Year: 2014

A Hospital That Is a World Leader On Transparency

Aug 31, 2014• 4

By LEAH BINDER

Jeremy Hunt, secretary of state for health in Britain, recently toured the Virginia Mason Medical Center in Seattle. He said the visit was “inspirational” and announced plans to have the British National Health Service (NHS) sign up “heart and soul” to a similar culture of safety and transparency. Hunt wants doctors and nurses in NHS to “say sorry” for mistakes and improve openness among hospitals in disclosing safety events.

I had a similar reaction to my tour of Virginia Mason. The hospital appears impressive—and truly gets impressive results. My nonprofit, the Leapfrog Group, annually takes a cold, hard look at the hospital’s data and named Virginia Mason one of two “top hospitals of the decade” in 2010. Every year, it ranks near the top of our national ratings.

Virginia Mason’s success is rooted in its famous application of the principles of Japanese manufacturing to disrupt how it delivered care, partly at the behest of one of Seattle’s flagship employers, Boeing. There are numerous media stories and a book recounting the culture of innovation Virginia Mason deployed to achieve its great results, so I won’t belabor the point here. But at its essence is Virginia Mason’s unusual approach to transparency. Employees are encouraged to “stop the line” – that is, report when there’s a near miss or error. Just as Toyota assembly workers are encouraged to stop production if they spot an engineering or safety problem, Virginia Mason looks for every opportunity to publicly disclose and closely track performance.

It is not normal for a hospital to clamor for such transparency. Exhibit A: the Leapfrog Hospital Survey, my organization’s free, voluntary national survey that publicly reports performance by hospital on a variety of quality and safety indicators. More than half of U.S. hospitals refuse the invitation of their regional business community to participate in Leapfrog, suggesting that transparency isn’t at the top of their agenda. But for Virginia Mason and an elite group of other hospital systems, not only is the transparency of Leapfrog a welcome feature, but they challenge us to report even more data, faster.

The Quantified Doctor

Aug 31, 2014• 12

By SAURABH JHA, MD

88.2 % of all statistics are made up on the spot
– Victor Reeves

There’s a growing movement in medicine in general and imaging in particular which wishes to attach a number to everything.

It no longer suffices to say: “you’re at moderate risk for pulmonary embolism (PE).”

We must quantify our qualification.

Either by an interval. “Your chances of PE are between 15 and 45 %.”

Or, preferably, a point estimate. “You have a 15 % chance of PE.”

If we can throw a decimal point, even better. “You have a 15.2 % chance of PE.”

The rationale is that numbers empower patients to make a more informed choice, optimizing patient-centered medicine and improving outcomes.

Sounds reasonable enough. Although I find it difficult to believe that patients will have this conversation with their physicians.

“Thank god doctor my risk of PE is 15.1 % not 15.2 %. Otherwise I’d be in real trouble.”

What’s the allure of precision? Let’s understand certain terms: risk and uncertainty; prediction and prophesy.

By certainty I mean one hundred percent certainty. Opposite of certainty is uncertainty. Frank Knight, the economist, divided uncertainty to Knightian risk and Knightian uncertainty (1).

What’s Knightian risk?

If you toss a double-headed coin you’re certain of heads. If you toss a coin with head on one and tail on the other side, chance of a head is 50 %, assuming it’s a fair coin toss. Although you don’t know for certain that the toss will yield head or tail, you do know for certain that the chance of a head is 50 %. This can be verified by multiple tosses.

Calling Mrs. Kafka

Aug 30, 2014• 9

By HANS DUVEFELT, MD

“Prior Authorizations, Mrs. Kafka. May I have your name and the patient’s policy number.”

“My name is Hans Duvefelt, and I don’t have the patient’s number but I have her husband’s – it is 123456789”.

“Thank you, Doctor. This is for Harry Black?”

“Well, no, it’s for his wife, Harriet. We asked for a PA for Lyrica for her, but it was approved for him instead, even though the forms we sent you clearly stated her name.”

“I see that Harry is approved for one year.”

“Yes, but he doesn’t need it. He has no diagnosis and no symptoms. Someone at your end reversed the names, because the application was for Harriet. I have a copy right here in front of me. So can we just get this approval switched over to her name instead?”

“I’m sorry, we can’t.”

“But why?”

“She’s a different patient.”

“But everything we sent in was on her. You were the ones who put it under his name instead. It was your mistake and I’m asking that you correct your mistake.”

“I’m sorry, but we have to process Harriet’s Prior Authorization separately. What is her diagnosis?”

(Sigh)

“Postherpetic neuralgia.”

“Is she currently taking Lyrica for this?”

“Yes.”

“I don’t see any pharmacy claims for Lyrica in her profile.”

XPRIZE Names 10 Finalists in Tricorder Competition

Aug 29, 2014• 1

By Kim Krueger

XPRIZE announced the 10 finalist teams competing for the $10M Qualcomm Tricorder XPRIZE, a 3.5-year global competition sponsored by the Qualcomm Foundation for teams to develop a consumer-focused, mobile device capable of diagnosing and interpreting a set of 15 medical conditions and capturing five vital health metrics. Launched in January 2012, the competition encourages the development of a device much like the medical Tricorder of Star Trek fame.

