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I’ll be honest. I was sort of conferenced out when I was heading to Park City, UT for the next Information Therapy Conference. I figure these conferences are only as valuable as the people I meet and the extent to which the information I learn impacts current or future behavior. “Conference Burn Out” is generally not a great foundation for conference-inspired behavior change!

Well, I’m actually really glad I went. This conference is sort of like the little gem in the industry in my opinion: it draws a lot of very forward-thinking people from some very well-known institutions and some very cutting-edge ideas are discussed.

For the uninitiated, here’s the definition of Information Therapy:

Information Therapy (n.)
Prescribing the right information at the right time to a patient so that the patient is elevated from “passive receipient of care” to ” educated and empowered active self-monitor of the care being received.”

Basically, it just means that a diabetic patient 30 years ago may have blindly gotten their A1C Test just because their doctor told them to. But his modern-day counterpart was educated by his doctor about what the A1C Test really is, why it’s so important, and what the different ranges mean. In other words, the patient is now empowered to monitor what’s happening to him in his healthcare experience.

I wasn’t too sold on the concept when I first started going to this conference a few years ago but today I take a long, savory drink of this particular Kool-Aid. It’s really game-changing stuff.

I think what’s most interesting is that it’s something very concrete, so people have used it to launch other ideas about what it means to be a patient in the “new” healthcare paradigm. Basically, there’s a growing trend toward people seeing the patient as a partner in the care process, someone who has a proactive care plan and works in partnership with his doctor to achieve his personal goals. It means the patients is educated enough to know at least generally why he’s getting the tests or treatments that he is.

It means that it’s actually possible that the patient might know more than the doctor does about her particular illness because she obsessively researched it prior to her visit. Dr. Paul Wallace, Chief Medical Officer at Kaiser Permanente and a former practicing oncologist, humbly admitted that one his more enterprising patients frankly knew more about her ovarian cancer than he did.

This isn’t a failure on his part; there’s simply too much information on every different type of cancer for him to be the world’s expert. Rather, it’s an indicator that we live in a world overflowing with more information than anyone can reasonably process. That means that the days of the doctors as the untouchable lecturer of all relevant knowledge are sort of gone, and the days of the doctor as highly-educated consultant who works together with the patient to make the best decisions are beginning to come here.

It’s funny because I sat next to a girl who was developing a wellness program for her Care Management company (for the uninitiated, Care Management Companies are hired by insurance companies to proactively call members who suffer from chronic conditions and help increase compliance to keep costs down). Anyways, I cynically told her that by the end of the conference we would have yet another “we know the healthcare system is broken and if we just close our eyes and squeeze our fists we can all change it.”

I was actually proven wrong, though. The seeds of change are already afoot. Here are a few examples from the conference:

This is a paradigm-changing practice started by Dr. Rushika Fernandopulle, who had possibly the most difficult-to-spell name at the entire conference. Dr. Fernandopulle studied healthcare policy at Harvard and utlimately decided the current system delivers systematically “crappy” care (his word; I like it). So he created a new model of primary care, which is supported by a different kind of labor setup and a different kind of business model.

Renaissance Health charges its patients $20 - $40/month and in exchange the patient goes from “episodic care” (i.e. visit doctor when I get sick) to having a proactive medical partner who works together to manage your current health and prevent future illness.

The sense of realism is what struck me most. Dr. F talked about a patient that had 5 co-morbidities. They determined that for her to do everything that was “optimal” for each condition would have required around 3 hours per day. So instead of unrealistically saying “go do these things” and then forgetting about her, they worked together to create a “care strategy”, they prioritized the list, and then they focused on the 1 or 2 issues that mattered most to her.

Dr. F also talked about how he wanted to change the paradigm of “protect the doctor from the patient at all costs” to “strategically avail the doctor to the patient in conjunction with supporting resources.” He introduced positions in his practice like “health educator” that simply don’t exist in most other practices. Sadly, Dr. F complained, the IT they wanted was more optimized to help the doctor code for the highest possible reimbursement rather than communicate proactively with the patient.

