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New Developer Contest: Create a Cancer Survivor Tool

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By Adam Wong, ONC and Abdul Shaikh, NCI
Optimized-AdamWong

ONC and the National Cancer Institute (NCI) are challenging app developers to create new tools to help cancer survivors. The new Crowds Care for Cancer: Supporting Survivors Challenge is asking app developers to create new tools meant to help survivors manage their care after they have completed cancer treatment.

HHS has had a series of developer contests that have spawned the creation of tools and apps to help patients and doctors better manage care. Some past app challenges include:

  • the Million Hearts Risk Check Challenge
  • the Blue Button Mash Up Challenge, and
  • the Ensuring Safe Transitions Challenge.

Cancer patients need more care coordination

The number of cancer survivors in the United States is currently estimated at 14 million people. With improvements in cancer screening, diagnosis, and treatment, as well as the aging of the United States, this number is expected to rise.

While celebrating advances in cancer care, there remains a need to help patients manage their health after they have completed their primary treatment. Cancer survivors experience a host of physical and psychosocial long-term and late effects of the disease, and it’s the treatment of this that requires coordinated follow-up care.

Despite significant progress in cancer treatment, the complex and often fragmented state of end-of-treatment care may lead to harmful breakdowns in patient-provider communication. This can result in unmet health care needs. Better communication, data exchange, and care coordination have been shown to help the patients.

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Wal-Mart Could Transform Care–But Does It Want To?

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By Dan Diamond

“Why is Wal-Mart speaking at a health care summit?” the company’s vice president for health and wellness, Marcus Osborne, rhetorically offered up at a conference back in January.

“Wal-Mart’s in retail, we’re not in health care.”

But as analysts, researchers, and other experts who spoke with me. took care to point out, Wal-Mart is in health care, and getting further entrenched by the year. In the past six months alone, Wal-Mart launched a major contracting initiative with half-a-dozen major hospitals, and dropped hints — since retracted — that the company is exploring new services like a health insurance exchange.

Notably, Osborne teased a broader health care strategy for Wal-Mart that would include “full primary care services over the next five to seven years,” in a Q&A at that January conference captured by the Orlando Business Journal.

Wal-Mart has since denied Osborne’s comments — the second time in about 18 months that the company has had to walk back stories about its planned primary care services — and Osborne subsequently stopped talking to the press. (Wal-Mart declined to comment, and Osborne did not respond to an interview request for this story.)
But Osborne’s remarks from that January conference, and his other archived speeches, are still readily accessible. And they paint a vivid picture of a company that’s not just a potential market-mover and disruptive innovator, but an organization that could do a lot to positively reform health care.

Background: Wal-Mart’s Growing Role in U.S. Health Care System

In many ways, this isn’t a new story. Back in 2007, Princeton University’s Uwe Reinhardt suggested to NPR that Wal-Mart could be “taking aim at the entire health care system” by expanding its new discount drug program.

“I think it’s a really fascinating way to come out of the corner and really slug the system,” Reinhardt said at the time. “At the moment, the body blows don’t hurt. But they add up. I’m watching this with great fascination, and expect more from them.”

And in subsequent years, Wal-Mart did grow its health care footprint, from launching retail clinics based within its stores to advocating for national health reform. Considering its history — as recently as 2005, Wal-Mart had little involvement in the health care market and was being pilloried for skimping on its own employees’ benefits — it’s been a significant turnaround for the firm, and has positioned Wal-Mart as one of the leading disruptive innovators in health care.Continue reading…

Thank You, Angelina

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By JAMES SALWITZ, MD

Dear Ms. Jolie,

Thank you for your bravery and leadership in the battle against breast cancer. In a small way, through my patients, I understand the challenge and pain it took not only to undergo prophylactic mastectomies, because you carry the BRCA1 cancer gene, but also to reveal this deeply personal part of your life to the world (NYT, 5/14/13; My Medical Choice). You had no obligation to open your soul; your selfless act leaves those of us that treat the dread disease, in awe.

