Published 4/29/2012 in Valley News
By Chris Fleisher
Valley News Staff Writer
Brownsville — Merle Bushkin is one of the more unlikely people working today to reform the health care industry.
He has no medical background. In fact, Bushkin has spent his 40-year career as an investment banker. And, at the age of 77, he probably should be putting his feet up and relaxing in his hilltop home in Brownsville.
Instead, Bushkin has been spending his time thinking about a vexing problem for doctors and hospitals across the nation — how to move patient records into the digital age.
“When I’ve seen what the industry has gone through, and how they have not come up with anything that works, it just amazes me,” Bushkin said last week.
Electronic health records have been championed as a way to make hospitals more efficient and improve patient care, and the federal government has been trying to spur their adoption through incentive payments that were part of the stimulus bill passed in 2009.
The transition has been a rocky one for many hospitals, including the region’s largest health care network at Dartmouth-Hitchcock. Not only has staff struggled to learn the new system, but the industry is still figuring out how to share patient records between providers who are working on different technology platforms. Dartmouth-Hitchcock, for example, does not use the same software package as Alice Peck Day, Valley Regional or other small hospitals, and there have been issues getting the systems to “talk” to one another.
Data breaches are becoming increasingly common throughout the country as health information technology comes into expanded use, having risen 32 percent in 2011 from the year before, according to the Ponemon Institute, a security research organization. Billions of dollars are being poured into solving these issues, but Bushkin said he thinks he has an easier and potentially cheaper way. His brainchild, called “Medkaz,” flips the current approach on its head by taking some of the responsibility away from hospitals and giving patients greater control over their own records.
His proposed solution is a $100 device small enough to fit on a key chain that patients could bring with them to appointments and have updated by all the different doctors they see.
Bushkin and his staff of 11 have applied for a patent on Medkaz and are now recruiting doctors and patients for a pilot study.
There is plenty of skepticism among health care practitioners about whether Buskin’s idea can work. Some physicians raised questions about security and the practical realities of expecting patients to keep track of the device. What if they lose their keys?
But, the concept behind it appeals those who wish to improve patient access to their own health information.
“I think there’s some really neat things about it,” said Mark Nunlist, a physician at White River Family Practice. “It puts the medical record in the patient’s control.”
“It’s fabulous,” said Volker Bradley, a former surgeon at Valley Regional Hospital who is now consulting with hospitals on integrated technology. “It think it would be wonderful if patients were to have accurate information with them.”
How It Works
The Medkaz device should seem familiar to anyone who has used a flash drive to back up files on a personal computer.
Smaller than a stick of gum, Medkaz plugs into a USB port to be updated.
There are other “medical ID” products on the market in drug stores like Walgreens and CVS. Some resemble credit cards, such as “911 Medical ID,” and hold personal and medical information in case of an emergency. However, Medkaz has much broader aims. It proposes to store all patient information — including doctor visits, allergies, medications, past treatments, etc. — and in a way that can be updated and read on any computer.
Bushkin’s invention seems to address problems around interoperability between doctors, and also lets patients have more control over who sees their records.
“This is the only place you can find the entire lifetime care record for an individual,” Bushkin said. “The only common denominator in care is the patient … so we are organizing around the patient.”The device complies with federal standards for the adoption of electronic health records, Bushkin said, as well as federal privacy laws that protect patient information.
In fact, data may be even more secure, he said. Large breaches generally happen when someone is able to hack into a database of patient files stored on a remote server.
The Medkaz device is encrypted and password protected so that only the patient and doctor can access files. But there is also no permanent storing of those records on a server.
When a doctor updates the patient file on his or her own electronic health records system, the information is also sent to a Medkaz server, where it is stored for a couple of days. Patients are expected to plug in their Medkaz at home after a doctor visit and update the information on the device. After that point, the files are deleted from the Medkaz server.
And so, there is no huge database of thousands of Medkaz patient records for hackers to expose.
If a device is stolen, “it is painful and it’s a real problem for me (the patient),” Bushkin said. “But it’s me. It’s not 250,000 people like me all at once.”
The most important innovation, however, is the business model, Bushkin said, which could help doctors make money instead of burdening them with the costs of installing expensive health records software, as is the case now.
