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The Day After

Oct 18, 2012• 6

By Rob Lamberts, MD

There is nothing exciting or glamorous about doing what I am doing: building a new practice from scratch. It’s a slow and often mundane process that takes far longer than it looks like it should. There are a thousand questions I need to answer: Where will my office be? What will my logo look like? Does it matter what my logo looks like? Can I get the video of my presentation done? Why is it taking so long? Which EMR system will I use? Will I use and EMR at all, or will a PHR product suffice? Who will I hire? What will I pay them? When will I start? How many patients will I accept at the start? What will I do about my website? Who should design it? Can I do that myself? Who should run it? What about a phone system? Each day uncovers a new set of questions that need answering, and each day passes with most of them left unanswered.

There are two things I’ve been doing which have kept me from becoming discouraged or overwhelmed by this process. The first thing is something called Centering Prayer, which is well-described in the book Into the Silent Land by Martin Laird. Whether from the tradition of the middle ages or from eastern religious practice, meditation is upheld by many in science as a sound life-practice. What makes centering prayer, a form of meditation out of the Christian Tradition, different from other forms is the way one deals with distractions or worries. I’m not an expert on eastern meditation, but my understanding is that the goal is to clear the mind from any thoughts and worries, coming to a place of peace and rest in the mind. Centering prayer, however, does not push away worries or distraction, it changes the perspective on it.

Walmart Moves Health Care Forward Again

Oct 18, 2012• 64

By Brian Klepper

Walmart’s sheer size makes almost any of their initiatives newsworthy. That said, despite being a lightning rod for criticism on employee benefits and health care, they have introduced initiatives with far-reaching impacts. Their generic drug program began in September 2006 – more than 300 prescription drugs for $4/month or $10 for a 90-day supply – and was widely emulated, disrupting retail drug markets and generating immense social benefit. Imagine the difference it made to a lower middle class diabetic who had been paying more than $120 per month for medications, and suddenly could get them for about $24.

Yesterday Walmart announced that “enrolled associates” – covered workers and their family members – needing heart, spine or transplant surgeries could receive care with no out-of-pocket cost at 6 prominent health systems around the country: Mayo Clinics (Rochester, MN and Jacksonville, FL); Cleveland Clinic (Cleveland, OH); Geisinger Clinic (Danville, PA); Mercy Hospital Springfield (Springfield, MO); Scott & White Memorial Hospital (Temple, TX); and Virginia Mason Medical Center (Seattle, WA).

Walmart’s Center of Excellence (COE) program builds on its own and other organizations’ pioneering efforts with similar programs. Walmart developed a relationship with Mayo Clinics in 2007 for transplant and lung volume reduction surgeries. In March 2010, Lowes reached a similar arrangement with Cleveland Clinic for heart surgeries and, last December, Pepsico announced a global pricing deal with Johns Hopkins for cardiac and joint replacement surgeries.

The Stockholm Syndrome and EMRs

Oct 18, 2012• 9

By Paul Levy

First the definition:

Stockholm syndrome, or capture-bonding, is a psychological phenomenon in which hostages express empathy and have positive feelings towards their captors, sometimes to the point of defending them. These feelings are generally considered irrational in light of the danger or risk endured by the victims, who essentially mistake a lack of abuse from their captors for an act of kindness.

Now, the health care connection. As a result of the billions of dollars allocated by Congress to health information systems as part of the stimulus program, those companies who had a head start in implementing electronic medical records quickly found themselves in demand. Of all those companies, Epic is the most successful. Forbes notes, “By next year 40% of the U.S. population–127 million patients–will have their medical information stored in an Epic digital record.” Here in Massachusetts, the biggest convert was Partners Healthcare System: “System development and implementation will occur over a 10-year period and represent a capital investment of approximately $600 – 700 million.” Elsewhere, notes Forbes: “The biggest win: a $4 billion project to digitize medical records for health care giant Kaiser Permanente.”

What is striking about this company is the degree to which the CEO has made it clear that she is not interested in providing the capability for her system to be integrated into other medical record systems. The company also “owns” its clients in that it determines when system upgrades are necessary and when changes in functionality will be introduced. And yet, large hospitals sign up for the system, rationalizing that it is the best. For example, Partners said, “The new health care landscape will challenge us to engage in population health management, improve the coordination of health care, and accept financial risk for the care of our patients. This new system will enable us to meet those challenges.”

Alvin Roth Receives Economics Nobel For Flawed Residency Match System

Oct 18, 2012• 3

By David Whelan

There’s a larger question here about why the scholarly world allows itself to be judged by secretive Scandinavian committees sitting on endowments funded by money made selling explosives. But let’s put anti-Nobel polemics aside.

The announcement today that Alvin Roth and Lloyd Shapley won this year’s award in economics came with the explanation that they had devised systems for matching buyers and sellers that led to more rational outcomes than existing markets.

