Author Archives

cindywilliams

I Wish We Were Less Patient

May 5, 2011• 7

By PAUL LEVY

The sad case of Kimberly Hiatt, a Seattle nurse who committed suicide months after being disciplined for administering a fatal dose to an infant, is starting to make the rounds. Josephine Ensign, for example, concludes her blog post on this by saying:

I am left with many questions. Why was the nurse treated so differently from the dentist or physician at the same hospital for similarly serious medication errors? If one in three hospital patients in the US experiences serious preventable adverse events and we know that it’s “the system, stupid,” why are most of our efforts put into educating patients to advocate for safer care? If nurses are simultaneously being told by hospital administrators to report errors and then facing serious retribution for making honest unintentional mistakes . . . what do I teach my students to do?

We can never know, of course, whether the suicide was related to the incident itself, the disciplinary action, or indeed, some other aspect of Hiatt’s life. But the sequence of events will cause many to draw the connection between the way Hiatt was treated after the accident and her death. In any event, though, the ambiguity as to whether or not it was connected does not take away from the kinds of questions raised by Ensign.Continue reading…

CABG in Decline

May 5, 2011

By MERRILL GOOZNER

The number of Americans with serious heart disease in need of hospital treatment is on the decline. A new study in today’s Journal of the American Medical Association shows the overall rate of coronary revascularizations — ranging from the coronary artery bypass graft (CABG) surgeries to in-and-out catheter-based procedures like angioplasties and stent insertions — fell from just under 1,500 per million adults a quarter in 2001 to less than 1,250 per million adults a quarter in 2008, a 15 percent decline.

The most intriguing finding in the data was that virtually all of the decline was in the most serious cases — those requiring CABG, which fell by about a third. The rate of percutaneous coronary interventions (where they snake a catheter through the thigh into the blood vessels feeding the heart, propping them open with either drug-eluting or bare metal stents) remained virtually unchanged.

The study authors, who hailed from the Philadelphia Veterans Affairs Medical Center, suspect the decline in CABG was driven by “a sizable shift in cardiovascular clinical practice patterns away from surgical treatment toward percutaneous coronary interventions” using catheters (so-called PCI). In other words, in recent years people with serious heart disease are more likely to be treated with the less invasive procedure.Continue reading…

Translation Needed

May 5, 2011

By DEREK LOWE

The “Opinionator” blog at the New York Times is trying here, but there’s something not quite right. David Bornstein, in fact, gets off on the wrong foot entirely with this opening:

Consider two numbers: 800,000 and 21. The first is the number of medical research papers that were published in 2008. The second is the number of new drugs that were approved by the Food and Drug Administration last year.

That’s an ocean of research producing treatments by the drop. Indeed, in recent decades, one of the most sobering realities in the field of biomedical research has been the fact that, despite significant increases in funding — as well as extraordinary advances in things like genomics, computerized molecular modeling, and drug screening and synthesization — the number of new treatments for illnesses that make it to market each year has flatlined at historically low levels.

Now, “synthesization” appears to be a new word, and it’s not one that we’ve been waiting for, either. “Synthesis” is what we call it in the labs; I’ve never heard of synthesization in my life, and hope never to again. That’s a minor point, perhaps, but it’s an immediate giveaway that this piece is being written by someone who knows nothing about their chosen topic. How far would you keep reading an article that talked about mental health and psychosization? A sermon on the Book of Genesization? Right.Continue reading…

HIT Trends Summary for April 2011

May 3, 2011• 3

By MICHAEL LAKE

This is a summary of the HIT Trends report for April 2011. You can get the current issue or subscribe here.

Europe. European progress reports on HIT show us that it’s evolving along many similar lines to current US efforts. One report highlights beacons of e-prescribing in Sweden and Estonia where scripts are stored centrally and available from any pharmacy. European states are also pursuing funding national centers of excellence in HIT. They are implementing EMR-like systems mostly less comprehensive than the US (34 countries); telehealth, most notably in the UK; and ID cards (24 countries). Governments are funding and because of that, also assessing results.

There are also success stories in cross-border health information exchange on a new website that gives us a comprehensive view into European HIE activities. There’s a report by the European standards community exploring barriers to personal health device interoperability, an issue that is holding back the world’s telehealth market. And CSC announced it is buying iSOFT, a subcontractor that’s been struggling, in hopes of faster progress in the UK’s National Programme for IT.

