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Health IT Future: A Tale of Three Watsons

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By MICHAEL L. MILLENSON

If you want to see the future of health information technology, take a look at the dueling visions of two Thomas Watsons that are on display this month in a game show and a trade show. The juxtaposition unintentionally demonstrates what doctors and patients will be doing together and also what they can do separately.

What I’ll call Game Show Watson is a computer named for IBM founder Thomas J. Watson, Sr. This Watson is appearing on the TV show Jeopardy to play a highly publicized set of matches against two human champions from Feb. 14-16. Although viewers will actually see a black computer screen with a revolving blue globe, Game Show Watson itself, in the tradition of “Big Iron” mainframes, consists of ten refrigerator-sized servers located offstage.

In contrast, the Watson at the trade show is not one computer, but thousands of them, all contained inside the mobile devices that are descendants of the telephone first demonstrated by Alexander Graham Bell and his assistant, Thomas A. Watson. (That Watson was also an inventor is a topic for another time.) The Telephone Watsons, on display for the tens of thousands of attendees at HIMSS11 from Feb. 20-24, are giving rise to a new field known as “mobile health.”Continue reading…

NIH and Drug Innovation

By MERRILL GOOZNER

For most of the past decade, Democrats and Republicans in Congress have competed over who could pour more money into the National Institutes of Health, the largest funder of biomedical research in the world.

But the party is over. The budget cuts proposed by a leading House Republican this week included cancellation of the $1 billion that the Obama administration wanted to add to the $31 billion NIH budget.

It was part of a broad assault on science funding that was announced by appropriations chairman Hal Rogers, R-Ky., who also called for large cuts at the National Science Foundation, the White House Office of Science, the National Oceanic and Atmospheric Administration and the National Aeronautics and Space Administration.

The purpose, according to Rogers, is “to rein in spending to help our economy grow and our businesses create jobs.”

If creating jobs is his goal, Rogers might want to take a look at a new study that appeared yesterday in the New England Journal of Medicine, which found that publicly-funded research is a far more important contributor to the creation of new drugs and vaccines than previously thought. The classical view of innovation is that government funds basic science, while industry comes up with the new and innovative products based on that science.Continue reading…

AQC to ACO: As Goes Massachusetts, So Goes the Nation?

By DAVID HARLOW

About four years ago here in Beantown, survivors of the last big ill-conceived or poorly-executed (depends who you ask) wave of health care management and finance innovation were kicking around for a new approach to aligning payor and provider incentives, focusing on quality and cost containment. To hear Andrew Dreyfus, CEO of Blue Cross Blue Shield of Massachusetts, tell the story, the Blues wanted to address both quality and cost, and therefore (after looking in vain for a model elsewhere that could be transplanted to Massachusetts) developed the Alternative Quality Contract, or AQC, which features a global payment model hybridized with substantial performance incentives, plus design features intended to lower the cost of care over time.

Many of the features put in place under the AQC will allow participating provider networks in Massachsuetts to make the leap to ACO (once the beast is defined by the federales), despite the difference in payment methodology (global cap for AQC vs. FFS for ACO).

I was invited to hear Andrew present the AQC story this week together with Gene Lindsey, CEO of Atrius Health, a Massachusetts multispecialty physician network of some 700 physicians that participates in the AQC.  (Atrius’  largest group is Harvard Vanguard Medical Associates, whose docs used to be employed by Harvard Community Health Plan, the pioneering staff model HMO ’round these parts.)Continue reading…

A Game-Changing Statistic: 1 in 250

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By BOB WACHTER

Bob Wachter

Although the medical profession has been harming unlucky patients for centuries, the patient safety movement didn’t take flight until 1999, when the Institute of Medicine published its seminal report, To Err is Human. And that report would have ended up as just another doorstop if not for its estimate that 44,000-98,000 Americans each year die from medical mistakes, the equivalent of a jumbo jet crashing each day.

Come to think of it, the quality movement also gelled after the publication of Beth McGlynn’s 2003 NEJM study, which produced its own statistical blockbuster: American medical care comports with evidence-based practice 54% of the time, a number close enough to a coin flip to be unforgettably disturbing.

These two examples demonstrate the unique power of a memorable statistic to catalyze a movement.

Last month, my colleague Rebecca Smith-Bindman, professor of radiology, epidemiology, and ob/gyn at UCSF and one of the nation’s experts in the risks of radiographs, gave Medical Grand Rounds at UCSF. Her talk was brimming with amazing statistics, but this is the one that took my breath away:

A 20-year old woman who gets an abdominal-pelvic CT scan (i.e., just about any young woman coming to the ED with belly pain) has a 1 in 250 chance of getting cancer from that single scan.

Did that fully register? One CAT scan, which until recently most of us ordered with no more restraint than we exhibit when asking the Starbucks barista for a tall latte, will cause cancer in one out of every 250 patients. Two-hundred fifty: that’s the number of students in my college Bio 101 class. Wow.Continue reading…

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