Peter Piper (Jaffray) picks a previously predicted point

June 30th, 2008 by David E. Williams of the Health business blog

From the New York Times (Google Tries Tighter Aim for Web Ads)

Google, with its deep reservoir of data about online behavior gathered by tracking hundreds of millions of computers, is for the first time testing ways to use some of that data to aim ads at Web users.

Ads that a person sees on one Google search may be influenced by what was searched a few minutes earlier. Searching for “scuba,” then something else, and then “vacations” could pull up ads for diving trips, for example.

This small but significant change in Google’s strategy was discovered by Gene Munster, a securities analyst at Piper Jaffray, who this year started a series of tests looking at which ads were displayed in a series of queries on Google’s search engine. Google assigns every computer that visits its sites a unique number — known as a cookie — and records searches and other activities in an unimaginably large file with those cookies.

The company previously said that it had not used any of that information to draw inferences about users for the purpose of selecting ads to show them.

As I described last year (What if Google finds out you have cancer before you do?)

[I]t’s more than possible for your search pattern in Google to reveal that you may have a disease before you and your doctor figure it out. A friend got a little worried when ads for Neulasta started popping up along his searches. The drug, made by Amgen…

…is prescribed to reduce the risk of infection (initially marked by fever) in patients with some tumors receiving strong chemotherapy that decreases the number of infection-fighting white blood cells.

There is something creepy about getting a knock from a virtual grim reaper even when if it turns out to be a false alarm. As ad placement technology gets better and better I expect you’ll see examples of targeted advertising portending the diagnosis of serious illness.

The scuba vacations example is fairly trivial compared with the cancer diagnosis scenario. Now tie in Google Checkout, Gmail, Google Calendar, Google Health and the rest of the Google product line and you have the basis for some pretty spooky scenes. Let’s see if Mr. Munster can figure out what to say about that.


Posted in e-health | 2 Comments »

Change of Shift is up at 20 Out Of 10

June 27th, 2008 by David E. Williams of the Health business blog

Change of Shift, the nursing blog carnival, is up at 20 out of 10.


Posted in Announcements, Blogs | No Comments »

It may soon be feast and famine for hospitals

June 27th, 2008 by David E. Williams of the Health business blog

If you’ve ever spent time re-engineering an old-line factory, you know the impact of rework. When a factory is managed poorly, products fail inspection the first time and need to be re-run. Sometimes a product is re-run multiple times before it gets out the door. Poor processing can also ruin a product before it reaches the end of the line. That scrap goes right in the trash or, best case, is recycled.

The difference between a smooth running factory with high first-pass yield and an old-fashioned factory with low yield is dramatic. The smooth-running factory produces much more output with the same assets and raw material inputs. If the factories are in the same industry, one will be far more profitable than the other. In fact, the poorly-run factory is likely to be pushed out of business before too long. This is how things work in most industries, and explains why productivity and quality have risen so much over time while prices (in general) have been stable.

Hospitals are different. When a hospital screws up (causing an infection for example), it can charge the customer to fix the problem! Unlike a factory, a hospital can make money from such rework. As a result, while there are differences in profitability among hospitals, the differences are smaller than they would be in a normal industry. Because inefficient hospitals can stay in the market, it also reduces the pressure to make productivity improvements. As a result, costs rise over time.

All this is starting to change. As Medicare and other large insurers start refusing to pay for errors, hospitals themselves will have to pay for rework. If the trend continues –which I think it will– and hospitals can no longer charge for preventable errors, soon hospitals will need to be managed much more like factories. Since we know there is plenty of rework going on in the typical hospital, there will be an opportunity for dramatic differences in hospital profitability, just like in regular businesses.

However, unlike normal companies, which are generally allowed to go out of business if they fail to compete, hospitals tend to be protected. What that implies is that payers will end up increasing payments so that low-performing hospitals can stay in business. That may provide a real opportunity for the best-performing hospitals to reap a windfall. It could also lead to a new wave of hospital acquisitions led by those hospitals that figure out how to eliminate errors.

I don’t have the data to back up this speculation, but I bet I’m right.


