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Archive for the ‘UpToDate’ Category
Health Content: There’s an App for That in EHRs
- Posted March 20th 2010
- Comments (0)
- by Janice
Approximately 30,000 people convened in Atlanta last week for the HIMSS conference. HIMSS stands for Health Information Management Systems Society, and its annual event has become the meeting place for vendors and users of electronic medical and electronic health records systems (EMR/EHR). This year’s conference program had a major focus on the impact of the ARRA HITECH[1] funding and incentives for adoption of new EHR systems. One of the most common topics of discussion at the event was “meaningful use” of EHRs.
I’ll reveal my bias upfront. My background is in digital information services, and I’ve always viewed information management systems as tools for increasing the utility of the content that flows through these systems. An information system that doesn’t optimize the utility of the content in a way that adds efficiency to a process or leads to better outcomes is not all that compelling to a user.
With EHR systems, it has been long apparent to me that their value would be far higher to the clinicians who use them if the knowledge embedded in medical textbooks, scholarly research publications, and other reference sources were incorporated into the EHR systems at or near the point of care. Over the past 10-15 years, we’ve witnessed the gradual migration of information that had been stored in separate online reference systems to systems that physicians and other clinicians can access on their handheld devices or EHR/EMR screens. Epocrates for drug reference information on early PDA devices was a pioneer. Now, nearly all the reference and research content is digitized, but most of it hasn’t been incorporated into EHRs in a manner that maximizes its utility for clinicians.
At this year’s HIMSS conference, there were myriad signs of accelerating convergence of EHR systems and health content. EHR vendors are eager to embed clinical information into their systems to demonstrate the value of incorporating accepted clinical guidelines, procedures, lab values, drug dosing suggestions, regulatory benchmarks and any other useful clinical reference content that would save the clinician’s time and lead to improved outcomes. Embedding the accepted rules and guidelines into an EHR system also provides the ability to customize recommendations based on the patient’s characteristics (sex, weight, other drugs being taken, allergies, and increasingly personal genome). The advantages of having the appropriate rules and guidelines embedded in the software are obvious. Just think TurboTax. [Note, I am focusing on clinical content in this post; benefits for administrative/performance improvement applications are equally compelling.]
Granted, medicine is more complex than the tax code. (It may be hard to believe anything is more complex than the tax code, even taking into account the state-wide variations, but it’s true!). Hospitals will continue to follow different procedures, guidelines will remain suggested guidelines to allow for individual variations, and new medical knowledge will be acquired daily. Nonetheless, the value of automating the practice of applying widely accepted medical rules and guidelines is immense-for practitioners and patients.
Medical publishers have been slow to adapt their content for usage in EHR/EMRs. Zynx Health, a Hearst Business company, was a leader in providing order set workflow systems that incorporate content. Their sister company, First DataBank, also proved the ground for transforming drug information to medication management systems. Based on my discussions at HIMSS, other medical publishers are accelerating their efforts to create clinical decision support systems from their collections of content that can be embedded in EHR/EMR systems. Elsevier, Thomson Reuters, and Wolters Kluwer, the big 3, have made great strides.
HIMSS is still a very technology-centric event with limited focus on health content and relatively few publishers exhibiting. Along with the big 3, a handful of other publishers, including EBSCO/DynaMed, Lexi-Comp, PEPID, and several patient education publishers (ExitCare, Healthwise, Patientedu.com) were present. And, of course, MedTech, the publisher of Healthcare IT New and Healthcare Finance News, which also publishes the Exhibit Guide and the daily HIMSS10 Guide, was there. BNA, a publisher of regulatory information, had a booth, too.
However, I see 2010 as a turning point for health content publishers. They have to learn to adapt their information for inclusion in EHRs. A digital version of a reference work is no longer good enough. The content has to become an “app” that can be incorporated into electronic systems.[2] Standalone content that doesn’t plug in to a user’s system or get embedded into clinical decision support systems will be left on the sidelines. By the time HIMSS11 rolls around next year, expect to see more health content publishers among the exhibitors and more clinical decision applications that can be integrated into healthcare information systems on display. Soon it will be difficult to identify where the content ends and the technology begins.
______________________
1 Health Information Technology for Economic and Clinical Health Act (HITECH Act) is part of the American Recovery and Reinvestment Act (ARRA) bill of 2009 (aka, the Stimulus Bill). For details see: http://healthit.hhs.gov/.
2 Official standards for Meaningful Use that include use of evidence-based order sets and other clinical decision support systems by 2012-2015 will fuel this trend.
Headline Commentary Dec 6-13
- Posted December 13th 2009
- Comments (0)
- by Janice
Press Ganey acquires Patient Impact, announced 12/6/09. Patient Impact to become the unit specializing in physician practice & outpatient surveys. More details to come. Note, Patient Impact was a Health Content Innovator and presented at our Health Content08 conference: http://www.infocommercegroup.com/healthcontent/index.html
Headline says it all. Gary dissects an actual memo used with TV journalists that promotes tying recent medical research to exaggerated claims of short-term benefits–and the specifically recommends against mentioning research labs or clinical work.
No doubt CME needs a redesign to change the current heavy subsidies by Pharma.
Article on the new building extension of MIT’s media lab designed by Japanese architect Fumihiko Maki. Contrasts Maki’s style of open space with lots of glass to original IM Pei buildling with limited windows. Interesting metaphor for move of technology from “black box” to enabling and thriving on “transparency”.
Article questions the affordability of new cancer drug, Folotyn, produced by Allos Therapeutics. Allos says price is in line with other specialty treatments and so far health insurers have agreed to cover it to treat aggressive tumors. Shines light on problem of high cost of developing drugs, but doesn’t offer any solutions.
An indictment of doctors and drug companies that promote drug interventions for preventive care. Uses example of hormone drug replacement for women.
Ad Age lists top magazines that have ceased publishing in 2009.
References CBO study (with link) that describes the allocation of marketing $$ to detailing, CME support, DTC and a measly $400 M in professional journals. Journals publishers need to reinvent themselves as a vehicle for reaching doctors/clinicians.
EBSCO’s DynaMed write-up on breast cancer screening. I don’t find their analysis and coverage very helpful.
Conversation between Milken and Pfizer CEO Kindler
Reports of small survey of device manufacturers; results show that social media isn’t yet part of the marketing mix for device companies.
