By JOHN R. GRAHAM

From the perspective of the average patient, going about his life unconcerned about health policy or economics, what is the most frustrating characteristic of U.S. health insurance? Surely, it is the madness of the billing cycle: Never knowing how much a medical service costs until long after you’ve received it, and sometimes only after a flurry of phone calls and paperwork that can take months to clear up.

This is surely why Michaela Dinan’s “winning entry” in a national essay contest, which invited people to submit anecdotes “illustrating the importance of cost awareness in medicine,” has struck such a chord.  Ms. Dinan’s story concerned a billing error for inserting an IUD.  Before the procedure, the patient learned (via “a few keystrokes”) that the cash price would have been $843.60. Insured, her out of pocket cost was to have been about $200.  Instead, she received a bill for $1,100 that took months to sort out.  I suspect that most readers and contributors at The Health Care Blog will use this story as further evidence of the need for a massive national investment in Health IT, along with Patient-Centered Medical Homes, Accountable Care Organizations, adherence to “meaningful use” standards, et cetera.

Continue reading “Crowdsourcing, Price Formation, and Health IT”

By DEVEN McGRAW

The Health 2.0 movement has seen incredible growth recently, with new tools and services continuously being released. Of course, Health 2.0 developers face a number of challenges when it comes to getting providers and patients to adopt new tools, including integrating into a health system that is still mostly paper-based. Another serious obstacle facing developers is how to interpret and, where appropriate, comply with the HIPAA privacy and security regulations.

Questions abound when it comes to Health 2.0 and HIPAA, and it’s vital we get them answered, both for the sake of protecting users’ privacy and to ensure people are able to experience the full benefits of innovative Health 2.0 tools. We can’t afford to see the public’s trust in new health information technology put at risk, nor can we afford to have innovation stifled.

To help solve this problem, the Center for Democracy & Technology (CDT) has launched a crowdsourcing project to determine the most vexing Health 2.0/HIPAA questions.

This is where you come in:

Whether you are a healthcare provider, a Health 2.0 developer or an e-patient, we hope you’ll visit our website to submit your questions on Health 2.0 and HIPAA.

Once CDT has received your questions, we’ll use them to urge the Office of Civil Rights, which enforces HIPAA, to provide clarification. We’ll accept questions until Feb. 11, 2011, so please weigh in soon, and ask others to do the same.

Deven McGraw is Director of the Health Privacy Project at the Center for Democracy & Technology.

By MARK HALL, JD

The following article, forthcoming in U. Penn. L. Rev., pinpoints the strongest arguments for and against federal power under the Commerce Clause to mandate the purchase of health insurance:   http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1747189

Among the key points I make in defense of this federal law are:

1. The “commerce” in question is simply health insurance, and not the non-purchase of insurance as challengers have framed it.  Because “regulate” clearly allows both prohibitions and mandates of behavior, mandating purchase is lexically just as valid an application of the clause as is prohibiting purchase or mandating the sale of insurance.

2. Although existing precedent might allow a line to be drawn between economic activity and inactivity, there is no reason in principle or theory why such a line should be drawn in order to preserve state sovereignty.  Purchase mandates, after all, are as rare under state law as under federal law.

Continue reading “Commerce Clause Challenges to Health Care Reform”

By SUSANNAH FOX

The Pew Internet Project recently issued a short report noting that people living with disability are less likely than other adults in the U.S. to use the internet: 54%, compared with 81%. The first question many people ask when they hear that is, Why? The second is, What can be done? The third is, or should be, What can we learn from this?

Why?

Statistically speaking, disability is associated with being older, less educated, and living in a lower-income household. By contrast, internet use is statistically associated with being younger, college-educated, and living in a higher-income household. Thus, it is not surprising that people living with disability report lower rates of internet access than other adults.  However, when all of these demographic factors are controlled, living with a disability in and of itself is negatively correlated with someone’s likelihood to have internet access.

Just 2% of American adults say they have a disability or illness that makes it harder or impossible for them to use the internet. Eight percent of people living with a disability say this is true. However, this estimate is based on a telephone survey, which does not include people who are not able to use either a landline or cell phone due to hearing loss. If you are interested in more details on this issue, Evans Witt, CEO of our polling firm, Princeton Survey Research Associates International, recommends the following article:

“Inclusion of People With Disabilities in Telephone Health Surveillance Surveys,” by Susan Kinne, PhD, and Tari D. Topolski, PhD [PDF]

Continue reading “What People Living With Disability Can Teach Us”

By IRENE WANG

As four Doctor of Pharmacy (PharmD) fellows affiliated with Rutgers and Thomas Jefferson University, we are conducting an online survey on the use and evaluation of medically-related social media websites. We are aiming to gather your feedback as the end-user on what you expect to find or benefit from medically-related social media sites.  This way, any potential unmet needs can be addressed in the future based on your valued responses.

Please visit our survey here: https://www.surveymonkey.com/s/T6K8XW8. All participants will remain anonymous and the survey will not ask for any private health information.  It should take a maximum of 10-15 minutes to complete all of the questions.

