invited me to dinner next week.


This is one of the most important and engaging books about health care I have ever read. I love Jonathan’s ideas, of course, but it is his perspective that is so unique. My books examine problems from a rarefied, conceptual, top-down perspective. Jonathan’s perspective on heath care occurs from the bottom up. It is refreshing. Over the years, he has been an ambulance driver, an army medic, and a consultant. He has seen firsthand the local and national politics of health care. He was initially a failed entrepreneur with a great idea, covered with scabs and wounds from wringing out reimbursements from insurance companies and wrestling with the status quo. Now Jonathan is the successful CEO of a marvelous and important health care IT company...
In Where Does It Hurt? Jonathan chronicles the people who occupy the last wagon in health care. These are the patients who don’t have access to the best care. They are caregivers and entrepreneurs who could give so much more and better care than they are allowed if they weren’t chained to a broken system. Those in the first wagon write the legislation and regulation. They debate health care in courts and legislatures. Many of their compromises and side deals fill the air with self-centeredness, complexity, ambiguity, overhead costs, and contested, delayed, and partial reimbursement. The lives of those in the last wagon are very different from the “visionaries” in the front. 

Thankfully, Jonathan has experience driving wagons in both the back and the front. He has a wonderful perspective of the entire wagon train. Jonathan has dedicated his life and his company to helping those of the last wagon in health care do their jobs in the best way possible and creating new opportunities for those entrepreneurs who are willing to take risks. 

I love to listen to Jonathan talk: His narratives come a mile per minute. His illustrations and metaphors help me envision the problems and their solutions clearly. And he is very, very funny. You will be able to hear Jonathan’s voice as you read this book. It is an easy, insightful, and entertaining read. 

Jonathan, thank you for writing this book— for what it says and how you say it. 
- Clayton Christensen, Harvard Business School JANUARY 2014

Bush, Jonathan; Baker, Stephen (2014-05-15). Where Does It Hurt?: An Entrepreneur's Guide to Fixing Health Care. Penguin Group US. Kindle Edition.
Interesting stuff to read and evaluate this week. Stay tuned.


Hans Rosling, by way of The Incidental Economist: "Lagged selection bias and possible declines in life expectancy."

Cool. Rosling rocks. Try that in an Excel sheet.

How health reform might cause harm
January 7, 2015 at 7:00 am  Austin Frakt
The Affordable Care Act made changes to government payments for Medicare services that are expected to save tens to hundreds of billions of dollars per year. This sounds like a good thing — and it very well may be — but only if those spending cuts don’t cause harm. Research suggests they just might...
To provide the same level and quality of care for less, hospitals will have to become more productive in converting dollars into care. Specifically, they’ll need to become at least 1.1 percent more productive per year. Is this likely? There are two schools of thought — one forward-looking and one that considers the lessons of the past.

Looking back, history provides a guide of what we might expect. Though hospital productivity grew from 1990 to 2005, it never came close to growing at 1.1 percent per year. Some years it was negative: Hospitals did less with more. Other years it was positive, but never above about 0.5 percent per year.

Looking forward, the great hope for new hospital payment models included in the Affordable Care Act and promoted by some private insurers is that they will encourage cheaper care that is also better care: doing more with less...
Good post. Difficult stuff, all of it. Lots of large of moving parts, many of them moving at cross-purposes, as they have done for decades.



After 'wasting' $4.3 billion, Connecticut shutters state HIE
January 6, 2015 | By Marla Durben Hirsch

Connecticut's health information exchange, known as Health IT Exchange (HITE-CT), has failed, in large part due to internal mismanagement and bad privacy policies that undermined the public trust, according to Ellen Andrews, executive director of the Connecticut Health Policy Project.

In a December blog post, Andrews said that the HIE wasted $4.3 billion in federal grants and accomplished nothing in its four years. She noted that many decisions were made in small committees behind closed doors and presented to the board as done deals. The HIE also refused to adopt a consumer opt-in policy, as used in neighboring states, which would have provided more privacy and security of patient health records.

Connecticut's General Assembly recently repealed the laws establishing the HIE and transferred some of its responsibilities to the Department of Social Services (DSS)...
Wow. Another one bites the dust. Will the HL7 FHIR eventually render HIEs irrelevant? I wonder what Margalit thinks?
FHIR - In this report JASON is taking an unequivocal stand behind a new HL7 standard for clinical information exchange, the Fast Healthcare Interoperability Resources (FHIR), which is actually pretty neat, and has been in development for approximately three years. FHIR is envisioned as a replacement for the C-CDA, which replaced the CCD, which replaced the CCR, which replaced an array of HL7 2.x messages. JASON is recommending that government “policies should make it advantageous for one or more leading EHR vendors to be the first to propose such standards”. Lo and behold, two days after the JASON report was published, a group of leading vendors and institutions, several of which briefed JASON, and some who are helping the government implement JASON’s recommendation, launched the Argonaut Project for precisely this “advantageous” purpose.
Ah, yes, Argonaut.

More to come...

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