Data Mining Case Reaches the Supreme Court
By GLENN LAFFEL, MD, PhD
Twenty years ago, IMS Health got the idea to purchase prescription records from pharmacies, license physician information from the AMA’s Physician Masterfile, and link the two databases so as to create something new and different: prescriber-level data (PLD).
It was a brilliant idea. Almost immediately, pharmaceutical and device companies, government analysts and public health officials began lining up to buy raw PLD and/or the reports that IMS created from it.
And with good reason. By applying statistical tools to analyze PLD (a technique known in the vernacular as “Data Mining”) IMS and the purchasers of its data could obtain fresh insight into many topics of interest. These include prescribing pattern variations across regions, where and when influenza outbreaks occur, how physicians respond to these outbreaks and hundreds of others. Drug makers found PLD information to be particularly helpful. With it, they could refine marketing pitches and improve sales force efficiency, among other things.
Since those early days, the scope of the data compiled by IMS and other PLD providers has expanded to a point where it is truly breathtaking. The AMA Masterfile includes current and historical data on 880,000 physicians. IMS and similar companies collect information on more than 70% of all prescriptions filled in the US. SDI Health, another PLD provider, has billing information from 100% of inpatient and outpatient activity at 500 hospitals dating back to 2002. Their databases are large enough to detect national trends and withstand the most exquisite stratification analyses. Furthermore, PLD providers have perfected ways to exclude information from their databases that could be used to identify patients, so the data comply with HIPAA and other privacy-protecting laws.
Cyber Insurance
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Insurance exists to cover a wide range of potential business risks. Cyber insurance is worth considering as companies increase their presence, business practices and data storage online. In fact, Cyber insurance is not just for companies conducting transactions online (e.g., online retailers).
It is valuable to any company who has critical systems or sensitive data, which is almost every business. While it is possible to have insurance that covers damage to your servers and other computer equipment, it is almost certain the insurance only covers the physical damage to the hardware, itself, and not the valuable data housed within. In fact, insurance policies regularly state that the policy is limited to the replacement costs of the hardware and not the data. This means that in the event a hacker gains access to your systems and disrupts operations, standard insurance coverage will probably offer little or no protection unless hardware is actually damaged.
The costs associated with restoring lost or damaged data, sending breach notifications to consumers, and other potential liability under each state’s breach notification statues can be astronomical. Cyber insurance can help cover some of the costs of a data breach, including the expense of sending notification to affected individuals, public relations, fines, penalties, responding to regulators and any subsequent litigation by affected individuals. The potential for attacks and breaches is growing exponentially as more and more businesses move operations to the cloud. Moreover, attacks do not necessarily derive from an outsider. Data breaches have resulted from careless, frustrated and vengeful employees who often attempt to profit from someone else’s information. Depending on the policy, Cyber insurance can offer protection from hackers, viruses, data breaches, denial of service attacks, and copyright, trademark, and website content infringement.
What Do Medical Errors Cost Your State?
By PAUL LEVY
GE Healthcare offers this calculator, based on data from the Society of Actuaries, to show the cost of medical errors for a given population. I inserted the population of Massachusetts from the most recent US Census to see what would pop up. Here is the result.
I suspect this figure of $260+ million is actually an underestimate because there is a lot of preventable harm that does not get counted as such. For example, we reduced our rate of ventilator associated pneumonia at BIDMC considerably over the last three years by rigorous application of the VAP bundle. Likewise at Cooley Dickinson Hospital in Northhampton, MA.
As best as I can tell, VAP is not included in the statistics above. Chances are those cases previously would not have been counted as medical errors. They were just part of the mentality of “these things happen,” a belief by many that the current level of harm caused by hospitals is a statistically irreducible number.
Notice that I say “caused by hospitals,” and not “occurring in hospitals.” Until we take ownership of the fact that a great degree of harm that occurs in hospitals is caused by failures in the manner of delivering care, we will not make progress.Continue reading…
Health 2.0 San Francisco РTim O’Reilly Keynote
How are Web 2.0 technologies changing healthcare? What are the implications of trends like cloud-based computing for major healthcare players like pharma companies and large health systems? What about mobile computing? What are the practical implications for providers? What can healthcare providers learn from like dominant Web 2.o players like Google? Silicon Valley legend Tim O'Reilly (The Web 2.0 conference, O'Reilly publishing) gives an overview in this keynote from this years Health 2.0 conference in San Francisco in October.
Health 2.0 San Francisco – Tim O’Reilly Keynote
How are Web 2.0 technologies changing healthcare? What are the implications of trends like cloud-based computing for major healthcare players like pharma companies and large health systems? What about mobile computing? What are the practical implications for providers? What can healthcare providers learn from like dominant Web 2.o players like Google? Silicon Valley legend Tim O’Reilly (The Web 2.0 conference, O’Reilly publishing) gives an overview in this keynote from this years Health 2.0 conference in San Francisco in October.
San Francisco Early Bird Price Ends This Week
The year may have just begun, but before you know it, the first Health 2.0 conference will be just around the corner! The Health 2.0 Spring Fling conference takes place in San Diego on March 21-22, 2011. In September, we will hold the 5th Annual Health 2.0 Fall Conference in San Francisco. Early Bird prices end on January, 14th at 5pm PST. To get your Early Bird tickets, please register here.
