April 21, 2008

1. Article: PHRs Are Great, Except for the Untrustworthy Companies Offering Them

Facts and Background

A New England Journal of Medicine article published Thursday supports the use of personal health record data for medical research, but raises privacy concerns involved with having large, for-profit companies such as Google and Microsoft in charge of it.

Opinion

I'd be worried about PHR privacy too, except (a) there's already no privacy, and (b) PHRs that rely on patient data input will never hold enough trustworthy information for anyone to want anyway. The gravy train of sellable data doesn't come from PHRs and never will.

Musings

• The article suggests that big companies be covered by HIPAA, but misses a major point: HIPAA lets providers do whatever they want with patient data under the blanket excuse of treatment, payment, and operations. Adding for-profit companies to HIPAA might actually give them more latitude for misdeeds.
• Microsoft, not surprisingly, doesn't like the idea of HIPAA restrictions on its business. Reasonably, in fact. If it screws up, there's a lot more at stake than the usual HIPAA slap on the wrist (like bad press, consumer distrust, and expensive lawsuits).
• Everybody complains that healthcare information should work like ATMs or online banking, but banks repay a lot of money to consumers whose accounts are hacked or fraudulently charged. How do you repay someone for having their medical information permanently and publicly exposed?
• What about the companies already rolling in the profits from buying and selling patient data? Why not just pass a law making patient data sales illegal without individual patient consent, thereby eliminating the market for it? Researchers would howl, but too bad. If they need that data, let them ask patients for it. It's their information (or are we still debating that point?)
• Much of the worry about PHI privacy is because of the bizarre system of medical insurance, which denies coverage to those who might actually use it and that incents employers to avoid hiring anyone who uses the health benefit they offer. I would bet that most consumer distrust involves insurance companies and employers.
• Taking the counterpoint, there's already no security in paper medical records. Put on a white coat in a hospital, scowl, and stroll over the chart rack and pull whatever you want with authority. You will probably not be questioned.
• Another problem that should have been mentioned: why do medical records contain identifiable information anyway? Mostly for billing and positive patient ID. Maybe PHI protection should start with an anonymized chart.

2.  Dutch Masters Smoke in Healthcare, Choke on TVs

Facts and Background

Philips announced quarterly earnings Tuesday, reporting flat sales and a 75% drop in profits, mostly because of poor TV sales. The company's healthcare division turned in a 5% sales growth and flat profit margins, far better than rival GE's earlier healthcare numbers.

Opinion

Philips 1, GE 0. Both companies have a smorgasbord of unrelated businesses ranging from light bulbs to juicers to TVs, so it's certain that some lines will do good, some bad at any given time. That's the best and the worst thing about being an unfocused conglomerate. It's like buying medical devices from a mutual fund.

Musings

• Big question: GE and Philips are heavily exposed to non-healthcare factors and credit problems, so will the healthcare-only vendors about to announce (Cerner, Eclipsys, McKesson) show better numbers in a down economy? Their upcoming announcements will be crucial for reading the market, much more so than Philips and GE.
• Other than medical equipment, Philips has a far better strategy than GE, which seems to simply buy and ruin everything in its healthcare IT path.
• Maybe lackluster conglomerate performance will give more innovative and customer-focused small vendors a chance to earn some business.
• Philips has used acquisitions to create a strong identity in the home monitoring market, which gives it a different way to attack the healthcare market.

3. Shaky Data Used to Predict Robust HIT Job Market Without Asking Employers

Facts and Background

A study announced Thursday by Oregon Health & Science University forecasts the need for a 40% increase in the healthcare IT workforcce.

Opinion

From the minimal information provided, it appears that the study took the IT FTE-to-bed ratio for hospitals in Stage 6 of the HIMSS Analytics EMR Adoption Model (which contains only 13 hospitals that range from 74 to 858 beds). It then applied that ratio to the number of employees in hospitals of lower stages, making the very shaky assumption that moving up the ladder requires the same ratio that those very few Stage 6 hospitals use. A couple of calculations and out pops the need for 41,000 new workers.

Musings

• The results were announced at a meeting run by an Oregon Congressman pushing for federal money for healthcare IT worker training. Oregon-based OHSU happens to offer that training. Coincidence?
• You could fill another article just with questions about this one's assumption, given that no details were released. It appears to compare entire IT department staffing, not just informatics people (so is there a dire shortage of IT secretaries, PC technicians, and switchboard operators?) Extrapolating a ratio obtained from 13 wildly dissimilar hospitals to cover thousands is a real stretch. The statistical validity of the reporting hospitals could not be ascertained, apparently, because the HIMSS Analytics database, while convenient for conducting armchair research, doesn't have that information. Were the beds counted as licensed, occupied, or other? Since the systems tallied in the Adoption Model are a tiny subset of those a hospital runs, where's the sensitivity in applying that to the entire IT department's staffing? What's the current standard deviation of FTEs per bed within Stage 4?
• One example of shaky underpinnings: the HIMSS Analytics database showed that Stage 4 hospitals had higher IT staffing ratios than Stage 6. Perhaps that's another study to release if you believe the data: moving to more complex clinical systems allows slashing IT staff.
• Study validity aside, its conclusions are  probably sound, even if not quantitatively defensible. Staffing goes up with clinical systems implementations, as does the IT budget (ask any CIO who's installed Cerner, Epic, or Eclipsys). That's compared to paper and legacy systems, however, so it's first-timers who take that hit.

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