John Moore writes a brief post about MSFT’s announcement of long-term care provider Golden Living’s adoption of Amalga & HealthVault.
Some commentary on benefits of move to ICD10 codes.
McClellan, former CMS adminstrator, MD, and PhD economist, will keynote Advanstar’s Center for Business Intelligence (CBI)’s Annual Strategic Medicare Policy Summit.
Good overview with links to other stories about Pharma’s slowness in developing mobile apps.
Nancy McKinstry interview: journals renewals are strong even with price increases; hospitals are spending more capital in 2009 than 2008 in anticipation of ARRA funds to come in 2010.
Note, this is the first I’ve heard of ebizMBA, who writes on their site that ebizMBA is “an eBusiness knowledgebase that helps you find the webs best ansers to your online business questions on topics ranging from online marketing and analytics to website development and venture capital”. To their credit, they offer some indication of the parameters they use to measure popularity.
Humana will establish MinuteClinic for its own employees and will encourage all members to use MinuteClinic for basic screening tests for cholesterol, blood pressure, bmi–and will couple basic screenings with its own LifeSynch health coaching.
Ovid to announce Universal Search, which allows clients to search across Ovid and client’s other internal databases in single search. Nice development.
WebMD, HealthVault (MSFT) and GoogleHealth comprise the panel moderated by Jane Sarasohn-Kahn. About 50 minutes long. Worth a look.
Not surprising to hear that Informa has decided against going forward with bid for Springer. Debt levels of Springer make the deal hard to digest and current Springer owners PE firms Candover and Cinven want a sale to conclude quickly. If PE company acquires Springer, perhaps they would sell off pieces.
Very good analysis of trends in IT research. Essentially says that high priced IT research reports are becoming commoditized and used for lead gen that is paid for by vendors. Analysts can still make money consulting, firms can put on events, and carry out customized research. Totally in line with my writings and demonstrated in the content value pyramid in my Publishing for e-Patients preso (on Slideshare/janicemc). Like comment about individual analysts becoming branded more so than firms. Agree there, too.
Dow Jones Venturesource reports Q2 2009 VC investments by industry. Healthcare the best performer and it outpaces IT for first time on record.
Kent Bottles provides excellent summary of recent lecture by David Eddy, MD (the “founder” of EBM) who has consistently challenged the robustness of existing methods of clinical decision guidelines. Dr. Eddy believes the future requires more complex models that consider a larger number of factors and interactions that in effect provide more personalized medical treatment. Eddy’s own company, Archimedes, builds “virtual patients” that can be used for complex modeling of probable outcomes. I don’t know enough about Archimedes to judge its efficacy, but I think Eddy has the right approach. We know that more data are available about patients and outcomes and will accelerating adoption of EHRs, the amount of data will expand rapidly. Along with the improved data sources, there is clearly a need for more complex models to analyze the data and test the benefits of medical treatments.
Good article with data and charts on changes in pharma sales & marketing over time and expected effects of health reform on pharma sales techniques.
Comprehensive article on HSAs and high-deductible health plans.
Perspective on whether use of EMRs reduce liability for physicians. Focuses on discounts offered by insurance cos to doctors and practices that use EMRs.
Schein will merge its animal health business with Butler; Schein to own 50.1%.
Press releases doesn’t provide many details; I will look at Elsevier site soon. Embase is an index to biomedical research; relaunching as standalone product seems old-world.
Good article that mentiones pricedoc.com, healthcarebluebook.com, and outofpocket.com, sites that provide info on prices for various procedures or office visits by doctor.
Story about Full Yield, a wellness program for employers that provides its own food & nutrition programs. Story describes how Safeway, IBM, Pitney Bowes and others have saved money on health care costs via wellness programs. Major issue, however, is that these are companies that self-insure.
Another story that critiques overly simple health care rating schemes. IMO, ratings needs to be based on analysis of outcomes, using real data, not observations from a third-party, which are subject to error.
A one-sided critique of the shortcomings of EHR/EMR systems from Huffington Post. Whereas I agree that there are shortcomings, a more balanced report would have more credibility. Still, it offers some good basic info on what the feds are trying to do with ARRA funding.
Excellent post and comments. I just added my own comment (7th in list).
Article mentions strong interest in healthcare sector by PE. Do PE professionals smell, taste and feel an opportunity in healthcare, too?
Good commentary on public reaction to public health announcements and EBM. More “infodemiology”, that is, providing trustworthy information and monitoring public response to epidemics, is needed.
Excellent video presentation by Peter Norvig of Google. Data, semantics, search and much more.
IDC Health Insights report on EHR vendors ($4,500)
Interesting article and site (which I just discovered) about opportunities in scientific/medical writing and journalism. Site focuses on female scientists.
Sponsored by Google, survey lists most popular resources used to find medical info. Surprise! Search engine/Google is at the top, followed by peer-reviewed journals. No category for online clinical information resources, such as UpToDate, MDConsult, DynaMed, as far as I can see. If no breakout were given on survey, Search Engine category may incorporate these resources too.
Money-Driven Medicine site with free streaming version of the movie. Nice example of offering free streaming with promo for the paid DVD.
FDA would need legislative action to approve new db, but given the ability to track more data from electronic records and online user-input, federal db makes sense.
More on Informa bid for Springer from FT, which quotes analyts.
Study of search behavior indicates that online search is often used to confirm or refute one’s internal knowledge. Hm, sounds rather Bayesian to me.
With over 2.1B Euros in debt (8X EBITA), Springer is a loaded target. Bids are expected to be under 400M Euros. But bigger question is: is there sustained value in publishers of scholarly research, an sector that is being disrupted by new models of scholarly communication and research?
Good review of press related to new mammogram guidelines. Interesting that so many who say they want EBM, object when they don’t like the data. “Don’t like” often means they stand to lose business or stature.
Zynx Health’s order sets will be integrated with Keane’s Optimum EHR system thru this partership. Another example of embedding EBM info into EHRs.
Article describes how students are sharing for-fee medical articles in a Napster-type environment.
“It” in this case, is the information in medical journal articles. Really good article about what could be done to help add context to each medical journal article that reports on new research so that journalists, patients, and even doctors can better understand the implications.
With pressure from patient groups and regulators, hospitals have make significant progress in reducing hospital-acquired patient infections. Checklists and focus on solving the problem (using best practices from other institutions as one means) are noted as key to changing the procedures and culture at hospitals.