The flash drive devices will be sold through doctors, who buy them wholesale and then turn around and sell them to patients.
In addition to the profit from selling the device, doctors are paid a fee every time a patient’s Medkaz is updated.
Bushkin wouldn’t say how much those fees would be. In a letter to doctors earlier this month, however, the company estimated that the devices could increase a typical primary care physician’s annual income by $25,000 to $50,000.
In shifting more responsibility for records to patients, the company is also shifting some of the cost burden. The patients not only pay for the device, but also pay for fees along the way ($25 for assembling records, if necessary, and an annual $75 subscription fee for software updates).Bushkin expects those patient costs to go away, however, once the device gains wider acceptance. He expects insurers, employers and government payers will pick up the expense after Medkaz can prove overall health care savings because of greater efficiency.
“We’ve aligned the economic interests,” Bushkin said.
Pros and Cons
Despite Bushkin’s promises, physicians remain skeptical about expecting a flash drive to solve complex problems with electronic health records.
“Is it virus free? Should we be comfortable taking one and putting it on (our computers)?” asked Patricia Wittaus, director of IT at Valley Regional Hospital in Claremont.
Part of the subscription to MedKaz includes a copy of Norton Antivirus software, which can be updated annually at a discounted rate, Bushkin said.
Another practical concern is whether patients will keep track of the device, Wittaus said. Suppose someone loses it or simply forgets to bring it to an appointment.
“I can easily see a patient saying, ‘I forgot my drive,’ ” she said.
For this, Bushkin has no ready answer except to say that those are the consequences of controlling your own information. Patients need to be responsible for backing up their information. Offering data backup services to patients could also be another opportunity for doctors to make money, he said.
Manchester resident Linda Ferris said she hasn’t had any problems keeping up with her Medkaz, which she keeps on her key chain. Ferris has been involved in the pilot project for several months and said it has saved her and her doctors time sorting through her records.
Since she was involved in a car accident in 1998, Ferris has had a complicated medical history with a variety of doctors who have helped her rehabilitate. Being able to consolidate that history in one place and keep it with her has been reassuring, she said.
“I was excited about it because I have a lot of records,” Ferris said. “And every time somebody retires, you have to change doctors and get all of your records again.”
Nunlist, the physician in White River Junction, said he sees some benefit for patients, but still would need more convincing before he gets on board. Thus far, he has declined an invitation to be part of the pilot study. He doesn’t totally dismiss Bushkin’s invention, but said he feels it could be a burden.
“It’s just one more set of clicks,” Nunlist said. “One more program that a medical office has to deal with.”Beyond technical considerations, there’s also a question of how this will affect physician behavior. The business model provides financial incentives to doctors for using electronic health records, but it may also encourage more treatment, said Chuck Podesta, chief information officer at Fletcher Allen Health Care in Burlington.
If doctors get paid fees for every update, and those updates are made during patient visits, then there’s a financial incentive for the doctor to schedule more visits, he said. But this runs counter to what many health reform advocates, including those at Dartmouth, are calling for to lower the cost of care.
“You’re basically incentivizing them to see that patient a lot,” Podesta said. “Aren’t we trying to go in the opposite direction?”
Bushkin said the fees weren’t large enough to sway doctors’ decisions on care. “You’re not going to ask a patient to come back in because of this,” Bushkin said. “Our payment is not enough to make a doctor do something.”
Still, Podesta saw plenty of benefits to the Medkaz, including engaging patients more in their own health.
“The future is patient engagement,” he said. “So, from that perspective, the goal of what they’re doing is in the right direction.”
The pilot study of Medkaz will be happening this spring and summer and Bushkin expects to have the results by mid-summer. About 220 people are participating, so far, and he is looking for more.
Meanwhile, Buskin and his team, which is scattered around the U.S., will make tweaks based on feedback from doctors and patients.
The problems within health care technology are significant, he said, and pose a great opportunity for entrepreneurs. It is not a position he expected to be in so late in life. But, given everything that’s happening in health care, Bushkin found the challenge difficult to resist.
“I’m probably the oldest entrepreneur you’ll ever meet. But I’m as passionate and fiery about it as a 25-year-old,” he said. “I’ve never seen an industry as screwed up as this and I’ve never seen an opportunity to do so much good and bring shareholder value to it.”