Posted in Economics, Hospitals | 2 Comments »

Health Wonk Review is up at Disease Management Care Blog

June 26th, 2008 by David E. Williams of the Health business blog

The latest version of the Health Wonk Review is up at Disease Management Care Blog.


Posted in Announcements, Blogs | No Comments »

Podcast interview with Dr. Jason Bhan, co-founder of Ozmosis (transcript)

June 26th, 2008 by David E. Williams of the Health business blog

This is a transcript of my podcast interview with Dr. Jason Bhan, co-founder of Ozmosis.

David Williams:  This is David Williams, co founder of MedPharma Partners and author of the Health Business Blog. I spoke recently with Dr. Jason Bhan, co founder of Ozmosis, a physician only social networking site whose motto is “Diffusing knowledge across the Internet.” We spoke about how physicians are using Ozmosis, differences between Ozmosis and other sites like Sermo, and the company’s somewhat unusual business model.

Jason, thanks for joining me today.

Dr. Jason Bhan:  I appreciate the opportunity, David.

David
:  Jason, what is Ozmosis?

Dr. Bhan
:  Let me give you a little bit of history about Ozmosis and where it came from. It is borne from experience, from my experience and those of my colleagues. We started to realize how difficult it was becoming to keep up with the increasing amounts of information that are available to us as well as the changes that are going on in medicine and health care on a day to day basis. PubMed is indexing thousands of new articles a day, guidelines and best practices are constantly in flux and we’re being pulled between patient care and managed care, which is increasing demands on our time. As physicians, we are just overwhelmed.

We got together and wanted to create a set of tools that will allow us to work together, to manage information, to share ideas, and to collaborate while tackling tough issues. In essence, we wanted to create an environment in which we really learn best, which is from each other. This is, in fact, how we’re trained as physicians. It’s the interactivity of the “See one, do one, teach one” philosophy that we lose fairly rapidly as we move from residency into reality.

David
:  Jason, there are a number of new physician only social networking sites. What makes Ozmosis different?

Dr. Bhan
:  Ozmosis has a number of unique qualities. First and foremost is trust. When we’re dealing with patients and health issues, it is absolutely critical that we trust the information and the source of the information before we use it on our patients. So, what we did was go about engendering trust in a number of different ways.

Firstly, we verify the identity of each and every member before they’re permitted access to the site. This is done through a proprietary solution we’ve developed; it’s rigorous and every member goes through it. So, every member who’s been through it knows that every member before and after them is going to get through it or has been through it. There’s a level of confidence that our members have that they’re operating in a community of their peers.

Secondly, Ozmosis is not an anonymous community. Members can very quickly recognize and interact with their colleagues anywhere on the site and rely on the information that’s being obtained. It’s a combination of knowing who you’re getting your information from and what your relationship is to that information source.

The other differentiator from a number of other sites is what we call our knowledge exchange. Our knowledge exchange takes the individual insights of physicians and transforms them into trusted knowledge nuggets for our members. We provide physicians a place where they can turn for trusted, reliable clinical practice management and health policy information.

We’ve done this by building from the ground up a solution that fits the physician rather than trying to wedge a physician into a box. By using simple tools to bookmark, post content –whether it’s journal abstracts, medical cases, videos, podcasts, blog entries, anything from anywhere on the Web–, the community then collectively evaluates it, discusses it, and rates it, and to the benefit of everybody. This allows the best and most timely information to just bubble up to the top.

David
:  Your physician users are all identified, they’re not anonymous. I understand why that’s useful in promoting trust, but I wonder if there are drawbacks to that? For example, I’m wondering if more junior physicians tend to defer to their elders even when they have different views.

Dr. Bhan
:  There’s always controversy in medicine, and generally, physicians aren’t afraid to stand up for what they believe in, especially if there’s evidence to back it up. In fact, when there’s evidence to the contrary, physicians are the first to admit that they may be wrong, especially when it involves patient care.

