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Winners of the Patient Safety Reporting System Challenge

Over the past several weeks, many of us at the Office of the National Coordinator for Health Information Technology (ONC), Agency for Healthcare Research and Quality (AHRQ), and Food and Drug Administration have been evaluating the submissions for the Reporting Patient Safety Events Challenge. Team 90, consisting of KBCore (created by CRG Medical, Inc.) and iHealthExchange, was selected the winner of the challenge—and the recipient of the $50,000 prize—because the company’s patient safety reporting system best fit the criteria of the challenge to find and reduce the risks associated with patient care. Right now, finding risks through the reporting of adverse events is slow because paper-based systems may be hard to read and require transmission by fax machines. By modernizing the patient safety reporting system through the use of computer-based applications we can better shed light on medical errors and augment the discovery of new patient safety hazards more timely and efficiently.

Reporting Patient Safety Events Challenge Submissions

The Challenge submissions were evaluated on a variety of criteria to determine which would potentially improve reporting of adverse events the most. The applications were required to make it easier to file an adverse event report using AHRQ’s Common Formats while allowing for:

  • The inclusion of additional information during the initial submission and from a follow-up investigation;
  • Import of relevant electronic health record or personal health record information, including screenshots; and
  • Ability  to submit reports to various entities including PSOs, FDA, and other health oversight organizations.

IDinc and Shands Healthcare finished in second place, while third place went to MidasPlus. They will receive $15,000 and $5,000, respectively.

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End of the Line in the ICU

Last year I graduated from nursing school and began working in a specialized intensive care unit in a large academic hospital. During an orientation class a nurse who has worked on the unit for six years gave a presentation on the various kinds of strokes. Noting the difference between supratentorial and infratentorial strokes—the former being more survivable and the latter having a more severe effect on the body’s basic functions such as breathing—she said that if she were going to have a stroke, she knew which type she would prefer: “I would want to have an infratentorial stroke. Because I don’t even want to make it to the hospital.”

She wasn’t kidding, and after a couple months of work, I understood why. I also understood the nurses who voice their advocacy of natural death—and their fear of ending up like some of our patients—in regular discussions of plans for DNRtattoos. For example: “I am going to tattoo DO NOT RESUSCITATE across my chest. No, across my face, because they won’t take my gown off. I am going to tattoo DO NOT INTUBATE above my lip.”

Another nurse says that instead of DNR, she’s going to be DNA, Do Not Admit.

We know that such plainly stated wishes would never be honored. Medical personnel are bound by legal documents and orders, and the DNR tattoo is mostly a very dark joke. But the oldest nurse on my unit has instructed her children never to call 911 for her, and readily discusses her suicide pact with her husband.

You will not find a group less in favor of automatically aggressive, invasive medical care than intensive care nurses, because we see the pointless suffering it often causes in patients and families. Intensive care is at best a temporary detour during which a patient’s instability is monitored, analyzed, and corrected, but it is at worst a high tech torture chamber, a taste of hell during a person’s last days on earth.

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Health 2.0 Europe Showcased the Latest Innovations as Health Care Goes Digital

Health care is transforming quickly due to mobile and web technologies. The driving forces behind this development are not the traditional players, rather they are start-ups and software experts. To keep track of innovation, Health 2.0 held its annual European session in Berlin last week.

Neil Bacon, founder of the rate and review platform iwantgreatcare.org, set the tone for the panels that followed: “Power, influence and money are still with the providers. It is crucial to unleash the power of the users.” More than 75 technology demos illustrated promising web and mobile solutions that live up to his claim:

  • The highly acclaimed mobile phone app mySugr helps diabetics to manage their condition. It employs a gamified approach to monitor the disease and has many rewards in store to keep patients engaged.
  • Nhumi.com‘s mission is to improve communication between doctors and patients by providing a 3D-model of the entire human body in which diseases can be localized and described.
  • To overcome language barriers, universaldoctor.com helps translating between many different languages. Its crowd sourcing approach makes it easy for doctors to submit their own bilingual suggestions to facilitate medical consultation.
  • Biovotion presented a sensor that monitors physiological functions non-invasively and thereby helps reducing hospital stays.

Social networks also apply more and more to professional interaction. In networks like BestDoctors.com, physicians can build communities where they can ask for second opinions from the best specialists from around the world. The Spanish Fundación Recover fosters cooperation between physicians in industrialized and third-world countries via the Internet. Khresmoi.com is a powerful search and access system for biomedical information that includes a multitude of text and image sources in combination with a semantic search engine.

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Building a Better Parkland

In recent years, Parkland Memorial Hospital in Dallas, Texas has faced intense media scrutiny and government investigations into patient safety lapses. As the hospital searches for a new CEO, the Dallas Morning News asked me and other experts to answer the question: “What kind of leader does Parkland need to emerge as a stronger public hospital?” Below is the column, re-used with the newspaper’s permission. While it is focused on one hospital, the themes apply broadly. The type of leader that I describe is needed throughout health care.

