Month: May 2008

Defending the benefits of prevention

May 31, 2008• 7

By Merrill Goozner

Last February, the New England Journal of Medicine ran a potentially misleading review of the cost-effectiveness of illness prevention strategies that may have led many casual readers (such as the editors of the Washington Post Health section) to conclude that most health-improving measures — such as aggressive counseling for people who are either overweight or smoke — cost more in the long run than they are worth. This week’s Journal of the American Medical Association carried a proper antidote by Steven H. Woolf of Virginia Commonwealth University, who is fast becoming a leading expert on prevention techniques for improving the nation’s health.

Woolf admits that personal behavior is difficult to change, and many intervention strategies for preventing disease cost more money for the health care system than they save. But he takes direct aim at the NEJM article claim that "drew similarities between the cost-effectiveness ratios of prevention and disease treatments, all but ignoring the much lower cost-effectiveness ratios of the preventive services that guidelines advocate."

E-patients can and will revolutionize health care

May 30, 2008• 18

By Susannah Fox Epatients

By taking advantage of new online health tools, e-patients and health professionals
now have the ability to create equal partnerships that enable individuals to be equipped, enabled, empowered and engaged in their health and health care decisions.

That was the vision of Dr. Tom Ferguson, who coined the term e-patients and launched e-patients.net in 2006. Ferguson intended to upload his book-length overview of the online health revolution, “E-patients: How They Can Help Us Heal Health Care.” But unfortunately, he died a month later 2006, after losing a fifteen-year battle with multiple myeloma.

Following Ferguson’s death, a group of his friends and colleagues completed the paper and adopted the blog to carry on his work, as well as our own. Each blogger brings a different perspective when commenting on Health 2.0 developments.

We think the “E-patients” paper remains relevant in 2008 (PDF, wiki) and we hope to extend the findings into the future. To that end, we are also working on the creation of the peer-reviewed Journal of Participatory Medicine with the help of Sarah Greene of the New York Times; Bruce Shriver, PhD, of the Liddy Shriver Sarcoma Initiative; and George Lundberg, MD, of Medscape. We welcome your comments and suggestions.

Analyzing the benefits of PatientsLikeMe social network site

May 30, 2008• 6

By John Grohol

Two research papers were published this month on the Health 2.0 Web site, PatientsLikeMe. PatientsLikeMe is arguably the only "real" health social network online today, because it allows patients to share actual data that matters with one another — their personal health data.

(Other supposed health social networks seem more focused on the "social" than the "health," allowing for little integrated data sharing.)

The two research papers provide some interesting data points and insights into the disease process itself and how e-patients are using Web-enabled tools, such as PatientsLikeMe, to improve their own care.

Real transparency in a socialist nirvana? UK releases hospital death rates

May 30, 2008• 1

By Michael Millenson

In yet more evidence that the transparency revolution is worldwide and not merely a product of American capitalism, comes news that in the UK death rates for specific types of surgery at NHS hospitals are to be revealed. Can this be happening in the single-payer government morass that we’ve been warned off for years? Michael Millenson, one of America’s leading experts in patient safety and quality, gives us his reaction.

This is mind-boggling, if, alas, short on some crucial detail: Is this based on claims data (high-school-graduate-coded administrative information) or clinical claims? If the former, it is impressive, if the latter, extraordinary. For those who believe in the superiority of American medicine, here are a few observations.

First, he who pays the piper calls the tune. If NHS decides to
collect this data, it’s done. One also presumes they don’t need an act
of Parliament to do so, thereby avoiding at least some degree of
political interference.Second, a leading physician, who
actually pioneered releasing clinical data to the public, went on to
serve in the Cabinet and continue leading this effort on behalf of the
broader public interest. By comparison, our equivalent of a cardiac
database, the Society of Thoracic Surgeons database, has strict
confidentiality requirements that don’t even allow city-city or
state-state comparisons. The exception: a physician can release his own
information for marketing purposes.Third, and most interesting, are these seemingly innocuous sentences. “There were initially fears
raised that releasing the information would lead to surgeons avoiding
difficult cases which could impact their rates. But agreement was
reached on a method to take into account the difficulty of cases and
mortality rates are released against the number of deaths expected. Sir
Bruce has been working with hospital specialists on a way of rolling out
a similar scheme across all areas of surgery and medicine to help
patients choose where to be treated.”

CBO assesses return on investment of HIT

May 30, 2008• 2

By Jane Sarasohn-Kahn

The return on investment of health care information technology isn’t uniformly positive, according to a recent analysis from the Congressional Budget Office titled, Evidence on the Costs and Benefits of Health Information Technology.

The underlying rationale for the report, which was requested by the Senate Budget Committee, is to sort out the federal government’s role in health IT. The report asks, "Whether — and if the answer is yes, how — the federal government should stimulate and guide the adoption of health IT."

The federal government is already in the health care IT fray. President Bush set the goal in 2004 that every American have an electronic health record by 2014. This was a vision, however, without a funding source. There are also several proposals in Congress that would expand the federal government’s role in health IT by mandating the use of electronic prescribing, provide financial incentives to providers who use health IT, and offer grants to purchase systems for providers.