Initially, there were some occasional hesitations among physicians to post certain types of cases or questions. It had to do more with the concern that the specifics of the case were such that the individual that they were presenting could potentially be identified by associating the details of the case with the physician’s name. So, based on the user feedback, we actually do allow some cases and questions to be submitted anonymously if they desire. We found it’s a pretty rare situation; it’s not a commonly used tool.

David
:  What kinds of issues are discussed? Could you describe a case example, maybe describe how the dialog is different than it would be in the physical world?

Dr. Bhan
:  Yes, absolutely. There are a number of different examples; we see some great conversations. I’ll give you one from a basic clinical pharmacology example, which was a discussion that had to do with comparing the efficacy of Sudafed versus phenylephrine. Amazingly, this is just something that’s written into our heads as physicians and what we found was that very few people actually knew the evidence surrounding it.

We will just recommend phenylephrine or Sudafed, whichever the patient prefers to use for the symptoms that they were having. What ended up happening on the site was a relatively in depth literature review and experiential accounts that compared the two. What we found was that literature and experience sort of meshed together and one tended to be better than the other, both by evidence and experience.

We’ve seen some excellent clinical cases from managing simple trauma in the office setting, where a physician might have had to make a number of phone calls or page a number of other physicians after hours to try and answer something. By posting it on Ozmosis, they got the answer in a more timely manner and a broader variety of answers as well and options.

Then there are some incredibly complex patient cases that are presented. Some that had to do with patients in hospital and what kind of medications they should be on for extremely complex cardiac patients. These are the kinds of patients and cases that you really don’t see in the textbooks, so it takes either an incredibly experienced physician and a number of others that they’re working with or a community to come up with the right answers.

David
:  How long has Ozmosis been around and how big is the site in term of the number of users or whatever metric it is that you track?

Dr. Bhan
:  We incorporated a couple of years ago in 2006. We launched our alpha version of the platform in February of 2007 and we did that with a small group of physicians who we felt were going to be good with feedback and basically grew the site from there with their input, making sure that we took into account the wants and needs of our community.

As far as the usership of the site we’re seeing extremely high activity levels and our membership is growing very well. We’re continuing to focus on building the community based on quality. Our members understand that these are new ways to communicate and interact and that ultimately they’ll lead to improved patient care.

We are receiving a significant amount of interest for invitations from physicians across the country and when we open up Ozmosis to all U.S. licensed physicians later this summer we are expecting a really excellent growth rate.

David
:  As physicians get used to social media how do you think their behavior will evolve? Will physicians visit just one site or do you think they’ll use Sermo, usenet groups and other sites? How do you think about that as a physician and as an entrepreneur?

Dr. Bhan
:  Ozmosis is unique. There are other sites that provide a completely different experience than Ozmosis and other opportunities for physicians that Ozmosis doesn’t provide so there’s no reason to necessarily believe that this space will be different from any other in social media where multiple sites or multiple platforms exist, that individuals, including physicians, will bounce between depending on their needs.

David
:  Tell me about your business model.

Dr. Bhan
:  At Ozmosis we are absolutely focused directly on benefiting the physician to improve patient care. In the same way that our physicians use Ozmosis for knowledge discovery they also use it for product discovery.
We provide opt in areas of the site that allow physicians to learn about new products and services from other physicians. Again this is an example of physicians learning from each other.

A client would provide content, product literature, multimedia content. All that is displayed in a well identified and branded opt in area and the real value is in the peer-to-peer discussion that occurs around the product.

As a physician it’s more useful to learn about how my colleagues are using a product in day-to-day use and in their practice as opposed to from a sales rep. I’ll give you an example. One of our clients, PocketMed has a mobile charge capture solution and rather than relying entirely on a large sales force, they use the Ozmosis product discovery area to house discussions on tips, tricks, feedback and testimonials. Other physicians that want to learn more about the product have the opportunity to go and quickly get a sense of how other physicians are using it and if it’s the right one for them.

David
:  Within those sponsored areas does a sponsoring company have a rep who’s a physician or do they just put the materials out there for the users to discuss?

Dr. Bhan
:  It depends; there are obviously companies that have physicians in their ranks. We do ask, and it’s in our user terms that the physicians who are associated with companies or other entities on the site actually disclose that to the rest of the community.