Study performed by Prof. Ashish Jha at HSPH and Catherine DesRoches at MGH indicates that using EHRs makes little difference in outcomes. This article goes on to point out that researchers also focus on the importance of changing processes & culture in hospitals to benefit from positive effects of using EMRs/EHRs. I’d add that hospitals and hospital systems that incorporate clinical information systems (order sets, point-of-care CDS) are more likely tho demonstrate improved outcomes. At this stage, not enough evidence-based content has been incorporated into EMR/EHRs.
MD who wrote this post suggests that Kolata’s article is biased toward the big pharma position, since her only sources were from pharma.
Headline Commentary Nov 9-22
- Posted November 22nd 2009
- Comments (0)
- by Janice
Very good article by Linda Peitzman, MD, CMO (Medical) of Wolters Kluwer Health on benefits of order sets. Article provides some detail on how to implement order sets to ensure everyone receives latest most current version. Note, hour long interview with Linda, Nancy Greengold (of Hearst Business Media and co-founder of Zynx Health), Sundeep Karnik (fmr VP Strategy Elsevier Health) and Gary Kennedy, CEO of Remedy MD can be found here: http://www.berkerynoyes.com/pages/innovations_in_evidence_based_medicine.aspx
InformationWeek profiles Transparent health Network, which is compiling prices for direct purchases of healthcare services by patients.
IL launches its hospital compare site. Article points out that public ratings rarely reflect quality of care.
Flybridge invests in woman-owned pilates equipment seller, which has sold over $500M in equip on QVC over the past 12 years.
WSJ writes about new x-discipline collaboration among research scientists. Key point relates to how these scientists are creating their own databases. No mention of third party publishers in this new world of data-driven research.
Workflow study that follows patient through hospital identifies areas for improvement.
Jane Sarasohn-Kahn reviews recent study by Buck Consultants on growth of wellness programs in a variety of countries and compares the priorities of each country’s wellness programs. US is only one where cost-saving is key objective.
Brian Ahier writes about recent developments in electronic healthcare records with a focus on Practice Fusion and GoogleHealth’s attempts to offer patient info that is consistent with physician info.
Matt Holt comments on Practice Fusion’s announcement of patient portal to coincide with their free EHR s/w.
John Moore of Chilmark Research, who moderated closing panel, recaps the day’s highlights. I’ll add that John did a very good job on the last panel, which included Esther Dyson, Steve Munini COO Dossia, Fred Smith of CDC, and George Willock, CEO of HealthString. Audience appreciated the focus on the patient (Adam Bosworth did focus on patient, too). I believe it was Esther who said: “the patient is the most important input into health decisions”. She mentioned the “quantified self” movement and Society for Participatory Medicine also got a plug. This was the most forward-looking session that addressed social media and the exploding amount of new data that will be available for analysis.
Very good video by Nobel laureate in biochemistry, Paul Nurse, who makes the point of the importance of recording healthcare outcomes and analyzing data to prevent misunderstandings based on false correlations. He uses the vaccination scare as an example.
DataONE (Data Observation Network for Earth) is one of two $20 million awards made this year as part of the National Science Foundation’s (NSF) DataNet program. The collaboration of universities and government agencies coalesced to address the mounting need for organizing and serving up vast amounts of highly diverse and inter-related but often incompatible scientific data. Resulting studies will range from research that illuminates fundamental environmental processes to identifying environmental problems and potential solutions.
Good balanced view of response to recent breast cancer screening guidelines.
Center for Ix Therapy, which was represented at our first Health Content07 conference, to shut down Nov 30, 2009. The Center was small organization with limited resources, and suffered from trying to define a space that already existed and was far more widespread and diverse than their definition of Ix Therapy.
Lois Wingerson writes about Healthcamp NYC and ePatients.
Wonder what Lexis and Westlaw will say about this?
HR and billing IT apps are helping hospitals save money that can be applied to clinical improvements.
Makes sense. FDA and other govt sources are not best at marketing and distribution. Everyday Health (Waterfront Media) can take on that role to extend reach of FDA info.
Latest version of Allscripts (version 11) was launched before it was debugged. HDM asks if Allscripts has overreached its grasp since its merger with Misys. Note also the prices for the KLAS reports: $980 for providers; $11,850 for others!
Grove, former CEO of Intel, promotes concept of new degree to help accelerate the cycle from medical research discoveries to mass production of new treatments. Essentially, Grove wants to combine skills of researchers and engineers to disrupt current cycle that can take many years from bench research to broad availability.
ModernMed, a concierge medical service in Milwaukee, launches with 2 primary care MDs. Founder believes healthcare costs can be controlled via effective primary care.
Physician posits that dependence on checklists may not be to the benefit of good patient care if insufficient attention to individual patients is paid.
CambridgeSoft, which provides IT solutions for pharma BI (esp R&D), receives funding from Health Evolution Partner (David Brailer’s PE company). CambridgeSoft is touting its SaaS solution for pharma & chemical research.
Gary slams the morning TV shows for their promotion of junk information about weight-loss and other health issues. I agree that for the most part, TV news health info is superficial and very seldom put in context. Wouldn’t it be great if the money were spent on disseminating helpful information and pointing people to more trustsworthy sources?
“The Centers for Medicare and Medicaid Services plans to boost data sharing among its various programs that have common functions using the Medicaid Information Technology Architecture (MITA) and the nationwide health information network (NHIN).” Sounds reasonable…
How much information is optimal to share between patients & doctors? Great comments here.
Good article that points out the importance of system change (behavior change) for checklists and the like to be effective.
Article makes the point that it’s great that gov’t agencies are providing more open data, but that data needs to be put in context and displayed in an engaging manner to really have full impact. And that, dear publishers, is what you should be doing…
Another outstanding post by DC patient, who writes that een though she is an engaged patient, she never would have thought to file reports of adverse effects (AE) via FDA’s MedWatch. Her comments make it pretty clear that the MedWatch channel is not effective for monitoring Rx AEs. Patients consider many factors before they single out any particular cause.
Excellent round-up of Day 1 of FDA hearings on social media use by Pharma.
Another story on the funding for Caring.com which recently acquired the Gilbert Guide.
CVS sees value in studying interaction between genes and medication for its PBM business and for its end-customers.
Google’s proposed ad format for Pharma ads. Presented at FDA’s hearing on social media.
