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Month: October 2008

Ready or not, it’s time for Health 2.0!

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By Matthew Holt

Tonight the party starts, the beautiful (and not so beautiful) people gather, and the shows under way—and that’s just the Health 2.0 team! There’s also 900 + speakers, guests, media, volunteers and the community is buzzing. Wall Street may be going crazy, the election may be a cakewalk (or not) but in health care interest in combining user-generated content with personalization based on data is growing. Last year around 500 people got together to find out what Health 2.0 was. Really, we only had about 35 decent options from which to choose our eventual 25 demo panelists (and one or two of those were a little of a stretch).

This year we’ll hit about 1,000 in attendance, and Indu & I have chosen from over 250 possible presenters. Attendees will see about 100 of them. Jen McCabe Gorman, Ranger extraordinaire, has sat through 3.2 million demos—making sure that the presenters get it right. And our phalanx of moderators, advisors and presenters have also been burning the midnight oil.

Meanwhile John Pluenneke & Jamie Cao are corralling sponsors & exhibitors, Robin Smiley is about to issue 900 badges, graphics whizzes Patrick Wang & Lauren Golik are putting the final touches to a huge presentation, and head wrangler Joi Hawkins is smiling serenely through the chaos she’s been managing since Sara Walker retired into her confinement. Perry Hallinan is managing the production schedule while making a video on the side, Blake Robin is creating the best soundtrack of any conference you’ll ever hear, and behind the scenes, the staff at Scribe Media, the Marriott and McCune AV are (and will be) working their tails off. Not to mention the 60 volunteers coming to help!

Given that Indu & I thought we’d have a little conversational meeting with 50 people when we started this less than 2 years ago, I’m still amazed every day! Thanks to everyone for their incredible hard work (and of course my love and thanks to Amanda for putting up with me and the hordes of people in her house!)

And yes, there are still a few overflow only tickets left for those true procrastinators! Details about this and much more are on the Health 2.0 Site

An Impending Hanging: Will Health 2.0 Be Compromised By The Economic Downturn?

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By Brian Klepper

Nothing focuses the mind like an impending hanging. — Samuel JohnsonBrianklepper_2

I’ve been preparing for tomorrow’s 3rd Health 2.0 conference in San Francisco, where I’ll join my pals Matthew, Indu Subaiya, Jane Sarasohn-Kahn and Michael Millenson amid a Who’s-Who cast of health industry luminaries. I spent part of Monday reviewing the attendee and sponsor lists, impressive indeed, testament to how seriously this topic is being taken throughout health care.

The meeting is sold out at 950 participants. It’s worth remembering that, before the first Health 2.0 conference 13 months ago, Matthew, who with Indu took enormous professional and personal financial risk to pull this off, told me he’d be surprised if 75 people showed up. There were almost 500, many of them with genuine influence.

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Overregulating patient safey

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Robert_wachter
By Bob Wachter

In responding to dysfunctional systems, America instinctively turns to “more regulation” (Exhibit A: today’s Wall Street). But regulation can, and often does, go too far, and – in patient safety – I believe that it now has.

Note that this comes from someone who believes that health care was under-regulated
until recently, not a popular viewpoint (just more mavericky behavior,
I guess). But you must admit that it was rather odd that until 5 years
ago, I was more likely to have my order read back when I called my
Chinese takeout restaurant than when I called my hospital ward with a
complex medication order. (Parenthetically, the reason for this
disconnect is that my takeout restaurant has a more powerful business
case to avoid screw-ups – they lose a customer – than does my
hospital). So now there is a Joint Commission requirement to perform
“read-backs” of important verbal communications. And it’s hard to
question the need for regulation when a prescription that said, “Inject
10U Insulin,” could be followed without question, despite the fact that
such orders have been mistaken for “100 Insulin” thousands of times,
leading to scores of patient deaths.

I reviewed the first 5 years of the patient safety field a few years ago. In an article in Health Affairs,
I opined that increased regulatory/accreditation pressure had been the
most potent force for change in the first years of the safety
revolution:

Because physicians remain highly
individualistic (which causes them to resist regulatory solutions and
standardization), and hospitals continue to lack a robust set of
incentives to drive patient safety, regulatory solutions have arguably
been the most important early step, particularly when it comes to
procedural safety (creating safe systems, standardization, and
redundancies) in hospitals.

