Transparency, in the form of a complete, patient-centered and accessible health record is a policy principle that can drive the next wave of health care innovation. Investing exclusively in institutional EHRs will further stifle efficiency, innovation and improvement. Web-based clinical summaries (CCR+DICOM+PDF) that are available for patient control foster patient-centered care, clinical collaboration, and research, and must be included in health care reform if we are to effectively improve provision of health care for patients and clinicians.We’ve been stuck on interoperability long enough to realize that EHRs are a tool and not a solution. To frame the problem, the National Research Council weighs in with a timely assessment and vision. A great summary by David Kibbe highlights the caution: “that current efforts aimed at the nationwide deployment of health care IT will not be sufficient to achieve the vision of 21st century health care, and may even set back the cause if these efforts continue wholly without change from their present course.” In the same vein, a recent Booz, Allen, Hamilton report, sponsored by the Federation of American Hospitals, reminds us that “Other countries experience shows that EHR adoption does not automatically lead to interoperability.”
How to read articles about health and health care
If you’ve just read a health-related headline that’s caused you to spit out your morning coffee (“Coffee causes cancer” usually does the trick) it’s always best to follow the Blitz slogan: “Keep Calm and Carry On.”
On reading further you’ll often find the headline has left out something important, like “Injecting five rats with really highly concentrated coffee solution caused some changes in cells that might lead to tumors eventually. (Not to mention that the study was funded by The Association of Tea Marketing)The most important rule to remember: “Don’t automatically believe the headline.” It is there to draw you into buying the paper and reading the story. Would you read an article called “Coffee pretty unlikely to cause cancer, but you never know?” Probably not. Before spraying your newspaper with coffee in the future, you need to interrogate the article to see what it says about the research it is reporting on. Bazian (the company I work for) has interrogated hundreds of articles for "Behind The Headlines" on the NHS health news Web site, and we’ve developed the following questions to help you figure out which articles you’re going to believe, and which you’re not.
A whole lot more Medicaid, but there’s a catch
It looks like the stimulus package is going to spend a whole lot more on Medicaid AND subsidize the purchase of COBRA for laid off workers. Unlike the “let them eat cake” brigade who’ll decry this as extending welfare to the worthless, I have no problem with it. So long as it really is only a temporary measure,
But let’s be clear—Medicaid is dumb public policy. It’s divided between paying for care for the poor and paying for mostly long-term care for the elderly and chronically disabled, and also has subsidies for hospitals in poor areas thrown in. Then it has S-CHIP as its bastard relation. Furthermore, while the Federal government giveth, the states (which are broke but can’t borrow—California alone is $45 billion in the hole!) are by necessity going to have to take away.
A tale of two pilots
The pilot of the US Airways flight that crash landed safely in the Hudson River earlier this month after taking off from Laguardia Airport is rightly being praised as a hero. But how significant of an accomplishment was it, really? In 1977, the pilot of a KLM flight on the runway at Tenerife's Los Rodeos Airport faced a similar test of his decision-making skills. The outcome was very different.
The New Science of Vascular Disease
Vascular
disease and the conditions that produce arterial problems consume
roughly one- third to one-half of the $2 trillion annual spend in
American health care. The science and systems exist today to dramatically improve the quality and cost related to cardio-metabolic
conditions but almost nothing has been done to implement these new
tools since the Institute of Medicine (IOM) published “Crossing
the Quality Chasm” in 2001.
The most glaring
example of the failure of medical and political leadership in these
matters can be found in the treatment of chronic conditions, which
consume 70 percent of our health care dollars. “Crossing the
Quality Chasm” was a stinging indictment of American medicine,
describing a system that is in need of fundamental change, with many
professionals and patients concerned that the care delivered is not
the care that we need. The report described a system that harms too
frequently and routinely fails to deliver its potential benefits.
CEOs’ Urgent, Shared Commitment to Change
A few weeks ago, I joined five of my peers in health care leadership throughout the country to help launch Health CEOs for Health Reform, a coalition dedicated to transforming health care and creating a more sustainable health system.
In mission, we committed to moving past policy concepts toward a detailed blueprint that would reconcile legislative goals with operational realities of the health care system. Our goals are lofty and the challenges immense. What struck me in recent months, with the current state of the economy, is the tremendous sense of urgency we all feel and the confidence we have that now is the time to truly transform health care.
I read Michael Millenson’s post The Inevitability of Health Care Reform: This Time, the Politics Have Changed with great interest and personal reflection. What is different this time around? What do I think a handful of health CEOs can really do to change a system entrenched with waste and cost that does not add value to our very customer – the patient?
The Virtual Health Home
The virtual health home is
the “other half” of the patient-centered medical home. Some might
say it’s the better half. Though related in purpose, the two “homes”
differ dramatically in perspective. While both place the patient at
the center of care:
- In the medical
home the perspective is that of health professionals who are looking
and managing in toward the patient. - In the virtual
health home the patient is looking and managing out from the center.
The difference is astounding.
The British are revolting!
The BBC (British Band of Communists) has created an appalling piece of propaganda suggesting that the American health care system is an unfair mess. And they’re not exactly too polite about the rest of America, including setting up some doubtless fake multi-millionaire with a spendthrift wife to look ridiculous while saying that we shouldn’t be sharing the wealth.
And if you want to watch it, luckily it won’t be shown here on TV. But those communists have now invented something call YouTube, so you can see it there. But I’m sure none of you realists will want to watch it, and instead will join my call to make sure that these tax-subsidized radical extremists are banned from these shores.
And of course, these are the fools who claimed that spaghetti grows on trees.
Is Medicare backpedalling on evidenced-based medicine?
Note: This post first appeared at Gooznews.com
Both the New York Times and the Wall Street Journal
carried stories today on Medicare's expansion of the number of
drug-listing compendia that can now be used to justify reimbursement
for the off-label use of anti-cancer drugs. This expansion, which
GoozNews covered last summer (see posts here, here, and here), will sharply increase Medicare spending on anti-cancer drugs of questionable medical value.
It has also provided drug companies with an alternative system for
getting reimbursed that won't require their going to the Food and Drug
Administration to prove that the regimens listed in the compendia
actually benefit patients.
The effects of this new system were understated in the articles. The Times
estimated that the higher spending by Medicare will come on top of the
$2.4 billion the senior citizen health care program spent on cancer
drugs in 2007. But according to this 2006 testimony
by Center for Medicare and Medicaid Services official Herb Kuhn,
Medicare spent about $10 billion on "Part B" drugs in 2005 (these are
drugs administered in physicians' offices, which includes most cancer
drugs), and about half of that went to oncologists.
Heard around the Web
Rating hospital quality
Healthgrades.com
released findings today from a national study that identified 270
hospitals, out of 5,000, where patients are on average 27 percent less
likely to die and 8 percent less likely to suffer a major complication (adjusting for hospital case mix).
Open philanthropyBill Gates writes a 10-page letter discussing progress of his health care foundation and future challenges to reducing the global burden of disease.
The future of researchObservational studies using electronic medical record databases offer significant promise for future research, according to a study published today in The British Medical Journal. The University of Pennsylvania researchers replicated randomized controlled trials using the databases and found the results were mostly similar, particularly when applying a new statistical method to control for confounding.
Major Pharma mergerPfizer's plan to buy Wyeth Pharmaceuticals for $68 billion would create the fourth largest company in the U.S. The NY Times explores the impact, management changes and golden parachutes.
OctupletsA California woman gave birth to eight babies at once. The six boys and two girls are alive and said to be doing well. Wow.