Medkaz

Published 4/29/2012 in Valley News
http://www.vnews.com/04292012/9513343.htm
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.

“This is the only place you can find the entire lifetime care record for an individual,” said Merle Bushkin, of Brownsville, about Medkaz, the device he developed to store an individual’s medical records. “The only common denominator in care is the patient … so we are organizing around the patient.” (Valley News — Sarah Priestap)

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.”

Date: July 12, 2011

Merle Bushkin, Founder and CEO of Health Record Corporation, posted the following blog on The Health Care Blog.com. He suggests that people – especially those who want to remove profits from healthcare – should reconsider their position. He concludes that “the pursuit of profits just might solve our healthcare problems.”

To date, more than 166 comments have been posted, and more are added daily. The original blog follows. To read the informative comments, click here.

Let’s Stop Bashing Profits and Business In Healthcare

By MERLE J. BUSHKIN

I’m tired of profit-bashing and business-bashing in healthcare. And every American should be, too!

Well-run, profitable businesses, along with our sense of decency, democratic institutions, education and free enterprise systems, and adherence to the rule of law, have made the United States the most extraordinary nation in recorded history. Together they have unleashed the talents, creativity and productivity of our people, generated enormous sums of capital, and created unheard of social, economic, scientific and political advances.

Is there anything nobler than providing the environment and opportunity for people to fulfill their potential and achieve their dreams, and for providing the goods and services that enable people to raise their standard of living? Not even the practice of medicine can do so much good for so many people. But that’s precisely what businesses do. (That also may explain why far more Americans today are interested in job creation than restructuring healthcare.)

In our system, an individual has an idea, attracts capital, and hires people to build a product or provide a service. When they meet a need, they prosper – and attract more capital and hire more people. Everybody wins. If they fail, they alone suffer the consequences. That’s what capitalism is all about and that’s what has made America great.

Sure, there are ups and downs. Some caused by business cycles, some by global competition, some by excesses on the part of companies and individuals. Unfettered competition can be terribly harmful and that’s where government comes in. Government must ensure there is a level playing field so businesses and individuals have equal opportunity and can compete fairly. Additionally, government should protect against harmful excesses, and apply monetary and fiscal policies to moderate the ups and downs.

The last thing we should do, however, is abandon the very values and forces that have made America great. We should improve not destroy them, so let’s stop bashing businesses and profits.

For example, many think it crass and wrong for insurers, pharma or other healthcare vendors to earn a profit — so they want to get rid of profits. But where will capital to support these activities and innovation come from if investors (who include Wall Street and Main Street investors alike) can’t earn a return on their capital? From the government? Hardly. The government today doesn’t have reserves to fund the $37± trillion in future Medicare liabilities or our massive deficits. Our children and grandchildren will have to meet them. And how much in additional liabilities can our economy carry before our cost to borrow capital becomes prohibitive and we default on our debt? At least the insurance companies have reserves to back their obligations – so shouldn’t we force them to compete fairly rather than disband the concept of private insurance?

Similarly, many docs who consider the pursuit of their calling as noble and the pursuit of profit unseemly, apparently don’t understand that they are just as driven to earn a profit and return on their investment as profit-focused companies are – only they use different words to describe what they do. They claim they provide a noble service and therefore are entitled to large incomes because they have invested years of their lives and lots in tuition to develop their expertise. Described in other terms, isn’t their expertise their trade, and aren’t their practices really small businesses? In truth, aren’t they demanding a return on their investment – just like all businesses do? (If they don’t, their practices won’t survive.) And how much income does one have to earn before part of it is recognized as a return on investment?