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Researchers question publishing ethics of leading economics journal

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By Sarah Arnquist

Update: The Harvard Health Policy Review site is back up with an apology and disclaimer for not seeking a response from the JHE editors.

A Harvard Health Policy Review article that details two researchers’ account of unethical editing at the Journal of Health Economics (JHE) mysteriously has gone missing from the Internet (but not entirely–here’s the PDF). Actually, the journal’s entire site has been taken down.

The article is full of drama that rivals a John Grisham thriller. It involves the Ivy League, corporate greed, a suggestion of tainted science, and legal threats — which I’m guessing may not be over.

In the "missing" article, University of Pennsylvania sociologist Donald Light and health economist Rebecca N. Warburton, of Canada’s University of Victoria, recount their two-year ordeal to publish a critique of a 2003 study published in JHE, in which Tufts researchers — using confidential data supplied by drug companies — estimated research and development costs for a new drug at $802 million.

Light and Warburton had several criticisms of this article, namely the undisclosed conflicts of interest of the Tufts authors. But they say the JHE editors thwarted their efforts to publish a fair critique.

The "missing" article details the back and forth between the JHE editors (three of whom are Harvard professors) and the original authors. Light and Warburton called it "ultimatum editing," and said the editors "violated almost every ethical standard set for editors."

At one point in the process, Light and Warburton even threatened to sue. Alan Millstein agreed to make a legal case on behalf of the authors and drafted a complaint. “He did not expect much in monetary damages, but expected to win before a jury, revealing to the world how leading economists handled an independent critique of a key article concerning the high costs of drug development form an industry-sponsored research center.”

Merrill Goozner wrote about the conflict in his post, "Where’s Harvard’s Missing Health Policy Journal?" PharmaGossip also writes about the missing journal here.

You can lead a horse to evidenced-based medicine but …

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By Merrill Goozner

Note: This post first appeared at Goozner’s blog, Gooznews.

A new important and depressing study appeared last week in the Journal of the American Medical Association. Researchers who poured over Medicare records found that
less than half of seniors (44.5 percent) with stable coronary artery
disease who complained of symptoms like angina were whisked off to the
catherization lab for percutaneous coronary interventions (PCI) like
balloon angioplasty and stenting without first confirming by a stress
test that they were indeed suffering from reduced blood flow to the
heart (ischemia). Guidelines published by American College of
Cardiology, the American Heart Association and, significantly, the
Society for Cardiology Angiography and Intervention call for the tests.

Previous studies among the commercially-insured population are even
worse. Only a third of patients in the under-65 crowd with stable heart
disease but having symptoms are likely to have gotten a stress test
before getting PCI.

Why is this important? Let us count the ways:

* PCIs have increased 300 percent over the past decade and
accounted for at least 10 percent of the increase in Medicare spending
since the mid-1990s.

* Medicare spends $10,000 to $15,000 per PCI.

* While PCI may reduce ischemia and angina more effectively than
drugs, more than a half dozen studies conducted over the past decade
have established that in terms of reducing deaths or heart attacks, PCI
is no better than drugs alone.

* Patients who fail a stress test and then get PCI do better and have shorter hospital stays; and

* Patients who get PCI with minimal symptoms, with or without the
stress test, are at increased risk of repeat procedures and may
experience a deterioration in their overall quality of life going
forward.

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Video games to revolutionize health and health care

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Gaming_2By Douglas Goldstein

The worldwide video gaming industry is a thriving business – with hardware and software sales reaching 43.5 billion in 2007 and projected to grow to more than 61 billion in the next 4 years.  This growth isn’t propelled by just the latest teenage gaming craze, but by a variety of nontraditional organizations integrating video games, immersive simulations and virtual worlds to improve effectiveness and engagement across all business lines.

