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cindywilliams

Is There an Independent Unbiased Expert in the House?

Dec 1, 2018

By SHANNON BROWNLEE

Last week, U.S. Food and Drug Administration Commissioner Margaret Hamburg told the advocacy group Public Citizen that the FDA may loosen conflict-of-interest rules for experts who serve on the agency’s advisory panels. These panels wield considerable power when it comes to FDA decisions about approving drugs and medical devices, and for pulling them off the market when evidence surfaces that they may cause patients harm.

Why loosen the rules? Commissioner Hamburg said the agency is having trouble finding experts to fill its advisory panel slots. In other words, anybody expert enough to be on an FDA panel undoubtedly has a conflict.

Or maybe the FDA just isn’t looking very hard. In 2008, Jeanne Lenzer — an independent journalist — and I created a list of more than 100 experts in fields ranging from epidemiology to neurology to emergency medicine, every one of them independent from industry conflicts of interest. We made the list available to our fellow journalists at the website, Healthnewsreview.org, a site that grades health stories. Dozens of journalists from top news outlets, including the New York Times,Bloomberg, and the Wall Street Journal, have requested the list, and used it to find sources for their stories — or at least we hope they have.

The Pace of Change

Dec 1, 2018

By JOHN HALAMKA, MD

My travels in Japan included lectures in Tokyo and Kyoto, sharing lessons learned from the US health information technology national efforts. I highlighted that the Office of the National Coordinator has to balance the desire for innovation with a pace of change that vendors and clinicians can tolerate.

This led me to think about the pace of change that CIOs are experiencing right now. The IT innovations of the past few years have been dizzying and the cycle between the peak of hype to the trough of obsolescence is now measured in months, not years.

Some examples of rise and fall

1. Blackberry – I was one of the earliest adopters of Blackberry technology, using a small pager-like device for short text messages. As each new model was announced, I welcomed the innovations – the evolution from thumbwheel to joystick to track pad, larger color screens, cameras, video features, and voice memo recording. However, in 2011, my mobile device needs have outpaced Blackberry’s engineering. I now need a full featured web browser, a book reader, the ability to zoom/drag via touch screen, and a robust App Store. Until 2010, Blackberry seemed to be unstoppable in the corporate messaging world. Now it is laying of 2500 people as the iPhone and Android devices rapidly replace Blackberries in consumer and business settings. They tried very hard to introduce new devices such as the Storm, the Playbook, and the Torch, but came up short as customer expectations exceed their pace of innovation.

More About Balancing Business, Humanity, and Restraint in Cancer Care

Dec 1, 2018

By HAROLD POLLACK

I published a column in Kaiser Health News about the challenge of cost control in cancer care. KHN needed to cut one section for space, which notes that oncology has become an ecosystem of multi-billion-dollar public, private, and nonprofit ventures in pharmaceutical development, imaging, acute care, and more. This ecosystem draws upon and then reinforces broader cultural biases that promote overly aggressive approaches to diagnosis and care. I wanted to add some more discussion, and one revealing advertising table….

Consider the issue of routine mammography for younger women. In questioning the benefits of such screening, the United States Preventive Services Task Force ran afoul of Americans’ powerful draw to the notion of early detection in confronting an especially frightening disease. The USPSTF committed some political blunders in its approach to this freighted and genuinely complicated issue. It should have anticipated the powerful political, cultural, and commercial resistance it was likely to encounter.

In American popular culture–though not in the epidemiological data–breast cancer is often depicted as a young woman’s disease. A terrific 1998 paper by Paula Lantz and Karen Booth examined magazine depictions of breast cancer. Lantz and Booth concluded that “the increase in incidence is commonly portrayed as a mysterious, unexplained epidemic occurring primarily among young, professional women in their prime years.” Public service announcements concerning mammography and breast cancer show similar patterns. These announcements, with their myriad images of beautiful young swimmers, emphasize that one in nine women will be diagnosed with breast cancer. The PSAs do not emphasize that only about 12 percent of breast cancer patients are diagnosed before age 45.

Hospital-Physician Mergers: All Is Not Well

Dec 1, 2018

By JAAN SIDOROV, MD

The Disease Management Care Blog, believing that the ultimate end game will be an historic insurer-physician alignment, checked out an “Issue Brief” on the Rising Employment of Physicians, courtesy of the Center for Studying Health Center Change (hat-tip to the folks at KHN). The authors interviewed hospital, health plan and other provider executives from 12 representative locations around the country and came away with some telling impressions on what’s happening in the hospital market place.

The authors didn’t find much in the way of insurer-physician alliances, but they sure found evidence of increasing employment of physicians by hospitals. Why? For the docs, it’s a perfect storm of declining reimbursement, growing overhead, increasing insurer hassles, the cost of implementing an EHR and the high premium for liability (malpractice) insurance. In addition, younger physicians are attracted to the prospect of a better work-life balance that comes with steady employment. For the hospitals, it’s the opportunity consolidate market-power, maintain a referral base and do away with the revenue-stealing physicians’ in-office and surgi-center procedures.

Yet, while economics are driving docs into the arms of the hospitals, the authors cautioned that all is not well when it comes to 1) coordination of care/quality, 2) costs and 3) access to care.

Vesalius, Hooke, Hood and Steve Jobs

Dec 1, 2018

By ALEX EPSTEIN

Has Steve Jobs and his company altered the practice of medicine as significantly as Vesalius, Hooke, Hood and other giants in the field?

A radical supposition perhaps. One that I am not altogether comfortable with. Yet there is no denying the impact of the technologies adopted as a result of his touch.