I thought it was a phenomenal model, and I have so much respect for Dr. F for “doing” instead of just talking. I hope we’ll get the chance to work together.

These guys actually presented at last year’s conference, but I ran into their CEO, Jeffrey Greene and we chatted a bit.  I obviously can’t share the details of our conversation, but just based off their public demo last year and other “winds” I’ve heard since, here’s another potential game-changer.

MedEnctive is a pay-for-performance company (for the uninitiated, that means they help setup incentive programs so that doctors who provide higher quality care are rewarded by earning more money), except that they set up a very clever incentive scheme: the patient is incentivized financially to engage the doctor (the patient gets 30 bucks if he can get the doctor to give him an information prescription) and the doctor can earn up to 10% - 15% more income per year if he gives the patient an information prescription and gets high satisfaction ratings from the patient.

The results from their first pilot were IMPRESSIVE.  Like, I’m talking 30% overall cost savings in the system.  That’s crazy!  Crazy good, that is.

Finally, we have another game changer.  This was the first conference I’d been to since Microsoft announced their HealthVault product last week, and their was a palpable excitement in the air.  Essentially, MS has setup a Personal Health Record (that’s a medical record that patients can access and update) and set up an open, free interface for accessing it.

That’s huge.  It means that Omedix systems can talk with some random EMR company we’ve never even heard of as long as both of us talk with Microsoft Healthvault.  Here again we have the seeds of change being sowed.

Overall, I guess you could say I’m almost kind of euphoric.  I feel like American Healthcare — in all its big, clumsy, excessively wasteful and inefficient glory — is finally beginning to lumber around to a better system.  For the first time, I actually feel like there are things I can do as an entreprneur that are simultaneously fun, good for America, and profitable.  Finally, capitalism works the way it’s supposed to.

It’s an exciting time in our industry…as much as I’m suffering from conference burnout, I can’t wait to go to the next one!

I’m still here in San Francisco, and yesterday (Thu, Sep 20) was the Health 2.0 Conference. The idea behind the conference was to see how the latest & greatest on the Web (”Web 2.0″) applies to Healthcare. Does it get any more relevant for what we do?

Most conferences are better for the people you meet than what you learn in the sessions. I thought the panels here were actually quite interesting (except for the insurance company one which was extremely boring and overly “health 1.0″), but the attendee list here was incredible: CEO of WebMD, Former CCHIT Head David Brailer, CEO of AllScripts, the list goes on.

During the boring insurance company panel I was joking with the woman next to me that I think someone forgot to tell them it’s a Health *Two*-point-oh conference, she laughed, we introduced ourselves and it turns out she was the head of Internet Services for all of Kaiser. Cool!

Anyways, here are what I saw as some of the key trends:

Key Trend #1 — Social Networks for Patients
Seeing some of the social networks for patients was pretty interesting. Personally, I felt the two best were:

www.DailyStrength.org — This was an online community built around different disease groups. Its core concept is basically “social network for patients” but the way it was implemented was clever and fun (I give you “Hugs Received Today”).

www.PatientsLikeMe.com — This concept was just amazing. The business model is another story, but the actual user experience is incredible. Hopefully you can see in the screenshot below, each patient joins a “disease community” (the example here is Parkinson’s) and reports their history of medication usage, symptoms, weight, etc. The brilliance is in how the data is visually shown. Trends over time and relationships between, say, medications and symptoms are clearly visible. Your data can also be compared against that of other patients. Although it’s limited to chronic diseases and moreoever to just a few diseases, the potential to connect patients throughout the country (world?) is really amazing.

Key Trend #2 — Social Networks for Providers
There was also a panel on these. Sermo.com is basically the leader in terms of both visibility and number of physicians registered. Within3 was also interesting, though Sermo appears to be focused around connecting physicians to each other whereas Within3 seems to center around connecting physicians to other healthcare researchers or industry members.