David
:  Do you think your business model will change over time or is it robust and sustainable the way it is now?

Dr. Bhan
:  Yes, I absolutely believe it’s robust and sustainable. I think every business has the opportunity to change over time so I won’t put it past us to take another look at it in the future.

David
:  You recently announced a relationship with The Doctors Channel. Can you describe that please?

Dr. Bhan
:  Yes, absolutely. You know one of the things that we didn’t anticipate from our physicians was this interest in seeing video based content, so we went out and looked for a good partner to provide this for us and found The Doctors Channel. They have an incredibly creative approach to video and informational videos so we integrate their original video content into Ozmosis and general physician-only discussions that take place on our site.
It’s been fascinating, in fact. Some of our physicians have enjoyed the videos so much that they want to take part in them and we’ll actually be seeing some of our users be featured in some of The Doctors Channel videos fairly shortly.

David
:  As you prepare to open the site to other users, do you expect to include physicians outside the U.S. or is it meant to be domestic only?

Dr. Bhan
:  Yes, absolutely. Physician-first and patient care improvement is our goal, so I don’t see any particular reason to not include the global health care community in Ozmosis. For now it’s just a matter of being able to maintain that trust level that comes with making sure that physicians are in fact physicians when they become members, so that’s the hurdle that we’ll cross when needed.

David
:  What do you see as your biggest challenge moving forward? What are the things that keep you up at night?

Dr. Bhan
:  The largest challenge that we’ve got ahead of us is constantly providing value to our physicians. Adapting, changing to their wants and needs, especially as the community grows. It’s been fairly simple to iterate and make decisions and change when the community’s been a controlled size. As we continue to expand I’m looking forward to finding out who the most excited members are and listening to their activity level and feedback as we grow and just keeping that vibrant community going and making sure that our members are getting the most they can from what we offer.

David
:  I’ve been speaking today with Dr. Jason Bhan, founder of Ozmosis, a social networking site for physicians. Jason thanks for your time today.

Dr. Bhan
:  I appreciate the opportunity very much David, thanks.


Posted in e-health, Entrepreneurs, Physicians, Podcast | 1 Comment »

MedHelp teams up with HealthCare.com

June 25th, 2008 by David E. Williams of the Health business blog

MedHelp, a doctor/patient and patient/patient health care community will begin offerings its users access to HealthCare.com‘s health care provider directory.

From the press release:

“We are pleased to provide HealthCare.com Care Provider Search™ to MedHelp, the leading health community, for the benefit of its millions of members,” said Howard Yeh, VP of Corporate Development at HealthCare.com.  “Adding new partners, especially of the size and quality of MedHelp, pushes us ahead in our goal to assist online users in making better and more informed healthcare decisions for them and their loved ones.”

“HealthCare.com’s Care Provider Search™ is a natural extension of MedHelp’s goal of providing expert advice and information to the millions of visitors to our community,” said John de Souza, CEO of MedHelp.  “We are excited to be able to offer this functionality to our users, and especially pleased to welcome HealthCare.com as a partner.”

I interviewed de Souza for the Health Business Blog last year.


Posted in e-health | No Comments »

Health 2.0 for neurologists

June 25th, 2008 by David E. Williams of the Health business blog

SimulConsult CEO (and Health Business Blog contributor) Michael Segal, MD, PhD and Kaiser Permanente’s Barbara Scherokman, MD, FAAN, FACP are the authors of Health 2.0 for Neurologists, posted at the American Academy of Neurology’s website.

From the introduction:

The core of Health 2.0 is something that doctors have been doing in medicine for well over a century: collecting case reports and research results. Health 2.0 improves this practice in several ways:

  • Opening up the process to patients as well as doctors
  • Using modern ways of finding information
    • Internet connectivity that speeds our access to information
    • Web searching that allows us to find information
  • Adding new forms of information exchange that depend on Internet technology

This article discusses these Health 2.0 advances and their implications for neurologists and patients.