The Tricorder prize is something we’ve supported since its launch, and last year at the 7th Annual Health 2.0 Fall Conference, we got to host part of another XPRIZE competition: the Nokia Sensing CHALLENGE, a $2.25 million global competition to accelerate the development of sensors and sensing technology that is smaller, lighter, and capable of capturing true clinical data on a personal level. The teams on display were examples of how Health 2.0 technologies are pushing the boundaries of access, diagnosis, and discovery.

The recently announced finalists for the Tricorder prize promise to be equally impressive as they work to move the science fiction of the Star Trek Tricorder to science reality. The ten teams represent diverse backgrounds from non-profits to academia to start-ups, and include:

Aezon (Rockville, Md.), led by Tatiana Rypinski, a team of student engineers from Johns Hopkins University partnering with the Center for Bioengineering Innovation & Design.
CloudDX (Mississauga, Canada), a team from medical devices manufacturer Biosign and led by company chief medical officer, Dr. Sonny Kohli.
Danvantri (Chennai, India), a team from technology manufacturer American Megatrends India and led by company Director and CEO, Sridharan Mani.
DMI (Cambridge, Mass.), a team led by Dr. Eugene Y. Chan of the DNA Medicine Institute partnering with NASA, the National Institutes of Health and the Bill and Melinda Gates Foundation.
Dynamical Biomarkers Group (Zhongli City, Taiwan), a team of physicians, scientists and engineers led by Harvard Medical School professor Chung-Kang Peng.
Final Frontier Medical Devices (Paoli, Pa.), a team led by the founders of Basil Leaf Technologies—brothers Dr. Basil Harris, an emergency room physician, and George Harris, a network engineer.
MESI Simplifying diagnostics (Ljubljana, Slovenia), a team from diagnostic medical device manufacturer MESI and led by company CEO, Jakob Susteric.
SCANADU (Moffett Field, Calif.), a team from Silicon Valley-based start-up SCANADU led by technology entrepreneur and company co-founder and CEO, Walter De Brouwer.
SCANurse (London, England), a team from diagnostic medical manufacturer SCANurse and led by biomedical engineer and company founder, Anil Vaidya.
zensor (Belfast, Ireland), a team from clinical sensor and electrode company Intelesens and led by chief technology officer, Prof. Jim McLaughlin.

Matthew Holt had a chance to speak with Grant Campany, the Senior Director of the Qualcomm Tricorder XPRIZE and Nokia Sensing XCHALLENGE, about the finalists and the competition. We’re excited to follow these teams on their quest and see how their technologies change our world. To hear more, take a look at the interview below:

[youtube=http://www.youtube.com/watch?v=qAr3PKFbK7w]

Kim Krueger is a Research Analyst at Health 2.0.

Is It Possible That All Healthcare Needs to Know We All Learned In Kindergarten?

Aug 29, 2014• 10

By JOSEPH M. SMITH, MD

US Healthcare is sick and getting sicker, and while its chaotic complexity suggests to many that it will need to fail big before it can be rebuilt, some simple rules may help to get it back on track. As this the time of year when many of us prepare to send our children on grandchildren off to school in the hopes that they will learn what they need to succeed, I thought we could revisit the lessons of Kindergarten and their application to healthcare. The following list, initially from “ALL I REALLY NEED TO KNOW I LEARNED IN KINDERGARTEN” by Robert Fulghum. has been adapted (read ‘man-handled’) for applicability to US healthcare. You’ll find the original list here: http://www.robertfulghum.com/

Share everything – In healthcare, this means share ALL the data, all the information, all the acquired wisdom. Interoperable systems are essential. Price transparency is the right side of history. Automated, coordinated, connected systems are essential. Healthcare is too much of a team sport not to share all that we know, so that we can quickly understand what works, what doesn’t, and what it’s all going to cost.

Play fair – It isn’t fair when decisions are made without a person’s input. It isn’t fair that a patient should bear the risks, the pain, the scars and the costs without having unfettered access to all the relevant information. Shared decision making is part of playing fair in a world where healthcare is meant to happen for patients and with patients, but not to patients.

Don’t hit people. – We must avoid ‘hitting’ patients with costs they can’t bear, or complications they didn’t know could happen. We should avoid ‘hitting’ clinicians with unsophisticated systems that complicate their lives and distract them from their patients. We need to stop ‘hitting’ innovators with unanticipated or needlessly complicated regulatory hurdles. And we need to work hard to have all of us avoid the ‘hit’ of a financially and logistically unsustainable healthcare system.

Put things back where you found them. Except for things like an infected appendix or a malignant growth, this continues to make great sense. And as we go about transforming healthcare, we must recognize that wholesale, sweeping changes are easier to envision than execute. While progress requires change those changes that align with / enhance / expedite existing workflows will be easiest to achieve.

