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John Irvine

Health Data-Palooza!!!

Jun 2, 2011• 2

Thursday June 9, 2011, 9:00am EDT
Watch the Live Webcast: http://videocast.nih.gov/ or http://www.hhs.gov/live/

Harnessing the Power of Data to Improve Health

Featured Speakers: Aneesh Chopra, US CTO; Tim O’Reilly, O’Reilly Media; Matt Miller, NPR; Harvey Fineberg, IOM President; Todd Park, HHS CTO; and many others

The Health Data Initiative is a public-private collaboration that encourages innovators, entrepreneurs, startups, data geeks, community activists and policy makers to utilize health data to develop products and applications to raise awareness of health and health system performance and spark action to improve health.

On June 9th the Department of Health and Human Services and the Institute of Medicine will hold a second health data forum that will bring together over 500 people in person to showcase how health data can create tools and applications to support more informed decision-making by consumers/patients, health care systems, and community officials.

The innovators presenting are a great example of how data and technology can be harnessed in powerful ways to help provide better care and better health.

Over 40 companies will be featured. This event will be live streamed throughout the day with a series of major announcements (challenges issued, new university programs and partnerships, and new major activity in the startup world).

Follow along on twitter: #healthapps

See the Agenda (The full day will be webcast live)

Attend a Viewing Party near you

Do We Have Any Clue How to Cut the Cost of Healthcare?

May 24, 2011• 60

By ROBERT WACHTER, MD

At the Society of Hospital Medicine’s annual meeting last week in Dallas, Lenny Feldman of Johns Hopkins presented the results of a neat little study. His hypothesis: physicians given information about the costs of their laboratory tests would order fewer of them.

Feldman randomized 62 tests either to be displayed per usual on the computerized order entry screen or to have the cost of the test appear next to the test’s name. Some of these were relatively inexpensive and frequently performed tests. After randomization, for example, the costs of hemoglobins ($3.46) and comprehensive metabolic panels ($15.44) were displayed, while TSHs ($24.53) and blood gases ($28.25) were not. He also randomized more expensive tests: the costs of BNPs ($49.56) were displayed, while hepatitis C genotypes ($238.62) were not.

The educational intervention was surprisingly powerful. Over the six-month study, the aggregate expenditures for each test whose costs were displayed went down by $15,692, while non-displayed tests had a mean increase of $1,718. Over the entire group of 31 tests whose costs were shown to physicians, costs fell by nearly $500,000.

Coincidentally, last week’s Archives of Surgery reported the results of an intervention aimed at decreasing lab ordering on the surgical services of Rhode Island Hospital. There, simply announcing the service’s overall expenditures on non-ICU laboratory tests for the prior week at a house staff conference led to significant savings: $55,000 over an 11-week study period.

Have we found the Holy Grail, the key to flattening the cost curve? A little physician education leads to increased awareness of the cost consequences of their choices and, voila, our economy is rescued from the brink of disaster. How nice.Continue reading…

NPfIT Blazing the Trail

May 24, 2011• 5

By MARGALIT GUR-ARIE

The National Audit Office (NAO) in the UK has recently published a report evaluating the status of “The National Programme for IT in the NHS” (NPfIT). The program is a very ambitious top down initiative to deploy Health Information Technology across all NHS facilities in an attempt to provide an electronic care record for every patient in the UK. The blunt conclusion of the report states that “The original vision for the National Programme for IT in the NHS will not be realized” and “This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme”. Is this gloom ridden report in any way pertinent to our own quest for an EHR for every patient by 2014? Of course not. We don’t have a Socialist system where the government can decide on a particular EHR product, buy it, contract billions of dollars in services, and force all hospitals and doctors to install it and use it in their facilities on a government dictated schedule.