Medical practitioners these days employ easy to use mobile/connected devices to learn, to stream, to take CME, or monitor patients, prescribe, ensure compliance, download and consume digital media, or just communicate and collaborate more robustly. Even crowd sourcing solutions to medical conundrums has become a concept mainstream institutions are embracing.

That the world’s data more and more exists in the palm of your hand – instantly accessible from the office to the operating room to any remote corner of the world – is due in large measure to devices and markets either pioneered by or made user friendly by Steve Jobs and Apple.

The CSI Effect Hits Medicine

Dec 1, 2018

By EVAN FALCHUK

I’m in Israel, home to some of the most innovative care in the world. Doctors here wanted to know if the high-tech tests that are an increasing part of their work helps. A couple of weeks ago, they published their results.

It turns out that in about 90% of cases, it didn’t matter.

A physical exam, the patient’s history, and the basic set of tests that doctors have done for decades was almost always all that was needed to get a diagnosis. As one of the doctors in the study put it, “ basic clinical skills remain a powerful tool, sufficient for achieving an accurate diagnosis in most cases.”

The conventional wisdom is that doctors – at least in the U.S. – order extra tests to protect themselves from getting sued. But this study was done in Israel, where the problem of medical malpractice is nothing like it is in the U.S. American-style defensive medicine can’t be the reason doctors in Israel use so many diagnostic tests.

HIT Trends Summary for August 2011

Dec 1, 2018

By MICHAEL LAKE

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

Incentives driving the EMR market. According to a report by Sage Healthcare, most physicians (65%) buying EMRs are doing so because of federal incentives. The biggest obstacle is still cost with 32% of non-users saying it’s the number one issue. This is creating a mainstream market, even in solo practices, which report over 30% EMR adoption rates in a new survey by SK&A.

Incentives may also be driving hospital implementation of computerized physician order entry (CPOE). 80% of hospitals still lack CPOE capabilities as of last year. Meaningful use requires providers to order at least one medication for 30% of unique hospital patients. In a new KLAS report, CPOE projects have more than doubled, being led by Cerner and Epic.

It is a likely unintended consequence that the incentives are speeding the dominance of market leaders.

The Impact of 9/11 on Healthcare IT

Dec 1, 2018

By JOHN HALAMKA, MD

On September 11, 2001, I was sitting in my Harvard Clinical Research Institute office (I was CIO there from 2001-2007 as part of my Harvard Medical School CIO duties). A staff member ran into my office and told me that a plane had crashed into a World Trade Center Tower. This sounded like a horrible accident. Then, the second tower was hit and we knew this disaster was planned. News of the Pentagon and Pennsylvania crashes trickled in. I gathered all the staff and told them to focus on their families and personal safety, to go home and stay in touch virtually as we learned more about the day’s events.

What impact has 9/11 had on my healthcare IT world since then?

9/11 had a profound impact on our culture, making us all understand our vulnerability.

The loss of life gave us an appreciation of the preciousness of each day we have on the planet, putting the problems of our work lives in perspective.

The loss of infrastructure, including many data centers, was a wake up call that redundancy goes beyond servers, networks, and storage. Whole buildings can disappear in an instant through natural or manmade disaster.

One Word Can Save Your Life: Too Simplistic

Dec 1, 2018

By DAVIS LIU, MD

Newsweek has a very provocative and yet incredibly too simplistic piece for the public and patients on its cover story – One Word Can Save Your Life: No! – New research shows how some common tests and procedures aren’t just expensive, but can do more harm than good.

The piece is actually well written and highlights facts that have been apparent for some time. More intervention and treatment isn’t necessarily better. Having a cardiac catheterization or open heart surgery for patients with stable heart disease and mild chest pain isn’t better than diet, exercise, and the prescription medication treatment. PSA, the blood test previously suggested by many professional organizations, isn’t helpful to screen for prostate cancer, even though the value of the test was questioned years ago. Antibiotics for sinus infection? Usually not helpful.

Certainly doctors do bear part of the blame. If patients are getting routine colonoscopies sooner than every 10 years or are getting them despite being quite a bit older (80 and older) and frail, then clearly patients should say no to more care. More isn’t better. (Whether a patient has the conviction to do so is another story. When my auto mechanic says it is time to change the brakes or change the oil, who am I to say no?)

Bucking the Established

Dec 1, 2018

By DR. WES

“Out with the old, in with the new!”

Who’s your doctor? Do you have one?

If you have one, you aren’t that interesting to them any longer because you’re “established.” This is not the fault of your doctor, but because of government rules for paying doctors: “new patient” visits pay better than “established patient” visits. “New patients” have a much better chance of needing new procedures, so they are even more special. Add to that the fact that more and more patients are going to need to become part of the “system” soon, and “new patients” quickly achieve the health care value trifecta.

Sorry. Those are the rules.

The higher payments made by insurers and government agencies for new patients was meant to offset the longer amount of time and cognitive challenges of dealing with a new patient that enters the doctors office. There is no question that there is more work to do when a new patient enters a medical facility: entering demographic data on a computer, actually taking a set of vital signs, performing a careful history and physical. But thanks to the explosion of ancillary health care assistants, imaging studies, the availability of the internet, and a constant push to do more in less time, doctors work differently today than they once did. Much of the data gathering is accomplished before the patient enters the office, imaging studies and baseline testing often occurs before a patient is even seen (remember those tests “required” for “quality” care?). Furthermore, because limitations for the frequency of testing has been imposed by government regulators, health care systems leap at the opportunity to “direct” doctors to order tests the moment the test might be needed. As such, “new patients” become particularly valuable to health care systems compared to “established” ones.