Category: e-health

Are privileged people wasting their time using healthcare portals?

published date
October 27th, 2015 by
Should I enter the portal or not?
Should I enter the portal or not?

A new study on use of electronic health portals by patients with chronic kidney disease is another example of telling us something we already know: people with lower socioeconomic status don’t adopt healthcare innovations to the same extent as those with higher status. In this case, white, young, married, commercially insured, higher income patients used the portal more.

Here’s what the lead author told NPR about the study:

“Despite the increasing availability of smartphones and other technologies to access the Internet, the adoption of e-health technologies does not appear to be equitable,” Abdel-Kader says. “As we feel we are advancing, we may actually perversely be reinforcing disparities that we had been making progress on.”

Presumably the portal users expected to receive some sort of benefit as a result of logging in. However, from what I can understand from the NPR story and study abstract, the researchers were unable to document the clinical benefit (better blood pressure control) that they were expecting to find.

So maybe a better conclusion is that relatively privileged people with the luxury of time and bandwidth on their hands tend to waste time and resources on a portal that doesn’t provide benefits, while those with lower status focus on more important and productive pursuits.

Ok, that conclusion may not be correct either, but I have real doubts about the usefulness of this research.

It’s ironic that the authors –while bemoaning barriers to access and arguing passionately for policies to address it– published their study and accompanying editorial behind a paywall in the Clinical Journal of the American Society of Nephrology rather than with an open access publisher such as PLOS. I’m curious about the details of the study but not enough to pay $27 for the article and another $27 to read the editorial. I’m going to spend my $54 on something better.

Image courtesy of basketman at

By healthcare business consultant David E. Williams, president of Health Business Group.

Mercy Virtual’s Randy Moore: ROI isn’t good enough (Podcast)

published date
September 25th, 2015 by
Randall Moore, MD. President of Mercy Virtual
Randall Moore, MD. President of Mercy Virtual

Mercy Health has been doing big things in digital health. Last year I interviewed EVP Shannon Sock after he spoke in Boston. And recently I met Mercy Virtual’s president, Randall Moore, MD at Qualcomm Life’s Connect2015 conference to ask him some follow-up questions after his talk.

  1. (0:10) You came out on stage and said ROI isn’t a high enough bar to cross. You really have to consider cash flow. Say more about that.
  2. (1:16) You showed a compelling video of a patient’s experience. How much of that is vision and how much is real? For example, do you really have ‘warm handoffs’ to the ER when someone arrives after calling ahead?
  3. (3:34) Many people at the conference have been sanguine about the new ‘value based’ models. But you said hospital-based ACOs are likely to fail. Why?
  4. (6:07) You discussed radically reducing length of stay and increasing market share to stay viable. Does your business model rely on putting your competitors out of business?

By healthcare business consultant David E. Williams, president of Health Business Group.

Digital health at Walgreens: Podcast interview with Adam Pellegrini

published date
September 8th, 2015 by
Adam Pellegrini, Walgreens VP, Digital Health
Adam Pellegrini, Walgreens VP, Digital Health

Consumer adoption and scale-up were big themes at last week’s Qualcomm Life Connect 2015 meeting in San Diego.  Many digital health initiatives are still stuck in the concept, prototype and pilot stages, but Walgreens has been charging ahead. The presentation from Adam Pellegrini, Walgreens VP for digital health was refreshing and inspiring. I caught up with him afterwards to follow up on some key points:

  1. (0:12) How does Walgreens use its Balance Rewards loyalty program to generate engagement with digital health?
  2. (1:13) What is the role of Walgreens pharmacists in telehealth?
  3. (2:49) What consumer friction points are you obsessing about in healthcare today?
  4. (4:06) What is Walgreens doing with telehealth outside the US? Are you bringing lessons from abroad here?


By healthcare business consultant David E. Williams, president of Health Business Group.


par8o and IRCDA team to automate clinical assessment with SCAMPS

published date
July 24th, 2015 by
Scamp meet SCAMP
Scamp meet SCAMP

par80 and the Institute for Relevant Clinical Data Analytics (IRCDA) have teamed up to enable sophisticated clinical decision support at the point of care using SCAMPS. I asked Dr. Adam Sharp,  par80’s cofounder, president and chief medical officer to explain.