Public hospitals such as Parkland are a public trust, serving the community’s health needs by providing safe and effective care to a population that lacks alternatives.

Major shortcomings in the quality of care provided at Parkland have eroded that trust. Now trust must be restored. The community is counting on it. It’s literally a matter of life and death.

Parkland’s board is searching for a new CEO to lead this journey. The CEO’s task will not be easy: Resources are tight, resident supervision is insufficient, staff morale is low, systems need updating, and preventable harm is far too common.

History may provide some guidance. Historian Rufus Fears notes that great leaders – leaders who changed the world – have four attributes: a bedrock of values, a clear moral compass, a compelling vision and the ability to inspire others to make the vision happen. Parkland needs one of these great leaders.

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Roundup of State Ballot Initiatives on Health Issues

This November, voters weighed in on an array of state ballot initiatives on health issues from medical marijuana to health care reform. Ballot outcomes by state are listed below (more after the jump).

Voters in Alabama, Montana, and Wyoming passed initiatives expressing disapproval of the Affordable Care Act, while a similar initiative in Florida garnered a majority of the vote but failed to pass under the state’s supermajority voting requirement. Missouri voters passed a ballot initiative prohibiting the state executive branch from establishing a health insurance exchange, leaving this task to the federal government or state legislature.

Florida voters defeated a measure that would have prohibited the use of state funds for abortions, while Montana voters passed a parental notification requirement for minors seeking abortions (with a judicial waiver provision).

Perhaps surprisingly, California voters failed to pass a law requiring mandatory labeling of genetically engineered food. Several states legalized medical marijuana, while Arkansas voters struck down a medical marijuana initiative and Montana voters made existing medical marijuana laws more restrictive.

Colorado and Washington legalized all marijuana use, while a similar measure failed in Oregon.

Physician-assisted suicide was barely defeated in Massachusetts (51% to 49%), while North Dakotans banned smoking in indoor workplaces. Michigan voters failed to pass an initiative increasing the regulation of home health workers, while Louisiana voters prohibited the appropriation of state Medicaid trust funds for other purposes.

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The Next Generation of Entrepreneurs

When I was 13 years old, the Altair 8800 appeared on the cover of Popular Electronics.   By 16, I was building enough hardware and software that I achieved the Malcolm Gladwell 10,000 hours of competency by age 18.     By 19, I founded a company that produced tax calculation software for the Kaypro, Osborne, and new IBM PC.   Every week in the Silicon Valley of the early 1980’s brought a new startup into the nascent desktop computer industry.

To me, we’re in a similar era – a perfect storm for innovation fueled by several factors.  Young entrepreneurs are identifying problems to be rapidly solved by evolving technologies in an economy where existing “old school” businesses are offering few opportunities.

This morning, I lectured to an entire classroom of MIT Sloan school entrepreneurs .   Today the Boston Globe published articles about the Harvard Innovation Lab and the Mayor’s efforts to connect entrepreneurial students with mentors.

Tonight I’ll introduce a Harvard Medical School entrepreneurial team at the Boston TechStars event.

This pace of innovation reminds of that time 30 years ago when Sand Hill Road was just beginning its evolution to the hotbed of venture investing it is today.

Who are these new entrepreneurs and what kind of work are they doing?   Tonight I’ll be introducing Lissy Hu and Gretchen Fuller.

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Beacons: Beaming EKG Results to Emergency Departments

I grew up watching the Star Trek television series and was always intrigued by the amazing technology that included phasers, warp speed, cloaking devices and the transporter – the fastest (and coolest) way of getting from point A to point B!  “Beam me up Scotty” still comes to my mind as the iconic phrase that promises fast and immediate action in the most dire of circumstances.

Today, the San Diego Beacon Community is implementing our own “beaming” technology with dramatic results.  We are using health information technology to electronically transmit electrocardiograms (EKGs) from ambulances to hospital emergency departments to ensure faster and better coordinated care for emergency cardiac patients.  When a patient demonstrates symptoms of a heart attack, getting the right information quickly to a cardiac specialist is critical.

“Beaming” the EKGs and other relevant health information to the hospital while the patient is still miles away allows for the patient’s condition to be appropriately assessed by specialists before he or she arrives.  Then, immediate treatment can be provided as soon as the patient arrives at the hospital.  The sooner blood flow is restored to the heart muscle, the better the outcomes for surviving a heart attack.

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Does America Really Want Change?