Key Trend #3 — Everyone Remains Pissed Off at the Healthcare System but No One in Incentivized to Do Anything About It

Okay, so this is me ranting, but it’s just getting so frustrating. Even at a conference like this where discussions were all about the next generation of healthcare, the “the system is broken and we KNOW we can fix it someday” attitude was still quite prominent.

I agree the system’s broken — defensive medicine, perverse incentives for doctors, rising premiums, unacceptably high numbers of hospital errors, 1 out of every 6 Americans is uninsured, etc. — but the problem is after a conference like this I go back to my world and think about how I can do a better job of helping our physician practice clients use the Web to become a better practice. I help them; that helps grow our business; but does the healthcare system itself change? Sadly, I don’t think so.

It’s like my (cardiologist) Dad says: “Some things are bigger than you.” It’s a defeatist statement from someone I know to be the anti-defeatist, but it’s kind of true.

Key Trend #4 — Patients Will Soon be Presented with “Find a Doctor” Services

There are a few startups I saw that aim to help patients find doctors and dentists the way they find what movie theater they want to go to:

www.xoova.com — Patients can search their zip code for a doc and learn about which one they like the best.

www.vimo.com — Vimo is the same concept as xoova, at least for finding a doctor. But Vimo is cool because they focus mostly on letting you shop for health insurance in a nifty online “apples to apples comparison” kind of way. Simple model, simple business, easy to make successful. These are my favorite kinds of business models.

Closing Thoughts

My first thought is that this is a reallly long blog post. I can’t believe you’re still reading this (j/k…I know it’s interesting stuff). My second thought is perhaps (*perhaps*) more profound:

It really is clear healthcare is undergoing a quiet revolution. Maybe I’m being ego-centric, but I think companies in our space have some of the greatest potential to effect change out of everyone. I mean, we help the doctors do cool things online that help them appeal to patients and become more efficient, and how do we earn revenue? The practices pay us money direct because we offer valuable services to them.

Case in point: Earlier this morning, I spoke with a wonderful client of ours who runs a 2-physician OB/GYN practice and she shared with me how they get now upwards of 5 online appointment requests PER DAY and how their website has really altered the dynamic of their practice — they get patients from search engines, patients read information about their condition before and after their visit, etc.

What if when we equip this client with our Patient Portal we linked them into “PatientsLikeMe” via some kind of cool partnership? What if we made sure that patients searching on xooma or vimo are guaranteed to find our clients for relevant searches? What if our doctors logging in get automatic access to sermo or within3?

The future is exciting and unknown. You can probably see now why I love my job so much. ) Thanks for reading!

Well, it’s been about one year, so it’s time to gear up for the annual BONES Conference! To the uninitiated, BONES is the national society for Orthopedic Practice Managers and is one of the major shows of the year for us. About 500 practice managers show up, and an army of vendors readies their booths, free pens, and most physically attractive employees to sell-sell-sell like they’ve never sold before.

I’ll be honest. I love what I do, and I really love meeting clients/attendees, but occasionally you run into the attendees who equate the word “vendor” with “scum of the earth” and treat you as good for nothing but supplying free candies and free contests. I understand that giving away fun free stuff is just plain part of the game, but when people approach you solely in the context of freeloading, it’s just demoralizing on some level.

My conference pet peeves aside, there are quite a few interesting realizations to be had about conferences and I’ve gone to enough now as the exhibitor that I feel at least somewhat authoritative writing this. So here goes!

Observation #1: Managing the “Surge” Effect
Unlike normal day-to-day operations where the Law of Large Numbers safely ensures that a relatively manageable stream of leads will come in, a conference is a three-day massive surge of exposure. Unless your company is going to conferences every week (we don’t…at least not yet), I would estimate that at BONES we will probably generate 10 times the normal demand we receive for our services. Ten times!

That sounds great when I tell that to my parents, but the problem is I get back to the office later that week and I have a stack of business cards so high the sun no longer shines in my office. I try to delegate some of the contacts but in the end it’s just…overwhelming. It’s a good problem to have, and maybe I should really do a better of job building in scalability to our processes, but, hey it’s challenging!

