Aging Boomers & Market Opportunties

Anyone following the healthcare IT market has a clear understanding (or at least should) that a key market driver for consumer-facing healthcare IT solutions is that ever aging baby boomer generation. This generation is relatively wealthy, compromised of over 77 million adults (if you include adults not born in the US it’s about 83M), often seen as narcissistic, has some degree of computer skills (although this can vary widely) and a significant portion is health conscious. As Boomers age, they will seek any number of tools and services that will help them maintain their health creating a very lucrative market.

PHRs are one such solution that may benefit as boomers take on more responsibility for managing their health (provided we address the numerous PHR adoption challenges, e.g., getting data clinical feeds securely into a PHR). Another area that is already seeing strong growth is the market for software that promotes “brain fitness.” By now you have probably seen one of the ads promoting a “brain game” that one would use on a hand held game console. Doing a search on Google for “brain fitness” will serve up nearly 1 million hits. Clearly, baby boomers want to keep those minds sharp.

Taking a deeper look at this market, the analyst firm, Sharp Brains, released a report in March 2008 on the brain fitness market. Sharp Brains’ leader, Alvaro Fernandez was kind enough to provide me a copy of the report and following are some of the highlights:

• Market more than doubled from 2005 to 2007 growing from ~$100M to $225M.
• Of the four sub-sectors studied (consumer, healthcare, education (K-12) and employer), the direct to the consumer market is experiencing the greatest growth, blossoming from just a few million dollars in 2005 to over $80M today. The authors refer to this as the “Nintendo Brain Age effect.”
• Consumer market is dominated by those over the age of 50 (back to those baby boomers!).
• Much like the PHR market, it appears that the brain fitness software market is equally elusive to accurately define and categorize leading to some confusion in the market as to what exactly is a brain fitness solution. (Not uncommon in any new, rapidly developing market where definitions and requirements are in a state of constant flux.)
• Twenty-one vendors are covered, most you’ve never heard of and the authors provide brief profiles, that are on the thin side, but still useful.
• Being a young market, solution claims today are often not well-supported by clinical evidence. Those solutions that have the evidence tend to be highly structured, often difficult to use, and better suite for clinical settings.

My Final Take on the Report

For the nominal cost, the report provides the reader a pretty accurate picture of the market today. While I would have liked to have seen more details on the vendors of these solutions, the report does counter-balance this need with a thorough discussion on brain science, how theories have changed in recent years (e.g., neuroplasticity), and impending market demand, ala the boomers. If this is a market you are evenly remotely interested in, this report will serve you well in gaining a deeper understanding of its current state and future direction.

New Twist on the Risk/Benefit Balance for PHI

Any frequent visitor to this site knows that I have some strong opinions regarding privacy of medical records. Primary among those opinions is that while there are certainly risks inherent it the move to digital records, in an instant they can be broadcast worldwide, something that won’t easily happen with paper records, there are also a number of benefits. Unfortunately, virtually all articles in the press focus on the risks giving little attention to the benefits.

Imagine my surprise when I came across an article in the UK newspaper, The Times, that focuses on the benefits of electronic medical records and more importantly, the value to the consumer to be able to access, view and comment upon their personal heath information (PHI). The system being used is the UK’s NHS PHR initiative, HealthSpace, which appears to be a relatively modest effort today, relying primarily on consumer entered data, with some limited trials that are more broader in scope, such as the one outlined in this article

Well worth the read. Now if I could also find similar reporting here in the States.

The Tour is Coming, The Tour is Coming…

This Saturday begins another epic Tour de France.  The 95th Tour, it will be comprised of some 21 stages, cover 3,500 miles, including a mountain stage towards the end that will have those still in the race climbing nearly 15,000 vertical feet in a single day.  Awesome!

Despite the all too numerous drug scandals the Tour has seen lately, it is still an amazing event to follow for an avid cyclist and sometime racer such as myself.

This is the only time in the year when I wish I had cable.  So for those special stages, I’ll go to a local pub that broadcasts the stage and watch.  For all those other stages, here is what I do.

A stage is typically over by around lunchtime here on the east coast.  For lunch, I get comfortable and head on over to Velonews.  Velonews has a daily live coverage report written by a couple of their reporters who give great commentary, basically giving a play-by-play (or is it pedal-by-pedal) report on the action in the peloton. I always jump right to the beginning of the reporting so as not to get any hints as to who won that day’s stage and spend the lunch hour reading through that day’s stage report.