Don’t misunderstand. I recognize that all businesses, like all doctors, aren’t noble, and I don’t support the power of insurers today to dictate what they will pay doctors for their services, or most of the other distortions in our healthcare system. But let’s stop the profit and business bashing. Properly directed, the pursuit of profits just might solve our healthcare problems.

http://thehealthcareblog.com/blog/2011/07/22/most-americans-don%E2%80%99t-yet-perceive-the-benefits-of-eh/

Posted July 22, 2011 by Jane Sarasohn-Kahn

In a blog posted on The Health Care Blog.com,
Jane Sarasohn-Kahn, a health economist and management consultant in healthcare technology, discusses the findings of a study commissioned by Xerox. It reports “that 83% of people have concerns about digital medical records. The most concerning issue is that “my” personal health information could be hacked, cited by two-thirds of people. The second most common concern is that digital medical record files could be lost, damaged or corrupted (noted by 54%) and that personal health information could be misused (52%). Another worry is that a power outage or computer problem could prevent providers from accessing health information, cited by 52% of people surveyed.” She concludes that there is a “need for education and raising awareness of EHRs.”

Merle Bushkin, Founder and CEO of Health Record Corporation, posted several comments to this blog. He says these consumer concerns are well founded and shouldn’t be ignored, and that we’re not making progress (with the adoption of electronic health records, EHRs) because we’re defining the problem incorrectly. He writes “the problem isn’t how to make a patient’s records available over the Internet. The problem is two-fold and requires separate, independent solutions. One is how doctors should keep records. The other is how to make a patient’s records available to their care providers when and where they need them.”

He believes every doctor and hospital should keep electronic records but that the systems available today don’t work for care providers. He writes: “We need to encourage the development of new systems that actually help and benefit them (i.e., care providers).” Similarly, on the issue of how to make a patient’s lifetime health record available to their care providers, he suggests we need a different kind of system, one that doesn’t store patient records on the Internet-accessible servers. He says the system should be patient-focused and give the patient control of their aggregated lifetime medical record which they, in turn, can give to their care provider when they seek care. The MedKaz System works just that way. It avoids the problems cited by consumers in the Xerox study. It also could be the precursor of a new generation of EMR systems for providers.

Google’s June 24th announcement that it is terminating Google Health has evoked endless comments on most healthcare sites. They attribute its demise to various factors: the lack of consumer interest, the fact that it didn’t have a game or social network focus, that it didn’t enable consumers to e-mail their doctors, schedule appointments or renew prescriptions, and so forth.

Virtually no one puts the blame where it belongs. Simply put, Google Health didn’t meet the needs of the two most important groups in healthcare: consumers and providers. Neither have the many other previous attempts at launching a viable personal health record.

Google’s search engine disrupted the world because it met the needs of people to quickly and easily access information. Google did the work, the user got the information they wanted. Then Google met a need for advertisers, it gave them exposure to consumers. The result: incredible acceptance by both consumers and advertisers, growth and financial rewards!

With Google Health, Google did exactly the opposite. It created a system in which the user had to do all the work and the providers were taken for granted and all but ignored.

Patients want convenience and to know their records are secure, yet Google Health required that they become data entry clerks, and stored their records on breachable Internet-accessible servers! Providers don’t want to be bothered unless they benefit in a meaningful way, yet Google Health did nothing for them.

The lessons to be learned from the failure of Google Health are that providers must embrace a personal health record system or it will fail, that convenience, ease of use, and a sound business model are critical, and that despite one’s size/prominence, financial resources, or technical expertise, they will fail if they do not to meet these requirements.

Our healthcare system is broken.  We pay too much and get too little. Serious medical mistakes abound—with dire, costly consequences. While there are many explanations and excuses, most agree that one way to improve care quality and reduce care costs is to make a patient’s complete medical record available to care providers when and where they treat the patient.

Easier said than done!  A patient’s complete record isn’t available because care provider records are too varied and can’t be aggregated.   Most physicians and hospitals keep paper records and can’t share them easily.  And those relatively few who keep electronic records use systems that are incompatible and can’t exchange information either.

Established leaders in health information, including vendors, professional organizations, care providers and government agencies, have spent thousands of hours over many years plus millions of dollars trying to overcome this problem. But despite the endless conferences, committees, hoopla and hundreds of millions spent to date, they have made precious little progress.  Medical records still can’t be shared or—in the jargon of the industry—aren’t “interoperable!”  Why?

