The following two blog posts from Microsoft Vice President Peter Neupert one appeared over the last few days.
The first started off as follows:
Message to Washington – It’s all about Outcomes
Yesterday, I testified before the Senate Health, Education, Labor, and Pensions Committee, otherwise known as HELP. You can see a video of my testimony here. Before getting to the substance, I need to highlight how I continue to be awe-inspired about how our government works -- in a positive way. Anybody can walk into the halls of Congress and sit in and listen to a hearing. Folks from all walks of life have input via a variety of means -- and while I get it's not perfect and can be better -- I remain proud of our democratic system and feel honored to be able to contribute/participate in it.
My main message to the Senate was: We should really focus on the health outcomes we want to achieve, not just on the technology itself. What the health system needs is to adopt technology in ways to deliver better outcomes, better chronic care management, better hospital effectiveness. We really want to make sure that we have the leadership focused on encouraging the usage of technology to achieve certain goals, like better chronic care management.
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Since I spend the bulk of my time building software -- decisions about features, hiring great people, how and where to sell -- the hardest question from the staffers to answer is - how do you recommend we spend the money?
My answer is in my closing remarks with the five key things that I think the government needs to focus on:
- Encourage innovation in health IT by setting out objective goals and criteria, not by mandating specific technologies or development models.
- Reward innovative doctors who make the Internet the foundation of the patient-physician connection.
- Provide incentives for sharing data.
- Focus on making data interoperable today, not waiting for standards tomorrow, and insist that vendors separate data from applications.
- Enable the private sector to develop an information infrastructure that connects data, systems, and people.
These are really critical, so we don’t end up in the wrong place. They’re based on our learnings as we’ve delved into this complex world of health.
Full blog is here:
Peter also featured on Fox Business News on the same day. See here:
The second started this way:
The Truth About Health IT Standards – There’s No Good Reason to Delay Data Liquidity and Information Sharing
David C. Kibbe and Peter Neupert
Now that the Obama administration and Congress have committed to spending billions of tax payers’ money on health IT as part of the economic stimulus package, it’s important to be clear about what consumers and patients ought to expect in return—better decision-making by doctors and patients.
The thing is, nobody can make good decisions without good data. Unfortunately, too many in our industry use data “lock-in” as a tactic to keep their customers captive. Policy makers’ myopic focus on standards and certification does little but provide good air cover for this status quo. Our fundamental first step has to be to ensure data liquidity – making it easy for the data to move around and do some good for us all.
We suggest the following three goals ought to be achieved by end of 2009:
- Patients’ clinical data (diagnoses, medications, allergies, lab results, immunization history, etc.) are available to doctors in 75% of emergency rooms, clinic offices, and hospitals within their region.
- Patients’ doctors or medical practices have a “face sheet” that lets any staff member see an all-up view of their relevant health data, including visit status, meds, labs, images, all of which is also viewable to patients via the Web.
- Every time patients see providers, they are given an electronic after-visit report that includes what was done and what the next steps for care will be according to best practices and evidence-based protocols, whenever these are applicable.
Some who view this seemingly humble list of achievements will say that we can’t do it, because the standards aren’t ready, or the data is too complex. They’ll say that delays are necessary, due to worries about privacy or because too much data is still on paper.
Continue reading here:
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http://blogs.technet.com/neupertonhealth/default.aspx
Both these blogs deserve careful reading. There are some good ideas here.
My key problem with what is said is that the complexity of health information is being ‘gracefully slid over’ and that the information management and privacy issues can’t easily be ignored if success is to be achieved.
In the more successful RHIOs in the US there are working models and it is these I would look to for frameworks that can be extended and scaled to provide real clinical and administrative improvement and the associated savings.
The RHIOs have not sprung into existence overnight and many have failed. Those that have not have a lot to teach and should not be underestimated or sidelined.
If this were really as easy and quick as these two blogs seem to infer it would have happened long since. That is hasn’t means there are some traps for the unwary. Mr Obama needs to be careful to take things one step at a time and to rely on things that are already working well as some of the initial steps.
David.
3 comments:
There could be a shift to seeing essential health data as a matter of national security, instead of providing a conduit for more profits to the usual suspects. The sober fact that some of the incinerated bodies from the Victorian fires will be unidentifiable may help to sharpen the focus on what is essential data.
Barry McCaffrey, US security wonk, has an eight-page power-point of his view on the national security issues for his country. He says
85% of our critical infrastructure is privately held.
So, if essential health data is a matter of our national security, do we want to keep heading in a direction where much of the data will be firewalled behind private assets?
I'd hazard a guess that Microsoft executives have had more than a sniff of the Obama plans for Health IT. There could be a view building up in Oz, too, that governments will never throw another $5b at the "industry" for bugger-all gain in outcomes for the public health. There will be PPPs, but they will be set up on conditions that preserve the public interest. Well, that's a hope.
Oh, and perhaps Peter Neupert has been told about the likelihood the Obama administration would underwrite a user platform that included the security horrors and litany of upgrades that are offered by the XP-Vista-W7 pathway.
“RHIOs look to for frameworks that can be extended and scaled to provide real clinical and administrative improvement and the associated savings.”
That sounds like very sensible advice. It also raises some interesting questions in a country of only 20 million people. Do we have any examples of anything in Australia that might resemble RHIOs? Would Medicare Australia be a contender? Would Victoria’s HealthSmart shared services model be a contender? Does Nehta’s IEHR model fit the RHIO mould?
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