Monthly Archives: November 2014

Comments on WSJ Post- “EMRs: A Huge, Expensive Burden”

Electronic Medical Records (EMRs) provide the foundation to improve healthcare quality and improve cost performance. And standardized EMRs open the door to telehealth and new analytics to improve clinical decision support systems and save lives. But the transition from paper records, as we learned in the e-commerce revolution, will take time and create disruption. I posted comments on a WSJ post to share my view on the benefits we can expect to see. WSJ post and my edited comments at http://tinyurl.com/ksnav8e

Copy of my complete comments as follows:

We need a standardized, full- featured EMR system- this is powerful building block to improve today’s healthcare system. The U.S. lags Australia, the Netherlands, New Zealand, Norway and the U.K., all of which have EMR adoption rates above 90 percent. No surprise these countries have healthcare systems that lead the U.S. based on all patient outcomes/cost performance metrics. Coupled with the ACA’s new core quality measure reporting (‘eCQM’s), we are taking the right steps. But EMR also enables predictive analytics which I see as the Holy Grail here. What lies ahead- new clinical decision support systems improving outcomes; new tools to minimize adverse drug events; improving patient selection for new drug trials; improving surgical outcomes examining chronic issues; and many more. The Social Progress Index report, created by Harvard Business School’s Professor Michael E. Porter’s team, ranked 132 countries using 50 indicators. In the Health and Wellness category the United States ranks poorly at 70th, behind Mali (69th), and Nepal (68th), but, small consolation, ahead of Kuwait (71st). Keep that in mind the next time you hear a pundit say “…our healthcare system works just fine and we don’t need to change it.” These studies are based on metrics/data analysis, not hype or talking points. There will be some disruption, but a standardized EMR system will benefit both the entire healthcare community and the public.

Paul B. Silverman

 

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Failure Is Often A Key Driver for Success: Check out “Failing Forward — 3 Tips for Failing Your Way to Success”

Most entrepreneurs are familiar with the story of Thomas Edison’s invention of the light bulb. To outsiders, looks like a waste of time and effort- we see about 10,000 failures and one success. Thomas Edison saw it differently in his widely quoted views on success and failure: “I have not failed 10,000 times. I have not failed once. I have succeeded in proving that those 10,000 ways will not work. When I have eliminated the ways that will not work, I will find the way that will work.”

I agree with Thomas Edison and always define failures as “Learning Experiences” — this works for me.

I recommend checking out “Failing Forward — 3 Tips for Failing Your Way to Success” – an excellent perspective on success and failure from Marshall Graham, Managing Partner at Indian River Advisor, LLC. Excellent insights here for all entrepreneurs.

 

Paul B. Silverman writes about entrepreneurship, healthcare, and strategy management and serves as Advisor, Speaker, Educator, and Managing Partner of the Gemini Business Group, LLC, a consultancy firm, and Adjunct Professor in the R.H. Smith School of Business at the University of Maryland.

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Posted Comments -Ex-Apple CEO Invests in Telemedicine

Health telemonitoring market is moving quickly with many major players including Xerox, Medtronics, others.  Posted comments on Fierce Medical Devices article: Ex-Apple CEO investment in remote health monitoring market. Link to article and comments at http://tinyurl.com/lwchryc

Here is copy of my posted comments:

MDI, Xerox’s Healthspot investment are moving us in the right direction-using internet and telemonitoring technology to improve healthcare and create value. As example, look at one area – prenatal care and chronic conditions treatment in rural areas with 25 percent of population but only 10 percent of physicians- you realize very quickly the benefits offered by these emerging healthcare telemonitoring applications. But we can and should be doing more here. Several observations:

— We need standardized EHRs and adoption now being driven by ACA’s Meaningful Use rules. Integrating EHRs with remote monitoring and analytics, we create exciting new opportunities linking to medications for compliance, drug efficacy, adverse effect tracking, and so on. EHR adoption is over 90% in many countries and we are about 60%- we can do better here. EHRs provide the transactional data to support “big data” analytic solutions.

