Every week we bring you a video from Health 2.0! This week we’re featuring a golden oldie, David Kibbe’s motorcycle tour across America.
To see more videos from past Health 2.0 conferences, or to purchase the entire conference DVD sets from ’07 & ’08 click here. 2009 DVD sets will be available shortly, please check back for updates.
The latest polls are an unmitigated disaster for Democratic efforts to get their health care bills passed.
This from Rasmussen this morning:
“Just 38% of voters now favor the health care plan proposed by President Obama and congressional Democrats. That’s the lowest level of support measured for the plan in nearly two dozen tracking polls conducted since June.
“The latest Rasmussen Reports national telephone survey finds that 56% now oppose the plan.
James Currier founded Tickle, a self assessment testing company later sold to career site Monster.com. But he's set the bar much higher in his next venture, Medpedia, Medpedia, as the name suggests, aims to be a comprehensive encyclopedia of medicine. It uses the wiki platform but it has more editorial control and restriction than Wikipedia–particularly limiting final editing rights to credentialed physicians. But Medpedia is also trying to do a whole lot more than that.
This effort has raised controversy from patients who feel (perhaps wrongly) that they're excluded from the process, from Clay Shirky (who suggested that Wikipedia is good enough), and from me (wondering why Medpedia is trying to do so much). James talked with me to discuss what Medpedia's goals are and to answer some of the criticisms.
By MERRILL GOOZNER
The Obama administration’s commitment to cost control in health care can now be summed up in four words: Not on our watch.
Health and Human Services Secretary Kathleen Sebelius told American women this week that they have nothing to learn from the science that led to the U.S. Preventive Services Task Force guidelines on mammography.Insurance companies won’t change their payment policies, and the independent doctors and scientists who made up the USPSTF task force “do not set federal policy” or determine what services are covered by the federal government.”
What a golden opportunity has been missed to educate Americans about the implications of their health care choices. Otis W. Brawley, the chief medical officer of the American Cancer Society, in an op-ed in today’s Washington Post condemning the USPSTF guidelines, confirms that mass screening would only save at a maximum 600 out of the 4,000 women under 50 who die of breast cancer annually. What he failed to point out is that 1.14 million American women would have to be screened annually for ten years to achieve that goal. To cover the entire cohort (all women between 40 and 49) to replicate that benefit every year would require screening 11.4 million women annually. The cost, at $200 per mammogram (my initial estimate was accurate, according to this New York Times business section article), would come to $2.24 billion annually for the health care system.
Yesterday, but the U.S. Treatment Services Task Force announced that leeches aren’t a particularly good treatment for most ailments. While noting that leeches might still be useful for certain specific circulation disorders, the USTSTF recommended against their use in other situations, like treating fever and abdominal pains.
Although the Task Force has no power to make anyone do anything, Rep. Dave Camp (R-Mich) was heard on NPR’s Morning Edition saying, “Some people discounted the idea that the government would actually put people to death … this actually is really showing how the insidious encroachment of government between the patient and their doctor plays out.” Camp neglected to address the facts: (1) overuse of leeches is expensive, and science-based recommendations about appropriate use would save the government money without harming patients, and (2) bloodletting can lead to negative side effects, such as upsetting the body’s natural humoral balance.
America’s hospitals are a triumph of modernity, stocked as they are with PET scanners, ECMO machines, and ICUs bedecked in eye-popping gadgetry.
They are also the most complex organizations ever created by man. The seemingly simple process of delivering a drug from the pharmacy to the bedside for example, typically involves a 30-step process executed by a half-dozen people on 3 floors. There are hundreds of ways it can fail.
It often does, and that’s just half the story. Each hospitalized patient requires a unique combination of services including lab tests, physical therapy, a discharge plan and so forth. Since a complex process must be executed to produce each service, the hospital becomes a job shop.
By contrast, the processes used to produce cars and silicon chips are relatively unfettered. That is why piston rods can be produced in batches with every item meeting specs to the micron, while hospital processes often feature error rates of 10-20%.
This explains why hospitals have struggled for decades to improve quality. It also explains why a study by Ashish Jha and colleagues at Harvard has shown that hospitals using electronic health records (EHRs) don’t have better quality.
There is growing tension within the Obama administration’s health team over who will control health data exchange: everyone (including consumers and their doctors), or just large provider organizations. The public debate will be framed in terms of privacy, security, and the adequacy of current exchange standards. But what really matters is who gets to make decisions about where health data resides, how it can be accessed, how much exchange will cost, and how long it will take for exchange to become routine.
Now is a good time to re-visit the plans for a National Health Information Network (NHIN), since we can finally observe and compare different health data sharing and exchange models in the marketplace. NHINs represent an older model that tries to use regional health information organizations (RHIOs) to establish secure networks, privately owned and operated by large provider organizations, mostly hospitals and health systems. The idea was that, over time, each private regional network would develop a gateway to other networks, creating a “network of networks” that would allow Stanford to talk to Partners Health, or Kaiser to Mayo. This communications model was enterprise/provider-centric. Patients/consumers were relegated to depending upon each RHIO’s policies for access to their health information. It was also a massively expensive and time consuming – think decades – way to build a health data network.
There is growing tension within the Obama administration’s health team over who will control health data exchange: everyone (including consumers and their doctors), or just large provider organizations. The public debate will be framed in terms of privacy, security, and the adequacy of current exchange standards. But what really matters is who gets to make decisions about where health data resides, how it can be accessed, how much exchange will cost, and how long it will take for exchange to become routine.
Now is a good time to re-visit the plans for a National Health Information Network (NHIN), since we can finally observe and compare different health data sharing and exchange models in the marketplace. NHINs represent an older model that tries to use regional health information organizations (RHIOs) to establish secure networks, privately owned and operated by large provider organizations, mostly hospitals and health systems. The idea was that, over time, each private regional network would develop a gateway to other networks, creating a “network of networks” that would allow Stanford to talk to Partners Health, or Kaiser to Mayo. This communications model was enterprise/provider-centric. Patients/consumers were relegated to depending upon each RHIO’s policies for access to their health information. It was also a massively expensive and time consuming – think decades – way to build a health data network.Continue reading…
It all sounds simple enough. You measure everything you do. You gather claims data. You measure what works. You show measures of what works to doctors and nurses. You write protocols for doctors and nurses to follow what works. You pay more for what works. You pay less for what doesn’t work. You remove pay incentives that cause doctors to do more. You gather together doctors who lead organizations with track records for providing better care at lower costs at the White House.
Until now, non-health care business has been noticeably absent from the health care reform proceedings , and quiet about the bills’ impacts on their management of employee benefits, on cost, and on the larger issues of global competitiveness. Where have the voices been of the powerful business leaders who will pick up much of the tab?
They’ve finally surfaced, and now we’ll see whether they have the will to bring reform back on track. They certainly have the strength. The question is whether this salvo by the business mainstream could force Democrats to reconsider and revise the content and structure of their proposals.
On October 29th, a powerful collaborative of major employer organizations sent a letter to Speaker Pelosi and Republican Leader Boehner asserting that the House legislation “falls short of the bipartisan goal of controlling costs and jeopardizes employer-sponsored coverage which now serves more than 160 million Americans.” The same group sent a similar letter to Senate President Reid earlier that week.
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