The October release of a new book, Changing the Game: How Video Games are Transforming the Future of Business, underscores this notion that video games are becoming a valuable tool for mainstream business. Used for everything from marketing to training to increasing productivity, “the evolution of video games has definitely given companies the ability to create virtual sandboxes that can provide a competitive edge.” As importantly, gaming can also create opportunities to reduce costs and increase profitability.

It may be surprising to some that the health care industry has been among the first to recognize the ‘game-changing’ potential of games in business and other environments.  Leaders in the health care sector are now embracing video games as an integral part of a digitally enabled health culture.

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MRIS: The good, the bad and the useless

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By Christine Gray

Note: This post first appeared at e-patients.net

Gina Kolata’s must-read article in last week’s Science Times points out vast differences in the quality of MRI’s as well as vast differences in the expertise of the radiologists who interpret them.

Patients need to understand this, because physicians sure as Hades aren’t going to tell you.

Kolata uses sports injuries as example. With suspected cancers, the stakes are life and death. A poor MRI was part of the reason my daughter nearly failed to get a proper diagnosis of a malignant sarcoma in her arm, and then nearly failed to get the proper treatment.

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Personal health records and the law

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By Bob Coffield

The October edition of the Health Lawyers News, a publication of the American Health Lawyers Association (AHLA), contains an article I co-authored with Jud DeLoss, a principal in the law firm of Gray Plant Mooty, who blogs at Minnesota Health IT. On the eve of the Health 2.0 Conference this week the article provides a look at some of the legal issues around PHRs.

The article, The Rise of the Personal Health Record: Panacea or Pitfall for Health Information (pdf version),
provides an introductory background on the changing world of PHRs,
highlights Health 2.0 and covers some of the legal implications and
compliance issues for PHRs. We are working on a longer and more
detailed analysis that will be turned into a Member Briefing for the Health Information and Technology Practice Group.
I would appreciate your posting a comment on topics or legal
implications that we might consider covering in the full Member
Briefing.

If you are a health lawyer, law student interested in
health law or otherwise interested in the the legal aspects of the
health care industry and not already a member of AHLA
— think about joining.

Bob Coffield is a health care lawyer practicing in Charleston, West Virginia in the law firm of Flaherty, Sensabaugh & Bonasso, PLLC who blogs on health care legal issues at Health Care Law Blog.

Finding ‘Original Faith’ but not in the health care system

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By Paul Maurice MartinPaulmartin

Thank you to The Health Care Blog for this opportunity to share my patient’s
perspective on health care and how it has helped shape my new book, Original Faith: What Your Life Is Trying to Tell You. I should mention at the outset that the book speaks to human experiences and actions, not doctrine. It argues neither for nor against any form of religious belief.

My progressive illness began with the sudden onset of what was misdiagnosed for several years as Myofascial Pain Syndrome. Despite eleven years of research and medical travel, no diagnosis was ever reached. For the past several years I’ve been housebound, increasingly bedridden and essentially without access to medical care related to my condition, which includes severe peripheral neuropathy and osteoporosis, connective tissue degeneration, and special adaptive needs. My situation may be a good starting point for considering the cracks – or crevasses – in the system.

In an under-regulated health care environment where the only bottom line is the bottom line of increasing profit margins, those with long-term illnesses that are difficult to diagnosis or treat are literally not worth the extra time and effort. Here’s one example from my own experience; I could give many more.

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The toughest job in America

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By Jane Sarasohn-Kahn

Today, the loneliest job in American isn’t being the Maytag repair man. And the hardest job in America isn’t necessarily the Presidency. It’s being a state governor.

Take Pennsylvania (the state I call my home). Governor Ed Rendell sought the position with an explicit goal of expanding health insurance to uninsured Pennsylvanians. After two years in the job, Rendell is facing declining tax revenues, increasing costs. Rendell is already facing a $281 million deficit in this fiscal year, which could increase to over $1 billion. A detailed analysis of this story was published by PR Newswire, "Pennsylvania’s Loss of Employer Health Coverage Outstripping National Average."

The Kaiser Commission on Medicaid and the Uninsured has been studying other state initiatives targeting covering the uninsured. The Commission has found that in California, Illinois and New Mexico, for example, have been unable to broaden health insurance access to citizens without it.

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