Month: October 2012

Großes Potential für digitale Gesundheitsdienste

Oct 31, 2012• 1

By Martin Schmucker

Digitale Innovationen mit echtem Mehrwert für die Patienten sind europaweit auf dem Vormarsch. In Deutschland gibt es jedoch viele Vorbehalte gegenüber neuen Technologien. Alexander Schachinger, Gründer und Geschäftsführer von healthcare42.com und Moderator auf der Konferenz Health 2.0 Europe, über die Chancen digitaler Gesundheitsdienste in Deutschland.

Herr Schachinger, derzeit bereiten Sie mit healthcare42 und Publicis Healthware / razorfish eine Haushaltsbefragung zur Nutzung von Gesundheitsinformationen im Internet durch chronische Patienten vor. Worauf genau zielt die Studie ab?

Alexander Schachinger: In Deutschland wurde noch nie repräsentativ und basierend auf der internationalen E-Patientforschung untersucht, wie sich die Nutzung von Gesundheitsinformationen durch Chroniker auf deren Wissen, ihre Einstellungen und ihr Verhalten auf dem Gesundheitsmarkt, also vor allem gegenüber Ärzten und Apothekern auswirkt. Hier wollen wir eine Forschungslücke schließen, denn das Thema „E-Patient“ ist in Deutschland bisher sträflich vernachlässigt worden. Unter anderem in Zusammenarbeit mit der KWHC GmbH haben wir bereits eine Online-Befragung mit 3.500 E-Patienten durchgeführt. Wir konnten zeigen, dass das Internet, der Austausch in Foren und ähnliches Auswirkungen auf die Patienten haben, insbesondere auf das Arztgespräch und auf die Entscheidung für oder gegen eine bestimmte Therapie.

Wie definieren Sie den “E-Patienten“?

Mit diesem Begriff meinen wir Patienten, die an chronischen Erkrankungen leiden, aber auch Akutpatienten, die das Internet zur Information über Gesundheitsthemen und zum Austausch nutzen. Wir verwenden einen sehr umfassenden Begriff, der auch die Angehörigen mit einbezieht, die sogenannten „Caregiver“, also Eltern, Kinder oder Ehepartner, die sich im Internet über Krankheiten von ihnen Nahestehenden informieren.

The Enormous Potential for Digital Health Care Services in Germany

Oct 31, 2012• 2

By Martin Schmucker

Throughout Europe, digital innovations with substantial benefits for the patients are spreading quickly. However, stakeholders in Germany are still reserved about these new technologies. Alexander Schachinger, founder and CEO of healthcare42.com and speaker at Health 2.0 Europe, talks about the chances of digital healthcare services in Germany.

Mr. Schachinger, healthcare42 and Publicis Healthware/ razorfish are currently preparing a survey about the utilization of health information by chronic patients in the Internet. What exactly is the objective of your investigations?

Alexander Schachinger: Up to now, there haven‘t been any representative scientific studies about the usage of health information by chronic patients. We still don‘t know how this influences their knowledge, their attitudes or their behavior in regard to the healthcare market, in particular towards doctors and pharmacists. We are attempting to close a gap here since research on e-patients has been unfortunately neglected in Germany. In a survey in cooperation with KWHC and others, we interviewed 3,500 e-patients online. We were able to show that the Internet, exchange in forums and suchlike do have an effect on the patients, especially in regard to medical consultations and the decision for or against a certain therapy.

How do you define “e-patients?”

With this term we refer to people suffering from chronic diseases, but also to acutely ill patients, who use the Internet to find out and share information about health issues. This term also comprises all sorts of caregivers, including parents, children or spouses who inform themselves about the medical conditions of their loved ones via the Internet.

Improving Patient Safety Through Electronic Health Record Simulation

Oct 31, 2012• 2

By William Hersh, MD

Most tools used in medicine require knowledge and skills of both those who develop them and use them. Even tools that are themselves innocuous can lead to patient harm.

For example, while it is difficult to directly harm a patient with a stethoscope, patients can be harmed when improper use of the stethoscope leads to them having tests and/or treatments they do not need (or not having tests and treatments they do need). More directly harmful interventions, such as invasive tests and treatments, can harm patients through their use as well.

To this end, health information technology (HIT) can harm patients. The direct harm from computer use in the care of patients is minimal, but the indirect harm can potentially be extraordinary. HIT usage can, for example, store results in an electronic health record (EHR) incompletely or incorrectly. Clinical decision support may lead clinician astray or may distract them with unnecessary excessive information. Medical imaging may improperly render findings.