Your action will save more lives than all the patients I could help, even if I were to practice oncology for hundreds of years. By opening up the conversation, by educating and by boldly stating that beauty, strength and health are possible, even when radical choices are made, you open up life saving opportunities for many. Mastectomies may not be the answer for all women, but the very idea that cancer can be prevented, instead of simply waiting in fear, is earth shattering.

Women and men will now better understand the genetic risks for cancer, be exposed to the different options which are available in the prevention of cancer and know that it is possible, whatever path is taken, to continue with full lives. You have made it easier for patients, their families and physicians to have vital discussions.

The announcement of your surgery coincides with a critical legal battle, the deliberations of the United States Supreme Court regarding BRCA genetic testing. You have put pressure on the Court to find against Myriad Genetics Corporation in the company’s attempt to protect their expensive monopoly of the breast cancer genetic assay. Thus, the Court will have the opportunity to reduce the cost of testing, which as you note, can run thousands of dollars per patient.

Your action changes the war against breast cancer. You have prevented the suffering of thousands and given them the opportunity to go on with life and be part of what is truly important, families and communities.

Thank you for your remarkable sacrifice.

Humbly,

James C. Salwitz, MD

James C. Salwitz, MD is a Medical Oncologist in private practice for 25 years, and a Clinical Professor at Robert Wood Johnson Medical School. He frequently lectures at the Medical School and in the community on topics related to cancer care, Hospice and Palliative Medicine. Dr. Salwitz blogs at Sunrise Rounds in order to help provide an understanding of cancer.

Did Angelina Do the Wrong Thing?

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By SHIRIE LENG, MD

A woman’s mother dies at age 56. A blood test is done. The woman finds out she has a genetic pre-disposition to cancer. She takes what action she thinks she needs to take. A familiar story repeated over and over again every day. I’ve met many women who have made this choice. While not “normal”, it is a familiar situation. These women’s difficult choices go unheralded. But not Angelina. She has a voice and she’s not afraid to use it.

I am of two minds about Ms. Jolie’s announcement. Unlike double mastectomies for ductal carcinoma in situ (DCIS), which isn’t necessarily a cancer and can be treated with a lumpectomy, BRCA1 gene mutations can’t be treated any other way. Unless I hear differently from my breast surgeon friends, I’d say she probably did the right thing. Her decision to talk about it is probably encouraging to women who have or will have to make that choice. It raises awareness of the gene mutation. It puts breast cancer on the front page of the New York Times. Again.

Here’s my problem: double mastectomy is not a benign procedure. Ms. Jolie seems to have had a remarkably easy time of it. Yes, she says she was right back to her normal life soon after, but since Jolie’s life is not normal that’s hard to generalize. The truth is there is significant pain involved, a long period of waiting while the tissue expanders do their work, then there’s further procedures for the implants, which can develop capsules around them, or rupture, or get infected. If Angelina had chosen breast reconstructive surgery there would be the risk of the flap losing blood flow, multiple drains, overnight stays in recovery rooms or ICUs, and many many surgeries for revision, nipple creation, etc. And the results are not always beautiful. I understand that it is not Ms. Jolie’s role to scare people, but to encourage them. I would just warn against falsely rosy expectations.

I am not trying to discourage double mastectomy. Sometimes it is necessary. I do think that people who have extraordinary access to public attention must pay extraordinary attention to what they say. I wish Angelina all the best for a complete, and beautiful, recovery.

Shirie Leng, MD is a practicing anesthesiologist at Beth Israel Deaconess Medical Center in Boston. She blogs regularly at medicine for real.

The Leapfrog Group and the Spring 2013 Hospital Safety Score Release

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By Leah Binder

Q: Have hospitals improved since the first Hospital Safety Score last year?