I am not alone, by any means in this practice.  The past couple of years the reporters have solicited emails from readers promising a prize for the most out of the way place.  There have been people at sea, a researcher in the Antarctic, several soldiers in Iraq and Afghanistan and just about any other place you might imagine. This is a global event that I love being a small part of.

So consider yourself forewarned if I do not jump for that phone call during the lunchtime hour.  It may be that I am just terribly involved in reading some exciting developments in the Tour.

Are You Sure You Want that Genetic Test?

Last night, PBS’s science show, ScienceNow (a spin-off of Nova) had a story looking at the controversial issue of consumer initiated genetic testing from such services as 23andMe, DecodeMe, Helix Health, and Navigenics. The brief video (~10 minutes), does a nice job of framing the issues (though the intro with the “liability rejection” is alarmist in light of recent legislation) with regards to such genetics’ tests.

One of the scientists interviewed, Dr. Rudy Tanzi happens to be the my son’s boss (he’s working in the Tanzi lab at MGH). Through this “connection” I’ll be having an interview with Tanzi next week to further discuss the benefits and risks of genetic tests and will post a report of that interview.

Which gets me to thinking, when will Google Health announce a partnership with 23andMe? They are already funding it, seems like a no-brainer.

Baseline Article on PHRs - Half Correct

One of the better IT publications is Baseline.  Their reporters typically do in-depth stories on various IT subjects and their case studies of large IT implementations are some of the best I have seen (and in my decade plus as an analyst, I’ve seen a lot).

This week, Baseline published an article on privacy and PHRs.  Article was prompted by the Markle Foundation’s announcement last week of the Privacy Framework.  The article does a good job of laying out the privacy issue for the reader, but like all too many articles on the subject of PHRs, it sits on the privacy issue as being the key deterrent to PHR adoption among consumers.

Are reporters just being lazy?

Really getting quite tired of this argument.  When will reporters start focusing on what are some of the real barriers to PHR adoption?  We can start with the lack of data liquidity and the paltry investment of the healthcare sector in IT. Do you really think most consumers are going to enter all that data by hand? We can then move to the immaturity of standards and their adoption that hinder data exchange. Ditto! And let us not forget vested interests that would rather not let you have control of your personal health information. Give me my data and let me take it wherever I choose to go.

From there, we can then focus on what benefits might the consumer accure from using a PHR that is automatically populated with their data, allows them to share that data at a granularity desired with whom they choose, possibly monitor the health of loved ones, subscribe to highly personalized services, be made aware of pertinent clinical trials that they may wish to participate in and the list goes on.

Will these benefits be enough to overcome the risks? For the majority of Americans, I would argue yes.

Now, if I could only get a few reporters to sign-on to such in-depth reporting, we might actually get somewhere.

NYT Editorial Stirs up a Hornet’s Nest

On June 24th, the New York Times had an editorial promoting the adoption of EMR. Editorial was a prompted by the recent report from the NEJM on EMR adoption. As one might expect, the editorial generated a number of letters to the editor which make an interesting read as well exposing some of the entrenched issues, vested interests and challenges that adoption of EMRs will continue to face for the foreseeable future.

eRx Gaining Momentum?

There has been a lot of talk over the last 6 months regarding e-prescribing (eRx) and what is needed to drive adoption. Today, adoption of eRx practices is about as bad as physician adoption of EMR. Now that Medicare is looking to push eRx, it is really starting to get the attention of physicians as this has the potential to directly hit their bottom-line.

But some common and very real arguments from physicians have been:

1. The evidence is inconclusive as to how effective eRx truly is in minimizing adverse drug events.
2. eRx systems often do not work as promised, ultimately creating more work for the physician.
3. Without an ability to write eRx for controlled substances, the physician is left to juggle two systems simultaneously; paper scripts for controlled substances, and eRx for other medications.
4. The benefits of using eRx are not typically seen by the physician but by the payer.

But within the week, two big things have happened that may alleviate a couple of these concerns.

Last week, the DEA (I’m sure under a lot of pressure from HHS) released proposed regulations for eRx of controlled substances. This will address problem number 3.

Today, the two big eRx services, RxHub and SureScripts announced that they will merge. This will help address problem number 2.

