Month: February 2010

Chilmark Needs to Chill Out on CCR/CCD Findings

Feb 22, 2010• 16

By VINCE KURATIS

John Moore of Chilmark Research and I agree on things 90+ percent of the time. He even thanked me personally for our collegial relationship in a Thanksgiving Day essay on his blog.

However…I can’t help but comment on John’s misleading story “CCD Standard Gaining Traction, CCR Fading” on THCB. He writes: “In a number of interviews with leading HIE [Health Information Exchange] vendors, it is becoming clear that the clinical standard, Continuity of Care Document (CCD) will be the dominant standard in the future. The leading competing standard, Continuity of Care Record (CCR) appears to be fading with one vendor stating that virtually no client is asking for CCR today.”Continue reading…

Health on the Net Foundation goes Web 2.0

Feb 22, 2010• 5

By Denise Silber

The subject of the quality of healthcare information on the Internet is rich and recurring. The main question we hear regularly is whether or not Internet users are finding quality health information. But it’s not the only one. There is also: how governments can/should protect citizens? And more recently, do Web 2.0 tools give users more power or make them more exposed to poor quality information?

This article focuses on Health on the Net. Established in 1995 in Geneva Switzerland, HON is the longest running, most widespread code of conduct dedicated to health and the Internet. HON will release its next Web 2.0 tool during the Health 2.0 Europe Conference, Paris April 6-7, 2010

HON plays a special role in France. In October 2007, after a lengthy review process, the French High Health Authority (Haute Autorité de Santé) accredited HON as its partner for the certification of health sites in France, in view of its simplicity, widespread presence, and accessibility for webmasters free of charge. 859 French sites are currently certified by HON, one of the largest numbers for a single country, except for the U.S.

To be certified, web sites commit to the respect of 8 principles that primarily concern transparency. HON certification status is indicated on the site by presence of the HON seal. HON uses online tools to monitor the certified sites and also performs a systematic annual review of each one. The HONcode is used by over 6,800 certified websites, covering 118 countries and has been translated into 26 languages.

In addition to the HONcode, HON has developed various search and other tools.

Healthcare: Right or Responsibility?

Feb 20, 2010• 47

By STEPHEN C. SCHIMPFF, MD

During the presidential debates, Tom Brokow asked, “Is healthcare a right, a privilege or a responsibility?”The candidates did not answer the question, but now would be a good time for Congress and the Obama Administration to balance the rights being offered as part of reform with corresponding responsibilities.

We are the only developed country that does not assure all of its citizens basic medical care insurance access – shame on us. We spend more per capita for medical care than any other developed country yet our outcomes are not the best – shame on us. We mostly use price controls to try to slow rapidly escalating costs. They not only don’t work but leave patients with less than adequate care and huge bureaucratic frustrations – not logical. All too many individuals find that they are denied coverage because of a preexisting condition when they move from one job to another or find themselves unemployed – unacceptable. As a population we have all too many adverse behaviors such obesity, lack of exercise and smoking that are leading to expensive, lifelong chronic illnesses like diabetes and heart failure – killing ourselves. And primary care physicians find that they do not have time to offer good preventive care nor care coordination to those with chronic illnesses because insurance does not pay for these essential activities, thereby resulting in more visits to specialists, more expensive prescriptions when life style changes could have been effective, more procedures and tests – all of which lead to higher total costs of care.

Wellpoint: just incompetent?

Feb 20, 2010• 84

By MATTHEW HOLT

I’m viewing the latest rumblings in the US health care debate from the confines of a clear but cold Britain, where the big news is that the country is joining the PIGS in entering economic meltdown—or at least being a lot more broke than it thought it was. (PIGS are Portugal, Greece, Ireland & Spain, not farm animals). And yet it appears that health reform is making if not a comeback then at least vigorous palpitations. The reason for this seems to be the strength that the Anthem Blue Cross/Wellpoint premium rises have imbued into the Administration.