Twenty years ago, in order to keep presidential candidate Bill Clinton’s campaign on message, James Carville hung a sign in their “war room” that read:

  1. Change vs. more of the same
  2. The economy, stupid
  3. Don’t forget health care

While point number two swiftly entered the national vernacular, the other two slogans have equally influenced the U.S. political landscape, especially since 2008. Four years ago, the country was on the precipice of transformation. Meaningful change was promised, and opportunities for significant, long-lasting reforms were abundant. Americans, particularly the millennial generation, turned out in record numbers to vote, and hope for the future was palpable. America, like a patient suffering from a debilitating chronic disease, seemed finally ready to put in the time and do the hard work to get healthy before that fatal heart attack occurred. After decades of procrastination, we heeded Carville and health care system overhaul became a top priority.

Pause: The State of America’s Health

Obesity prevalence increased 137 percent over 20 years, from 11.6 percent to 27.5 percent of the population. In 2008, more than one-third of children and adolescents were overweight or obese. The medical care costs of obesity in the U.S. totaled about $147 billion in 2008 dollars.

Diabetes has almost doubled in prevalence since 1996, rising from 4.4 percent to 8.7 percent of the adult population. For children, the prevalence of Type 2 diabetes increased 21 percent from 2001-2009, while Type 1 diabetes rose 23 percent. Estimated total diabetes costs in the U.S. were $174 billion in 2007.

Asthma diagnoses grew by 4.3 million from 2001 to 2009, and 9.4 percent of children currently have asthma. Asthma costs in the U.S. grew from about $53 billion in 2002 to about $56 billion in 2007.

Developmental Disabilities prevalence increased 17.1 percent over the last 12 years. The prevalence of autism increased 289.5 percent, and the prevalence of ADHD increased 33 percent. Autism alone is estimated to cost the U.S. $137 billion per year.

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The Mentalists

Obama’s most significant healthcare-related accomplishment this year may well have been his campaign’s demonstration of the effective use of analytics and behavioral insight – strategies that also offer exceptional promise for the delivery of care and the maintenance of health.

For starters, of course, there’s the widely-reported “big data” success of the Obama campaign.  In unprecedented fashioned, they collected, mined, analyzed, and actioned information, microtargeting voters in a remarkably individualized fashion.

Imagine if healthcare interventions could be personalized as effectively (or pursued as passionately).

Another example:  according to the NYT, the Obama campaign hired a “dream team” of behavioral psychologists to burnish their message and bring out the vote, using a range of techniques the field has developed over the years.

According to the article, the behavioral experts “said they knew of no such informal advisory committee on the Republican side.”

This idea of focusing intensively on behavior change is without question an idea whose time has come.

Earlier this year, for instance, a colleague (with similar training in medicine, molecular biology, and business) and I were surveying the biopharma landscape, and were struck by the extent to which classic biology hasn’t (yet) delivered the cures for which we had hoped; physiology turns out to be extremely complicated, and people, and communities, even more so.

We were also struck by the remarkably low adherence rates for many drugs, abysmal whether you look at this from the perspective of clinical care or commercial opportunity (imagine if Toyota lost half their cars on the way to the dealership).
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The Next Digital Health IPO?

Practice Fusion, Castlight or ZocDoc will be the next digital health IPO. That’s according to a survey of over 100 innovative digital health entrepreneurs, conducted by my firm, InterWest Partners.

Nearly one third of respondents said Practice Fusion was most likely to be the next digital health IPO with approximately 20% of entrepreneurs voting for Castlight and ZocDoc, respectively.    Among the trio, all three have been impressive generating media coverage and raising money (collectively raising over $320m in the last 2 years alone with valuations ranging from $450m to upwards of three quarters of a billion dollars), in addition to having some of the most visionary leaders in the space.

Contrary to popular belief that digital health is primarily about the next iPhone app for weight loss, sleep or exercise, it was interesting to note that all of the leading “IPO” candidates in our survey have B2B models.  This is consistent with an insightful RockHealth report ( which found that nearly 80% of digital health companies have B2B models.   Future growth in this category is likely to continue as the leading healthcare accelerators such as RockHealth, BluePrint Health and Healthbox are all seeing more applications from B2B companies.

The responses to the IPO question reflect an interesting industry trend.  Though often classified as “B2B”, many of the leading digital health companies are really B2B2C – meaning that without the C there is no B2B.   Pricing transparency tools (Castlight), scheduling platforms (ZocDoc), employer based wellness programs, medication adherence solutions – they all must find a way to engage the end user or they won’t be purchased by the employer, physician, healthplan, hospital, or pharma company.    And though it’s impossible these days to sit through a day of pitches without hearing the phrase “consumer engagement” twenty times, I’m excited that people are starting to ask more of the right questions.  Why will someone want to use this?  Does it really solve a true need?  Is the product easy to use, intuitive, and fun?Continue reading…

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