  1. What are SCAMPs? How do they differ from evidence-based protocols?
    • SCAMPs are Standardized Clinical Assessment and Management Plans. SCAMPs outline a data-backed, consensus-based, care pathway for a diverse patient population with a particular diagnosis or condition. Data is collected on the treatment and outcomes of that population, analyzed, and then used to improve the care pathway
    • While evidence based protocols can answer highly specific medical questions, the traditional methods are inadequate to address the interdependent questions related to defining effective care
    • SCAMPs aim to bridge the gap with a method that is integrally linked to continuous improvement
    • Additionally, SCAMPs aim to reduce the cost of delivering care to patients while improving quality by focusing on standardization of care and reduction of unnecessary utilization
  2. What are some examples of SCAMPs? What value do they provide?
    • There are a wide variety of SCAMPs, ranging from the inpatient to outpatient to ER settings. Some examples of SCAMPs are the Congestive Heart Failure SCAMP (inpatient) Distal Radius Fracture (outpatient), and Acute Kidney Injury (ICU)
    • They reduce variability in care. The algorithm drives consistency among participating providers. In addition to providing a layer of liability protection, organizations want to drive towards best practice guidelines. SCAMPs do so from the grassroots level
    • SCAMPs gain support from providers because in spite of a foundational algorithm driving decisions, providers are free to diverge from the SCAMP recommendation, so long as they provide a reason. This empowers providers to use their own intelligence alongside the best practice guidelines laid out by the SCAMP
    • Finally, a SCAMP is never perfect. After using it in the field for a given amount of time, the data is collected and analyzed by IRCDA’s analytics team. The output is then used to reevaluate the SCAMP and to change the algorithm to account for the decisions doctors made. These iterations ensure care pathways are constantly improving based on the latest empiric evidence
  3. And what is IRCDA? How does it relate to SCAMPs?
    • IRCDA is the Institute for Relevant Clinical Data Analysis. In 2006, clinicians in the Cardiology Department at Boston Children’s Hospital began to toy with a new methodology. This methodology would ultimately create SCAMPs
    • As success grew and institutions around the world became interested, IRCDA was created in 2010 to spread and promote SCAMPs to interested institutions
  4. You’re a founder of par8o, which you describe as a healthcare operating system. You’re partnering with IRCDA to implement SCAMPs. How does all of this fit together? If par8o is the operating system, what does that make IRCDA, SCAMPs, and hospitals?
    • IRCDA, SCAMPs, and hospitals in many ways represent a microcosm of the healthcare system as a whole. A major benefit of working with IRCDA is that it touches so many major components of the healthcare industry
    • It ranges across healthcare settings (inpatient, outpatient, ER) in addition to focusing on the most important players in the industry – the providers
    • As healthcare’s operating system, par8o wants to layer itself onto as many aspects of care as possible. Doing so will allow us to bring efficiency to all parts of the industry
    • Finally, pathways in healthcare are manifold. From taking a patient through the right care pathway, to following a pathway created by an insurance company for specialty pharma, to finding eligible patients for clinical trials, the foundation par8o builds with care pathways will have many implications for driving efficiencies in other aspects of healthcare
  5. How are EMRs involved in this initiative?
    • par8o integrates with all EMRs via the Direct protocol developed by HHS Office of the National Coordinator (ONC). SCAMPs can be initiated out of an EMR using a direct message – the direct message will trigger a draft SCAMP to be created in par8o and will notify the provider that they must complete the SCAMP
    • Therefore, so long as the EMR supports Direct messaging, par8o can use that functionality to integrate
  6. What impact will this partnership have for patients?
    • Patients will benefit because par8o’s technology will address two key pain points currently in the SCAMP process. The first is unwieldy data entry – par8o will enable providers to complete SCAMPs from their mobile phone. Using decision support, the forms will seem less onerous
    • Additionally, by leveraging form versioning technology, par8o will enable faster iterations on SCAMPs. Faster iterations means the data gathered during SCAMP collection can be leveraged sooner, resulting in enhanced care for affected patient populations
  7. This is clearly a first step. How do you see development rolling out over the next few years?
    • Over the next few years, par8o has a big vision. To start, our aim is to successfully launch a pilot program at a single institution. We hope to ease data entry issues and therefore increase adoption. Additionally, we hope to see faster iterations between SCAMP versions
    • In the future, in addition to expanding to more member institutions, we would like to see a social element brought to SCAMPs where providers are able to participate in chat forums and share the latest literature concerning that area of care
    • par8o also plans to build a SCAMPs “Editor”, which would enable the IRCDA team to build and version their own SCAMPs, greatly increasing the iteration process

By healthcare business consultant David E. Williams, president of Health Business Group.

Checking the symptom checkers

published date
July 10th, 2015 by
I have a small problem
I have a small problem

Online “symptom checkers have deficits in both diagnosis and triage, and their triage advice is generally risk averse,” according to a new study in BMJ by Harvard researchers. Some of the press coverage of the study has been pretty critical of the symptom checkers, but the study itself is quite balanced.

Symptom checkers are a lot better than “Google Diagnosing” (typing a list of symptoms into Google and seeing what comes up). They’re very similar to nurse triage lines used by health plans, which is no great surprise considering that many of the triage lines use the same logic that drives the symptom checkers. They’re inferior to a primary care physician, but of course physicians aren’t infallible either.

People use symptom checkers to self-diagnose and to figure out if they need to go the emergency department, doctor’s office or can treat at home. Not surprisingly, the symptom checkers err on the side of suggesting patients seek care. No producer of these tools wants to get sued for recommending self-care to someone who should have called an ambulance. But in this regard symptom checkers are similar to nurse triage lines and also –at least in my experience– to physicians who are covering call. Too often they suggest a trip to the ED.

There’s an opportunity to reframe the next generation of symptom checkers as tools for navigating the medical system. That means not just suggesting a diagnosis and level of care, but pointing to an appropriate specialty, facility, or individual clinician to follow up with. This could be especially useful for patients in areas with fewer specialists and sub-specialists, and those with rare or hard to diagnose conditions. Primary care physicians could use such a tool as well to help direct referrals.

Image courtesy of David Castillo Dominici at

By healthcare business consultant David E. Williams, president of Health Business Group.