Dr. Pauline Chen’s column about the decline in # docs who want to go into primary care. In large part, it’s due to large number of routine cases they deal with and the amount of paperwork and coordination required. Of course, pay is an issue too. This ties with articles I’ve published about the commodization of routine health care enabled by health IT. Programming routine tasks and allowing nurses and other clinicians to take over these tasks should relieve primary care physicians of the “burden” of routine tasks.
Forrester’s CEO on how old media needs to reinvent itself for digital world where customers decide what is valuable.
Nice rundown of vetted sources of online health information from medical librarians.
Explorys, a start-up search engine, partners with Cleveland Clinic to develop search/analytics tool for patient records.
David Blumenthal’s latest statement on goals of the ONC for interoperability of electronic health records.
Chris Truelove’s review of 1st morning of #FDASM
linking patient data and related information
Very good article and great comments on hurdles that impede implementation of electronic health records/electronic medical records.
Live webcast of FDA’s hearing on use of Internet and Social Media Tools by FDA-regulated Medical Products, Nov. 12-13. Much anticipated meeting on topic of use of online media by Pharma and other FDA-regulated companies.
Geonetric survey lists top objectives of patient portals created by hospitals.
More outlets for distributing health and fitness gear as focus on wellness and prevention increases.
Pretty interesting application. Not as far-fetched as it seems.
No matter the outcome on ONC pronouncements about meaningful use, CCHIT, the certifying board for EMR/EHR systems, is continuing to play its previous role. CCHIT describes itself as a “community” and believes they offer meaningful services to small hospitals and group practices.
Lots of info on various IT standards for EMR/EHRs
Comments on Erik Engstrom’s new position as CEO of parent company Reed Elsevier. Engstrom has been CEO of Elsevier, the STM group of RE, for some time. Smart and analytical, I think he’s a good choice.
CareMedic, a Florida revenue cycle management (RCM) company, to be acquired by UnitedHealth’s Ingenix group. Ingenix now has near end-to-end platform for managing every step of the revenue cycle, from patient registration to reimbursement.
Well, even though someone’s gotta pay for the production and dissemination of information, I don’t like this alliance and don’t believe AAFP can be objective in its research on effect of sugary soft drinks if Coke is the sponsor.
WaPo on how some people may overreact to info they find on online health sites. Writer overreacts a bit herself in implying that online resources shouldn’t be used to help diagnose one’s condition. Agree that health literacy is needed; that is, consumers need better training to vet health resources. But, we’ll have hypochondriacs in the real and virtual worlds. Not everyone will gain the same benefits from online health resources.
Google now incorporating dat aon flu shot availability and mashing it up with Google Maps to illustrate where flu shots are currently available. Note, Google is compiling info provided by clinics. More proof positive that Goog is a content publisher.
SDI Health, a PA company that provides healthcare data analytics services, receives funding from Tailwind Capital.
FastIgnite site offers tools for start-up companies to calculate pre-money valuation, vesting, and more.
Article on lack of transparency in reporting health research and health statistics.
CareFocus, parat of the Clinical Xpert suite of CDS workflow solutions from Thomson Reuters (fmly Mercury MD) extends functionality of product line.
Narrated slide slow illustrating new features of reports on Patients Like Me. Impressive.
Dr. Danny Sands on why he believes in participatory medicine and informed patients.
PhRMA proposes methods for verifying FDA-approved data in health info provided to consumers. FDA logo on sites?
Good concise review of Merck Manual Professional Ed. for iPhone
Excellent slide deck that describes influence of social media in healthcare: pharma, med school, epatients, doctors, nurses.
Describes use of mobile devices to monitor steadiness of eldery to prevent falls. Good descriptions of how data from monitoring devices can be used in research to vastly improved current snapshot approach of medical research.
Focus on shortage of primary care doc and how nurses will take on more resposibility. Agree, but shortage isn’t the source of problem. Rather, commoditization of basic medical care & procedures due to digitization of health care info is source of change. See piece on “heatlh content is rapidly becoming a commoditiy” in my blog at Health Content Advisors.
Merck offers iPhone app that allows chemo patients to track symptons, etc.
Sermo creates community on practice management topics for docs to share info about healthIT and the business issues of running a practice. There are even CME activities with 8 module curriculum titled: The New Business of Medicine.
Chief scientist at Endeca, a specialist in faceted search, joins Google.
Microsoft will launch a video web series on health IT beginning Nov 11, 2009.
Review of data.gov with emphasis on healthcare data.
Long interview with David Brailer, now a PE exec, fmly Director ONC.
Emap titles Health Servie Journal and Nursing Times partners with Doctors.net.uk to share content and conduct research.
Anne Woods promoted to CNO (Chief Nursing Officer) at WK Health. She’s responsible for nursing strategy across Medical Research & journals publishing businesses.
Hope Leman’s interview w/ John Sharp of Cleveland Clinic.
Headline Commentary July 7-13
- Posted July 13th 2009
- Comments (0)
- by Janice
Modern Healthcare’s analysis of recent IOM and Federal Coordinating Council reports on comparative effectiveness research (CER). Key finding: data infrastructure is need and investment in creasting databases is critical (and probably > total funds allocated for CER –$400 M–in ARRA).
Perhaps the UK will promote & accelerate adoption of Google & MSFT’s PHR platforms before they gain traction in US.
Pretty good list of useful purposes of Twitter–mostly business related.
Interesting new aggregator of top journal content (based on impact factor & google scholar rankings) in clear, attractive interface. Access to premium fulltext journals is limited to existing subscribers via Athens. [edited 7/15] Note, Clinical Reader has been called out by medical librarians because of sloppy copyright practices and use of false implied endorsements by NLM & others. To gain credibility as source of authoritative content, CR team needs to tread carefully!]
Decent article in Telegraph about Reed Elsevier’s need to focus on IT infrastructure to enhance value of content assets. Title a bit misleading, but it does mention specific title/markets where Reed might reconsider selling RBI assets: Construction, chemical, energy, XpertHR & Totaljobs.com.
I wouldn’t call it WebMD, but it includes health and wellness information and lots of information on the institution.
PhRMA site offers limited access to Adis’s R&D Insight drug pipeline db for no charge. Limited info on each drug is output, but list of drugs by phase is available. US only.
