We are proud to be chosen by Beth Israel Deaconness Medical Center to provide project management and practice consulting services to their EHR deployment project. We're working closely with BIDMC's excellent staff and with eClinicalWorks and Concordant, who were also chosen for the project and who we know very well from the MAeHC project.
This is the first commercial project undertaken by MAeHC. As we near the end of our seed funding from Blue Cross Blue Shield of Massachusetts, we are pursuing a 'public service' strategy and a 'commercial' strategy. The public service strategy is to get collaboratively provided resources to build on the successess and lessons of the pilot projects and launch Phase 1 of a statewide rollout. The 'commercial' strategy is to pursue paying customers inside and outside of the Commonwealth who have needs that we have the skills and interest to address. These strategies are complementary -- the lessons we learn from clinical leaders such as BIDMC will make us even more seasoned for the challenges of a statewide rollout. In return, if we can get any organization to avoid our mistakes and replicate our successes, our mission will be forwarded.
Showing posts with label sustainability. Show all posts
Showing posts with label sustainability. Show all posts
Monday, February 25, 2008
Monday, February 18, 2008
More woes for NHS
When I was younger, I took an immersion Russian course at Norwich University in Vermont. On the first day, our teacher, who was himself a gifted, fluent non-native Russian speaker, asked each of us why we wanted to learn Russian. One of the students said "I've always dreamed of reading War and Peace in the original." The teacher responded in a joking tone that revealed the hard truth: "Yes, and I too hope to be able to do that someday." We all realized in that moment that we had a hard slog ahead.
I was reminded of that moment when I read an article in this week's Economist magazine about the UK National Health Services's much troubled "Choose and Book" system (see Notional Health Server). The goal of the system is to "allow patients in the National Health Service (NHS), advised by their doctors, to choose the treatment they want, and book an appointment when they want it." Unfortunately, after 3 years of hard work, it still hasn't worked out that way. Over 50% of physicians have a negative view of the system according to the British Medical Association. One of the physicians interviewed said that in her experience the system is so slow that it takes about 2 minutes for each visit request, and even then, it functions properly only 10% of the time.
Those familiar with health IT will immediately recognize how ambitious Choose & Book goals are and, I suspect, feel sympathy for their plight. As the article put it, the system will only perform as designed if everything goes right, meaning that the hospital, physician, and health trust systems that it needs to interact with fit together perfectly, and that the physicians and administrators who use those systems fit together perfectly as well. You would think that this could be accomplished in a government-owned health system...........and you'd be wrong. Which leaves those of us living in a highly decentralized system wondering just how ambitious we should be.
Unfortunately, users, and especially physician users, assume that they'll immediately be able to do the kinds of things that Choose & Book is supposed to, and it's often hard to ratchet expectations back to reality. In the MAeHC pilot projects, we're launching health information exchanges in three pilot communities and we're constantly in the struggle of trying to prevent the perfect from being the enemy of the good by reminding physicians that the first version is "Version 1.0" which will be improved over time. It's fantastic that our users are engaged and they want to get value out of the system; it won't be fantastic if "Version 1.0" isn't good enough to want them to stick around for Versions 2, 3, and 4.
I find managing this tension -- between designing the perfect architecture vs launching something good and attainable -- to be one of the biggest challenges in the health IT space. The most difficult part of the challenge is that the culprit isn't the technology, it's the lack of alignment of the technology and processes used by the most important data sources, hospitals and physician offices. It's the same problem faced by Dossia and Microsoft's Health Vault and Google Health -- will our users be willing to wait for the system to catch up with the technology?
I was reminded of that moment when I read an article in this week's Economist magazine about the UK National Health Services's much troubled "Choose and Book" system (see Notional Health Server). The goal of the system is to "allow patients in the National Health Service (NHS), advised by their doctors, to choose the treatment they want, and book an appointment when they want it." Unfortunately, after 3 years of hard work, it still hasn't worked out that way. Over 50% of physicians have a negative view of the system according to the British Medical Association. One of the physicians interviewed said that in her experience the system is so slow that it takes about 2 minutes for each visit request, and even then, it functions properly only 10% of the time.
Those familiar with health IT will immediately recognize how ambitious Choose & Book goals are and, I suspect, feel sympathy for their plight. As the article put it, the system will only perform as designed if everything goes right, meaning that the hospital, physician, and health trust systems that it needs to interact with fit together perfectly, and that the physicians and administrators who use those systems fit together perfectly as well. You would think that this could be accomplished in a government-owned health system...........and you'd be wrong. Which leaves those of us living in a highly decentralized system wondering just how ambitious we should be.