Those of you reading THCB over the years will know that I think the individual insurance market is doomed to fail and should be replaced. It has its apologists; for example Cato’s Michael Cannon here criticizes Paul Krugman who explained last Friday why the individual market goes into a death spiral. Michael claims that Mark Pauly’s research shows that the individual market works. What Pauly’s work (and I despair at having to read it again, so this is from memory) tends to show is that insurers are incompetent at charging sick people to the full extent that they cost them, but do charge them roughly three times what they charge healthy people. Pauly also said in Health Affairs that the individual market works pretty well for 80% of the people in it, but he seems to think that screwing the remaining 20% is OK. Coming from a tenured Ivy league professor who’s probably never had to buy health insurance in his life, that was pretty rich. But apparently Wellpoint’s latest performance shows that it’s not OK for much of the other 80% either—hence their dropping out, leading to Krugman’s death spiral.Continue reading…

McAllen, TX As Outlier? Why Not Houston?

Feb 19, 2010• 27

By MERRILL GOOZNER

Or Lubbock? Or Oklahoma City? Or New Orleans? Or any of a dozen major and minor metro areas throughout the South? According to the Medicare Payments Advisory Commission, all of them have significantly higher usage rates and costs per Medicare enrollee than McAllen, which was high-cost locale ground zero for Atul Gawande’s famous New Yorker article, “The Cost Conundrum,” which has become, to use the New York Times‘ formulation, “must reading in the White House.”

Gawande grounded his analysis on per-patient Medicare claims data compiled annually by researchers at Dartmouth Medical School. “The explosive trend in medical costs seems to have occurred here in an especially intense form,” Gawande wrote after the Dartmouth Atlas of Health showed McAllen as the highest spending region in the country outside Miami, where Medicare fraud is an especially virulent problem. Not so, MedPAC said. Adjust for prices and McAllen’s outlier status compared to the rest of Texas and large parts of the South all but disappears.Continue reading…

Why the iPad Matters (For Healthcare)

Feb 19, 2010• 31

By THOMAS GOETZ

In case you’ve been preserved in amber the past month, there’s been lots of excitement in technology circles about the iPad – as well as other tablet computers – and how they’ll transform (take your pick): games and word processing and movies and magazines and newspapers and music composition.

But there hasn’t been a great deal said about their possible usefulness in healthcare.

In truth, healthcare has a horrible record with technology. Medical technology, after all, is one of the principle reasons that annual healthcare costs in the U.S. are at $2.5 trillion, and climbing. The CT scan may beguile radiologists and diagnosticians, but it’s also a horribly inefficient technology (it doesn’t scale, there’s no price transparency, etc.). In short, everything that technology is good for in the rest of the universe – lowering costs, reducing expertise – it has exactly the opposite effect in healthcare and medicine.

There have been attempts here or there to introduce consumer-style tools to medicine. Dozens of companies, for instance, offered versions of the Palm Pilot that promised to recognize a physician’s unique needs. But too often these one-off gadgets fell into the wrong quadrant of the efficiency and expense matrix. And the fact that pagers are long dead in every corner of the world except in hospitals serves as yet more proof that healthcare is a bizarro world when it comes to technology.

And consumer-facing tools have fared just as poorly. Fancy set-top boxes that promise to connect patients to their doctors via telemedicine, and cumbersome monitoring devices for people with diabetes or other chronic conditions haven’t exactly inspired confidence.

So: enter the iPad. Does it have a chance?

Yes, and for two reasons. The first is this: In the past healthcare technology has always been about the hardware – building a box that promises to do something, and then trying to educate patients or providers on how to use the box. That hasn’t worked because of bad interface design; the mission was complexity, not simplicity. But the tablets, and the iPad in particular, are designed to be as simple as possible (just one button). They’re not really about the hardware, at all – in fact, if these tools work as promised, the hardware disappears. The device will let users engage with information immediately, without having to negotiate a cumbersome interface. Indeed, the device itself vanishes and the user connects directly with the experience. That’s a powerful shift, and it has great potential for health.Continue reading…

No Country For Young Nurses

Feb 19, 2010• 34

By OLGA KHAZAN

The nursing profession takes a certain dedication to love. After all, most office jobs don’t involve standing for 12 hours at a time, scarfing a bite of lunch between “clients” or handling gallons of bodily fluids on a daily basis. But for years, nursing schools lured students with the promise that they would be snapped up by prestigious hospitals upon graduation, remunerated for their hard work with good pay and enviable job security.