Observation #2: Fallacy of Composition
Of all the fallacies taught in a basic economics class, my most favorite of all is the much-adored Fallacy of Composition. It’s just a fancy way of saying that if you see a company do awesome at a single conference, it doesn’t say anything about that company overall, but that people often make the fallacy of making a lot of other conclusions anyway.

At last year’s conference, we had a pretty awesome booth location along with a pretty awesome booth. All in all, we may have had one of the best locations of the conference. Naturally, we had GREAT traffic while some of our competitors were tucked away, hidden in the tenements of the exhibitor hall where few attendees dared roam lest they be attacked by roving gangs of hungry wolves. Well, something like that at least.

But my point is that they saw us get this huge amount of traffic and suddenly it created this adversarial thing that wasn’t quite there before. It was weird, and I was thinking that the only new information they got about us was “Omedix do good at conference.” On the flipside, I saw gynormous companies like Canon have a total of two people stop by their booth the entire conference.

It’s not that there’s no correlation between heavy conference traffic and company success, but it just doesn’t really tell you much except, well, how the company did at that conference.

Observation #3: Forging Personal Relationships
Hands down the best thing you get at a conference is the opportunity to meet your clients in person and become a real person instead of some anonymous phone voice. I happen to really like people in general and I think it’s fun to talk to people, so I think I do well in this kind of setting.

Observation #4: Building Your Brand
We also recently exhibited at the AzMGMA Conference and one vendor admitted to me that his company once decided not to exhibit at a conference at which they’d exhibited for four years straight. He said everyone then thought they were going out of business, just because they didn’t show up. That got me really worried, actually. In a way, it almost makes it better to never exhibit than to exhibit just once. In either case, I guess the reality is we’re BONES Exhibitors for life now, or else people will wonder why we left!

Observation #5: Vendor Socializing
The other funny thing about conferences it the social dynamic among the vendors. Everyone there is basically in the same boat: away from home and nothing to do but the conference itself. There’s quite a bit of downtime as a vendor, particularly during non-exhibiting hours, and so you socialize and meet the other vendors. They’re usually sales people and therefore fairly outgoing and interesting. I actually kind of like this feature of conferences.

Summing Up
All in all, there’s no question it’s a total pain to drag the booth, organize the furniture and carpet, pay $500/day for Internet, print fliers, etc. But, once it’s all done, it’s actually kind of cool to rep your company on a national level and do some travelling you might not otherwise get to do. Check back here for some updates I’ll post either at the conference itself or when I get back. Wish us luck!

My job is basically to help doctors and medical practice use the Internet effectively.  I help them attract patients with their website, use patient education on their website to make their lives easier, etc.

In a lot of my meetings lately, it keeps coming up that it would be really cool if the doctor were interested in blogging on their website.  Here’s how it would work:

Either the doctor writes quick blogs posts written for patients.  They’d have information on what’s timely for their patients, new ideas in preventive care, new relevations in the literature, etc.  Or the doctor writes a sort of “online grand rounds” where he reviews interesting cases online with the goal of educating referring physicians.

The thing is, patients would absolutely LOVE this.  I kmow I’d certainly love it.  It’d be awesome to go to my doctor’s website, read his latest blog entry on say, eating healthy, or the importance of low sodium, and then to see him/her a few weeks later and be able to discuss what he had written about.  How cool would that be?

It would also serve an important role in helping me choose a doctor. I think the same goes for referring physicians.  Suppose you’re a PCP and you go online to read Dr. X’s cardiology blog where he talks about a common misconception PCPs often have when requesting cardiology consults.  Wouldn’t it be helpful for the PCP to read that?  Wouldn’t it make him that much more likely to refer to that doctor?

I don’t have the data (or raw anecdote) to back it up, but I’m convinced a doctor’s blog would make a big difference.