Beta version released; official release sched. for Q4 2009. Breakthrough sounds like an exaggeration, but it is a step forward for a traditional directory publisher who sells to libraries.
Tim Berners-Lee talks about data that do stuff (an ICG mantra): “And now there are lots of different ways that people need to be able to look at data. You need to be able to browse through it piece by piece, exploring the world of data. You need to be able to look for patterns of particular things that have happened. Because this is data, we need to be able to use all of the power that traditionally we’ve used for data. When I’ve pulled in my chosen data set, using a query, I want to be able to do [things like] maps, graphs, analysis, and statistical stuff.
SpringerImages, which includes over 1.5 million scientific images, tables, charts & graphs, to be officially launches at ALA in Chicago this week. Was originally planned for Q1 release.
Can’t resist tagging this article, since it intersects the key topics I follow & my interests (tennis). Serena Williams launches skincare line developed by chairman for American Academy of Dermatology Chair, Dr. Bryan Adams. Skincare line is targeted for those with “demanding and active lifestyles” like Serena.
Serials Solutions, a ProQuest company, expands the content indexed by its Summon Service. Summon aims to offer “Google-like” search interface across library’s holdings. For now, content from ProQuest, Gale, Springer, IEEE, Taylor& Francis and some other scholarly publishers and university presses participate. Summon is in beta at Dartmouth, Claremont Colleges, and 5 other universities in US, Canada, UK, and Australia.
Some good analysis of Amazon’s Kindle pricing strategy and why share to publishers may shrink. Quotes couple of analysts.
Kent Anderson of NEJM writes about Amazon’s growing role in book publishing, not just redistribution of books. How should publishers react? Comments as of 7/9 suggest scholarly publishers stick to their knitting of creating content and build their own open repositories– and be more aggressive with digital distributors. Granted, scholarly publishers should take more control of digital distribution, but in order to do that, they have to invest in digital infrastructure & know-how.
Monster cuts 160 jobs; will add 80 in new technology innovation center. New focus on long-term strategic planning and customer engagement. Evidence of need to add layers of analytic and other value to core content.
Good dialogue about social media’s relevance to clinical practice.
Healthcare reform may include tax credits for employer-sponsored wellness programs.
Good write-up of interview with Berners-Lee by ReadWriteWeb’s founder, Richard MacManus. W3C’s focus on data content is exciting development for us at InfoCommerce Group, where the role data in publishing businesses has been a central focus on ours from day 1. s
Survey conducted by Rodale on behalf of FDA DTC division provides data that show that almost 50% of consumers rate online health videos information websites as top resource when searching for medical conditions and prescription drug info online. Next in line were pharma websites, video sharing sites, and social networking sites.
Good article on the under-tapped value of customer lists held by publishers. As author points out, many print publishers seem to miss the connection between their ability to build communities of interest for publications and adapting that ability to web-based communities. Instead, too many publishers are letting upstarts replace them online.
Candover & Cinven (current PE owners) ask bidders to resubmit bids for up to 49% of Springer. Initial bids from TPG, EQT and consortium of Carlyle & Providence did not meet current owners’ expectation. Owners asked for 500M Euros for up to 49% of Springer; 2 sources said 350-380 Euros was a more reasonable valuation.
The concepts of EBM and Comparative Effectiveness Research are reaching consumer-focused publications. IMO, considerable education via general press and other venues will be necessary to help consumers/patients understand EBM and CER.
Interesting partnership between Mayo Clinic and Winn-Dixie grocery chain, whereby Mayo provides info related to nutrition and conditions including cold & flu, heart disease, digestion, asthma and allergy (most of which have OTC products sold in grocery stores to help manage these conditions).
SDI, which acquired Verispan last year, releases results of most respected pharma companies by pediatricians.
CDC launched a web-based public health tracking interface that includes state-by-state data through 2006 on air & water quality, lead paint, and other public health measures. My first attempt to extract data for air quality in MA led to an error message. It’s likely that no data were available for the query I entered through the menu-based system, but a better-designed faceted search would have alerted me to this fact. In sum, it’s great that CDC is providing more data in easy-to-use formats, but there’s lots of room for improvement by commercial information services that can add value by aggregating data and improving the search experience.
Thomson Reuters, already one of the biggest webcast providers, acquires Toronto-based webcasting s/w firm Streamlogics.
Emdeon, a RCM vendor, buys eRX Network, a vendor of epharmacy solutions. eRx has established base in government, providing claims-processing services for CMS.
A medical librarian’s comparison of DynaMed and UptoDate
Headlines for May 9 - May 14
- Posted May 15th 2009
- Comments (0)
- by Janice
From Mark Logic User conference #MLUC09, write-up of Webmedx, a company that provides transcription s/w to convert dictation to coded XML documents. Notes that approx. 60% of physician-created documentation is dictated & transcribed. Note section on CDA: Clinical Data Architecture & link to this open source standard.
Kevin MD on whether doctors who follow EBM should be protected against malpractice. Short answer, yes.
Dr. Thomas Frieden, NY City’s health commissioner, will be announced today as Obama’s pick for director of Center for Disease Control & Prevention (CDC).
Mark Leavitt, MD, CEO of CCHIT, says “meaningful use” of EHRs = “a certified EHR, it has to include e-prescribing, it has to be able to exchange information and it has to be able to report quality data.” I’ll add: to exchange information and report quality data, common standards for coding information are needed between the senders & recipients of info, and quality info must be input into the system before quality data can be reported. GIGO.
Google is experimenting with asking users who search for health-related topics why they are searching, e.g, looking to diagnose, find treatment, etc.
Philip Pead, former CEO of Per-Se Technology, is named successor to Andrew Eckert as CEO of Eclipsys.
Elizabeth Satin, who has focused on healthcare industry in her investment banking career, joins Wolters Kluwer as SVP & head of Corporate Development & M&A for N. America.
John Goodman raises issue of poorly-designed healthIT systems that in some circumstances increase the likelihood of error & cites a 2005 study.
Ad Age nicely surveys the state of digital marketing & social media usage by Big Pharma and their agencies. Highlights J&J, GSK, AstraZeneca, Novartis, Sanofi & Boehringer Ingelheim. Good quotes from top digital agencies, too.