Shapley, a contemporary of “A Beautiful Mind’s” John Nash, introduced an elegant theory 50 years ago to explain the (relative) stability of marriage pairings despite the fact that individuals have complicated preferences when choosing a mate. Shapley’s idea is that the person you end up with is the best match given everyone else’s preferences.

You might prefer someone else more than your current mate, but that person has you lower on her list, and so on. Imagine Larry. If he could Larry would have definitely married Elizabeth Taylor. But she was taken so now Larry is happy with his actual wife. (To sum it up in a way that would make an economist cringe.)

Alvin Roth built on that early theory. He designed actual markets that used the matching principle, also known as the deferred acceptance algorithm, as a guiding principle. The most famous example of a Roth market is the Residency Match.

Medical residency is a job that lasts three to seven years, depending on the program, and follows graduation from medical school. It is required for a doctor to complete a residency in order to be licensed to practice.

In the “old days” medical students would apply to hospitals and rank their preferences in a way that was visible to those institutions. A hospital would first review those applicants who had indicated them as the first choice. If spots remained to fill, a hospital would then look at those who had picked it second, and so on. You can quickly see how this system punished people who shot high and missed. They would end up at one of their last choices because the best places would fill up quickly.

Health 2.0 Berlin Code-a-Thon Sponsored by Aetna International

Oct 17, 2012

By Health 2.0 Staff

Health care stakeholders join forces with developers to build new apps for health and wellness

On 3-4 November 2012 web and mobile developers meet health professionals, patients and other health care stakeholders at the Health 2.0 Berlin Code-A-Thon 2012 to create innovative solutions and build brand new prototype applications for improved health and wellness in only two days.

Berlin, October 18, 2012 – What if a smartphone app could check for signs of sleep apnea and help patients and their families sleep more soundly? Or what about an app that lets Parkinsons patients take standard motor skill tests at home instead of in the doctors office? Sound too good to be true? And how long do you think it would take to develop a working prototype? The answer is as few as 48 hours.

These are just some of the many excellent prototypes that have been developed by Health 2.0 Code-A-Thon teams in the past. Find out on 3-4 November 2012 what brilliant health care solutions will be created at the Health 2.0 Berlin Code-A-Thon. For this two-day event, sponsored exclusively by Aetna International, gifted coders and health professionals will come together in Berlin to compete to develop the most innovative solution to improve health and wellness. The event is part of the Health 2.0 Code-a-Thon series, which includes a range of developer-focused events happening in the United States, Europe and Asia.

Linking Meaningful Use and HIT Sector Consolidation

Oct 16, 2012

By Barrett Lynner

Since January, the Centers for Medicare and Medicaid Services (CMS) have implemented incentive programs to drive meaningful use of Electronic Medical Records (EMR) technology – software and support tools that represent a roughly a $40B marketplace.

In August, CMS reported that $6.9B in total EMR incentives were paid to 143,800 physicians and hospitals – a number that will likely increase markedly in the coming quarters. This is because hospitals and eligible professionals know that to receive the highest possible financial incentive they must deploy and demonstrate meaningful use of an EMR before 2014.

Curiously, these incentives don’t seem to be enticing as only 20% of Medicare and Medicaid eligible providers are taking strides toward EMR implementation and only 55% of eligible hospitals have received an EMR incentive payment. We think they’re delaying investments for a few reasons.

· Implementation costs are high, and the financial return of EMR systems isn’t fully proven
· Poorly preforming EMR vendors are causing senior hospital executives to consider their options
· Clinical leadership unwilling to change the clinical processes required to derive value from an EMR system
· Creating and maintaining clinical content for a successful EMR system is very complex

The Future of Health Is in #Opendata

Oct 16, 2012

By Eugene Borukhovich

This Saturday I had the pleasure of helping organize a hackathon that was put together by the Open State Foundation (HackDeOverheid). The theme was “Open Data, open for business” and took place at a very unique place in Rotterdam – WORM (an institute for avant garde recreation). It was a perfect spot to gather almost 150 people from all disciplines and sponsors/partners ranging from the Hogeschool Rotterdam, TNO, Internet Valley Rotterdam to name a few, but also a contribution from Health 2.0.

Open health data is relatively a new initiative within the Open State Foundation with a simple but strong message:

“Open Zorg Data is an initiative to build a community that utilizes open healthcare data, encourages innovation & entrepreneurship, improves transparency in our healthcare system and most importantly turns healthcare into health for our digital citizens”

In the last few weeks, we worked with the Ministry of Health (Ministerie van VWS) to plan out the OpenZorgData Workshop and help inspire the community of developers to use the data for social and entrepreneurial good.

The turn out was great!! We have more then doubled (2X) the number of attendees to the workshop from the previous workshop that took place in Amsterdam. First up in the morning data pitch session was, Ron Roozendaal (CIO of the Ministry of Health), who took a few minutes to introduce all the stakeholders within the Ministry and the newly opened data sets. He exuded enthusiasm and excitement!

