August 11, 2008

1. Survey: EHRs, HIEs Needed; Plus Joshua's Tops on 'So You Think You Can Dance'

Facts and Background

Results of a Harris Interactive survey announced Thursday show that a vast majority of those surveyed think the American healthcare system needs to be overhauled, quality should be improved, and computerized medical records and connectivity among doctors should be pursued.

Opinion

Having an opinion is different from being qualified to render one. The survey obviously was intended to elicit the response that the system needs overhauled, which is not an unreasonable question, but to have randomly chosen lay people involved in discussions about computerized records and electronic data exchange is ridiculous.

Musings

• If you were surveyed about something you knew nothing about, you'd choose answers calling for change and for anything that sounds both progressive and free. Just like these respondents.
• The folks calling for big changes aren't paying for the majority of their own care today, and with the expensive changes they voted for, would likely either pay more or have less coverage (and the survey omitted the real question: would you pay for these changes?)
• Surveys repeatedly show that healthcare discontent is not universal. Those with insurance and resources (like every politician in Washington, who get their own special coverage) are pretty happy with things the way they are, although the survey didn't have that finding (most likely because of the telephone methodology).
• This was a telephone survey. People at home with listed telephone numbers who don't have caller ID to ignore surveyors are certainly not representative of the entire population.
• The groundswell for major change wasn't as dramatic as the headline writers said. Less than a third of those surveyed called for major changes; 50% said some change was needed.
• All that aside, and ignoring the silly technology questions, the survey is clear that people aren't happy with the way healthcare works. Will they vote and pay to change it? Do they really have a voice and a choice?

2. athenahealth, Missing a Capital Letter, Buys a Company With Two

Facts and Background

athenahealth announced Monday that will acquire physician internet services vendor MedicalMessaging.net of Rome, Georgia, for $7.7 million in cash.

Opinion

It's a tiny company that was already an athena partner, but it gives athena new capabilities.

Musings

• MedicalMessaging.net provides communication between doctors and patients under a service model.
• The company's web site says they have customers in 13 states, but the actual number is 40.
• Services offered include appointment reminders, results delivery, and healthcare messaging.
• MedicalMessaging.net is minimally known, but athenahealth is obviously more interested in complementary capabilities rather than cash flow or marquee value.
• This may be athena's first foray outside of physician systems and into broader physician services.
• It was a cheap acquisition since athena bought the company early in its life cycle, so it doesn't have to yield much to pay for itself.

3. California Needs a New Gold Rush to Replace All the Fired UCLA Snoops

Facts and Background

A California state report released Monday revealed that UCLA employees inappropriately accessed the electronic medical records of celebrities even after the initial breach and punishments were announced. Of the 127 now implicated, twice the number originally reported, the hospital wants to fire seven and discipline 14.

Opinion

If they identified 127, you can bet there were at least several hundred employees who snuck a quick peek.

Musings

• The fact it hasn't happened elsewhere is more a testament to LA's large number of celebrities than the fundamental honesty of hospital employees elsewhere.
• What happened to all those system controls that were supposed to prevent unauthorized record access? Probably failed because of system overhead, the obligation to maintain and audit, and lack of electronic assignment of hospital staff to know who had a legitimate need.
• Interestingly, while the report did not name the celebrities, the newspaper worked its own sources to name former Cheers actress and attempted suicide patient Shelley Long as one of them. Wouldn't that in itself be a privacy violation, even though newspapers aren't covered by HIPAA?
• Why not shut down demand by making it illegal for tabloids to publish PHI? HIPAA covers only providers because it was developed around EDI for billing, but medical privacy should really extend everywhere.
• One employee used her boss's security code to look at the records, bringing to light the universal problem of hospital users who are lax about security.
• There are probably other Hollywood has-beens who would do anything to get newspaper coverage for having their records compromised. Depression, detox, and Botox are hardly news there and "there's no such thing as bad publicity" in El Lay.

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