Unfortunately, users, and especially physician users, assume that they'll immediately be able to do the kinds of things that Choose & Book is supposed to, and it's often hard to ratchet expectations back to reality. In the MAeHC pilot projects, we're launching health information exchanges in three pilot communities and we're constantly in the struggle of trying to prevent the perfect from being the enemy of the good by reminding physicians that the first version is "Version 1.0" which will be improved over time. It's fantastic that our users are engaged and they want to get value out of the system; it won't be fantastic if "Version 1.0" isn't good enough to want them to stick around for Versions 2, 3, and 4.
I find managing this tension -- between designing the perfect architecture vs launching something good and attainable -- to be one of the biggest challenges in the health IT space. The most difficult part of the challenge is that the culprit isn't the technology, it's the lack of alignment of the technology and processes used by the most important data sources, hospitals and physician offices. It's the same problem faced by Dossia and Microsoft's Health Vault and Google Health -- will our users be willing to wait for the system to catch up with the technology?
Friday, June 15, 2007
RHIOs still a tough row to hoe
This week's GovernmentHealthIT reports the dissolution of the Northeastern Pennsylvania Regional Health Information Organization ("Pennsylvania RHIO to close"). This follows on the demise of the Santa Barbara County Care Data Exchange. In the coming weeks another relatively high profile effort will announce their decision to dissolve.
There are over 200 HIE efforts across the country, most still burning through their initial grant funding, trying to find the elusive "sustainability" model. None have yet been able to replicate the successes of the only self-sustaining efforts to date: Indiana Health Information Exchange, HealthBridge, and MA-SHARE.
It's worth noting that the lines of business that have made these efforts sustainable so far haven't been about ubiquitious sharing of data, per se; success in these efforts has come from creating a single "pipeline" that efficiently channels disparate streams of data. The successful product/service areas have used technology to create economies of scale in basic backoffice functions, and collaboration to convince participants to outsource these functions to the "RHIO".
This general model can be replicated in many other places, so there's still plenty of opportunity out there, but it's not a universally applicable solution. Making this model work in other places where it fits, and establishing other value-generating product/service areas where the model doesn't fit, will be key to getting more RHIOs firmly in the win column.
There are over 200 HIE efforts across the country, most still burning through their initial grant funding, trying to find the elusive "sustainability" model. None have yet been able to replicate the successes of the only self-sustaining efforts to date: Indiana Health Information Exchange, HealthBridge, and MA-SHARE.
It's worth noting that the lines of business that have made these efforts sustainable so far haven't been about ubiquitious sharing of data, per se; success in these efforts has come from creating a single "pipeline" that efficiently channels disparate streams of data. The successful product/service areas have used technology to create economies of scale in basic backoffice functions, and collaboration to convince participants to outsource these functions to the "RHIO".
This general model can be replicated in many other places, so there's still plenty of opportunity out there, but it's not a universally applicable solution. Making this model work in other places where it fits, and establishing other value-generating product/service areas where the model doesn't fit, will be key to getting more RHIOs firmly in the win column.
Thursday, February 15, 2007
Keeping my fingers crossed for Kaiser
There was a depressing story in today's Los Angeles Times about Kaiser's $4 billion EHR implementation project. Apparently, technical problems with the project have dramatically increased costs (by about $1 billion) and are also threatening patient safety. Not suprisingly, morale seems to be dropping faster than George Bush's credibility (okay, maybe not that fast), and it's not clear that management has fully grasped the seriousness of the situation, as reflected in the following pair of quotes:
"This is the worst [technology] project I have seen in my 25 years in the business," said Andrew Brewer, a systems analyst for Kaiser who worked on the project for two years before voluntarily leaving the HMO last week.
"This is one of the largest and most ambitious efforts anywhere in the world to modernize our healthcare system," Kaiser Chief Executive George Halverson said. Considering that, he said, "it couldn't be going better."
As one who's also on the front lines of EHR implementations, I feel Kaiser's pain. Large-scale EHR implementation is extremely challenging, and the end-users are usually not nearly as flexible and forgiving as they should be given the immaturity of the technology.
Though they're a continent away, I'm worried about Kaiser's implementation, because a failure at Kaiser will reverberate throughout the healthcare industry. Why is that? It's because when you tick off the key success factors for effective EHR implementation, Kaiser seems to have it all.