Get your San Diego Conference tickets today. Our Spring Fling will focus on three themes where Health 2.0 can make a difference: making health care cheaper; the evolution of research; and prevention, wellness, exercise and food. For each theme we’ll be showcasing new technologies, new services, and new partnerships, as well as catching up with leaders in health care, and Health 2.0. We'll also be highlighting winners of the Health 2.0 Developer Challenge. Sponsorship and Exhibiting opportunities are now available! For more details, see AGENDA.
We are happy to have best-selling author, Dean Ornish, President, Preventive Medicine Research Institute as the keynote speaker. We also are thrilled to announce that Todd Park, CTO, Health and Human Services, and J.D. Kleinke, author of the new novel “Catching Babies” will also be speaking.
Newly Confirmed Speakers:
- Brian Witlin, CEO, ShopWell
- Lindsey Volckmann, Director of Business Development, KEAS
- Carol Diamond, Managing Director, Markle Foundation
- Nikolai Kirienko, Project Director, Crohnology.MD
- Josh Sommer, Executive Director, Chordoma Foundation
- Deborah Estrin, Professor of Computer Science, UCLA
To get your tickets before it's too late, please REGISTER HERE.
Hospital Culture and Surviving the New Landscape
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A recent flight on Southwest reminded me of the importance of culture in navigating change in a rapidly evolving environment like we have in health care in the United States today. It is all too easy to focus on all the technical issues hospitals face in setting up Accountable Care Organizations to handle the inevitable global payments that will replace the current fee for service system. This blog is a plea for hospitals and doctors and consultants to pay attention to both the technical and the cultural or adaptive challenges we face in transforming a $2.5 trillion American industry.
Recent articles on companies outside of health care have highlighted how important culture has been to the success or failure of Southwest Airlines, QVC, and Zagat to respond to changing business conditions. Southwest’s COO states “our culture is our biggest competitive strength,” and the flight attendant and pilots’ union worry about how the recent purchase of AirTran will affect their unique culture. I have seen Southwest pilots help clean up the cabin, and the flight attendant on my recent trip told me she was giving up her day off because the company needed her help. QVC is trying to use the same methods and culture that made selling on TV popular with Internet customers. And Zagat, which had cultural troubles moving from book format to online, is now hoping that smart phone applications will reinvigorate their business model.
Harvard’s Ron Heifetz differentiates between technical and adaptive work and I have found this concept useful in working with health systems responding to payment reform. Everyone involved in hospital physician integration efforts will need to undergo a cultural (adaptive) shift because the healthcare reform law and the transition from fee for service to global payments mean the old ways of doing things are not sustainable.
Seeding the Cloud
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The newest new future of computing is floating your way. Lie back on the grass and enjoy. It is The Cloud. Not the corporate Cloud that is the trademarked provider of Wi-Fi services in Europe. But the broader Cloud that is the internet. The World Wide Web. The electronic blanket that invisibly but none-the-less completely shrouds us all. The cloud.
We are exhorted to upload it to the cloud. Store it in the cloud. Share it through the cloud. Download it from the cloud.
Your photo albums and your diaries and your work product and your deepest darkest secrets are slowly migrating from your computer to for-profit warehouses that promise safekeeping for your life’s work and memories. Even our medical records are going to wind up in the cloud. And because they are in the cloud, they are theoretically available to me or to those I authorize to viewse them – anywhere in the world. Instant access. Anywhere. Safety. Security. Total redundancy and backup.
What else is in the cloud? The apps that power our smart phones. The programs that power our computers. Our phone calls. Our video streams. The social media that passes for communication. All are drawn from and sent back out through the cloud.
And as long as you have great wi-fi service or five bars on your cell phone, you will always have access to your stuff, Right?
Why Christians Should Support Health Care Rationing
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It’s coming. Health care reform, Round II.
Republicans pledged to do it as part of their manifesto during the midterm election campaigns. And House Speaker John Boehner, less than a day after the elections, vowed that the GOP would “do everything we can to try to repeal this bill and replace it with common sense reforms to bring down the cost of health care.”
But why was this such a high priority? The lack of cost controls? Unfunded state mandates? Questions surrounding federal funding of abortions? Well, yes, but the go-to critique of health care reform can be summed up in one word:
Rationing.
Recently, as part of a response to the FDA revoking its approval for a late-stage breast cancer drug, several key Republicans criticized this kind of rationing, but set their sights on a much bigger target:
“Unfortunately, this is only just the beginning,” they continued. “The new health reform law — the so-called Patient Protection and Affordable Care Act — creates 159 new boards, commissions and agencies that will destroy the doctor-patient relationship and replace it with federal bureaucrats deciding who gets care and what treatments they can receive,” The Hill’s Jason Millman reported.
And the GOP will have backing in this effort from a pro-life Christian base crying out against ‘euthanasia’ and ‘death panels’ in the new health care law.
But this attitude refuses to admit two undeniable truths about human existence:
We have virtually unlimited health care needs. (All of us will die some day.)
We have limited health care resources. (There is a finite amount of ‘stuff’ out there.)
We will never not be rationing health care. Any other conclusion misunderstands the human condition.
