P4P in Physician Group Practice

CMS recently published interim findings on the use of Information Technology to achieve measurable improvements in the quality of care for patients with chronic diseases. They have 29 measures for Diabetes, Coronary Artery Disease, CHF and preventative care. The results are very strong; the participating practices consistently achieved improvements. In the first year, all the practices achieved benchmark or target performance on at least 7 out of 10 diabetes clinical quality measures. Similar results are posted for subsequent years.

Other bloggers have written about it as well.

Having the data available really works; the trick is to get people to recognize that the pain of implementation and the challenge of change are worth it.

High Tech and High Touch

Kaiser Permanente recently published an interesting study. They did a two year trial of patients with prior coronary artery disease. Approximately half the patients got their intense follow up program (including regular direct calls to the patient from a specialty pharmacist). The other half got electronically generated reminder letters to schedule the blood checks on their cholesterol.

The fascinating result was that both of these groups showed dramatically better results that patients without any reminder system. The difference between the "high touch" version and the simply "high tech" version was not very high. But the difference between nothing and either reminder system was very high, meaning the cheaper solution was highly effective.

Most institutions are not yet at the point where their EMR could be generating the reminder letters that Kaiser did. But it appears that processes like this may be where the meat of the cost savings promised by Healthcare IT will come from.

Real doctor using an EMR and building a PHR

I really like what Stasia Kahn, MD, had to say about Electronic Medical Records.

She is now "exporting PDF Healthcare files to my patients for the purpose of populating an untethered personal health record (PHR). I believe that a patient-directed PHR that has been pre-populated with authoritative data from a primary care physicians’ electronic medical record is the quintessential, longitudinal health record..."

See my earlier post about how hard it is to enter the data yourself. People should begin to see the value added from practitioners that will contribute to the record for them and let those become the more popular providers.

EMRs and Meaningful Use

He's a horror story that is clearly not meaningful use.

Doctors and other clinicians are busy. EMRs have to have an obvious benefit to attract use. Complaints that providers would rather go back to paper just says we aren't paying enough attention to good design in the data flow of the EMR.

Social Media

It's all the rage to talk about using new forms of media for selling your goods and services. To be seen as a cool company by many, you need a facebook and Twitter presence. Despite the countless Tweets about how to make social media pay, the people I have talked to are having a hard time quantifying the payback.

Personally, I have found facebook to be a great way to reconnect with old friends, as well as keep in better touch with local friends I only see every month or so. As the piece of flair that one of my cousins sent to my 72 year old father said, "facebook - now with old people".


My personal experience with Twitter has been much less satisfying. Perhaps I'm not following the right people, but it doesn't seem to be adding much. Although the NYT says that Twitter is not for teenagers, I haven't found it to be for many of my contemporaries yet either.

Dave Winer suggests that Twitter and facebook are too ephemeral, and is especially upset about the possibility that all the shortened URLs in Twitter will disappear someday. He wants us all to blog, and to store the content is a simple text file.

My 20 year old daughter, on the other hand, thinks no one is interested in blogs. But she does read my family blog, which has been the greatest pleasure I get from social media.

So, where is all this going? For my post, I'm not so sure. For social media itself, no one is sure. There are a lot of different ways to communicate today, both personally and professionally. In both contexts, we need to choose the media that's right for the message and use it.

Leaders

Leadership is scarce because few people are willing to go through the discomfort required to lead.

Seth mostly talks about marketing, but after reading this excerpt from his book Tribes, I'll be buying that (on the Kindle for iPhone)

Home Care's place in the Health Care debate

Despite my obvious bias after 18 years serving the home care industry, it is simply unavoidable that care in a patient's home is cheaper AND better than forcing people into other places to live when they need care.

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