As an HMO, they are both insurer and health care provider, which means that they stand to capture all of the benefits of their EHR. They can order their physicians to use the systems in ways that offer the greatest value, and they can fully capture all of the gains that accrue from better outcomes, higher safety, and cost efficiency. They've got world-class researchers who can use the EHR data to not only better measure their own progress, but to also generate tons of interesting and ground-breaking research. Finally, they've got an extremely capable staff, and they're using one of the best EHR products from one of the most highly regarded EHR companies in the industry (Epic).
In short, if Kaiser can't get this done, and also show that they're getting real value after it's up and running, there'll be a lot of disillusionment about the prospects of getting it done among the 80% of physicians who don't have an EHR today -- physicians who don't have anywhere near the sophistication, resources, and incentive that Kaiser has.
So, best of luck, Kaiser, in your efforts to turn this around. I'm rooting for you!
Monday, December 04, 2006
Do the right thing
Yesterday’s New York Times article on privacy and security of electronic health records, coupled with an article in the Wall Street Journal last week on WalMart’s foray into electronic health records, points to what could be an ominous twist in the movement to expand the use of EHRs and health information exchange in health care delivery. Large businesses -- burdened by spiraling costs of health cost premiums -- are increasingly investing in technologies to gather health information on their employees to try to more directly manage (and, they hope, stanch) the growth of these costs.
I completely sympathize with the plight of these businesses -- MAeHC is a small business, after all. I also applaud their recognition of the key role that EHRs and clinical IT can play in improving health care delivery. Yet, their whole approach raises serious concerns for patient privacy. By creating proprietary systems to gather and control the health data of their employees, these companies are, perhaps unwittingly, stumbling into the most important and fragile issue in the health IT debate.
There is an irony in all of this. Some existing privacy laws, which were designed for paper-based records, don't make sense in an electronic world, and indeed, are in some cases presenting obstacles to better management of electronic data in ways that no one could have anticipated at the time. Many of those laws were designed to prevent employers from getting access to sensitive information that could affect a person's employment status. Employers need to be hyper-sensitive to those concerns. If they appear to be violating the spirit (even if not the letter) of those laws, it will sow seeds of patient distrust and perhaps draconian laws that will undermine not only their own efforts but also the many community-based efforts around the country that are working hard to do this the right way, namely, using IT to empower physicians and patients to improve the cost-effectiveness of care.
While there is a crying need to bring modern IT systems to health care delivery, this effort won’t be economically or morally sustainable if it’s not based on trust. Patients and physicians have to trust the systems being created. Otherwise, patients won’t agree to having their data in these systems, and physicians won’t agree to using them because they’re concerned about their patients’ privacy and about the legal liability associated with breaches of confidentiality. But neither patients nor physicians will trust these systems if they aren’t set up with privacy as a fundamental design consideration, rather than a bolt-on afterthought.
The reason that employer- and insurer-based schemes are problematic is that they undermine what I think of as a core principle of health information exchange – the need to create the healthcare equivalent of a Chinese Wall between those who collect and aggregate the data on behalf of providers to facilitate direct care delivery, and non-providers who would use the data for any purpose other than direct treatment of patients. Just because electronic data is more easily available for treatment purposes doesn’t mean that we permit it to be more easily available for other purposes. Data collection and aggregation may happen in a new way (ie, using EHRs and secure networks), but access has to happen the old way (ie, explicitly negotiated among the owners and key stakeholders). This is the principle behind such leading community-based efforts as the MA-SHARE, RIQI, IHIE, HealthBridge, THINC, and MAeHC.
So how do you do that? Create, operate, and govern these systems by building on the trust engendered in today’s physician-patient relationship. Patients have a well-placed trust in their physicians. Physicians will only use the systems if they’re valuable from a user design perspective and they promote their patients’ welfare. Rather than setting these systems up as proprietary company systems, they need to be set up more like public utilities. Put hospitals, physicians, and patients in joint control of these systems so that they are designed, managed, and governed by those who are going to be using the systems. These key stakeholders will get behind investments in “wiring” the care delivery system to improve quality, safety, and efficiency; what they won’t get behind is investments whose primary aim is surveillance.