–No doubt telemonitoring and kiosks will improve healthcare and hopefully achieve the $6B projected healthcare savings. All players should emphasize analytics, how analytics will be used to support clinical care decisions, how patient data to personalize healthcare, develop improved treatment modalities and so on. These analytical tools exist, can make a difference, and help address the 30% of all medical errors due to misdiagnosis. Very high leverage and upside here but I do not hear these discussed- they should be

–New ACA regulations/penalties imposed to reduce readmissions are forcing institutions to establish new processes to address after discharge patient tracking- while the emphasis of these “kiosk centric” ventures has been mostly walk-in users, I see several major hospital related markets such as readmission reduction and others which I believe will be significant.

–Pharma clinical trials demand working with 1,000’s of patients and closely tracking their meds during the Phase I/II trials. Networks of remote kiosks provide an excellent vehicle to support new drug clinical trials more efficiently than done today

No question exciting times and strong growth ahead in the remote telemonitoring and medical monitoring device market – lets do what is needed here to use these new offerings to create value and improve our healthcare system

Paul B. Silverman

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Comments – NPR: Surprise Medical Bills: ER Is In Network, But Doctor Isn’t

Posted comments today on NPR story about ER billing problems using ER services in Texas. Ironic, as noted in my comments,  Texas is one of the states that has pushed back most strongly on ACA efforts to improve our healthcare system. So if you do have an emergency while traveling in Texas, on the way to the ER in the ambulance, I suggest make sure you check that you are covered for both hospital and doctor costs. Looks like “every doctor  for himself” there- what a way to run a healthcare system. We can fix this and I believe with modifications ACA is the vehicle to accomplish this objective.

You can read my comments and the NPR article at http://tinyurl.com/pfd5zwe

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WSJ – Comments on Alibaba “Singles Day” Results

On November 10th, the WSJ reviewed Alibaba results and the Gross Merchandising Volume or “GMV” metric used to measure performance of e-marketplace companies such as AliBaba and others. I find GMV and related platform business model metrics not well understood. These will be increasingly important as growth of “customer to customer” platform networks accelerate in healthcare and other sectors. Below is a full copy of my comments. Link to the WSJ article and edited comments at http://tinyurl.com/n369mha

Eeading about Alibaba’s business model, I recall the “eyeball model” driving the e-commerce explosion in the 1990’s. The premise- attract large numbers of users/customers to your site, generate value by product and service sales and, most important, generate scale to drive advertising revenue and “exponential” future earnings. Some did it well such as eBay, but the model spawned hundreds of new ventures and most failed. Why? Management, undercapitalized, poor execution strategy- these are the usual reasons most ventures fail. But there was also a fatal flaw here- the eyeball model at the time could not create a universally successful business in all sectors without careful positioning and deep pockets, not the outcome many investors expected. “Build it and they will come”- they didn’t.

Fast forward to today. Alibaba reported very impressive results on “Singles Day”, I.e., 111114, reporting 35 billion yuan ( about $5.75 billion) in the 24 hour Singles Day period. GMV or Gross Merchandise Value is their key business model metric- high GMV translates to higher revenue and presumably long term earnings growth. Following a $25 billion IPO two months ago, there is great pressure to show high GMV.

Several comments here. No question Alibaba is an outstanding success by any measure. One question is long term sustainability. Having merchants offer steep discounts ( 50 % in some cases) to create high single day sales volume looks like a “loss leader” strategy- at least one analyst also questioned whether this is sustainable long term. Remember Groupon and LivingSocial issues. Secondly, note GMV shows total value of transactions sold through Alibaba’s marketplace platform and is not a well defined standard. GMV may include shipping charges, items that will be returned, and other components for the “customer to customer” sales via Alibaba’s platform. GMV is excellent for comparing marketplace companies, but each player may use different assumptions to calculate. Finally, recognize GMV is one of several platform model metrics such as Gross Transaction Volumes or GTV which is well suited for platforms using commission-based pricing strategies. Bottom line here- Alibaba’s success will spur other “GMV” centric new ventures as did the “eyeball” model- lets understand the definitions here and standardize, ensure the proper financial accounting and reporting practices are in place, and ensure the e-marketplace sector achieves the global market growth we all foresee.

Paul B. Silverman writes about entrepreneurship, healthcare, and strategy management. He serves as Managing Partner of the Gemini Business Group, LLC, a consultancy firm, and Adjunct Professor in the R.H. Smith School of Business at the University of Maryland.

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