The thing is, almost every doctor I talk to seems, well, not to be so into it.  I met with a group of wonderful, passionate, very well-trained hematologist-oncologists today and they were really passionate about providing great care, but the idea of writing a blog entry represented “yet another thing at the end of the day” and it seemed like one too many.

I can undertand that position, but I think in 5 years (if not sooner) most doctors will be expected to blog, and there may even be specialized “medical blogging” software designed to make the process more efficient.  Patients will then go to a doc’s website not just to find the office location, read the patient education, or check out the doc’s profile.  The patient will go to read the doc’s thoughts on the best way to treat atrial fibrillation.

Docs are already talking a LOT at places like Sermo.  When will they start reaching out online to patients?

I read a fascinating article in Wired Magazine this month.  It talks about how back in the day, a company would issue a crusty old press release to announce news that it wanted its clients (and maybe others) to hear — new service announced, new revenue milestone reached, new partnership formed, whatever.

But today, as far as I’m concerned, the press release is basically dead.  It’s been replaced by the blogosphere.  Why read the “official” press release from a company when you can read the “real deal” behind the scenes as written about by bloggers who have no vested interest in the company?  Or as written about by an individuals within the company versus carefully crafted by a PR team?  Don’t we place infinitely more value on the opinion of an impartial third-party than the official company line which is obviously going to be biased?

I think the simple answer to all these questions is “Yes.  Transparency is pretty darn attractive in a company.”

So, as President and Founder of Omedix, I’ve made an executive decision: Omedix will become a transparent company.  Not a RADICALLY transparent company (a term bandied about in the Wired article) — after all, I don’t plan on putting the personal lives of myself or any of my colleagues out for public consumptions, but we’ll be a REASONABLY transparent company.

What does that mean, exactly?  It means that I’ll make a concerted effort to write a blog post here at least every eight weeks or so.  It means that I’ll cover pretty much any significant event — whether it’s positive OR negative.  It means that the unavoidable “What is Omedix really like?” uncertainy experienced by every single client who’s considering working with us just went down a whole bunch of notches because when they Google “Omedix” they’ll be led straight to this blog where we’re, well, transparent

Disclaimers Disclaimers Disclaimers  

Okay, so the realities of business do requires us to impose some limitations on this.  For starters, anything told to anyone at Omedix in confidence (whether by a client or business partner) will never be posted on here.  No one will ever have to worry that by talking with me about something sensitive (or simply not appropriate to be blogged about) that they’d see it written about online later that day.  That would be betraying people’s trust, which takes years to earn and minutes to lose.

Second, I would estimate that no one will follow this blog more closely than our competitors (I actually have a funny story about that phenomenon; be sure to ask me sometime).  Anyway, that means that as much as I’m excited about certain initiatives, I have to be a little careful about what I write here. 

That’s pretty much it.  I figure we’ll make the rest up as we go along, being sure to place trust of our clients and business partners as our first prioirty.

Okay, So Let’s Get Started!

With all the formalities out of the way, let’s get going already!

Transparency Topic #1: Operations

One of the area we’ve been working on quite a bit lately is operations — how fast can we pump out a great-looking, well-built website?  Where can we cut the fat from our process?  Omedix building websites faster is a win for everyone since clients wants their sites ASAP and we can’t bill for the full site until it’s done.

One of the things I’ve been realizing lately is that we have to calibrate for how much the client wants to be involved. At one end of the spectrum, we have the client who basically wants us to just do our job and deliver the site.  The less interaction, the fewer meetings, the better.  For this client, we make a lot of assumptions, get deliverables to the point where they’re in a position to be evaluated and approved, and then move on.

At the other end, we have the client who wants to be involved in EVERYTHING.  We actually haven’t had too many of those, but these clients like to get into the nitty-gritty of how we do things, and really dive into our work at the process level.  To be hones, it’s a more time-consuming process than the “just tell me what I need to do and let’s launch the site” client, but I can still respect that they’re passionate about their site (which is a good thing). 