The CBO report points out a major benefit of health IT that has been largely overlooked: IT’s role in research on the comparative effectiveness of medical treatments and practices. When individuals’ health data is in electronic format, it can be depersonalized, aggregated, and analyzed for a range of uses, such as medical effectiveness, quality, and system efficiency, among other research questions.

One sentence in the 48-page report encapsulates the Mother of All Barriers to Health IT Adoption: "How well health IT lives up to its potential depends in part on how effectively financial incentives can be realigned to encourage the optimal use of the technology’s capabilities."

AHIP & Health 2.0 — caveat whatever the Latin is for movement

May 30, 2008• 3

By Matthew Holt

Last month, the trade group America’s Health Insurance Plans sponsored a seminar on Health 2.0 with Lynne Dunbrack at IDC Health Industry Insights and Roy Schoenberg from American Well. Any resemblance in Lynn’s presentation to the talk I’ve been giving since mid-2007 is I’m sure completely coincidental. (To be less snide, it’s all pretty obvious stuff, and many others are doing it, too). Meanwhile, next month at the big AHIP meeting in San Francisco, another analyst from a Massachusetts research outfit (Carlton Doty of Forrester) will be presenting on this “new” trend.

Now, I’m not exactly blaming these guys for getting into a good thing. Both American Well and David Sobel (who’s appearing with Doty) have been featured at Health 2.0 Conferences already, and Indu and I certainly didn’t discover them, the term Health 2.0, or the Internet. And given the “praise” I’ve heaped on AHIP and its President on THCB over the years, I wasn’t exactly sitting by the phone waiting for their call. Certainly slightly more, ahem, compliant pundits can do a great job instead — even if flying a guy from Boston to talk in San Francisco, when I could walk three blocks may not be the best use of their members’ money.

While it’s good that AHIP is introducing its member health plans to the potential of the Health 2.0 world, let’s not forget that the motivations of the organization don’t exactly square with where many of us think health care, including Health 2.0, should be going — and nor that matter do the Association’s President’s public pronouncements fit with the long-term interests of those of its members who do have something to offer society (e.g not Mega Life/HealthMarkets). Meanwhile, over the years, the quality of AHIP’s research and the veracity of its public statements about the value its members deliver to society have been laughable. So let’s be a little careful about AHIP’s role in Health 2.0

OK, rant over. You can all go back to Friday dog blogging

Charley

Vision for hospital’s future HIT

May 29, 2008• 2

By John Halamka

The role of the chief information officer is very operational — keeping the trains
running on time, ensuring budgets are sufficient and aligning IT resources with the needs of stakeholders.

One other important task of the CIO, however, is to market the work of the IT Department to internal and external audiences. Although IT staff and those involved in IT governance committees are interested in the granular details of projects and their time lines, many audiences want the vision – the big, audacious goals that are really transformational.

To ensure I target the right message to the right audience, I create two documents each year — an operating plan and an "elevator speech." I’m working with all our governance committees over the next few months to complete the details of the operating plan, but here’s my strawman elevator speech for 2009:

Using studies to prove virtually anything

May 29, 2008

By Matthew Holt

This one is great. A British academic has shown that e-breaks — allowing workers to use the Internet for “personal” reasons — actually improve productivity.

A game company paid for the study, but then again the RAND study on EMR effectiveness was paid for by Cerner so caveat emptor. But I suspect that it might be true that 10 minutes playing Grand Theft Auto IV or trawling Match.com probably helps reduce stress and improve focus when back on the job. And, anyway, a more trusting work environment when the boss isn’t micromanaging every minute is probably a better and happier, and therefore, more productive environment.

But be honest. When you’re distracted by personal Internet use (think about the last time you got lost in YouTube), do you really spend just 10 minutes?

Athena announces payer rankings

May 29, 2008• 1

By Matthew Holt

AthenaHealth has announced its rankings on the best and worst payers in health care. Athena CEO Jon Bush discussed the PayerView rankings on the CNBC Squawkbox with Ron Williams, CEO of Aetna, the No. 1 ranked fastest payer. Williams pontificated about how great it will be when all the stuff Aetna is putting in motion is up and running.

Johnbush
Then, he got a tough question about the pressure that high-deductible health plans have put on physicians by making them figure out payments from consumers and insurers. This is a real problem for doctors and getting worse. The amusing thing is that the question came not from the journalists but from Bush.

After Williams’ somewhat waffly answer, Bush said that he’s looking forward to announcing real-time claim adjudication with Aetna any time now. I’m not sure if Bush intended that as a slam or a promise (maybe both), but it seems AthenaHealth has had it with Humana and United Healthcare for a while.

Here’s the video and here’s the press release. New York’s Medicaid program is the worst payer, as if you were surprised.

Caring.com & Trusera — two Health 2.0 newbies talk

May 29, 2008• 1

By Matthew Holt

Two of the more interesting newcomers in the Health 2.0 scene gathered around the electronic watercooler, which is THCB’s podcast series, to talk about what they’re up to and why they are worth looking at.

Andy Cohen is CEO of Caring.com and Keith Schorsch is CEO of Trusera. Some of you may have seen Keith at the March 2008 Health 2.0 Conference. Andy is providing content checklists and much more for those who have sick or frail parents, which will be most of us. Keith is providing a sophisticated place for story telling and information exchange for those facing serious health conditions. Both have serious ambitions.

Interesting stuff — listen to the podcast