Combining these two with the aforementioned changes to Medicare reimbursement has real potential to drive physician adoption of digital systems such as eRx and more broadly, EMR.

This is excellent news for the consumer as it has the real potential to drive adoption and use of digital systems in the physician’s office thus liberating clinical information from a paper-based system to one that is digital. Once in a digital format, the consumer will be in a better position to take direct control of their personal health records.

P4P, Change & Vested Interests

Matthew Holt provides some interesting, and spot-on commentary regarding last weekend’s article in the New York Times on the misuse of technology. The technology in this case is the use of 64 slice CT scans for cardiology, a technology that is widely used, but rarely needed.

Very serendipitous timing of the article as just last week I had the pleasure to meet with Dr. Richard Parker, the medical director for Beth Israel Deaconess Physician Organization (BIDPO). It is BIDPO who works directly with the 1,500 or so physicians that are affiliated with BIDMC throughout eastern Massachusetts. The purpose of the visit was to follow-up on a conversation I had in late May with SafeMed’s CEO, Richard Noffsinger, regarding their partnership with Google Health.

While Noffsinger related to me many of the unique attributes and features of SafeMed during our call, I wanted to hear first-hand from one of their customers as to their experiences with the SafeMed platform. A few weeks later I was sitting in Dr. Parker’s offices.

Background on SafeMed:

• Physician founded (Ahmed Ghouri) in 2000 as a clinical decision support (CDS) platform. But like many a technologist founded company, big on technology and addressing needs, but short on go to market strategy.
• July 2007 saw Hicks Equity Partners make a significant investment. Time to ramp up that go to market strategy and Richard Noffsinger was recruited.
• Core to their CDS platform is the Rules Engine. Platform also provides a comprehensive thesaurus and is optimized for extremely fast processing speeds. I’m quite sure that Google Health was intrigued by all three of these features, which are a very nice fit for their PHR platform.

Leveraging SafeMed at Beth Israel:

BIDPO was approached several years ago by BCBS of Massachusetts to consider using SafeMed as part of a Pay for Performance (P4P) program targeting imaging. BCBS/MA offered to sponsor initial deployment and outlined for BIDPO that there could potentially be several million dollars in P4P payments if deployment went according to plan and P4P targets were met.

The problem BCBS/MA was having was that as imaging technologies were proliferating, physicians were often prescribing tests that had not shown efficacy. This resulted in significant cost overruns, similar to what the NYT article alluded to. BIDPO physicians, for example, had over 2,000 different radiological studies at their disposal which they could potentially order. Unfortunately, this plethora of choices led physicians to not always choose the most appropriate tests for a given condition and patient profile.

The physicians had a few headaches of their own as well. In an effort to crack-down on run-away imaging costs, insurers were requiring pre-authorizations. This was, and continues to be with some insurers, a time consuming and subsequently frustrating process.

To address these problems, BCBS/MA introduced BIDPO to SafeMed sponsored deployment of the solution, which is now fully integrated with BIDMC’s homegrown EMR. Today, BIDPO is in its third year of using the solution with all imaging orders for BCBS/MA members processed through the SafeMed CDS. Dr. Parker was kind enough to give me a live demo of the SafeMed solution at BIDPO and it was impressive.

First was the ease of use. In looking to perform a radiological test on a patient, the physician enters the type of condition being tested for (one can even use layman terms), say severe headache and the SafeMed thesaurus automatically guides the physician to which tests may be most appropriate based on the patient’s profile (takes into consideration medications, allergies, weight, age, and numerous other parameters).

A selection of radiological options sorted in ranking order by evidence of efficacy. Cost information is also provided as well as alerts (in red) of any technologies that show risk based on patient profile. When a physician clicks on a given test, a brief informative summary of the test is provided including where it is most appropriately used and why. Upon selecting a test for the patient based on this information, approval is virtually instantaneous. (Remember, this is for BCBS/MA members only, for other plans, BIDPO physicians must still go through a lengthy pre-authorization process that takes on average 15 minutes/transaction.)

Throughout the demo, the SafeMed CDS was blazingly fast in delivering results. Note, nothing in this demo was scripted - Dr. Parker did demos on anything I asked him to, in real-time.

As with any technology deployment, there was initial resistance by some physicians and there were bugs in the system that took about six months to work out. Now, Dr. Parker claims, they have 100% adoption and use by physicians of the system who are all benefiting from those P4P bonuses from BCBS/MA.