Incentives. Provider incentives have been in the news. CMS released a report on its quality (PQRI/PQRS) and e-prescribing (MIPPA) incentive programs for 2009 with providers earning $5,000 on average. Disincentives for the e-prescribing program begin in 2012 and the quality program in 2015. Quality data will be available over time on the CMS Physician Compare website.Continue reading…

Microsoft HSG Bets Future on Amalga

May 3, 2011• 1

By JOHN MOORE

Microsoft’s Health Solutions Group (HSG), which has straddled the fence with consumer-facing (HealthVault) and corporate-facing (Amalga), is increasingly moving to the corporate side of the fence. Not that surprising considering that the consumer market continues to struggle (Google Health is in virtual mothball state, consumer adoption of HealthVault is nothing to write home about) and that HSG has now moved out of R&D and is now under the business solutions group, Dynamics. At the end of the day, HSG head Peter Neupert has to show that he can deliver the goods and Amalga is the horse he’s betting on (Note: Sentillion is there as well, but think of Sentillion as the gate-keeper to accessing Amalga).

Yet Amalga has gone through its share of birthing pains with some in the industry beginning to question its value.

Amalga has suffered from two significant problems, both inter-related. The first is that Amalga is an extremely powerful set of data aggregation and analytical tools, but it is more of a toolset then a product and this leads to long implementation time-frames and subsequently an inability to extract value quickly (ROI for Amalga is measured in years). For example, in 2009 Golden Living signed on to adopt Amalga and HealthVault. At last week’s Connected Health Conference, (CHC) Golden Living presented some remarkable results of how they are transforming long-term care through the use of Amalga. But in their presentation, Golden Living also stated that they knew full well when signing on to Amalga that this was going to be a multi-year effort and their implementation team has been given 5 years to put Amalga in place. Five years to fully implement a software solution is a very long-time and similar to the installs of the largest EHR systems. Unfortunately, many early Amalga customers did not have the foresight of Golden Living. In recent conversations with Microsoft, Chilmark has been told that significant resources are now being dedicated to improving time to value for Amalga. We’ll have to wait and see as the CHC sessions we attended on Amalga and HealthVault Community Connect, did not make this readily apparent.Continue reading…

GOP Bill Promotes Greater Federal Control of Exchanges

May 2, 2011

By MERRILL GOOZNER

The latest Republican effort to undermine health care reform hits the House floor this week with the law of unintended consequences clearly in play. If the bill actually became law – an unlikely event since the Democrats still control the Senate and the White House – it would promote the federal takeover of health care, something Republicans have consistently opposed on the campaign trail.

The legislation, sponsored by Rep. Fred Upton, chairman of the Energy and Commerce Committee, withdraws federal financial support for state-based insurance exchanges. The exchanges, which will provide a clearing house for health insurance policies sold to individuals and small groups, are supposed to be up and running by January 2014.

The original Patient Protection and Affordable Care Act created an open-ended federal grant program to help states defray the costs of setting up the exchanges. Eliminating that support would save the federal government about $1.9 billion, according to the Congressional Budget Office, which released a cost estimate for H.R. 1213 late Thursday.Continue reading…

The Identity Theft Smoke Screen

May 1, 2011• 3

By CHRISTOPHER J. ASAKIEWICZ

Personal data privacy once again has taken front stage in Sorrel v. IMS Health, Inc.[1] Vermont passed the Vermont Confidentiality of Prescription Information Law that allows doctors which prescribe drugs to patients, to decide whether pharmacies can sell their prescription drug prescription records.[2] IMS Health as well as other health information companies contested the law, arguing that the law poses a restriction on commercial speech as access to such information helps pharmaceutical companies market their drugs effectively to doctors. The Supreme Court is now tasked with determining the constitutionality of the restriction on access to prescription information with regards to our First Amendment. [3]

However, this post is focused on the secondary effects asserted in amici curiae briefs supporting the petitioners of allowing companies to purchase such information, specifically the concern of data privacy and patient re-identification. [4] Under the Health Information Portability and Accountability Act (HIPAA), personal health information is de-identified by your local pharmacy prior to such information being shared with any third party. By de-identifying the data, your personal data cannot, it is believed, be linked or traced back to you. De-identifying your health information is a way for covered entities to share your information without your consent or authorization and in accordance with the law. The information once shared is completely anonymized. After the transfer to a third party, like IMS Health, your information is solely data of zeros and ones that translate to dates of dispensing and drug names. No longer does your prescription record list your name or month or day of birth. [5]Continue reading…

Medicare Announces Rules For Quality Bonuses To Hospitals

May 1, 2011• 5

By JORDAN RAU

Medicare took its broadest step yet in moving away from its traditional hospital payment method, finalizing a plan to alter reimbursements based on the quality of care hospitals provide and patients’ satisfaction during their stays.

The initiative is the beginning of a transition from paying hospitals on the basis of the amount of care they provide. Many health care researchers believe this fee-for-service system has encouraged unnecessary care, driving up costs and giving hospitals no incentive to economize.

Medicare’s new “value-based purchasing” program was mandated in last year’s health care law. It has sparked less discussion than has another experiment to change Medicare’s payment system through accountable care organizations, where a select group of doctors and hospitals get bonuses if they find ways to save money.

But this latest payment change affects twenty times more hospitals than would ACOs. More than 3,000 acute care hospitals will have their payments adjusted starting in October 2012.Continue reading…