Microsoft Connected Health Conference: Keynote Day 2

The first keynote speaker on Friday was Mark D. Smith, M.D., M.B.A., President & Chief Executive Officer of The California HealthCare Foundation.

If you ever get an opportunity to hear Dr. Smith speak, take it! He gave probably the best keynote talk I’ve ever heard: Funny, educational, and mildly provocative.

It’s clear that Dr. Smith has extensive real world experience in healthcare, and he has an extremely engaging way of presenting his point of view.

It’s interesting to note that Dr. Smith is on the Google Health Advisory Council…not insignificant, since the Connected Health conference was largely a marketing vehicle for Microsoft’s HealthVault.

My favorite part of Dr. Smith’s talk was when he put the following Los Anglees Times excerpt on the screen:

This year or next, Congress will almost certainly enact a comprehensive medical insurance plan to provide coverage for almost everyone in the country…

[The president] has submitted his proposals for reorganization, Sen. Edward M. Kennedy and others have offered theirs. There is no argument about the need for reforms; everyone agrees our present system is unsatisfactory. Rather the debate will be the scope and methods of change.

The funny thing about that editorial is that “the president” is not Barack Obama—it was Richard Nixon, and the editorial was written in 1971.

Some key points I picked up:

• There are three primary things that we need to get right, as we work for healthcare reform:
  1. Reimbursement policy
  2. Comparative effectiveness
  3. Recognizing the need to promote new things in healthcare
• New things:
  • OpenTable: Essentially allows small restaurants to provide online services that rival those of chains. Someone needs to do the same for independent physicians – so that they can provide services similar to those offered by Kaiser Permanente and the Mayo Clinic.
  • WebMD
  • Neighborhood clinics that provide convenient urgent care service, so that patients don’t have to visit the ER
• If we let librarians control the rate of uptick in search engines, or we let travel agents drive the uptick in travel sites, or we let bank tellers drive the uptick in banking sites, we’d be in the same place we are with consumer-enabled healthcare today.
• There are some things that we needed doctors for 30 years ago, but we don’t really need them for any more. Dr. Smith was involved in a pilot of an automated, kiosk-hosted system that diagnoses urinary tract infection. It worked very well, and patients’ satisfaction with the automated system was far greater than their satisfaction with live doctors. In fact, when asked about their “satisfaction in time with the doctor”, only 17% of those who saw a live doctor expressed high satisfaction, vs. 60% of those who used the kiosk…even though they had no time with the doctor at all!
• How do standards develop? Windows – Wi-Fi – Walmart
  • Windows: A company or individual “wins” market share and unilaterally established a standard
  • Wi-Fi: A group of smart people get together every year in Las Vegas, and come up with the “a” standard, then the “b” standard, then the “g” standard, then the “n” standard…
  • Walmart: A buyer in the marketplace decides they need something, but no one is doing it, so they demand it from their suppliers. Walmart says, “We want RFID, so if you want us to sell your toilet paper, put our RFID on it.” Toilet paper manufacturer says, “OK”.
    Medicare (the government) is the WalMart of healthcare…but they are trying to be Windows.

Dr. Smith praised Phreesia, a popular high-tech replacement for the clipboard. Over a million check-ins have been processed in 49 states, and not a single doctor has ever met an employee of Phreesia.

The philosophy of Phreesia and other upstart HIT companies: “We’re going to assume that we’re not going to be able to change doctors’ behavior. Instead, we’re going to insinuate ourselves into their workflow and help them do things that they need to do anyway.” No army of IT geeks required.

What is important to encourage HIT adoption?

• For providers: Simplicity, adaptability (us to them, rather than the other way around), functionality
• For patients (aka “consumers”, humans):
  • Value (“what does it help me do?)
    Most of us are healthy. HIT promoters don’t recognize that what is of value to most (reasonably healthy people) is not the archival and retrieval of claims data. We need to solve problems that regular people, who see their doctors once a year, need solved.
  • Security
    Security is always measured relative to the value. We’ll give up some privacy if enough value is there.
  • Beauty (“elegance'”)
    Things that have elegance (like the iPod) have uptake among consumers. How do we provide things that consumers want, instead of what we want?

And, finally, addressing the adoption of EMRs among physicians, even in light of the HIT stimulus money:

“How do you deal with a market where free is not cheap enough?”