Habush Habush and Rottier

Friday, July 1, 2016

A Patient-Centric Database

I've been thinking a lot lately about patient registries, accountable care networks, and Healthy Planet-type stuff. Personal fact: I'm prone to think up conspiracy-theories and am, at the macro-level, a glass-half-empty person. When you put the two together, it makes this blogger concerned about the future of healthcare.

"With the Patient at the Heart" is printed on the back of Epic's business cards, and emblazoned proudly on company vehicles. I've worked at different organizations that had similar slogans about patients being first and foremost and the most important thing. The underlying sentiment with these slogans is that each patient is a unique individual, and each patient deserves personalized care.

Healthy Planet (and its primary drivers, Obamacare and MU) are active obstacles to that. No longer is Joe Smith a relatively healthy male and a compliant patient with diabetes whose lab tests happen to run slightly abnormal, he's now the 37th entry on the list of patients with an A1C over 7. He's been on that list for a year now, and gets a letter every month saying he needs to come in for a checkup. Mr Smith's doctor is worried, because even though Joe is healthy and doing everything to correctly manage his diabetes, the lab tests run high enough that the doctor gets dinged on his metrics. The doctor is therefore considering dropping Mr Smith as a patient.

Enter Accountable Care Networks. Now, not only is Medicare tracking all your stats, but your employer is too. And because your employer is paying the hospitals, your employer has a vested interested in your health. The healthier you are, the cheaper it is for your CFO, and those savings can be passed directly to the stockholders. Taken to its logical conclusion, given equal experience, equal qualifications, and identical answers during the interview, it's going to be the younger/skinnier/male candidate who gets the job. Age/Gender Discrimination will morph into Health Discrimination.

Discuss below. Are my fears irrational? Is your organization re-working existing teams to meet a growing list of reporting needs that must be available in prod yesterday?


  1. Strongly disagree. Population health increases the health of patients. You don't like that health is tracked now? Sounds like you'd prefer the patients to be unhealthy. You don't want the Doctor to be "pinged" that Joe Smith has a low lab value? My Panel Metrics are not used as an indicator of whether or not the physician should be paid. It's used to show the health of the population. I think that health discrimination may very well become a thing, but that has nothing to do with Healthy Planet. It has to do with common sense, and it probably existed long before EMRs.

    Your version of "personalized care" leads to patients being forgotten, and not taking care of themselves. Those reminders are useful. Those "dings" keep the physician focused on at-risk patients. ACOs encourage physicians to keep their patients healthy as opposed to fee for service models which encourage acute care.

    You made a pretty big leap that the physician would want to drop Joe Smith as a patient. I suppose I have more faith that clinicians do what they do for the right reasons. Even if they're not, dropping a patient due to their chronic disease would be an easily recognizable pattern that would damage the organization's reputation, and therefore their bottom line. It may even open the organization up to a law suit.

    Again, strongly disagree with everything written here. However, I do appreciate this site and have found it useful. This is the first thing that I read that looks like click bait.

  2. The real problem is that the government gives employers tax credits to supply health insurance to employees. Instead these should be given to all Americans so they can buy their own health insurance, or provided as a public option.

    Price discrimination based on age or gender seems fair, this already occurs with car insurance and is publicly available information. The level to which this could occur with pre/post-existing conditions may be debatable - but that is the beauty of having individual rather than employer-derived insurance - it is no longer tied to which company you work for.

    The main problem we need to face as a nation is our rapidly escalating health expenditures. We can't afford for it to keep increasing at super-inflationary rates, it is already above $10,000 per person in the USA ($3.2 TRILLION). The question we need to be asking of ACO's and Healthy Planet is not whether there is some sort of conspiracy to use our health information - no one really cares. The question is whether they can improve value by expending less resources for greater outcomes. I am not convinced that they achieve this currently, but I remain cautiously optimistic for the future.

  3. Is there anyway to ask the blog writer specific questions through PM?

    1. Post with your email address-I won't publish it-and I'll be in touch.

  4. Hello there! Not sure if youre still reading this, but I am looking for info on Epic as an employer, and their practices... namely specific information that I cannot easily gather from scouring the web (not that I've found at this point).

    Do you happen to have any resources connected to the training department? As a current out of state resident with a few years EHR experience with one of the top five, permanently relocating to WI is a big leap. My other company offered to relocate to my homebase after training and a few months stint in office.

    Any assistance would be greatly appreciated!