The simple answer is they have based their proposed solutions on at least a dozen bad assumptions, or “myths,” which have led them astray! They have pursued unnecessarily complex, elaborate and expensive strategies, and have little acceptance to show for it.

Myth #1: The best, most efficient and cheapest way to exchange patient records among care providers is to make them available over the Internet.   Reality: Storing patient records on Web servers is extraordinarily complex, expensive and creates more problems and issues than it solves.  They are trying to use a nuclear bomb when they need a fly swatter!  The MedKaz is a simpler, cheaper, less disruptive way to share records.

Myth #2: Complex, expensive, state-of-the-art networks linked across the country, such as RHIOs, HIEs, and an NHIN, are required to exchange patient records.   Reality: Complex networks are unnecessary and financially unsound.  They will take years to build, will cost hundreds of billions of dollars, are not sustainable financially, and don’t accommodate out-of-network encounters. This is another nuclear bomb!

Myth #3: When everyone agrees on the requisite standards and technology, the funding needed to implement and exchange interoperable patient health records will be available—as a last resort from non-profits, the Federal government, and/or state and local governments.   Reality: The money simply isn’t and for the foreseeable future won’t be there to fund financially unsound solutions.  We must adopt a solution like the MedKaz that we can afford, implement quickly and is financially self-sustaining.

Myth #4: It is acceptable to spend years developing and installing a Web-based network; there is little urgency.   Reality: The needs couldn’t be more urgent or the costs of delay greater.  People are dying while we dawdle.  Lives can be saved, pain and suffering avoided, and billions of dollars saved each year.

Myth #5: Web-based networks or services can guarantee that a patient’s medical records are safe, secure and private.   Reality: No one despite their claims and best intentions can guarantee security and privacy over the Internet.  Web servers, including the Defense Department’s, often are breached and data are stolen. Additionally, patient records too often are lost, misplaced and even published on the Internet.  Consumers know this which is why they resist Web-based systems.

Myth #6: Physicians don’t want to adopt electronic medical records.   Reality: Most would like to do so but the costs—both financial and operational—are greater than they can or will tolerate.  They want a simple system like the MedKaz that is cheap, easy to install, easy to use, and gives them the information they need without completely disrupting their workflow.

Myth #7: Sooner or later all care providers will adopt a comprehensive electronic medical record (EMR) system (which can cost as much as $50 thousand per physician to install and $10 thousand per year per physician to maintain).  If they refuse, they must be required to do so.   Reality: More than 80% of physicians and 70% of hospitals have not done so and refuse to do so because it is against their economic self-interest.  Forcing them would be draconian and is unnecessary. We need their support not their opposition.

Myth #8: Physicians and hospitals will install electronic medical records if they are subsidized.   Reality: Most paper-using care providers don’t want subsidies to install elaborate systems. They want a simple, manageable system like the MedKaz that fits into their workflow and helps—not hurts—them.

Myth #9: It isn’t necessary to give patients copies of their medical records.  It is sufficient for a care provider to make a patient’s records available to other care providers.   Reality: Increasingly, patients want to control their records, who accesses them and how they are used.  Moreover, one Meaningful Use requirement is that care providers must be able to give their patients electronic copies of their notes within 36 hours of a visit.

Myth #10: Patients don’t mind entering extensive information into a PHR and keeping it up to date.   Reality: They are put off by the burden and inconvenience which may explain why so few have embraced available PHR systems.  To be acceptable, a PHR system must be easy to use by patients and physicians alike.

Myth #11: Patient-provided information, claim reimbursement records and/or information from other third parties are acceptable substitutes for actual physician notes, test results, images, etc.   Reality: They are incomplete, may be inaccurate, and do not contain the clinical content care providers need.  They are poor substitutes for the real thing.

Myth #12: New online healthcare platforms like Microsoft’s HealthVault and Google Health are the solution.   Reality: They are not.  They are focused primarily on wellness and disease management, not personal health records.   Their PHR applications are incomplete, and require the patient to input extensive data (which may not be correct).