Clean up your own mess – Healthcare is big enough that there are messes everywhere. We should favor local control over central planning. Patients must bear some responsibility for the consequences of their life-style choices that might be reflected in their insurance costs. Hospitals must monitor and manage their own quality metrics. Medical boards need to step up their efforts to spotlight and sanction professional inadequacy. Our federal government must do a better job of limiting inappropriate payments in healthcare. If each of us cleans up after ourselves, things get better quickly.
Continue reading…

The Power of Small

Aug 29, 2014• 10

By David C. Kibbe, MD & Vince Kuraitis

Everywhere we turn these days it seems “Big Data” is being touted as a solution for physicians and physician groups who want to participate in Accountable Care Organizations, (ACOs) and/or accountable care-like contracts with payers.

We disagree, and think the accumulated experience about what works and what doesn’t work for care management suggests that a “Small Data” approach might be good enough for many medical groups, while being more immediately implementable and a lot less costly. We’re not convinced, in other words, that the problem for ACOs is a scarcity of data or second rate analytics. Rather, the problem is that we are not taking advantage of, and using more intelligently, the data and analytics already in place, or nearly in place.

For those of you who are interested in the concept of Big Data, Steve Lohr recently wrote a good overview in his column in the New York Times, in which he said:

“Big Data is a shorthand label that typically means applying the tools of artificial intelligence, like machine learning, to vast new troves of data beyond that captured in standard databases. The new data sources include Web-browsing data trails, social network communications, sensor data and surveillance data.”

Applied to health care and ACOs, the proponents of Big Data suggest that some version of IBM’s now-famous Watson, teamed up with arrays of sensors and a very large clinical data repository containing virtually every known fact about all of the patients seen by the medical group, is a needed investment. Of course, many of these data are not currently available in structured, that is computable, format. So one of the costly requirements that Big Data may impose on us results from the need to convert large amounts of unstructured or poorly structured data to structured data. But when that is accomplished, so advocates tell us, Big Data is not only good for quality care, but is “absolutely essential” for attaining the cost efficiency needed by doctors and nurses to have a positive and money-making experience with accountable care shared-savings, gain-share, or risk contracts.

Startups Seeking Series A? Apply to Pitch at Traction at Health 2.0!

Aug 28, 2014

Calling all digital health startups! If you are actively seeking Series A funding, then apply to Traction: Health 2.0’s Startup Championship. The deadline for applications is Aug 29th, so don’t miss out on this great opportunity.

Traction has plenty to offer for anyone who is interested in learning more about the digital health industry and to see some of the hottest startups of 2014. Between the startups pitches we’ll feature two panel discussions by industry leaders who explain current trends in digital health investment.

The Corporate Investor Perspective:

Joe Volpe of Merck, Noah Lewis of GE Ventures, and Jack Young of Qualcomm will share their perspectives on what criteria are most important for digital health investors. Get the scoop on the must-haves for young startups seeking funding.

Are Federal Regulations Stifling Disruptive Healthcare Technologies in the US?

Aug 28, 2014• 8

By TIM MALIYIL

In the past few years, we’ve seen headline after headline marveling at the advancements of medical technology. From wearable tech and micro sensors to 3D printing and health-oriented apps, it’s evident that technology and medicine have merged into an industry that’s pushing healthcare to a new level.

Yet many in the health tech industry are also voicing concerns about government regulators and their standards for healthcare technology. Some have even gone as far as accusing the FDA of “stifling” the creativity of healthcare tech and hindering the value these devices and apps could bring to the public.

In early 2014, legislation was introduced in an attempt to redesign the regulatory framework for certain types of technologies and lessen the FDA’s control over this growing industry. But are the FDA’s standards and actions so bad?

I’m in the tech field myself, and while I’ve heard many arguments against the FDA’s regulations, I strongly feel that it’s completely within its rights as a regulatory agency to place limits on medical technology. The FDA’s standards are put in place to protect consumers and to correct disingenuous manufacturer claims — an alarmingly frequent trend in today’s digital world.

How Much Is My Colonoscopy Going to Cost? $600? $5,400?

Aug 27, 2014• 88

By JEANNE PINDER

How much does a colonoscopy cost? Well, that depends.

If you’re uninsured, this is a big question. We’ve learned that cash or self-pay prices can range from $600 to over $5,400, so it pays to ask.

If you’re insured, you may think it doesn’t matter. Routine, preventive screening colonoscopies are to be covered free with no co-insurance or co-payment under the Affordable Care Act.

However, we’re learning that with colonoscopies, as with mammograms, people are being asked to pay sometimes. It’s not clear to us in every case that they should pay, and since we don’t know all the details of these events, we can only offer some general thoughts. We’ve also heard from Medicare enrollees without supplemental Medicare policies that they think they’re responsible for 20 percent of the charged price — so 20 percent of $600 vs. 20 percent of $5,400 is a big deal.

If you’re on a high-deductible plan and the charge to you will be, say, $3,600, you can probably ask around and find a lower rate.

A thorough view of some colonoscopy billing issues is in this article in The New York Times by Libby Rosenthal, who has been covering health costs for the paper. We’ve heard also about in-network providers using out-of-network anesthesiologists, so it pays to pay attention.