A: We saw an incremental improvement in the scores, though it is not as rapid or as dramatic as we would like. For the Spring 2013 Hospital Safety Score, there were more than 2,500 general hospitals scored, including 780 “As,” 638 “Bs,” 932 “Cs,” 148 “Ds” and 16 “Fs.” Those hospitals that lowered their grades demonstrate how patient safety can be seriously impacted when hospitals don’t stay vigilant. Safety is a 24/7, 365-day effort with all hands on deck; there is no time for excuses when it comes to preventing errors, injuries and harm. On the other hand, hospitals that showed improvement should be celebrating. They have clearly accepted the challenge to improve and have proven that any institution can make significant advances in patient safety over a short period of time. Now, they need to work on sustaining that achievement into the future.

Q: How is the Hospital Safety Score different from other hospital ratings?

A: The Hospital Safety Score is the standard assessment of how well hospitals perform at protecting patients from accidents, errors and injuries. The Score is 100-percent transparent, and the only hospital safety assessment to be (favorably) peer-reviewed in the Journal of Patient Safety. Unlike any other rating, you can see all the data that was applied to every scored hospital, as well as the entire methodology. Also unlike many other ratings, the Hospital Safety Score highlights both the best and poorest performers on safety in an effort to educate consumers on the hospitals they rely on for care.

The Hospital Safety Score assesses hospitals strictly on patient safety. Each “A,” “B,” “C,” “D,” or “F” score assigned to a hospital comes from expert analysis of infections, injuries, and medical and medication errors that frequently cause harm or death during a hospital stay.

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Is the Online Health Clinic the Wave of the Future?

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By Jason Shafrin

HealthPartners argues that the answer is yes. In a 2013 Health Affairs article, they argue the following:

HealthPartners in Minnesota launched an online clinic called virtuwell in late 2010. After more than 40,000 cases, we report an average $88 lower cost per episode compared with care received in traditional settings, strong indicators of clinical effectiveness, and a 98 percent “would recommend” rating from customers. The possibility of extrapolating such savings to larger volumes of cases is compelling.

Although I believe that there will be some savings from online health clinics, I believe that much of this perceived savings is due to patients sorting. If relatively healthier patients use the online health clinic, then it could be the case that average costs will be lower for those who use the online services simply due to patient sorting. The report does risk adjust for patient comorbidities and other factors.

Risk adjustment, however, is always imperfect. Thus, three confounding factors could bias these estimates.

  1. Individuals who are more educated, wealthier, more technologically savvy are more likely to use the online health clinic, but are also more likely to be relatively healthy conditional on observables.
  2. Individuals who use the online clinics may be more likely to seek treatment for less severe cases. If this is the case, then the treatment received during the online clinic may appear cheaper than is really the case since treating this same people in the clinic may have been cheaper than the average patient. Thus, there would still be cost savingings but the magnitude would not be as large.
  3. Whereas the points above mention that there could be differences in the types of patients that use the online services, within each individual preferences for online treatment may vary. The less serious an illness appears to be (i.e., the lower the likelihood urgent care is needed from the patient’s perspective) the more likely individuals will seek online care.

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Hacking Healthcare

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By Fred Trotter

There are two definitions of the word “Hacker”. One is an original and authentic term that the geekdom uses with respect. This is a cherished label in the technical community, which might read something like:

“A person adept at solving technical problems in clever and delightful ways”

While the one portrayed by popular culture is what real hackers call “crackers”

“Someone who breaks into other people computers and causes havok on the Internet”

People who aspire to be hackers, like me, resent it when other people use the term in a demeaning and co-opted manner.  Or at least, that is what I used to think. For years, I have had a growing unease about the “split” between these two definitions. The original Hackers at the MIT AI lab did spend time breaking into computer resources… it is not an accident that the word has come to mean two things.. It is from observing e-patients, who I consider to be the hackers of the healthcare world, that I have come to understand a higher level definition that encompasses both of these terms.

Hacking is the act of using clever and delightful technical workarounds to reject the morality embedded default settings embedded in a given system.