I suppose this is no magical revelation that embodies the spirit of the pioneering transparency in Omedix, but it’s a start, and I think I”ll get the hang of this after a few posts.

Incidentally, if there’s something you’d like to see me write about, you can contact me through the Omedix.com website.  Just click “Contact Us” and submit an online inquiry, and ask that it be routed to me.

Thanks for reading!  Most sincerely,

Josh

It’s interesting to see how society adopts new ideas and services. Let’s take a look at Search Engine Marketing. This is such a no-brainer promotional opportunity for a medical practice that targets the general public it’s almost laughable. A comparison is in order:

	THE YELLOW PAGES What You Get: Assuming your purchase, say, a quarter-page ad, you get, well, a quarter-page Yellow Pages ad, maybe in color, located in the section that makes sense for your practice What It Costs: For the above-described ad, roughtly $7,500 - $10,000/year (as I understand it) Value Proposition: You want people to find you when they need your services, and people find things using the Yellow Pages…well, at least they used to
	SEARCH ENGINE MARKETING What You Get: When people search for keywords that suggest they may be a good candidate for your services, your website shows up in the results What It Costs: Depends on if people actually click on your ad. If no one ever clicked on your ad, you literally pay $0. If 1,000 people clicked on your and and you bid $0.25/click, you pay $250. Assuming those rates hold for 12 months, you’d pay $3,000 for 12,000 visitors to your website you wouldn’t have otherwise gotten. Value Proposition: People who need your services reveal themselves via their search engine queries and you pay money to “advertise” to those searchers, except that you only pay when they actually view your site

RUNNING THE NUMBERS

So, you can pay about 1/4 of what you’d pay on the Yellow Pages for maybe 60 times the amount of traffic? Let’s translate that into numbers.

Let’s say I’m a Primary Care Physician and one new patient is worth, on average, $350 to me (that’s a very conservative estimate). Let’s say 50% of the visitors to my website are prospective patients. Let’s say 5% of all prospective patients who visit the site actually sign up with me. Let’s say I receive 12,000 visitors a year.
That means that for my $3,000 investment in Google I get back:

[$350 per Patient]*[12,000 Site Visitors]*[50% are prospective patients]*[5% enlist with me] = $105,000 in additional revenue

And if we figure out the Return-on-Investment on that:

ROI = $105,000 - $3,000 / $3,000 = 3400%

WOW. Can you imagine, a 3400% return?

BUT ONLY A MINORITY OF PRACTICES DO SEARCH ENGINE MARKETING

And yet, every single medical practice in existence goes with the Yellow Pages because “that’s the thing to do” while only a handfull of progressive physicians does Search Engine Marketing. That’s craziness!

There are some nuances to this. For example, how do you make sure you really are converting 2.5% of your visitors? How do you measure that? What keywords do you target? So, it’s a no-brainer investment (in my opinion), but not necessarily a no-brainer operation. Anyways, it’s just interesting to me when I see practices lay down thousands of dollars for brochures or sponsorhips, when that same money could be used so effective with Search Engine Marketing.

I’m here in Park City, UT for the sixth annual Information Therapy Conference. For the uninitiated, Information Therapy is simply the idea that Patient Education can be as “therapeutic” as medicine itself when exactly the right information is delivered at precisely the right time.

For example, one physician here at the conference said that after she delivers bad news to a patient, she figures the patient retains maybe 25% of what she tells them if that. Information Therapy is about recognizing that this patient is at the step “just diagnosed with Heart Failure” and then making sure that patient receives an article, watches a video, or is otherwise educated about “You’ve been diagnosed with Heart Failure. What now?”.

Conferences like these are interesting because you meet so many different people from so many different areas of healthcare each tackling a similar problem from a vastly different angle.

For example, I’ve seen Patient Portals here from three different companies each selling essentially the same core Patient Portal to three different markets. If it happened that a patient’s insurance company purchased the Trizetto portal, his hospital purchased the MedSeek portal, and his doctor purchased the Omedix portal, he would have three different ways of accessing almost the exact same thing!