Qforma, a healthcare-analytics company launches new directory for Most Influential Doctors in conjunction with USA Today. At launch, coverage will be national with doctors in these specialties: diabetes, high blood pressure, high cholesterol and asthma. QForma partnered with Wolters Kluwer Health for info on “millions of data points that reflect important collaborative indicators such as referral networks, practice patterns, publication history and leadership positions in professional associations.”
Dr. Gwenn interview Denise Basow, MD, editor-in-chief of UptoDate, to discuss appropriateness of patient site on UTD for spectrum of patients.
Pharma lobbying up 36% in Q1 2008, whereas most industries are down significantly. Pharma clearly wants active role in health reform.
NIH is seeking comments on possible changes to fed. regulations regarding potential conflicts of financial interest on part of researcher that could affect objectivity in design, conduct, or reporting of research fundeed under PHS grants. Note, transparency of researchers’ financial interests will be increasingly important as more medical & other scientifc research is made for widely available via the Web and other vehicles. Related to Open Access themes, too.
Intel-sponsored site on mobile healthcare
Some ideas for searching and mining info in Twitter.
Wal-Mart ready to expand onsite health clinics in partnership with hospitals. Initial partnership with Revolution’s RediClinics didn’t work out.
Extended list of academic, industry, and consultants who will advise on implementation of ARRA funds for health IT.
Brief summary of recent Forrester Research study on usage of social media in pharma marketing. Includes link to slides Josh Bernoff (author of the study) used at Social Pharmer, which I attended,. Note, many pharma marketers & agencies in the room didn’t agree with Forrester’s conclusions about target markets.
BreastCancer.org partners with HealthCentral.com for sponsorship ads. Is this a sign of new type of partnerships between online consumer health portals and non-profit consumer healthcare online communities. Can HealthCentral serve as effective ad/sponsorship agency for such sites? How will sponsoring social media healthcare sites like BreastCancer.org compare with Pharma’s direct development of community sites around a specific drug (e.g., Alli)?
New study on EMR adoption that surveyed Mass. doctors in 2005 and 2007 to be published in J. American Medical Informatics Assoc. cautions that inadequacies in most EMR systems lead doctors to only use pieces that work efficiently, e.g., e-prescribing. This confirms our view that lack of standards for data transfer and inadequate research in product design has resulted in EMR systems that do not improve efficiency of practitioners. Design that incorporates analysis of practitioner workflow and improved data standards are required before EMRs can be expected to improve productivity and lead to better patient outcomes. That’s what I think “meaningful use” should imply.
Health insurers, PhRMA, AMA, AHA, and SEIU say they will work to contain cost future increases in health care. Comments from readers reflect skepticism of pledge.
An essay from Times of London on future of printed books.
MobihealthNews interviews Roni Zeiger, product manager of Google Health.
HHS’s Federal Coordinating Council for Comparative Effectiveness Research (CER) is conducting “Listenning Sessions” for public to comment on CER. Upcoming sessions 5/13 in Chicago; 6/10 in DC.
Headlines for Mar 30-Apr 1
- Posted April 1st 2009
- Comments (0)
- by Janice
Physicians Interactive, which was acquired by Perseus last year from Allscripts, acquires MedManage, an e-sampling company that helps pharma and device companies market to doctors.
West Foundation, along with Scripps & Qualcomm create the West Wireless Health Institute in San Diego to invest in wireless/mobile health applications.
CareDataTrak launches kiosk system for self-screening of seniors.
Good interview with Linda Peitzman, Chief Medical Officer, Wolters Kluwer Health, that details how WK Health’s applications are being integrated into EMRs. Addresses clinical decision support tools (UptoDate), drug info tools (Medi-Span, Facts&Comparisons), and coding tools (ProVation).
Unbound Medicine’s 5 Minute Clinical Consult app now available for iPhone format.
AMA and Elsevier co-publish medical coding texts & websites by Carol Buck.
Thomson Reuters Healthcare launches campaign to save $4B in healthcare expenses by performance improvement practices. “The company’s Save $4 Billion campaign will offer U.S. hospital CEOs an analysis that shows how their hospitals compare to industry norms and benchmarks in clinical quality, patient safety, financial performance, and operational efficiency. Thomson Reuters will meet with hospital executives to discuss their results and where they should focus improvement efforts to have the greatest impact. There is no charge for these services.”
One medical librarian’s picks for online consumer health info sites. In her opinion, most of the big portals add little to the info that can be found on MedlinePlus and WebMD.
Post by physician in small practice about the process of moving to EMRs. Outcome was positive but it took time. Key objectives they kept in mind from start to finish: Simplify how things are done Always have the right information available Make communication clear and easy Achieve the highest quality possible
At a time when interest in wellness and preventive healthcare is rising rapidly, Prevention magazine’s circulation drops 15%. Article compares trend to some general interest pubs, but Prevention should be viewed alongside other health publications.
Bob Wachter details some shortcomings of rushing toward usage of clinical decision support tools & order sets that rely on inadequately examined results.
Run-down on best choices for a PDA device for med students. Covers iPod/iPhone, Palm, and HP.
Institutional review boards (IRBs) that oversee clinical trials on human subjects are in the spotlight after lax procedures found by congressional sting operation. Tougher regulations on pharma and device companies that sponsor trials may result.
New online journal, Database, from Oxford University Press is launched. “DATABASE: the Journal of Biological Databases and Curation will be a fully open access journal from launch. In addition, it will be a condition of publication that all databases and software described in DATABASE articles are made publicly available. The journal will be online-only, providing fast access of its full content to scientists worldwide.”
Dr. Val rants about Wellsphere’s recruitment practices for adding healthcare bloggers to their community. Wellsphere is now part of HealthCentral. It does seem that these bloggers should get a share of ad revenue generated by their content.
Headlines for Mar 24-29
- Posted March 29th 2009
- Comments (0)
- by Janice
Peter Suber’s blog summarizes stories about Springer’s owners, PE companies Candover & Cinven, hiring UBS & Goldman to seek potential buyers. According to FT, they want to sell 49% of Springer. But, asset sales are also possible. Springer publishes STM & B2B books, journals & magazines, and has strong collection of medical & pharma info, including Current Medicine Group and Humana Press.
MediaPost reports on FDA views on usage of social media advertising by Pharma. “The FDA hasn’t squarely addressed the role of social media in drug advertising to date. But an agency official offered some insight on the subject in a recent interview with Mark Senak, a Fleishman Hillard executive in Washington, D.C. who separately runs the EyeonFDA blog.” Article also quotes Waterfront Media and HealthCentral execs about slow pickup in advertising by pharma on social media sites.