This puts “Hacking” more on the footing with “Protesting”. This is why crackers give real Hackers a bad name. While crackers might technically be engaged in Hacking, they are doing so in a base and ethically bankrupt manner. Martin Luther King Jr. certainly deserves the moniker of “protester” and this is not made any less noble because Westboro Baptist Church members are labeled protesters too.

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Top THCB Blog Posts of the Last Two Weeks

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The E-mail I Want to Send to Our Tech Guys But Keep Deleting (40)

By Shirie Leng, MD

It really shouldn’t be this hard. This doesn’t seem like rocket science, but you keep telling us it is. What’s the deal with the passwords? Why can’t computers at different hospitals talk to each other? What’s the story with the obsession with mindless data entry? Have you ever tried using one of these things? Harvard’s Shirie Leng speaks for a growing chorus of annoyed EMR users.

The Rest of the Story About Hospital Pricing (26)

By David Dranove

Nobody would argue that opening up hospital prices is a bad idea. After all, it’s pretty hard to shop around when you don’t know how much what you’re shopping for costs. So opening up hospital price lists is a logical thing to do. But people who argue that giving the public access to this information without context will change anything are guilty of deeply flawed magical thinking, argues David Dranove.

Medicine in Denial (51)

By Leslie Kernisan, MD

Larry and Lincoln Weed’s 2011 exhaustive study on the problems facing the healthcare system and the ways technology might be able to help solve them did not exactly get the attention many more talked-about and hyped titles on health reform and the business of healthcare do. A pity that their sensible and timely book has largely been ignored by critics, writes THCB contributor Leslie Kernisan. Many of the ideas the Weeds discuss, such as the Problem Oriented Medical Record (POMR) and the need for a better way for physicians to manage their decision-making, are well worth our time.

Misunderstanding Oregon (31)

By Ashish Jha, MD

Critics looking at this months Oregon study are getting a bit carried away in their rush to weigh on the unbelievable significance of what it all means, writes Harvard’s Ashish Jha. The initial reaction served as a “Rorschach test,” reflecting critics’ view on Medicaid” which shouldn’t really have surprised anybody. The reality is a little more complicated. Actually, make that a lot more complicated.

Evidence That Health Does Not Equal Health Care?

Early Results From the Oregon Experiment Are In (4)

By Mike Miesen

Nonsense, writes THCB contributor Mike Miesen. The Oregon experiment may turn out to be the most important public health study in decades, if not in history. “Get ready for bombastic claims and scorching heat as opposed to illuminating light.” We finally have solid data that lets us understand what’s happening. And that’s a very good thing.

I Was Told There Would Be No Math (5)

By Shirie Leng, MD

You heard it here first. Doctors are going to need all sorts of special skills to survive in the future. A growing number of medical schools are experimenting with novel approaches designed to attract brilliant candidates with experience outside of the traditional science focused areas.

A Tale of Two Births (42)

By David Overton

Ezra and Silas. Two births. Two very different stories. After their obstetrician pushed for an early delivery when David Overton’s wife was pregnant with the couple’s son Ezra, the healthcare insider began asking questions. When their son Silas was born, they took the opposite approach, hiring a midwife to help them through the process using an all-natural, all “granola approach.” The two experiences could not have been more different. What was happening here?

Testing Wisely (20)

By Rob Lamberts, MD

In American society more is generally considered better. The result: health care costs more than anywhere else in the world. There is a better a way. And doctors have it in their power to do something about it. THCB contributor Rob Lamberts offers his house rules for winning the “war against more.” Never order a test that doesn’t help you decide something important. Never send a patient to a specialist, unless they need. Never prescribe a drug without telling the patient. And, well, if you want to know how the story ends you’ll have to read the whole thing for yourself…

Massively Open Online Medicine (6)

By David Harlow

Playing Games(MMORPGS), Massively Open Online Courses (MOOCs) like the Khan Academy have become one of the latest obsessions in the tech industry. That led Eric Topol to playfully suggest that the time may be right for Massively Open Online Medicine.(MOOM). That may not be a good thing.

