This fairly routine article about the very slow growth in online (email) consults had one line that made me sit up and pay attention.

At the least the more dubious online pharmacies can now double bill the insurers of the patients they’re already charging for the "consults" that get them prescriptions. OK that was just a wisecrack, but one day we may just wake up and find that the adoption of the online email visit as a compensated service just kind of happened– because of this new CPT code.

If you click on Forrester Research’s  FirstLook Archive you’ll see their predictions for next year and some other interesting stuff. They think this will be the year of the EMR (or at least the start of its mainstream appearance) and of the elderly getting wired to their providers. Knowing something about how to make lousy predictions myself, I wouldn’t put too much stock in this "big for next year" stuff. But at least they’ve lost the rhetoric about Why Doctors Hate The Net, which remains the research report in health care with the lowest ever "research validity to press column inches" ratio.

There’s quite a bit of tech push buried in the Medicare bill, but it’s mostly demonstration projects.  Go take a look at the summary by HIMSS and wonder what could be done if just some of the money used to bribe the AMA, the AARP, employers, the health plans and the PBMs into supporting the bill had been directed to info tech where it could do some good.

Then take a look at what just happened in the UK where contracts for the National Health Information infrastructure were awarded nationally and in some regions yesterday.  Consider the numbers, BT gets $2.8 billion to build a record infrastructure and to wire London, Accenture gets $1.9 billion to do the north-east, Cerner already got $64 million to build a booking system, and there are another 3 more regional contracts worth another $5 billion to be awarded. In American terms you need to multiply those awards by 6 for population and at least 1.5 for relative GDP (or 3 times for relative health spending!), so that’s the equivalent of the US awarding $100 billion of IT contracts (over 10 years).  Currently the US as a whole spends roughly $20 billion a year on health care IT.  So the equivalent program here would be a 50% annual increase in spending.

Then wonder whether the free market or socialized medicine is going to be making full use of information technology in health care first.

A recent Mass medical society survey shows that doctors view computers as a necessity for their office work but are not using them much in their clinical care. Slightly more concerningly, despite the fact that overwhelming percentages think that they should be using computers for electronic prescribing (85%), recording of patient summaries (89%) and the collection of treatment records (83%) less than half have plans to do so. You’ll have noted that despite ePrescibing being compulsory in the House version of the recent Medicare bill, that unfunded mandate didn’t survive the AMA’s intervention in the conference committee.  So the question remains, who is going to pay for this computerization? Hint: in every other country where physicians actually use computing in their practice (UK, Sweden, New Zealand, even Canada), it’s been the government that coughed up.

Medpundit points to a new study that questions the use of the PSA prostate test among the elderly.  As I learned via Family Medicine Notes, of positive PSA tests, some 7 in 10 are false positives (or at least don’t mean that the person concerned has cancer).  In the study, roughly 1/3 of 75 year olds got the PSA test, 88% because their doctor told them to get it. Meanwhile a substantial number of men die with but not from prostate cancer. In other words if you’re 75 and have no history of prostate cancer, what your PSA is doesn’t matter. Not only is the test a waste of money but chasing down the false positives causes more tests, costs and incoveniences down the road.

Medicare for ever has just paid  for procedures that are of dubious medical justification in its age group. Way back when there was a clinical trial of CABGs among men under 65, but very quickly and with no trial in the relevant age group, Medicare was paying for CABG’s in its population particularly in those over 75. The provision of kidney dialysis to the very old is another example of where age is not taken into account, although it is in the UK.  Whatever the moral rights and wrongs, the tradition of excessive care of the soon to-be-dead continues and there has been no debate about it. This is a classic case of where Medicare should change its payment mechanism to encourage the right behavior.  But it won’t.

Jane Sarasohn Kahn’s column in iHealthbeat about the impact of the Medicare bill on ePrescribing shows her being a touch cynical about the political process.  But don’t worry about it affecting her analysis. Jane explains in detail why nothing will really happen in terms of Federal ePrescribing before 2009, with only passing reference to the AMA, luddites and dinosaurs. She also has some interesting takes on activities on the state level, particularly in Massachusetts. I do think that its overly optimistic to think that this kind of voluntary effort can get more than a few cities or states well on the way to ePrescribing.  However, we should have some good answers within 18 months as to whether these efforts really save money.  If they do, pressure will increase on other providers to adopt ePrescribing too.