MedlinePlus, the consumer health database from NIH’s National Library of Medicine, partners with ADAM Corp to include ADAM’s Multimedia Encyclopedia. Interesting reversal of the typical pattern where US gov’t health info is incorporated into commercial apps. In this case, commercial health content is incorporated into gov’t resource.
Add Wellpoint to the list of insurers being sued by AMA &/or NY atty general Cuomo. Similar class actions suits have been filed against Aetna & Cigna for using the Ingenix db that led to overcharges to patients for out-of-network care.
NY Times writes about another article in upcoming NEJM about electronic medical records, which cautions about suitability of some of the EMR systems being sold and urges an open s/w platform be used to facilitate interoperability. Authors also point to the importance of looking beyond automating routine tasks to “how the technology will be used to improve clinical performance,” said Herbert S. Lin, a senior scientist the National Academy of Sciences, an advisory group to the government.
Press release on study published in NEJM online 3/25/09 that reports that only 1.5% of US hospitals use comprehensive electronic medical records systems that connect various depts, lab reports, prescription info. Link to int. with primary author/researcher included in release. Study conducted by Harvard Sch. Public Health, Mass General, and George Washington Univ; Ashish Jha of HSPH was lead author.
OptumHealth, the health & wellness division of UnitedHealth, partners with Rodale to publish “100 Smart Choices”, a book that offers health & wellness advice to consumers.
Elsevier launches Innovation Explorers, an online community of research scientists & librarians, to help involve customers in the design of products.
Google enhances search with longer snippets for longer searches and increases semantic analysis in presenting results.
David Rothman describes his experience trying to get a price quote for an information product that was promoting a 30-day free trial. Illuminates pricing practices by medical publishers that vary customer-by-customer.
BusinessWeek story on mobile clinical tools.
TechCrunch reports that Trusera, a recent entry on “health 2.0″ patient social-networking scene, will run out of money by end-of-April if it can’t raise more funds. Started by ex-Amazon exec in Seattle. Comments on post point out key problems: crowded field and lack of revenue model.
NPR’s interview with Dr. Jeffrey Siegel, founder of Medical Justice, which asks patients to sign waiver that they will not post comments on medical ratings sites. “There are dozens of such sites, but now doctors are fighting back. Dr. Jeffrey Segal, founder of Medic…”
AP article on importance of “getting it right” when spending $19B on electronic medical records investment. Emphasizes the importance of ability to transfer data between systems.
WSJ names some of the vendors that stand to benefit from HealthIT spending in stimulus bill (ARRA). Calls out eClinicalWorks, the company that has partnered with WalMart & Dell to sell EMR s/w in Sam’s Clubs.
Greenhill SAVP partners with Valhalla Partners and High Peaks Venture Partners on an $8M investment in Flat World Knowledge. Flat World, based in Nyack, NY, publishes open source textbooks and charges only for print-on-demand, audio textbooks and ind. chapter sales.
InnoCentive, a Boston-area company that offers a marketplace for buying & selling innovative solutions, partners with Nature Publishing Group to promote its marketplace to NPG’s readership.
DeepDyve (formerly Infovell), a Health Content08 Innovator, adds Steve Wozniak to its advisory board. DeepDyve released a new interface recently that is clear and simple, yet offers access to body of information not available through standard web search engines.
From press release: “The combination of Oracle and Relsys is expected to deliver the only suite of software applications that supports end-to-end drug safety processes across clinical development, post-market surveillance and patient care, and is expected to extend Oracle’s leadership in providing drug safety applications to the health sciences industry.” More on Oracle’s Health Sciences Global Business Unit, which was created last June, in the release. Berkery Noyes represented Relsys in the transaction.
Wolters Kluwer’s medical coding s/w, ProVation, is profiled by AARP with a focus on WK Health’s Clinical Solutions group in Minneapolis (which now employs 130).
Describes benefits/costs of medical tourism, ie, traveling abroad for medical care.
John Halamka,MD, offers definitions and descriptions of terms used in healthIT, along with some commentary on adoption rates and potential for healthIT. Worth a read.
Collection of pharmacists-related associations collaborate to make sure that pharmacists’ voices are heard in the health care reform debate.
Article highlights rapid adoption of the iPhone as a medical device to communicate info to patients. Further evidence to support my commentary last week that interfaces,design & convenience of electronic medical devices needs to be improved.
From Press Release: “The new web site will leverage WebMD’s proven technology and expertise in consumer health information services and will include original health news and features, wellness and condition centers and guides, interactive tools and applications, including WebMD’s proprietary symptom checker, health trackers, calculators and health and wellness videos. Boots UK plans to market the new health portal through in-store promotion, links on their current e-commerce site, outreach to their loyal group of affinity customers and promotion in their health and beauty magazine. The new service is planned to launch in the second half of 2009. WebMD and Boots UK will jointly share in the development costs and benefits of this new site. WebMD will directly manage the sales and revenue operation for the new site.”
Discusses business-rule management systems (BRMS) usage for clinicians. BRMS is really just another acronym for clinical decision support tools that rely healthcare data analytics. Article points out that such systems are only as good as the quality of the rules that are applied in the s/w–and I would add only as good as the quality (and quantity) of the data in the system that is mined to determine the recommendations. Article also refers to what has been called “alert fatigue”; that is, if too many warnings are flashed each time, and most are very rudimentary, clinicians will start ignoring the warnings about potential adverse effects, etc.
MedAptus, a provider of “charge capture” technologies for medical billing receives new funding from existing investors.
Press release from HHS describing $268M in ARRA (Stimulus bill) funds available to hospitals to treat most vulnerable patients.
Articles discusses need for data collection and analysis in determining effectiveness of wellness programs.
Headlines for Mar 16-23
- Posted March 23rd 2009
- Comments (0)
- by Janice
Notes from Conference Board’s event on Employee Health in San Diego, Mar 09. See additional related posts via this post. Addressess incentives for healthy behavior.
Dr. David Blumental named national coordinator for Health IT. Blumenthal, a former Harvard Med School professor, was senior advisor to Obama during campaign, and has advised Ted Kennedy. Most recently, Blumenthal was director of Institute for Health Policy at Mass General/Partners HealthCare.