I suggest that employers should get out of the business of trying to electronically capture their employees’ detailed health information, and into the business of getting health care providers to embrace information technology that improves the quality, safety, and efficiency of care. It's fair for them to want better data to measure performance, but they can get that without demanding access to detailed patient information. They can create urgency for better system performance using basic supply chain management principles that they're very familiar with: Invest in their healthcare delivery supply chain by setting basic technology and interoperability requirements for their suppliers (ie, providers), and facilitate their providers’ ability to meet these standards.
So, the program would run as follows. First, require physicians to use EHRs, help physicians pay for the upfront costs of getting outfitted with solid EHR systems, and train them and their staff to use the systems effectively. Second, require them to participate in data exchange networks that facilitate the effective coordination of care and the efficient transmission of clinical information. Third, put in place a new funding model that redirects reimbursement toward paying physicians for improving peoples’ health and away from paying them for the volume of care delivered and/or complexities that arise with their patients due to poor physician performance.
All of this is, of course, easier said than done, and no one knows that better than those of us slogging away in the trenches. But if Walmart and Pitney Bowes and IBM and UPS spent more time working with existing community-based efforts, and less time building their own proprietary data warehouses, it would happen faster than they might think, and it would be lasting and sustainable. There are many community-based efforts out there trying to do just this, and they could benefit enormously from the resources (financial, technical, and managerial), encouragement, and old-fashioned kick-in-the-pants that only the business community can provide.
I think the message employers should send to their employees is: “We don’t want your personal health data, but it's in everyone's interest to better monitor the overall performance of our insurer/provider network because the quality, safety, and cost of health care affects all of us.” That would reinforce the message that they’re not trying to undermine the sanctity of the doctor-patient relationship, but rather, trying to improve the performance of the overall system to better serve physicians, patients, and purchasers alike.
I completely sympathize with the plight of these businesses -- MAeHC is a small business, after all. I also applaud their recognition of the key role that EHRs and clinical IT can play in improving health care delivery. Yet, their whole approach raises serious concerns for patient privacy. By creating proprietary systems to gather and control the health data of their employees, these companies are, perhaps unwittingly, stumbling into the most important and fragile issue in the health IT debate.
There is an irony in all of this. Some existing privacy laws, which were designed for paper-based records, don't make sense in an electronic world, and indeed, are in some cases presenting obstacles to better management of electronic data in ways that no one could have anticipated at the time. Many of those laws were designed to prevent employers from getting access to sensitive information that could affect a person's employment status. Employers need to be hyper-sensitive to those concerns. If they appear to be violating the spirit (even if not the letter) of those laws, it will sow seeds of patient distrust and perhaps draconian laws that will undermine not only their own efforts but also the many community-based efforts around the country that are working hard to do this the right way, namely, using IT to empower physicians and patients to improve the cost-effectiveness of care.
While there is a crying need to bring modern IT systems to health care delivery, this effort won’t be economically or morally sustainable if it’s not based on trust. Patients and physicians have to trust the systems being created. Otherwise, patients won’t agree to having their data in these systems, and physicians won’t agree to using them because they’re concerned about their patients’ privacy and about the legal liability associated with breaches of confidentiality. But neither patients nor physicians will trust these systems if they aren’t set up with privacy as a fundamental design consideration, rather than a bolt-on afterthought.
The reason that employer- and insurer-based schemes are problematic is that they undermine what I think of as a core principle of health information exchange – the need to create the healthcare equivalent of a Chinese Wall between those who collect and aggregate the data on behalf of providers to facilitate direct care delivery, and non-providers who would use the data for any purpose other than direct treatment of patients. Just because electronic data is more easily available for treatment purposes doesn’t mean that we permit it to be more easily available for other purposes. Data collection and aggregation may happen in a new way (ie, using EHRs and secure networks), but access has to happen the old way (ie, explicitly negotiated among the owners and key stakeholders). This is the principle behind such leading community-based efforts as the MA-SHARE, RIQI, IHIE, HealthBridge, THINC, and MAeHC.
So how do you do that? Create, operate, and govern these systems by building on the trust engendered in today’s physician-patient relationship. Patients have a well-placed trust in their physicians. Physicians will only use the systems if they’re valuable from a user design perspective and they promote their patients’ welfare. Rather than setting these systems up as proprietary company systems, they need to be set up more like public utilities. Put hospitals, physicians, and patients in joint control of these systems so that they are designed, managed, and governed by those who are going to be using the systems. These key stakeholders will get behind investments in “wiring” the care delivery system to improve quality, safety, and efficiency; what they won’t get behind is investments whose primary aim is surveillance.