The HITECH section of the 2009 Stimulus Act provides almost $18 billion to reimburse physicians for adopting electronic medical record (EMR) systems, and $1.2 billion to subsidize creation of a health information network in each state that electronically links the care provider systems within each state.

To qualify for reimbursement, physicians must install an EMR system and meet Meaningful Use criteria.  In return, the government will reimburse them up to $44 thousand per physician, to be paid over three years starting in 2011.  If they do not install an EMR system and meet the three stages of Meaningful Use requirements by 2015, their Medicare reimbursement rates will be reduced.

While HITECH is raising every physician’s awareness of the need to have electronic medical records by 2015, it also is provoking a growing rebellion. Paper-using physicians are very aware of the traumatic experiences many colleagues have had installing legacy EMR systems.  As a result, many are seriously considering not participating in the reimbursement program and—starting in 2015—opting out of Medicare.   Moreover, many practices that previously installed EMR systems are abandoning them as too costly and too cumbersome.

Such resistance may force the government to extend its adoption and reimbursement deadlines. And if enough docs drag their feet or refuse to adopt EMR systems, state and federal efforts to network care provider EMR systems will stall as well.

Despite these possible problems and in part because of them, we believe the massive infusion of government funding will have a very favorable impact on the patient-focused MedKaz.

Most docs would like to have a simple EMR system that is easy to use, saves them money and enables them to keep and access their patient records electronically.  That’s precisely what our Patient Record Manager (PRM) does.  The legacy systems the government is urging physicians to adopt, do not.

Even the simplest legacy systems typically cost far more than the mere cost of the EMR software. Their installation seriously disrupts the doc’s work flow and requires expensive additional hardware, software, and staff training.  Most importantly, while the docs and their staffs learn how to use the system, which typically takes six to nine months, they must reduce the number of patients they see each day by up to 50%.  One four-doc practice in VT paid $40,000 for their EMR system but estimates their all-in cost totaled $316,000.  Others have had similar experiences.

In contrast, the MedKaz System benefits paper-using physicians in three important ways. It actually increases their revenue. They are paid for uploading a patient’s records following an encounter.  It does not disrupt their work flow. And its PRM serves as an EMR-lite, meeting their desire to have a manageable, low cost, easy to use electronic system even while keeping paper charts.

A copy of the digitized paper records already loaded onto the patient’s MedKaz, is automatically downloaded onto his or her PRM.  So now the doc has a manageable digitized copy of the paper records he or she has created for each patient.  The next time the patient comes for an appointment, the doc can open his or her PRM and review the patient’s chart on their computer rather than having to pull the patient’s paper chart.

Additionally, the MedKaz makes it possible for docs to meet important Meaningful Use requirements.  For example, by loading a patient’s encounter record on the patient’s MedKaz, the doc satisfies the requirement that the physician must be able to give his or her patient an electronic copy of their encounter record.  In turn, the patient can access the record and share it with his or her other care providers.

The PRM also enables paper-using docs to meet certain public health needs.  If there is a drug recall, they can electronically identify which of their patients take the drug.  Or if they need to contact patients with a particular illness, they can easily do so.

Thus, the PRM satisfies the needs docs have for electronic records even if they keep paper records.  Adding to its appeal, it is free, easy to use, and doesn’t disrupt the doc’s work flow or force them to reduce the number of patients they see.

Once paper-using physicians learn how convenient it is to use electronic records, we believe and hope they will opt to install a more robust EMR system, though their choices may be quite different from today’s legacy systems.  And when they do, they will avoid the cost of having to scan and digitize their active patient records.  They’ll merely upload their records from their PRM to their new system.

Thus, the patient-focused MedKaz and physician-focused EMRs will live side by side-with each meeting the unique needs of its owner.  The MedKaz will continue to meet patients’ needs to own and control their medical records, make them immediately available to care providers when and where they need care, and facilitate the coordination of their care.  And EMR systems will meet the record-keeping, practice management and public health needs of physicians.