Benefits Seen to Date:

When asked what kind of benefits has BIDPO seen from the use of SafeMed, he broke it down into the following:

• Physicians are getting instant approvals to their radiological requests, making life easier (Note, in addition to being integrated to the BIDMC EMR, SafeMed platform is also a part of their CPOE.)
• Physicians are also getting a nice little P4P payment at the end of the year. Since deployment, the system has met P4P targets each year.
• Patients are safer as physicians are making better decisions regarding which tests to use for a given condition and patient profile. Within BIDPO, 50% of all radiological orders are placed by internists and general practioners who typically do not have as much experience as specialists in various applications and best practices radiological tests.
• Approximately 1,000 radiological transactions/month are run through the SafeMed CDS. Typical time to get a pre-authorization the industry standard way is 15 minutes. With SafeMed, pre-authorization is immediate. This quickly adds up to 1.6 FTE (full time employee), who can be better deployed doing something more valuable like attending to a patient.

The Big Loser:

As with anything, where someone gains, another loses and with P4P initiatives such as this, it is no different, which gets back to that NYT article:

In the case of BIDPO’s use of SafeMed, the radiological department at BIDMC has seen a measurable drop-off in revenue creating some internal friction. Dr. Parker readily acknowledged this and in thoughtful reflection stated that many changes are occurring in healthcare, this just being one example with many more on the horizon. One can not sit back and await these changes to come to them. Rather, one must take initiative, as to wait puts the entire organization at a competitive disadvantage and subsequently at risk.

Now, how does this all relate to consumer-facing healthcare IT?

SafeMed is now “running under the hood” at Google Health, driving the medication checking algorithms for potential adverse effects of multiple medications. SafeMed joins quite a few other applications and services that provide similar capabilities such as A.D.A.M., Drugs.com (using Cerner), Drug Digest, and DoubleCheckMD. What is attractive about the Google Health-SafeMed partnership is that Google has signed agreements with a large number of pharmacy companies and pharmacy benefits management firms (PBMs) allowing the consumer to automatically load their medications into their Google Health account where they can readily check their meds for any adverse interactions.

Matthew Holt, co-organizer of the Health 2.0 conference did test drive of Google Health, including the SafeMed platform in Google Health and found the current solution lacking, particularly the UI and how information was presented. More than likely, the problem lies in SafeMed not fully completing the drug interaction platform prior to launch. This is a common issue with Beta or early releases and will in all likelihood be resolved over the next few months. What will be more interesting longer-term is to observe how SafeMed may expand beyond medication checking into other critical areas that may be useful for consumers. Not sure exactly what those might be, but SafeMed does have a powerful rules engine that is very fast making it attractive for Web-based apps. Being agnostic, SafeMed could become a key ingredient in other personal health applications (PHAs), becoming not just a CDS, in the clinical sense, but also a CDS in the consumer sense.

But this gets back to one of the features in the BIDPO deployment that I found so intriguing and also raises challenges for SaferMed. The BIDPO team that led that deployment spent many hours building out the meta-data and decision support capabilities for their SafeMed radiology solution. SafeMed will be challenged to find partners with a similar willingness to do such heavy lifting in other markets such as the consumer market. Not sure Google is up to the task. Hopefully, SafeMed has a few other partners who are.

Two CIOs Chime in on HIT & PHRs

Today’s eWeek has an interesting interview with two hospital CIOs, George Conklin, CIO of Christus Health, and Rich Temple, CIO and vice president of IT at Saint Clare’s Health System. Interesting questions with thoughtful answers.

And if you are interested in the CBO Report that is referenced in the interview, the CBO Director’s Blog has a good post on the content of that report.

Is that a Dark Cloud on the Horizon?

The latest issue of HIStalk mentioned a recent post by noted Harvard Professor Nick Carr (he wrote the controversial book, Does IT Matter).

The post addresses the rapidly evolving trend towards “Cloud Computing” and raises a number of issues/implications that cloud computing may present.

As all Personal Health System (PHS) platforms (Dossia, Google and HealthVault) are built upon the cloud computing concept, this post by Nick Carr is a must read for anyone trying to understand what cloud computing means to personal health information.

Is that “Stormy Weather” I hear in the background?