I suggest that employers should get out of the business of trying to electronically capture their employees’ detailed health information, and into the business of getting health care providers to embrace information technology that improves the quality, safety, and efficiency of care. It's fair for them to want better data to measure performance, but they can get that without demanding access to detailed patient information. They can create urgency for better system performance using basic supply chain management principles that they're very familiar with: Invest in their healthcare delivery supply chain by setting basic technology and interoperability requirements for their suppliers (ie, providers), and facilitate their providers’ ability to meet these standards.
So, the program would run as follows. First, require physicians to use EHRs, help physicians pay for the upfront costs of getting outfitted with solid EHR systems, and train them and their staff to use the systems effectively. Second, require them to participate in data exchange networks that facilitate the effective coordination of care and the efficient transmission of clinical information. Third, put in place a new funding model that redirects reimbursement toward paying physicians for improving peoples’ health and away from paying them for the volume of care delivered and/or complexities that arise with their patients due to poor physician performance.
All of this is, of course, easier said than done, and no one knows that better than those of us slogging away in the trenches. But if Walmart and Pitney Bowes and IBM and UPS spent more time working with existing community-based efforts, and less time building their own proprietary data warehouses, it would happen faster than they might think, and it would be lasting and sustainable. There are many community-based efforts out there trying to do just this, and they could benefit enormously from the resources (financial, technical, and managerial), encouragement, and old-fashioned kick-in-the-pants that only the business community can provide.
I think the message employers should send to their employees is: “We don’t want your personal health data, but it's in everyone's interest to better monitor the overall performance of our insurer/provider network because the quality, safety, and cost of health care affects all of us.” That would reinforce the message that they’re not trying to undermine the sanctity of the doctor-patient relationship, but rather, trying to improve the performance of the overall system to better serve physicians, patients, and purchasers alike.
Thursday, November 30, 2006
Hi, I'm from WalMart and I'm here to help.....
Yesterday’s WSJ reported on a WalMart/Intel collaboration in digital health records. I don’t have a well-formed opinion yet on whether this is good news or bad news for the HIT adoption effort that many of us are engaged in, partly because the article didn’t provide a whole of detail on what this collaboration is actually doing. So let me proceed, but with caution. John McDonough asks whether this might be a “disruptive technology”. I don’t think so. He also asks whether this will complement the work of MAeHC and others involved in promoting HIT adoption. I do think so.
On the technology question, it’s not obvious what’s meant by “digital records for employees” and “portable electronic records.” Patients don’t document medical care, physicians do. And only 10-15% of physicians have EHRs, and most of the country’s 7600 hospitals don’t have accessible data either, so unless this is really a program giving digital records to physicians – and then giving patients access to those records – I don’t see how patients will benefit much.
Perhaps the WalMart model will be based on models that are already out there for the two types of data that are already electronic: claims and prescriptions. Health insurers are well down the road toward providing claims-based PHRs for patients, and AHIP has even brokered a deal for portability of the data across health plans. Revolution Health is going to build a portal that allows patient access to health financial information and health education information. KatrinaHealth is a patient-centric digital record of prescription information. None of these incorporate any hospital or physician information (ie, what we typically think of as our medical records) for the same reason noted earlier, namely, the data isn’t accessible electronically.
So, I don’t think this is a “disruptive technology” from a technical or innovation perspective – I personally don’t believe that there’s a technology magic bullet out there (though we all keep wishing for one!). The main obstacles, as always, are structural (our health care delivery and financing system is broken) and cultural (providers are notoriously independent and resistant to change, and patients think they get the best care in the world, even though there’s tons of evidence that they don’t).
I also don’t think it’s a “shift left” a la Andy Grove. You can’t get data out until someone puts it in, so I don’t think there are any good shortcuts here. It also has to be good data -- you can’t aggregate data that isn’t structured, so having physicians use word processors rather than real EHRs won’t facilitate data warehouses and will actually set them back 10-15 years. I agree that we don’t want to have complex technology be a barrier to adoption, but it needs to be sophisticated enough to deliver value.
That said, I do think this WalMart effort might exert “disruptive pressure” which could push the agenda forward and be very helpful to efforts such as MAeHC. The problem in HIT is that there’s no compelling reason for physicians to adopt EHRs or for providers to link up their systems once they have them. Most efforts to date have focused on the supply-side (ie, providers) because there’s been no real pressure from the demand-side (patients and employers, and their proxies, the insurers). Pay-for-performance may be an indirect means of forcing technological transformation, but it’s indirect. By contrast, when working with their other supply chains, WalMart, GM, Intel, and others insist that their vendors set up electronic data interchange systems that allow real-time inventory management, order management, delivery tracking, etc. If employers start thinking of their health care supply chain in the same way – and require that providers have EHRs and interoperability – they will fundamentally alter the pace of change by creating urgency, where none really exists today. Patients will be the main beneficiaries in the end.