Open Data Advocate Joins Patient Privacy Rights Group

as Chief Technology Officer (8)

By Adrian Gropper, MD

The news the Patient Privacy Rights Coalition had appointed a chief technology officer caused a minor stir. After all, the Austin-based non-profit organization has a long history of challenging the tech industry at almost every turn, raising awkward (read highly annoying) questions about the EMR vendor practices, companies privacy policies and questionable use of data. In a THCB commentary, CTO Adrian Gropper talks about what it all means. Could a thaw be coming. Does the news signify that new era of peace, love and understanding is at hand? Probably not.
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The DIY Electronic Medical Record

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By Rob Lamberts, MD

There was a hole in the wall of our bathroom that was a painful reminder of a bad encounter with a plumber.  Yes, that hole has been there about a year, and it has been on my to-d0 list for the duration, daring me to show if I inherited any of the fix-it genes I got from my father.  Why not hire someone to come fix it?  I also got (as I mentioned in my last post) dutch genes, which scream at me whenever I reach for my wallet.  So this hole was giving me shame in surround-sound.

I attempted to fix it the hole last year, even going to the degree of asking for  a router table for my birthday.  Since there was previously no way to get to this all-important access to the shower fixture without cutting through the sheetrock, I decided I would take a board, cut it larger than the hole, then use the router to make a rabbet cut so the panel would fit snuggly.  Up until then, I thought a rabbet cut was a surgery to keep the family pet population under control, but my vocabulary was suddenly expanded to include words like rabbet, roundover, chamfer, dado and round nose. Unfortunately, my success only came in the realm of vocabulary, as I was not able to successfully master the rabbet cut without making the wood become a classic example of the early american gouge woodworking style.

I am not sure why, but something inside me told me today was the day to give this another shot, and to my shock (and that of my family), I was successful!

This home project is actually a late comer to the DIY party I’ve been holding for the past few months.

  • Don’t like your practice?  Build your own from scratch!
  • Don’t like the health care system, build a new one!

My latest DIY venture is in an area I swore I’d not go: I’m building my own record system.

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Into the Extrapolation Machine

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By Les Funtleyder

The Kaiser Family Foundation (KFF) recently released a study that showed that 42% of Americans are unaware that Obamacare (the Affordable Care Act) remains the “law of the land.” News like this seems to us, to act as a Rorschach test on how observers feel about the law. Considering 50% of Americans can’t identify New York on a map we tend not to read too much into these polls. However, according to the logic of extrapolation, since we know that the ACA remains law, we are in the elite 58% (it’s about time we made it into the elite of something).

In almost parallel to the KFF news, the New England Journal of Medicine published a follow-up study of the “Oregon experiment.” For those who haven’t been following closely, the study found that previously uninsured people who were enrolled in Medicaid did not see an improvement in clinical measures when compared to those who remained uninsured. The study did seem to show a reduction in the amount of financial distress for the insured however.

Another contentious study, another Rorschach test (example, example). The problem we see with the polarity of views is that both sides seem to be cranking up the extrapolation machine and use single studies/data points to draw broad conclusions to gin up opinions about ACA’s success or lack thereof. In light of the fact that for most practical matters ACA doesn’t really get going until 2014, use of the extrapolation noise generator approach smacks of a lack of analytical rigor in our view. We will know soon enough how the program is doing… exchanges start enrolling on 10/1.

As investors, we should state upfront that we tend to give more weight to financial returns than what the philosopher-kings might call the political context. So what caught our eye in the Oregon study was that Medicaid recipients had higher healthcare utilization rates (and associated costs) than the uninsured. The connection between gaining insured status and healthcare utilization should not come as a surprise since there is a very extensive literature elucidating this connection.

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