We plan on presenting the results of our survey as a poster presentation at the annual Drug Information Association (DIA) conference in Carlsbad, CA on March 9th, 2011.

We appreciate your participation and support. Please feel free to reach out to us if you have any questions. Thank you!  Dipam Doshi, Ashley Johnson, Edward Lee, and Irene Wang.

Irene Wang is a PharmD fellow affiliated with Rutgers University. She works for Daiichi Sankyo Inc.

By DAVIS LIU, MD

The most common question first year medical students ask me is how do they become efficient at taking a patient history.  Can they skip certain parts of taking the patient history and avoid asking about a social history, whether a patient drinks, smokes, uses drugs, or is sexually active?

When can they stop asking about the review of systems, a list of questions asked about each organ system?  A comprehensive history is used in the emergency room, hospital, or during an annual physical, not in urgent care or an outpatient appointment, right?

Wrong.

Patients lie and don’t even know it.  It’s not that they mean to.  In fact, they are trying to be helpful when giving a history of their symptoms.  Medical students concerns about taking a fast history reflects two things.  First is the reality of the limited amount of face time with patients, which unfortunately seems to be even less than the past.  Second, more importantly, is their fascination and desire to get started on real medicine — what are the diagnoses, treatments, and tests that must be learned to be a good doctor.

In fact, what they realize after working with me is that the most important part of being a doctor is talking to patients and listening.  Taking a good history is the essential part of being a good doctor.

Here are two examples of patients who I saw during the winter.  The practice is busy this time of year.  I’m often running late.  Like many encounters, I’ve never met these patients before.  In many ways, it can feel like an urgent care practice.  Which patient is lying?  Can you tell?

Continue reading “Patients Lie”

The Health 2.0 Conference, run by THCB founder Matthew Holt and colleague Indu Subaiya, announced additions to the lineup of its spring conference in San Diego. The Future of Research panel will focus on the emergence of user-generated content and patient involvement, and the impact on research and clinical practice. The panel of experts includes:

• Susan Love, MD, pioneer cancer surgeon
• George Lundberg, MD, former Editor JAMA, Editor in Chief, Cancer Commons
  
• Gilles Frydman, founder of ACOR
• Josh Sommer, Chordoma Foundation
• Paul Wallace, Kaiser Permanente and the Society for  Participatory Medicine
• Deborah Estrin, Professor of Computer Science, UCLA

Health 2.0 will feature cutting edge applications in the areas of prevention, wellness, exercise and diet. Among the presenters scheduled to speak:

• Lindsey Volckmann, Keas
• Brian Witlin, Shopwell
• Hemi Weingarten, Fooducate
• Will Roesenzwieg, Physic Ventures
• Abbe Don, IDEO
• Arnie Milstein, Clinical Excellence Research Center at Stanford University

For additional details, please see the Health 2.0 web site.

By BOB WACHTER, MD

Cindy Fenton is one of the best doctors I know, a superb clinician-educator who was directing the UCSF Department of Medicine’s educational programs when, in 2001, she stepped off the academic treadmill to raise her three children. With her youngest now in first grade, I recently managed to coax her back into clinical medicine. In early January she spent two weeks as an attending physician on the general medicine service at UCSF Medical Center, after a decade’s absence.

I asked Cindy for her observations, knowing that they’d be astute – and that sometimes the best way to truly see something is to step away from it, then view it again through fresh eyes. Some excerpts from her note to me are in italics (with irrelevant clinical facts changed to please the HIPAA gods); my comments follow:

The patients seemed sicker, the service busier, the residents’ abilities at about the same high level. There were far fewer “private” type admissions than I remember previously – mostly pulmonary transplant patients and some private GI patients. Even on these patients, the subspecialty attendings welcomed the medicine team’s input, so the dynamic seemed more positive.

Continue reading “Rip Van Doctor”

By KENT BOTTLES, MD 

Every morning at 5:30 AM, I am at my computer scouring the Wall Street Journal, the New York Times, the Philadelphia Inquirer, and other news sources for articles about health care and wellness. These articles are then summarized in 140 characters with a link to the original article and tweeted. As of today there are 3070 followers of my informal aggregated health care news service, and I hear about it if I am late or slack off on the job. My twitter community depends on me, and I depend on them.

Twitter has transformed my professional life as an independent physician executive consultant-keynoter who advises health systems and medical groups. Twitter is the main tool I use to monitor the latest developments in the world of health care delivery, payment reform, and physician integration.

I follow about 1,000 health care professionals on twitter, and I often learn about developments in real-time long before they hit the newspapers and journal articles. A few months ago, I was preparing a keynote for a Governance Institute Conference on Social Media for Hospitals and Doctors. One of the people I follow on twitter mentioned a Deloitee Touche white paper on just this subject. I looked it up and included some of their findings and recommendations in my talk (http://ow.ly/29QZy). Without my twitter community, I would probably have never seen this valuable resource.

Continue reading “Twitter: An Essential Tool for the Physician Executive”

By JOSEPH KVEDAR

Continue reading “Advances in Connected Health Sensor Technologies”