Instead, the United States Government is building a National EHR, and I find the business model fascinating. No, the Feds did not hire a team of software developers, did not set up a business entity and didn’t even hire a defense contractor to do all these things. Instead, they legislate and engage in a flurry of rule makings which are then applied in quick succession, like giant levers, to the delivery side of our health care system. This is nothing short of brilliant.Continue reading…

Patient Care in the Cloud

May 23, 2011

By VIJAY GOVINDARAJAN AND JUSTIN CHAKMA

When we envision an emerging market, we think of a rapidly growing country with small purchasing power, little infrastructure, and diminishing natural resources. These three aspects of emerging markets require innovations that can subsequently be taken global — a phenomenon known as “reverse innovation.” However, a fourth and powerful driver of reverse innovation is the comparative absence of intermediaries: an institutional gap.

As Tarun Khanna has described, institutions such as venture capital firms, legal support, universities, regulators, and third-party auditors help to make markets and value chains more efficient. Institutional voids can persist for decades, and cannot be resolved by throwing more capital at the problem. They also differ from physical infrastructure and limited natural resources, as they often manifest themselves in non-physical forms.

A concrete example of an institutional void is universities for training physicians. It takes more than a decade to train medical specialists. Building new medical schools or expanding existing ones will only have an impact on the needs of the local healthcare system in the distant future.

Medtronic is exploring ways to address that void in the area of chronic disease management.

Sixty-nine percent of deaths in the developing world are due to chronic disease, yet only 2.3% of international aid is allocated to chronic disease. In the United States, hospitalization of chronic disease patients accounts for the majority of health care costs. But innovation in managing chronic disease is happening faster in emerging markets such as India as a result of the scarcity of physicians.

India, which has more than one billion citizens, has only 100 qualified cardiac electrophysiologists. To tackle this institutional void, Medtronic developed a low-cost, pill-sized pacemaker that can be inserted into a stent, then embedded in the heart. This device eliminates the need for invasive inter-cardiac leads that deliver electricity to synchronize the heart. A much larger group of cardiologists and cardiac surgeons will be able to perform this procedure.Continue reading…

One Clue to Why Health Care Costs are So High?

May 19, 2011• 18

By DAVID WILLIAMS

I often hear from hospitals that they’re being squeezed greatly on cost and not getting paid enough by government and private payers. I have some sympathy for this argument, but on the other hand somehow this country outspends every other country by at least two to one, and hospitals are a big part of the reason.

So what gives?

An article in yesterday’s Wall Street Journal (One Way for Hospitals to Cut Costs of Tests), reporting on an Archives of Surgery study, provides part of the answer.

Making physicians aware of the costs of blood tests can lower a hospital’s daily bill for those tests by as much 27%, a new study suggests.

Researchers simply told the doctors what things cost.

“There was no telling anyone when, or when not, to order a particular test,” says Elizabeth Stuebing, a study co-author…

But she says it shows what can happen merely by giving physicians information they don’t usually have. “We never see the dollar amount of anything,” Dr. Stuebing says. “The first week I stood up and said that in the previous week we’d charged $30,000 on routine blood work and I could hear gasps from the audience.”

The situation doctors are in today is sort of like being sent to a store and told to get what they need, but not paying for the goods and not knowing the prices of the items or even which items are expensive and which are cheap. That’s certainly a formula to run up the bill, even if inadvertently –which is what the “gasps from the audience” indicate.

The experiment was analogous to putting prices on the items in the store, but still letting the shopper buy whatever they thought they needed. That’s a step in the right direction but not exactly draconian from a cost control standpoint! (Of course there are some cost control measures hospitals impose centrally, which is different from my shopping analogy.)

I have mixed views on whether physicians should be exposed to what things cost. Pricing in hospitals is not like pricing in stores, because “charges” are often a small fraction of what’s ultimately reimbursed. I don’t know that I want doctors making tradeoffs based on faulty data or an incomplete understanding of patient preferences.Continue reading…

A New Norm for Hospital Operations

May 17, 2011• 6

By CHARLIE EVANS

Since the passage of the Patient Protection and Affordable Care Act (PPACA), I have had the opportunity to engage a wide variety of colleagues, policymakers, and noted health care thinkers about the effects of health care reform on hospitals. With the hindsight of over 30 years managing hospital operations, I have developed the strong belief that if hospitals are to improve significantly the systemic delivery of care we must commit to making bigger changes than may seem reasonable. Moreover, hospital administrators entering the field will do well to consider changes of this scale as the “new norm” that will likely govern the industry for the next several decades.