Press release includes link to bios of council members. “Recovery Act Allocates $1.1 Billion for Comparative Effectiveness Research The U.S. Department of Health and Human Services today announced the members of the Federal Coordinating Council for Comparative Effectiveness Research. Authorized by the American Recovery and Reinvestment Act (ARRA), the new council will help coordinate research and guide investments in comparative effectiveness research funded by the Recovery Act.”
Link to Wolters Kluwer’s 2008 annual report site.
A biting indictment of current state EMRs for failing to consider workflow needs of clinicians by MedInformaticsMD on Health Care Renewal blog. Post includes a reading list of articles that offer reviews of various healthIT systems–mostly reviews that point out inadequacies of EMR systems to-date.
John Halamka, David Bates, and Blackford Middleton (from BIDMC & Partners HealthCare) respond to Groopman and Hartzband’s WSJ article on lack of effectiveness of implementing electronic medical records.
Article describes benefits of “information therapy”, which is defined as some combination of patient education and wellness programs, at Kaiser and other closed-system medical groups. Key point is that electronic health records and personal health records are far more useful (and will likely be adopted at faster rates) if information can be integrated and customized for each constituent group. More in this week’s lead article.
InstaMed, based in Philadelphia & Newport Beach, CA, announces further financing from Osage and Ashby. InstaMed is a leading provider of healthcare billing services and payment processing.
Generation Health, based in NJ, plans to expand Boston area presence. Generation is developing a PBM-like service for genetic testing.
3i invests 65M Euros in Labco, one of the largest medical diagnostic groups in Europe.
Reference to recent study that analyzes impact of incentives in ARRA (Stimulus Bill) on e-prescribing. Estimates usage will double in 5 years and will reduce adverse drug events.
Sekisui to pay “several billion yen” for Am. Diagnostica, which makes diagnostic drugs for hemophilia. Sekisui makes testing equip. for diagnosing thrombosis and measuring cholesterol.
Glaxo seeks to diversify into vaccines and consumer businesses in order to hedge against poor outlook for blockbuster drug development.
KLAS report describes why eClinicalWorks’ EMR software has been gaining traction faster than competitors. Price and appealing interface are key factors.
The Stimulus Bill (ARRA) raises issue of whether PHR providers (GoogleHealth and Microsoft HealthVault, in particular) need to sign business associate agreements with providers before they exchange data (to be consistent with HIPAA requirements which haven’t been applied specifically to PHR vendors before). Story points out that Mayo and Cleveland Clinic have yet to transfer any data to HealthVault and GoogleHealth respectively, even though they announced that they were working together over a year ago.
Missed this last month. Mike Cunnion, fmly of Health Talk, joins Medizine as President (Feb. 2009). Medizine is owned by VSS.
Health Content Needs to Drive IT Investment
- Posted March 20th 2009
- Comment (1)
- by Janice
There is plenty of buzz about the $19.2B in stimulus money earmarked for health IT, some of it positive (see here, too) and much of it negative. The positives focus on the improved efficiency of electronic medical records (EMRs) that will improve outcomes and minimize medical errors and adverse effects. The negatives focus on poor design of existing EMR technology and the reluctance of physicians to adopt medical records systems that require substantial investments in time, money, and behavior change.
Research Customer Workflow
Both sides agree that digitizing records and automating information flows is a good idea, but the skeptics emphatically insist that the workflow of the intended users be studied before the interfaces, navigation systems, and methods for data entry are determined. Simply stated, health IT vendors need to involve physicians more directly in the design of EMR systems.
Incorporate Content to Drive Adoption
Expert opinions from both sides of the argument touch on-but don’t clearly articulate-the importance of incorporating health content into the development of health IT systems; and that the content has to include external as well as internal data in order to be “mission critical.” Content-driven systems such as Epocrates and UptoDate demonstrate that doctors will flock to digital systems that offer useful information on an easy-to-use and convenient platform.
We at Health Content Advisors have been involved in transforming print-based content to online information tools for over 20 years and have been living by the mantra that technology + content = “data that can do stuff”. For instance, we have witnessed the productivity-enhancing benefits of transforming a print buyers guide into an online e-commerce site that not only helps buyers find the right goods and services, but also includes tools that compress the sales cycle. So we understand that digital information systems in the health industry will lead to better health outcomes and more efficient delivery of healthcare. But it will happen more quickly if physicians and content providers are more directly involved in design and implementation of EMR systems, and if content drives the technology.
Headlines for October 31-Nov 3
- Posted November 3rd 2008
- Comments (0)
- by Janice
WK Health’s Healthcare Analytics group’s Source and PHAST databases contracted to FDA for prescription usage analysis.
Hewlett Foundation is funding a study/paper on Health Open Education Resources (OER).
Brief piece in PaidContent.org on Harvard’s decision to back out of Google Book scanning project after recent settlement. Includes link to Crimson article.
MD Consult launches German version, DoctorConsult.
An AHC article looks at cost/benefit of EMRs for ambulatory surgery centers, based on survey by WK Health.
Robert Becker moves from CEO of Law & Business to CEO, Wolters Kluwer Health. It will be interesting to see if Becker’s success in Legal/Accounting will translate to the healthcare industry.
HAVAS working with WebMD’s Medscape to market “Virtual Convention Booth” to substitute for onsite clinical conferences.
Another voice on what health2.0 is and how it is hyped. Our view: like Web 2.0, Health 2.0 is overhyped, since convergence of IT and health information/healthcare workflow is an evolutionary process, not a step function.
“Since its launch, 23andMe has made significant strides towards achieving its goal of becoming the world’s most trusted source of genetic information. The Personal Genome Service has greatly expanded - from having detailed genetic associations for 13 health conditions and inherited traits last November to its current offering of over 90 conditions and traits. In an effort to democratize genetics, 23andMe has decreased the price of its service from $999 to $399 and also has launched community features that allow customers to connect to others with similar genetic make-ups or interests and learn about the latest research.” 23andMe,co-founded by Anne Wojcicki, who is now married to Google co-founder Sergey Brin.
Time Mag reports on NEJM article about results of the HCAHPS survey (part of the CAHPS program within CMS that requires patient satisfaction surveys be tabulated and made available online). Note, HCAHPS results are available at www.hospitalcompare.hhs.gov. Kaiser recently reported that only 6% of consumers know of its existance. Articles in pubs like Time will help!
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