By HANS DUVEFELT, MD

A long, long time ago, hospitals existed to admit patients when they were sick, treat them with medicines or surgery and good nursing care, and discharge them after they became well.

Hospital care was at one time a charity, which evolved into a nonprofit service, before it became a Very Big Business.

In olden days, nonprofit hospitals charged patients straightforward fees for their services. Then, when you were just a young whippersnapper or perhaps merely a gleam in your father’s eyes, Medicare and Big Insurance started collecting premiums from workers and dole it out to hospitals when the workers or retirees needed hospital care.

At that point, hospital fees became confusing. The people who received care didn’t see what the charges were, and the payers didn’t really know how much care was medically necessary or even actually delivered by the increasingly profit-driven hospitals, let alone how much it cost to provide those services.

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By JOSH GRAY

The NIH (National Institutes of Health) recently released initial results from its SPRINT (Systolic Blood Pressure Intervention Trial) study, suggesting more aggressive treatment for hypertension may reduce risk for cardiovascular events by 30 percent and the risk of death by 25 percent.

The SPRINT group recruited over 9,000 non-diabetic subjects aged 50 or older with systolic blood pressure (SBP) over 130. Individuals were then randomly assigned to either a standard treatment goal of lowering SBP below 140 or a more intensive treatment goal of lowering SBP below 120. The findings were sufficiently compelling that results were released more than a year in advance of the study’s planned conclusion.

While the SPRINT researchers have only released very high level findings, the general sentiment appears to be supportive of releasing this information early as the New York Times Op-Ed by Eric Topol, MD, so rightly notes. However, the lack of detail has generated sharp questions on several issues, including whether a reduction of cardiovascular risk by 30 percent actually translates into substantial numbers of individuals affected, potential side effects of increasing the number of medications, and general caution regarding findings released before peer reviewed publication.

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By ANDY DeLaO

Back in August, 2015 IBM announced their bid to acquire Merge Healthcare for $1B dollars. (Forbes article here) Merge is a product that helps to manage, store, report, and bill for the medical images of patients as read by Radiologists.   (More here) Today between the 7500 Merge customers they have access to roughly 30 billion images.

The promise for Watson Health is to learn how to “see” through machine learning from the vast amount of medical images that Merge Healthcare manages. Currently, Watson reads 66 million pages a second. It is predicted by IBM researchers that 90% of all “Big Data” stored by healthcare systems is related to medical imaging.

The offer to hospitals, healthcare systems, Radiologists, and ultimately patients is that Watson will be able to have information, including medical images, uploaded to the cloud for analysis. Based on the symptoms and a cross referencing of medical images against images of previously diagnosed medical conditions and diseases, Watson would be able to provide an initial recommendation. (supporting article)

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By BLAKE McKINNEY, MD

There has been at least one report that the Federal Trade Commission (“FTC”) is looking into anti-competitive practices based on the Texas Medical Board’s telemedicine regulations.

As a telemedicine company operating in Texas, we maintain that the rules put in place by the Texas Medical Board are by no means insurmountable and do not seriously limit competition. The rules merely allow better integration of telemedicine offerings with existing medical services and help ensure a better patient experience.

Telemedicine is possible in Texas as defined by the guidelines of The Texas Medical Board (TMB), but it has to be telemedicine done right. Telemedicine must be provided in a way which conforms with modern clinical safety standards, including ensuring continuity between traditional care encounters and telemedicine encounters.

The TMB regulations mandate that:

1. An individual must have a face-to-face visit with the provider group providing virtual care to establish a doctor/patient relationship;

2. Doctors treating a panel of patients virtually must have reciprocity (communication, accountability) with each other and should be under common medical direction; and

3. Physicians engaging in telemedicine must be able to follow-up with patients and vice versa.

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By MICHAEL PAINTER, MD

For more on this session at Health 2. 0 on Monday October 5, see the agenda here.

I’m reading the morning news on my iPad at 32,000 feet en route from New Jersey to Silicon Valley for the annual fall Health 2.0 meeting. I love coming to this place with its promise and hope pushing us toward better futures.

Of course, much of that hope is hitched to faster, smaller, cheaper driven by trusty Moore’s Law. Just when it seemed our Moore’s Law golden goose would soon be waddling a little more slowly, the New York Times reports today that IBM scientists may have found a way to keep the eggs coming. Apparently, they’ve discovered a chip manufacturing approach that may get around the looming laws of physics by using transistors with parallel rows of carbon nanotubes separated by a distance of just a few atoms. Whew.

In another Times article, Apple’s CEO, Tim Cook, takes us from that atomic level way up here to the macro where most of us live, work, learn and play. Business, Cook says—presumably especially the dynamic technology sector—has civic responsibilities beyond pushing profit.He and Apple, for instance, have made recent stands about equity, and he noted Apple would “continue to evangelize” about it.

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By NIAM YARAGHI

When President George W. Bush issued an executive order in April 2004 to establish the Office of the National Coordinator for Health IT, he had a clear vision in mind: to create a secure, nationwide interoperable network that allows authorized users to access medical records of anyone at anytime and anywhere in the U.S. President Barack Obama knew very well that his plan for providing health insurance to all Americans would not be successful unless it was paired with a plan for controlling the quality and cost of health care services.

Ironically, Bush’s health IT network was (and remains) the instrumental element that guarantees the financial sustainability of Obamacare. It was no surprise that the economic stimulus package of 2009 allocated $25.9 billion for promoting the adoption and use of electronic health records systems among American physicians and hospitals. But a decade and $30 billion later, only half of the U.S. office-based physicians have adopted a basic electronic health records system and a mere 20 percent of them use such software, according to the latest statistics by Robert Wood Johnson Foundation.Continue reading…

By ABRAAR KARAN, MD

The cost of medical service provision in the United States is one of the most palpable strains on the healthcare system, but we must not forget that cost is the sibling of quality and access—without considering the three as such, we will undoubtedly fail to navigate our country’s healthcare quandary. Low quality care inevitably results in the need for more care in the form of readmissions, while lack of access to primary care leads to increases in the utilization of expensive, emergency services. Of particular concern in our country, a growing contributor to cost, and driven by low quality care and even less access to that care, is the systematic exclusion of undocumented patients. This was made very clear to me through the example of a single suffering patient, Mr. Gomez.Continue reading…