Proposed reforms, like Medical Homes, Accountable Care Organizations and bundled payments, have consumed much of the focus since passage of PPACA, yet they will not be enough to achieve the national goal of high quality, low cost care. Many progressive organizations have been successfully utilizing variations of this payment methodology and these delivery systems for extended periods of time, but there is little evidence that national adoption of these delivery systems alone will produce the results the country needs. To have a substantial impact on slowing the growth of care delivery costs we must make a giant leap forward in everything from design of facilities to the processes that govern care delivery to how we utilize information technology.

With more than 5,000 hospitals operating in the country, the thought of altering the fundamental operating design of hospitals may seem to be unreasonable. However, if we are to design a health system for the 21st century then let’s begin from the ground up. The industries that produce the best quality products most efficiently today do not use production facilities designed and built 30-50 years ago. They have recognized the need to streamline facilities so that products move through the operational cycle more quickly; sub processes efficiently contribute to the overall system aim; and information technology delivers a snapshot of any component of the business on demand and in real-time.

Can our most modern hospitals do that? Overwhelmingly the answer is no. Those who say that we are diagnosing and treating people, not creating widgets, miss the essential truth that if we decrease the waste and inefficiency in hospitals, we can free doctors and clinicians from unnecessary tasks and give them more time to spend with patients. By embodying proven efficiency practices already established in other commercial sectors, within the clinical processes currently employed in hospitals, we can establish a foundation for total hospital efficiency that will significantly benefit patients and lowers costs.

The Quantified Self and the Future of Health Care

May 12, 2011• 5

By GARY WOLF

The Quantified Self is a global collaboration of users and tool-makers interested in the personal meaning of personal data. There are now Quantified Self groups in more than twenty cities around the world. Our inspiration is the Homebrew Computer Club. Once upon a time, computers were thought to be useful only for scientists, managers, and planners. But a few people saw things differently: they argued that computers were for all of us. That notion seemed very strange. What would an ordinary person do with a computer? But it turned out that the personal uses of computers were not just an important use, but the most important use.

We at the Quantified Self think of data the same way. Nearly every day, we hear about a new system to track human behavior. There is sensor-based tracking of sleep, activity, location, heart rate, blood glucose, metabolism, even facial expression. There are web services to track mood, diet, menstrual cycle, productivity, and cognition. (This is just a sample, to give a sense of range, and not an endorsement of any particular approach.) Often, when I talk to my friends in the health care field, they are eager to know how exploring these tools might be justified in conventional health care terms: return on investment, treatment outcomes, patient compliance, etc. This managerial view of data is part of the important conversation that happens every day on the The Health Care Blog. But for the remainder of this post, I’d like to ask you put these questions aside. Seeing something of the big culture change happening outside health care might prove useful for solving some of the seemingly intractable problems inside it.

There are three reasons people track themselves:

They have a specific goal, such as losing weight, keeping fit, sleeping better, ameliorating a chronic condition, or training for an athletic competition.
They are generally curious. Surprisingly often, people find their tracking data valuable even in the absence of narrowly-defined utility. These self-trackers see their data as a kind of mirror on the self, helpful in maintaining overall self-awareness. (Like keeping a diary.)

They want to establish a baseline with which to measure future changes. This often goes along with a belief that the data will become more powerful over time. Personal data, in this sense, is an investment that will pay off in the future, and is part of an exploratory, pioneering worldview.Continue reading…

The Social Life of Health Information

May 12, 2011• 2

By SUSANNAH FOX

“I don’t know, but I can try to find out” is the default setting for people with health questions.

The internet has changed people’s relationships with information. Data collected by the Pew Internet Project and the California HealthCare Foundation consistently show that doctors, nurses, and other health professionals continue to be the first choice for most people with health concerns, but online resources, including advice from peers, are a significant source of health information in the U.S.