Search engines may lead clinicians or patients to incorrect information. The informatics professionals who oversee implementation of HIT may not follow best practices to maximize successful use and minimize negative consequences. All of these harms and more were well-documented in the Institute of Medicine (IOM) report published last year on HIT and patient safety [1].

One aspect of HIT safety was brought to our attention when a critical care physician at our medical center, Dr. Jeffery Gold, noted that clinical trainees were increasingly not seeing the big picture of a patient’s care due to information being “hidden in plain sight,” i.e., behind a myriad of computer screens and not easily aggregated into a single picture. This is especially problematic where he works, in the intensive care unit (ICU), where the generation of data is vast, i.e., found to average about 1300 data points per 24 hours [2]. This led us to perform an experiment where physicians in training were provided a sample case and asked to review an ICU case for sign-out to another physician [3]. Our results found that for 14 clinical issues, only an average of 41% of issues (range 16-68% for individual issues) were uncovered.

Four New Tools for Brain Workouts

Oct 31, 2012

By H. James Wilson

How do you sharpen your thinking?

I’ve written already about how you can use auto-analytics to measure and improve the tasks you take on every day at work, but there’s another class of auto-analytics that help you improve at a more fundamental level. These tools strengthen the underlying brain and behavioral structures that support smarter thinking, decisions, and routines in any professional field.

Here are four new tools that I’ve spotted in my research. I use the term “DIY” because each option can be tested, and learning outcomes quantified, without the need for an outside instructor or expert.

Quantified Mind is a personal online cognitive testing platform based on psychometrics, the measurement of cognitive performance in areas like reaction time, executive function, and verbal learning. You take a battery of tests to see your current cognitive performance; then you introduce an intervention to understand whether it helps or hurts thinking. Interventions can include changes to daily routine or diet.

Why Obamacare Is Good for White People

Oct 30, 2012• 27

By Michael L. Millenson

With some pundits predicting that President Obama’s re-election could be sabotaged by a slim level of white voter support, I decided to dig through the small print on Obamacare to see how this right-wing lightning rod actually affects my fellow Caucasians.

It turns out that the high-profile legislative highlight of Obama’s first term is very good for white people. When the Affordable Care Act is fully implemented, 12.3 million more white people will have health insurance than have it today, according to an analysis in Health Affairs.

Obamacare looks even more positive for the pale skinned when put next to the Romney-Ryancare alternative. If Obamacare is repealed and replaced by the health reform plan Presidential-candidate Romney now proposes – not to be confused with the plan Massachusetts then-Gov. Romney enacted into law — an extra 24.8 million white people will not have health insurance. (That’s if you apply current demographics to a recent Commonwealth Fund analysis.)

By way of perspective, that’s nearly equivalent to the entire population of Texas (but all white people) having to cope with serious problems accessing medical care and paying for it. Or to use a more politically compelling comparison, 24.8 million white people would be more than twice the size of the whole population of Ohio.

Irresistible Forces

Oct 30, 2012• 16

By Brian Klepper

At our first meeting years ago, Tom Emerick, Walmart’s then VP of Global Benefits, told me,

“No industry can grow indefinitely at a multiple of general inflation. It will eventually become so expensive that purchasers will simply abandon it.”

He said it casually, as though it was obvious and indisputable.

Health care is playing out this way. From 1999 to 2011, health care premium inflation grew steadily at 4 times the general inflation rate. During that same period, the percentage of non-elderly Americans with employer-sponsored health coverage fell from 69.2 to 58.6 percent, a 15.3 percent erosion rate.

Health care’s boosters like to argue that it has buttressed the economy, and that it means more jobs and economic prosperity within a community. A February 2011 Altarum Institute report estimated that private sector health care jobs now account for nearly 11 percent of total employment. Since the recession began in December 2007, health care employment has risen by 6.3 percent while employment in other industry sectors fell by 6.8 percent.

But there’s a darker side. Health care’s ever-increasing revenue growth has come at the expense of individuals and firms that pay its bills, directly through health plan premiums, and through taxes, often instead of buying other goods and services. It transfers wealth to health care from everyone else. Like the finance services industry, health care has become a disproportionate “taker” industry, sapping economic vitality from America’s communities.

Laughing at the Chutzpah of the Right on Medicaid

Oct 30, 2012• 27

By Matthew Holt

There’s no one that pisses off the right in this country as much as Paul Krugman, and there’s nothing that pisses off the right as much as welfare for the poor. So when Krugman wrote recently in the NY Times supporting a program that is welfare for the poor, and describing how Romney/Ryan would decimate it, well you can expect an explosion from the GRWC. Yes the topic of today’s right-eous indignation is Medicaid.