And they were right – until now, that is.

It’s a paradox straight out of “Freakonomics:” Even though California still faces a shortage of nurses, up to 40 percent of nursing school graduates will be unable to find jobs, according to the California Institute for Nursing and Health Care.

The recession set off a domino effect that has caused California hospitals to virtually stop hiring newly-minted nurses. The Institute estimates only half as many nurses will be hired this year as in 2008.

It’s all thanks to Botox, healthcare reform and other people’s husbands.Continue reading…

Should the Feds Certify EHR Usability?

Feb 19, 2010• 3

By ROBERT ROWLEY, MD

In an interesting turn, the Commerce Department’s National Institute for Standards and Technology (NIST) says it is looking to develop standards for evaluating ease-of-use of health IT systems. This raises some questions about the appropriate federal role in guiding the evolution of Electronic Health Records (EHR) systems – should the feds be specifying “usability standards” in the first place?

The NIST notice is currently very preliminary – they are simply looking for companies with expertise in quantifying and measuring Usability in health IT systems. However, the NIST has been charged with developing the specific testing and process documents that will be used (by organizations yet to be selected) to certify EHR systems. The overall policy and specification about Meaningful Use of a Certified EHR, which is needed to access ARRA stimulus moneys available beginning in 2011, have been published for open commentary. However, the specific nuts-and-bolts of certification is being hammered out by the NIST. They have already contracted with Booz Allen Hamilton to help with this process.Continue reading…

The Reagan-Era Health Reform That Scares Both Parties

Feb 18, 2010• 31

By MICHAEL MILLENSON

Twenty-seven years ago, President Ronald Reagan and a Congress split between Republican and Democratic control agreed to a radical new payment scheme for Medicare. The resulting legislation trimmed billions of dollars from the federal budget and caused medical inflation to plummet, yet still maintained quality of care.

Although this stunning achievement led to a permanent change in how both the public and private sector pay for health care, it has gone curiously unmentioned during more than a year of rancorous health reform debate. Nor is it likely to arise at the much-ballyhooed bipartisan summit. The topic simply raises too many squirm-inducing questions. In this instance, conservatives and liberals alike can agree that political discretion is the better part of valor.

For Democrats, the changes in Medicare hospital payments enshrined by the Social Security Amendments of 1983 constitute an unpleasant reminder that reforms targeting cost can be, and have been, successfully decoupled from those aimed at improving access. Given the public enthusiasm for cost control over access expansion, acknowledging that reality might well deal a fatal blow to decades of liberal efforts to achieve the dream of universal coverage.

For Republicans, however, the reverberations of the Reagan-era Medicare revamp are even more unsettling. The most-revered figure in modern American conservatism agreed to an administered price system that the current guardians of conservative orthodoxy would undoubtedly denounce as socialist, Bolshevik or worse. Even more painfully, the scheme worked. Perhaps most painful of all, Reagan’s reasoning showed a pragmatic view of government much closer to today’s political center than it is to hard-right GOP ideologues.

The Gentleman From Indiana

Feb 18, 2010• 15

By PAUL LEVY

In his Washington Post column this week Dan Balz wonders whether Evan Bayh was overstating the degree of partisanship in Congress and whether, notwithstanding that, he should have stuck around to deal with the problem.

I don’t think any of us have been alive long enough to know whether the first is true. Politics always seems at its worst when you are in the middle of it. It may be, though, that the existence of social media has made it more combative, for the old-style behind-the-scenes sausage making is no longer possible. Also, clever users of these media can create a “movement” in just a few hours, pushing positions to the extreme. Though politicians have become experts in using social media to run election campaigns, they have not yet figured out how to use these tools to help build bipartisan coalitions to govern.

And, on the second, we have no right to judge this gentleman on his personal decision. If he no longer wants to try to stay in Washington to work on the problem, there will be plenty of other candidates. No one is indispensable.Continue reading…