These findings are based on a national telephone survey conducted in August and September 2010 among 3,001 adults in the U.S., with interviews conducted in either English or Spanish and including 1,000 cell phone interviews. The full report, “The Social Life of Health Information, 2011,” is available at pewinternet.org.

The survey finds that, of the 74% of adults who use the internet:

80% of internet users have looked online for information about any of 15 health topics such as a specific disease or treatment. This translates to 59% of all adults.
34% of internet users, or 25% of adults, have read someone else’s commentary or experience about health or medical issues on an online news group, website, or blog.
25% of internet users, or 19% of adults, have watched an online video about health or medical issues.
24% of internet users, or 18% of adults, have consulted online reviews of particular drugs or medical treatments.
18% of internet users, or 13% of adults, have gone online to find others who might have health concerns similar to theirs.
16% of internet users, or 12% of adults, have consulted online rankings or reviews of doctors or other providers.
15% of internet users, or 11% of adults, have consulted online rankings or reviews of hospitals or other medical facilities.Continue reading…

Outrage is Easy. Solutions are Hard.

May 10, 2011• 2

By MERRILL GOOZNER

The inspector general of HHS reported this week that nearly half of the anti-psychotic drugs fed to the demented elderly in nursing homes are inappropriately prescribed. That’s about one in fourteen nursing home residents.

Forget about cost, which is over a quarter billion dollars a year. “Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” wrote Daniel R. Levinson, the HHS I.G. wrote in his letter to Senators Charles Grassley (R-Ia.) and Herb Kohl (D-Wis.), who asked for the report.

Why is this happening? First, the medication patterns of the frail elderly are not monitored by the Centers for Medicare and Medicaid Services, which is afraid of a backlash from Capitol Hill where doctors and nursing home operators fiercely lobby to protect the hallowed doctor-patient relationship. The drug industry has also, in some cases, paid kickbacks to the pharmacy operators in nursing homes.

But at the root of the issue are the doctors who are faced with caring for these patients. Even though clinical trials have shown the drugs are likely to result in earlier deaths for some of these elderly patients, doctors prescribe them to reduce agitation, as Daniel Carlat, a practicing psychiatrist and purveyor of non-industry-funded continuing medical education, told the New York Times. “Doctors want to maximize quality of life by treating the patient’s agitation even if that means the patient will die a bit sooner,” he said.

As someone who watched his father’s decline with dementia over a ten year period (usually from a distance), I can attest that shortening one’s lifespan is not the crucial issue, especially in the last few years when the personality in the shell of the human being that has survived the loss of cognition has largely disappeared. The first question is whether the anti-psychotics are effective in reducing the outbursts associated with severe dementia, and whether those benefits outweigh the side effects (catatonia?). The second question is whether families have been adequately informed about the risks and benefits of this approach. That the drug companies deploy their marketing arms to stoke sales in this situation is outrageous. But even eliminating their right to do so wouldn’t solve the underlying problem.

Neither the Republicans Nor the Democrats Want to Face the Provider Cost Problem

May 9, 2011• 41

By ROBERT LASZEWSKI

A key piece of Paul Ryan’s deficit reduction plan is to change Medicare as we know it. It appears his bold Medicare premium support proposal is failing to gain traction–it is dead as part of any deficit reduction deal this year. Worse, his Medicare proposal looks to be giving Democrats lots of political ammunition for the 2012 elections.

What lies at the heart of Ryan’s Medicare difficulties is that he would all but abandon future seniors (those now under age-55) to a health care system whose age-adjusted premium support would increase each year only at a rate equal to the increase in the consumer price index while their health care costs would likely continue to increase far faster.

Simply, Ryan just shifts the future burden of uncontrolled Medicare health care costs from the federal government to the senior. That will solve a big part of our federal deficit problem but hardly help people.

Yes, he offers a defined contribution health care solution with the promise of invigorating the markets and making costs lower. But we have had a form of Medicare premium support and private competition for years (Medicare Advantage) and there isn’t a lot of evidence the market can get the cost control job done on its own. (See: Defined Contribution Health Care—The Conservatives’ Silver Bullet)Continue reading…