Our workshop kicked off at 11:45 with standing room only, but when I asked how many people were hackers planning to use the open health data, only one guy raised his hand (but noted that he had no plans of doing it that day). Here we are: room full of people, Ministry of Health in the room and not one single individual was planning to hack away at the data. We carried on with the presentations where Lany Slobbe, Hans Loonen & Christian Gonzales presented their respective data sets. The workshop presentations finished off with Seth van den Bossche from TNO presenting their open data & Atilla Erdodi showcasing an open API he put on top of the KiesBeter data (opened up back in June of 2012).

United Healthcare Expands to Brazil

Oct 13, 2012

By Bill Rusteberg

UnitedHealth Group is set to become the controlling owner of the largest healthcare company in Brazil, a country whose health market is rapidly growing, in one of the most high-priced overseas deals by a U.S. private insurance company.

The largest American insurer is spending $4.9 billion to acquire 90 percent of Brazil’s Amil Participacoes, which has about 5 million members, a provider network of 3,300 hospitals and 44,000 doctors, and also owns 22 hospitals and about 50 clinics, reported the Associated Press.

By entering the Brazilian healthcare market, UnitedHealth can better access the country’s 200 million population, only 25 percent of which has private insurance, at a time when Brazilian leaders increasingly are turning to private companies to insure its citizens, Reuters reported.

“Brazil has emerged as a consistently growing and evolving market for private sector health benefits and services. Its growing economy, emerging middle class and progressive policies toward managed care make it a high potential growth market,” UnitedHealth CEO Stephen Hemsley said Monday in a statement.

“Combining Amil, the clear market leader serving an under-penetrated market of nearly 200 million people, with UnitedHealth Group’s experiences and capabilities developed over the last three decades is the most compelling growth and value creation opportunity we have seen in years,” he said.

Amil’s founder Edson Bueno and his partner Dulce Pugliese will retain their 10 percent ownership of Amil for at least five years. Amil also will invest about $470 million in UnitedHealth Group shares, which it also will hold for five years, according to the Minneapolis Star-Tribune.

First, Do Net Harm?

Oct 12, 2012• 14

By Eric Topol, MD

Recently, the US Preventative Services Task Force reiterated its recommendation that women not undergo routine screening for ovarian cancer. This was remarkable, not simply because it was a recommendation against screening, but because the task force was making the recommendation again, and this time even stronger.

The motivation for the recommendation was simple: a review of years’ worth of data indicates that most women are more likely to suffer harm because of false alarms than they are to benefit from early detection. These screenings are a hallmark of population medicine—an archetypal form of medicine that does not attempt to distinguish one individual from another. Moving beyond the ritualistic screening procedures could help reduce the toll of at least $765 billion of wasted health care costs per year.

We already know the common changes in the DNA sequence that identify people who have higher risk of developing ovarian, breast or prostate cancer and most other types of cancer. Consumers can now readily obtain this information via personal genomic companies like 23andMe or Pathway Genomics. But we need to do much more DNA sequencing to find the less common yet even more important variations—those which carry the highest risk of a particular cancer. Such research would be easy to accomplish if it were given top priority and it would likely lead to precision screening. Only a small fraction of individuals would need to have any medical screening. What’s more, it will protect hundreds of thousands of Americans from being unnecessarily harmed each year.

The Mystery Data Set

Oct 12, 2012• 8

By Fred Trotter

In a few days, I will be releasing the most controversial healthcare project I have ever worked on. But you do not need to take my word for it. I will be releasing a completely new healthcare data set. That data set, which will remain a “Mystery Data Set” until its release to the healthcare data scientists attending Strata RX, should completely revolutionize the way we think about healthcare delivery in the United States.

This mystery data set is the first real outcome of the Patient Skunkworks project. Patient Skunkworks is a new way for me to try and create high-impact but low-profit software projects. This is part of a new Not Only For Profit software development model that I have been working on. The new company forming to do this work will be called Not Only Development.

I will be releasing this data during the last keynote on the first morning (Oct 16) of the 2012 Strata RX conference. There is simply no way, in a single keynote, to even begin understanding all of the ways that this data set will be leveraged to improve healthcare. More importantly, there is really no way to adequately explain why I would choose to give away such a valuable and dangerous data set.

To help people digest the implications of this data set, I will be writing two articles about the data set. This one, before the release which helps to explain the underlying motivation behind the release, and another one after the release explaining what the data set is, and how I think it can be leveraged.

I am releasing this dataset because I believe that the only way to solve the problems in healthcare is to embrace a radical openness with health data. Healthcare data, with the exception of patient identity data, belongs in the open, in the sunlight. When used correctly, I believe that healthcare data should make patients feel empowered, and everyone else in the healthcare industry uncomfortable. I believe that patients deserve deep, dangerous and real access to data. I think when we start talking about how data might actually be dangerous for patients, its just a sign that we are “doing it right”. I call this concept Radical Access to Data (and yes, that recursively spells “RAD”).