I think it’s fair for all of us to be concerned about anything related to healthcare that WalMart is involved in, because their business success is based on cost-reduction, not on maintaining high quality products or service, and they apply this approach to their suppliers and to their employees alike.
I also worry that there could be an element of coercion in their model as described. Will they derive revenue from selling the de-identified data from the warehouse? Will they ask patient permission to sell this data (HIPAA doesn’t require it)? Will they share the revenues with their employees? My fear is that the answers to these questions aren’t on the side of their employees. WalMart of course would argue that the data is theirs since they’re holding it, paying for it, and de-identifying it (I guess possession is 9/10 of the law, or something like that). Yet another reason that we should move away from our system of employer-sponsored health benefits, but I’ll wait for John McDonough to open up that can of worms……
On the technology question, it’s not obvious what’s meant by “digital records for employees” and “portable electronic records.” Patients don’t document medical care, physicians do. And only 10-15% of physicians have EHRs, and most of the country’s 7600 hospitals don’t have accessible data either, so unless this is really a program giving digital records to physicians – and then giving patients access to those records – I don’t see how patients will benefit much.
Perhaps the WalMart model will be based on models that are already out there for the two types of data that are already electronic: claims and prescriptions. Health insurers are well down the road toward providing claims-based PHRs for patients, and AHIP has even brokered a deal for portability of the data across health plans. Revolution Health is going to build a portal that allows patient access to health financial information and health education information. KatrinaHealth is a patient-centric digital record of prescription information. None of these incorporate any hospital or physician information (ie, what we typically think of as our medical records) for the same reason noted earlier, namely, the data isn’t accessible electronically.
So, I don’t think this is a “disruptive technology” from a technical or innovation perspective – I personally don’t believe that there’s a technology magic bullet out there (though we all keep wishing for one!). The main obstacles, as always, are structural (our health care delivery and financing system is broken) and cultural (providers are notoriously independent and resistant to change, and patients think they get the best care in the world, even though there’s tons of evidence that they don’t).
I also don’t think it’s a “shift left” a la Andy Grove. You can’t get data out until someone puts it in, so I don’t think there are any good shortcuts here. It also has to be good data -- you can’t aggregate data that isn’t structured, so having physicians use word processors rather than real EHRs won’t facilitate data warehouses and will actually set them back 10-15 years. I agree that we don’t want to have complex technology be a barrier to adoption, but it needs to be sophisticated enough to deliver value.
That said, I do think this WalMart effort might exert “disruptive pressure” which could push the agenda forward and be very helpful to efforts such as MAeHC. The problem in HIT is that there’s no compelling reason for physicians to adopt EHRs or for providers to link up their systems once they have them. Most efforts to date have focused on the supply-side (ie, providers) because there’s been no real pressure from the demand-side (patients and employers, and their proxies, the insurers). Pay-for-performance may be an indirect means of forcing technological transformation, but it’s indirect. By contrast, when working with their other supply chains, WalMart, GM, Intel, and others insist that their vendors set up electronic data interchange systems that allow real-time inventory management, order management, delivery tracking, etc. If employers start thinking of their health care supply chain in the same way – and require that providers have EHRs and interoperability – they will fundamentally alter the pace of change by creating urgency, where none really exists today. Patients will be the main beneficiaries in the end.
I think it’s fair for all of us to be concerned about anything related to healthcare that WalMart is involved in, because their business success is based on cost-reduction, not on maintaining high quality products or service, and they apply this approach to their suppliers and to their employees alike.
I also worry that there could be an element of coercion in their model as described. Will they derive revenue from selling the de-identified data from the warehouse? Will they ask patient permission to sell this data (HIPAA doesn’t require it)? Will they share the revenues with their employees? My fear is that the answers to these questions aren’t on the side of their employees. WalMart of course would argue that the data is theirs since they’re holding it, paying for it, and de-identifying it (I guess possession is 9/10 of the law, or something like that). Yet another reason that we should move away from our system of employer-sponsored health benefits, but I’ll wait for John McDonough to open up that can of worms……
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