Posted in e-health, Physicians | 1 Comment »

Kaiser posts Viewpoints: The Health Care Debate

June 25th, 2008 by David E. Williams of the Health business blog

From the Kaiser Family Foundation:

Viewpoints: The Health Care Debate, features interviews with leaders of organizations representing health care providers, insurers, policymakers, employers, labor unions and consumers sharing their views on shortcomings in the nation’s health care system and how it could be improved. In the interviews, health care leaders discuss their priorities for change, including covering some or all of the 47 million uninsured Americans, reducing health care costs, improving access to care, enhancing the quality of health care and changing the tax structure to allow more people to purchase their own insurance. These leaders also share their views on the prospects for change after the 2008 election and what the next President and Congress should do to make the health system work more efficiently.

Check it out.


Posted in Announcements, Podcast, Policy and politics | No Comments »

Suicide is preventable: 1-800-273-TALK

June 25th, 2008 by David E. Williams of the Health business blog

The National Suicide Prevention Lifeline, best known for its suicide prevention hotline (1-800-273-TALK), has launched the Lifeline Gallery, where avatars discuss suicide prevention and their experiences coping with suicide among family or friends.

“The media frequently reports tragic stories of suicide and rarely tells the stories of those who have found ways to cope with suicide loss or found a reason for living after a suicide attempt,” says Dr. [John] Draper, [Project Director]. “If someone is struggling with thoughts of suicide or experiencing the pain of losing a loved one, we encourage them to look at Lifeline Gallery and discover that they’re not alone. We also encourage them to express their feelings about suicide in a non-threatening environment where they can create an animated image of themselves and share their story. Their story can help us all spread the word that suicide is preventable and affects us all.”

I spent some time viewing the stories on the site. I like this application of avatars and found the videos to be informative and helpful without being too painful to watch. I like Dr. Draper’s focus on prevention and coping.

Very few of the stories are from men. That’s a real shortcoming that I hope is remedied soon. It would also be great to have more stories from people who have considered or attempted suicide and have recovered. All of the stories in that section so far are from women. The introduction to that section is well done –guiding contributors on how to produce useful stories rather than one’s that inadvertently encourage suicides.
Since the site allows users to create their own stories  I hope that many more will do so.

The project is funded by Simpsons’ producer James L. Brooks.


Posted in e-health, Patients | No Comments »

You gotta play to win

June 24th, 2008 by David E. Williams of the Health business blog

Aetna is sponsoring a clinical trial of a daily low-stakes lottery to see whether it helps promote adherence among coumadin patients. According to the Hartford Courant (Lottery for Pill-Takers Could Be Healthy Bet), the unusual trial design features a daily one-in-five chance to win $10 and a one-in-100 chance to win $100. The expected value is $3 per day (1/5*$10+1/100*$100=$3), which amounts to $540 over the six-month trial. (It’s not clear from the article if the odds for lottery participants improve when fewer people take their meds.)

It’s an unsual twist on the value based insurance design model and a variant on the negative co-pay concept I’ve advocated (When a $0 copay is too high).

In order to be entered in the lottery a patient has to report taking their medication. Each patient will be issued a Med-eMonitor device and the patient will need to press the yes button on the device every day to confirm that they are taking their medicine.

There are 50 patients in the lottery group and 50 patients in the control group, who will receive nothing. It wouldn’t have occurred to me that a lottery was the best way to test out the concept, but it makes more sense now that I think of it. In particular, there is an addictive quality to lotteries that may motivate the drug takers to adhere.
The experiment is interesting as far as it goes, but there are some other approaches that perhaps should be considered as well, such as:

  • Rather than giving people a shot at winning, hand everybody the $540 up front, then make them pay out $3 every day they don’t take their med. Those with perfect compliance at the end of the trial can then split the penalty pot.
  • Introduce a support group aspect to the trial in order to get patients to encourage one another to take their meds. This could be done by increasing the size of the pot based on the group’s overall level of compliance.
  • Introduce incentives for coaches/mentors. For example, pay a reward to a coach who succeeds in having his/her coumadin adhere


Posted in Health plans, Patients, Pharma | 5 Comments »

« Previous Entries