The place to go to see that explosion is the comments section of John Goodman’s blog. That’s the halcyon world where the poor are oppressed by government programs and would much rather be set free to swim in the happy waters of the free market. Goodman proves to himself that studies showing that people without health insurance on average die prematurely must be wrong because they’re not seen in any “credible, peer-reviewed social science journal” — just in biased rubbish like the American Journal of Public Health and reports from the crack-smoking wackos at the Institute of Medicine.

Having read the comments on Goodman’s article I’m very surprised that Heartland’s Peter Ferrera hasn’t gone on welfare to show how it’s now a guaranteed path to unlimited riches (as opposed to say the tough job of taking payola from a convicted felon) and that Goodman himself hasn’t rejected his health insurance and gone naked on the income of the single mom & waitress in Dallas that Uwe teased him about a few years back. After all it would give him so much buying power to impact the market!

A Sign of the Times

Oct 29, 2012• 10

By David Dranove

Coming Soon, North Shore University Health Systems Medical Office Building.

For me, this is sad news. I am not saddened that North Shore University Health is opening yet another medical office building. It is where they are opening that gets me. They are taking over a two story building that used to house a Border’s Bookstore. My Border’s Bookstore. Sure, Border’s may have been a bit corporate, but this was still a great bookstore. They sold best sellers there, of course, but they also carried all the classics and lots of eccentric titles. Heck, they even briefly carried one of my own books! They had a vast selection of books about military history and an amazing travel section. My wife lost herself for hours in gardening and my sons ogled the aisles of mystery and fantasy novels. Border’s also had vast CD and DVD departments (with classical CDs and Criterion Collection movies) and the café sold a chocolate bundt cake that was out of this world. Maybe best of all, the building had an odd layout with lots of nooks and crannies and surprises around the corner. For a corporate bookstore, it oozed charm. Medical office buildings never ooze charm.

Man versus Pizza

Oct 29, 2012• 4

By Peter Ubel, MD

As a fan of free markets, I recognize that sometimes intelligent government regulations (not always an oxymoron!) can improve markets by requiring companies to provide consumers with information that will help them make better choices. Informed consumers, after all, are a central ingredient of a successful free market. That’s why even most libertarians support regulations that ban fraudulent advertising.

That’s also why, at first glance, the federal government seemed to be promoting better markets when it passed rules requiring chain restaurants to post calorie counts next to their menu items. Research has shown that many consumers are horribly uninformed about the number of calories in most menu options, often significantly underestimating the amount in their favorite meals. Calorie count information should help these consumers make more informed, and therefore better, decisions.

But recent push-back from groups like pizza companies raises important questions about the proper size and scope of such regulations. More importantly, this controversy should remind all of us that, when debating government regulations, we should be humble, because it is often difficult to set a proper balance between helping consumers while at the same time allowing businesses to prosper.

To understand the push-back, it helps to take a guess – your best shot – at estimating the number of calories in a large Little Caesars pizza.

Stumped? You should be. There is no right answer to this question, because there is no such thing as a generic large Little Caesars pizza. Instead, there are hundreds of possible large pizzas one could buy from this company – cheese pizzas, pepperoni and sausage pizzas, mushroom green pepper and extra sauce pizzas . . . you get the idea. The number of calories in a large Little Caesars pizza depends on how many toppings consumers choose to put on top of their pies. This variability makes it hard for Little Caesars to post calorie counts on its menu.

How to Stop a Future Cancer Epidemic

Oct 29, 2012• 5

By Paul Levy

The theory of preventative care, including inoculations, is that we spend a little money now to offset big expenses later in life. But sometimes behavioral friction keeps this from happening, even when the technologies and approaches are proven. We are witnessing such a failure right now with regard to Human Papilloma Virus (HPV).

Here’s the story, from MGH’s James Michaelson, PH.D., arguably one of the most thoughtful, trustworthy, and sensible researchers in the field of analysis of cancer survival. Jim and his team develop sophisticated mathematical methods for predicting the risk of local, regional, and distant recurrence. He says:

There are a couple of good papers about Human Papilloma Virus (HPV), and the coming epidemic (yes, an overused term, but truly applicable here) of head and neck cancer. As Chaturvedi et al say in a recent paper: “If recent incidence trends continue, the annual number of HPV-positive oropharyngeal cancers is expected to surpass the annual number of cervical cancers by the year 2020.”

I get to see this problem from two angles: From my work as the the manager of the MGH/MEEI Head and Neck Cancer Database, and from my experiments in using computer telephone messages to get patients in for preventive health services, such as the fabulous HPV Vaccines: Cervarix (from GlaxoSmithKline) and Gardasil (from Merck). The vaccines are incredibly underutilized. Only about 1% of eligible boys and only 50% of eligible girls get one shot. Only about 25% of girls get all three shots.

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