I posted a while back on Manhattan Research’s new Cybercitizen health findings. In the past week I’ve received Forrester Research’s Healthcare First Look email and also seen a new article from Caroline Broder at iHealthBeat on Manhattan research’s eHealth findings. Forrester focuses on Rx sites and on physician sites.  The results are predictable.  There is good information on Rx sites, but consumers don’t trust drug companies as a source.  They’d rather see it from their own doctor or from a medical specialty society.  But the doctors don’t have a web site or if they do, only 6% of consumers have been to see it.

Manhattan concentrates on consumer use of the eHealth space generally and their intersections with health plan sites in particular.  And like in Forrester’s previous research on the topic, health plan sites are little used and not very functional. Around 20% use their health plan’s site, and are in general dissapointed with what they can do there.  Manhattan though believes that health plan sites are getting better and starting to incorporate more useful functionality. As regular readers know, I was trying to sell software to health plans to help them do this from 2000-2002 and we were well ahead of the market.  Nice to hear that they’re slowly moving in the right direction.

I posted a while back on Manhattan Research’s new Cybercitizen health findings. In the past week I’ve received Forrester Research’s Healthcare First Look email and also seen a new article from Caroline Broder at iHealthBeat on Manhattan research’s eHealth findings. Forrester focuses on Rx sites and on physician sites.  The results are predictable.  There is good information on Rx sites, but consumers don’t trust drug companies as a source.  They’d rather see it from their own doctor or from a medical specialty society.  But the doctors don’t have a web site or if they do, only 6% of consumers have been to see it.

Manhattan concentrates on consumer use of the eHealth space generally and their intersections with health plan sites in particular.  And like in Forrester’s previous research on the topic, health plan sites are little used and not very functional. Around 20% use their health plan’s site, and are in general dissapointed with what they can do there.  Manhattan though believes that health plan sites are getting better and starting to incorporate more useful functionality. As regular readers know, I was trying to sell software to health plans to help them do this from 2000-2002 and we were well ahead of the market.  Nice to hear that they’re slowly moving in the right direction.

This is one of those, "I’m glad they wrote it so I didn’t have to," posts. iHealthbeat has two articles updating physician use of email and physician IT use. You may have seen smatterings of some of the studies used there before in in this blog, but these are two excellent summary articles. Caroline Broder has an expanded summary about the state of play in her column about online consultations , and the ever-wonderful Jane Sarasohn Kahn puts some recent surveys of IT in the doctor’s office into perspective.  Both wonderful reads, so go read them.

Meanwhile, my long promised piece on PDA and physician EMR use is still in the production queue….

UPDATE: CHCF also has a new report out from First Consulting Group on how providers should select and introduce patient-physician email communication systems.

Not that it’s my natural proclivity, but I am enjoying the rumor-mongering abilities that writing this kind of a blog gives me. You’ll recall a while back that I came upon some rumors that Tenet had hired a company for its JCAHO reporting that may have put at risk its ability to remain certified to treat Medicare patients.

The latest I’ve heard is that this company is having problems with a related product. Apparently they found out that no (database) tables were being created for 7 types of medical errors that hospitals report using their software (e.g. medication errors, falls, etc.).  The error was part of a production release sent out over a month ago.  In other words, the 10 hospitals using the product could have (and probably did) reported adverse incidents using the system for over a month and the data for those incidents (that would be used to defend themselves in court, identify risky situations, prevent medication errors, etc.) would be lost. Apparently the head of QA recently left and another senior QA guy followed suit, resulting in a "go along to get along" QA department. 

This is a perfect example of how rushing software to market (without testing, let alone a detailed technical design document) can lead to big mistakes. Apparently this company develops on an ad-hoc basis, often sending out production releases every week.