I’ve seen an incredible demonstration from MedEncentive on Pay-for-Performance. Traditionally, I haven’t been blown away by Pay-for-Performance, but they’ve set up their program in such a way that patients are actually financially incentivized toward compliance, doctors are financially incentivized to follow Evidence-Based Medicine, and both parties are aware that their actual performance will be rated by the other party (Matthew Holt does a much better job of explaining this on The Healthcare Blog).

One theme that seems to come up every single year at the Ix Conference (hidden though it may be) is that medicine practiced in an Integrated Health Sytem (like Kaiser, Group Health, Cleveland Clinic, etc.) has some serious advantages and incentive alignments versus the standard “private practice” model. Seeing the EMR and Patient Portal that the Cleveland Clinic has in place makes me teary-eyed, and another doc here admitted it makes him “drool with envy.” So maybe part of our job is to take the magnificence of a Patient Portal / Patient Education Infrastructure as seen in an Integrated Health System and make it available to a private medical practice? Or at least to adapt it to better fit the needs of that market, but still enable them to achieve that nirvana?

Other interesting trivia at the conference:

• What billion-dollar healthcare industry are most doctors not even aware of? Disease management. Crazy stuff.
• Healthwise is starting to get very sophisticated with its Patient Education. They are actually able to now generate patient education content specifically for the moment in time when a patient has been diagnosed with asthma but has not demonstrated compliance. WOW.

And finally, I’m starting to realize just how a big of a deal patient education can be for patients. In fact the phrase “Patient Education” doesn’t event really do the concept justice. Information Therapy on the other hand is huge. When patients are empowered and encouraged to learn about their own condition, they do learn about it. And when they learn about it, they are actually able to monitor the care they receive, to interact with their doctor in a more elevated and more efficient manner, and they are so much happier because they don’t just blindly meander through the healthcare system; they actively navigate it.

The trick is distilling all of that down to a concrete value proposition for a standalone medical practice. Is it enough to say “We offer patient education.”? Is it enough to just encourage patients to look at it and leave it at that? I don’t think so. I think the graph of Patient Education Utility looks like this:

In other words, you don’t get a whole lot out of the Patient Education if it’s just there, but if you really use it, integrate it, engage with your patients, etc. it can make a huge difference.

More thoughts to come down the line!

Earlier this week I met with a professional HIPAA consultant. The purpose of the meeting was to review our products & services and make sure that everything we’re doing (and want to do) is HIPAA-compliant.

My job requires that I have at least a basic understanding of the different requirements of being “HIPAA-compliant” but this was an opportunity to get real confidence about exactly what has to be done to slap the “HIPAA-compliant” label on our services. What’s amazing to me is that it’s not that hard to officially list out what needs to be done to be HIPAA-compliant, but the government has done a terrible job of making it clear.

After many consulting hours and questions, I can summarize all the complexity of HIPAA as follows. Oh, and this list is for commentary purposes only; I very well may be missing information here. That having been said, here we go:

(1) HIPAA really stands for Health Insurance Portability and Accountability Act and has two “Titles”. When everyone thinks of HIPAA, they really only think of Title II: Administrative Simplification

(2) “Title II: Administrative Simplication” gave rise to five “rules”, only two of which most of us have to worry about — the Privacy Rules and the Security Rules

(3) The Privacy Rules are handled by the Office for Civil Rights within the Department of Health and Human Services and are officially outlined one-by-one here. The only relevants parts for a practice appear to be Part 160, Subpart C (talks about how you might get audited) and Part 164, Subpart E (talks about what you have to do and what patients’ rights are).

(4) The Security Rules are handled by the Centers for Medicare and Medicaid Services (CMS) within the Department of Helath and Human Services. Those rules are officially outlined here. There is a huge amount of text that doesn’t apply to most people, but the good stuff is in Part 164 and is broken down into Physical Safeguards, Administrative Safeguards, and Technical Safeguards.

(5) The rules are very open-ended, saying things like data should be encrypted but leaving open-ended as to which encryption algorithm you use. That means that being “HIPAA-Compliant” is not a certified stamp you earn when you pass a rigorous inspections. Rather, it is a self-assigned description that your organization thinks that it’s made a reasonable best effort to comply with HIPAA. In other words, “HIPAA-Compliant” really means, “we took a look at HIPAA and did the best we could.”

(6) And finally, there are a bunch of non-official templated HIPAA contracts or agreements that are floating around — Notice of Privacy Practices, Privacy Policy, Business Associates’ Agreement. These agreements aren’t official, just based on the stuff above.

And well, that’s it! As I understand it, that is the entirety of the complexity of HIPAA as it relates to an ambulatory practice and by extension a healthcare IT vendor. In my opinion, the government has done such a terrible job of making that clear. I could take two days and set up a website called “The Official HIPAA Resource Center” and leave out things no one cares about like legislation that was proposed and rejected. Because no one has setup a simple-to-use resource center, an entire industry of HIPAA consulting exists that capitalizes on people’s fear.

The reality of HIPAA is also that it was drafted not by clinicians, but by legislators who consulted experts on healthcare. So there is a ton of stuff in there that is a total pain to do. And for Healthcare IT vendors like us? We get a huge amount of latitude as to how we choose to implement HIPAA and apparently “HIPAA-compliant” varies quite a bit.

So, those are my thoughts on HIPAA. Patients should absolutely have privacy and security with their medical records, but the implementation of how that’s legislated leaves quite a bit to be desired. For someone not in the industry, this article must have been incredibly boring. But for the healthcare people, you probably share my frustration with this.

I just finished speaking with a researcher doing a report on the market for the different services we sell, and it instantly became clear to me how problematic these reports are.

When I worked for GE Healthcare (at the time called “GE Medical”) the marketing department would have a fun time disparaging the expensive and ultimately totally inaccurate reports they received on the various markets.  What was amusing was that these reports would estimate the total market size, but sometimes that size would be lower than GE’s sales alone!

I didn’t have a sense at the time of why these reports were so bad, but now I do.  Let me count the ways:

(1) Zero Incentive to Contribute Good Information
So, I was asked questions like “what do you think will drive the market in the future?” or “what do you think practices will be looking for most when selecting this product type?”.  I certainly have my thoughts on that, but why would I want to effectively publish my strategic thinking by revealing it to a researcher?  What benefits do I gain from doing that?  If anything, I expressly do NOT want this information published because it’s potentially helpful to competiting companies. 

(2) A Strange Expectation that My Time is Worth $0/Hour
Maybe this falls under the incentives issue, but when I asked about how I was being compensated for my (presumably valuable) time I was told that I could receive a free preview of the report and that sales people would then follow up with me to see if I was interested in purchasing the report.  Huh? 

(3) What benefits do I receive from participating?
Again, this could fall under the incentives issue, but, honestly, what benefit do I receive by participating?  The only benefit I did see was that I get to ask the researcher my own questions about the market since he’s been speaking with everyone, but don’t these issues apply to them as well, so do I really trust the information?

At the end of the report’s development cycle, it will be sold for somewhere in the neighborhood of $15,000 to medical device companies, pharma companies, private equity groups, and the like, and will serve as the basis for investment decisions (I suppose) in various companies.  But it’s whacky information…so…is it even a net positive influence (versus a net negative influence)?

We’ll see what happens when I get my free preview.

I spoke earlier today with a large multi-doc specialty group and the physician described their current website as “vestigial.”  Although I was aware of the meaning of the word, his comment takes on added humor and depth when juxtaposed to the dictionary definition:

ves·tig·i·al (v-stj-l, -stjl)
adj.

1. Pertaining to structures or organs that were well developed in an organism’s ancestors but have become rudimentary or degenerate during the course of evolution.

We all got a good laugh out of this one.  There are definitely benefits to serving the physician market.