Category: Uncategorized

Precision Medicine’s First Test is Blue Button on FHIR

Mar 17, 2016• 2

By ADRIAN GROPPER, MD

flying cadeucii President Obama’s legacy for health information technology is about to see its first test at the hands of a little-known project for access to Medicare beneficiary data. The President’s Precision Medicine Initiative (PMI) database is the big brother of Medicare’s database. Although both databases will be managed by the Government, the PMI one will also have our DNA and as many of our health records as we are willing to move there. How much control will patients have over our data in either of these databases? Federal policy on these databases will impact all of healthcare.
The test is whether either of these databases will limit one’s ability to control and use our own data.

Can I have free first-class network access to my own data?

Can I send my own data instantly to anywhere I choose?

Can I direct my data digitally, without paper forms?

These three questions apply equally to my Medicare data, my data in a private-sector EHR, and my PMI data. Current HIPAA law allows it but will the Government and hospitals actually implement it? The policy for the Medicare database is being implemented as Blue Button on FHIR this summer, and so-far it doesn’t look good.

If our Federal Health Architecture (FHA) will not allow us the maximum control allowed by the law, then how can we expect private-sector healthcare systems to do it? I wrote about the current HIPAA law and how it needs to be changed to make a patient’s first-class access a right, instead of an option, in a previous post.

What Healthcare Can Learn From Silicon Valley

Mar 16, 2016• 4

By ED PARK

flying cadeucii As consumers, we expect that when we bank, our ATM card will work in any machine worldwide, dispensing the cash we need and sending the record back to our home financial institution. Similarly, we would be enraged if we bought a new MacBook and couldn’t access our Gmail or load Microsoft Office. We expect this level of connection in so many aspects of our lives. Yet we accept a great deal less from health care than we do from our ATM cards and MacBooks.

How we got to this state is a long and complicated story. Health care has had few incentives to open up to innovation. Hospitals and physician groups have worked on their own closed information systems, hoarding data to keep their care in-network and maintain market share. This practice discouraged innovation and created a generation of ugly, unusable, and disconnected technology that has failed woefully to connect care for patients.

Congress Has a Little Drug Problem

Mar 16, 2016• 15

By BRIAN KLEPPER

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The Congressional committee that recently demanded Martin Shkreli’s appearance must have hoped to spotlight a smug jerk responsible for the outrageous prescription drug pricing that we’re all up against. Of course there are lots of Shkrelis running drug companies, but most are shrewder and less brash, and might not make for such good theater.

Rep. Elijah Cummings (D-MD), one of the Committee’s questioners, seemed to think that his witness could move healthcare forward by disclosing the machinery of the drug sector’s excesses. “The way I see it, you could go down in history as the poster boy for greedy drug company executives or you could change the system. Yeah, you.”

Excessive treatment and cost are at the core of the entire U.S. healthcare crisis. The fact that other societies and a few innovative firms here consistently deliver equal or better quality care at dramatically lower cost betrays the idea that conventional U.S. healthcare is necessarily superior or even appropriate.

Every part of healthcare is guilty, but the pharmaceutical sector is a case in point. An open record of lobbying spending and what pharma has obtained from Congress makes clear that its contributions have worked to that sector’s economic advantage and against the interests of American patients and purchasers.

Rethinking How U.S. Health Care Policy Approaches the Mouth

Mar 16, 2016• 7

By MARKO VUJICIC

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Dental care has traditionally been financed and delivered separately from medical care. This is despite the Surgeon General’s report in 2000 that emphasizes the importance of oral health to whole body health. Now, new data show the consequences of the approach taken in U.S. health care policy to oral health.

Medicaid Children Seeing Big Gains in Access to Dental Care

The American Dental Association Health Policy Institute (HPI) recently launched The Oral Health Care System: A State-By-State Analysis. This first-of-its-kind data repository brings together data from multiple sources related to oral health and is meant to serve policy makers and researchers. One of the most significant findings from these data is that access to dental care has been increasing steadily among Medicaid children for more than a decade.

Nationally, the percent of Medicaid children who visited a dentist within the past twelve months went from 29% in 2000 to 48% in 2013, the most recent year for which data are available. What is striking is that the trend is remarkably widespread across states, with all but one state experiencing gains over this time frame. As a result, the gap in dental care utilization between Medicaid- and privately-insured children has been shrinking steadily. In fact, it narrowed in every single state for which we have data between 2005 and 2013 (see figure below). There are two states – Hawaii and Texas – where there is actually a “reverse gap”: children enrolled in Medicaid are more likely to visit a dentist than children who have private dental benefits. Moreover, this progress has all been happening during a time when the number of children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) has been rising steadily. In 2013, nearly four out of ten children in the U.S. were enrolled in Medicaid or CHIP compared to two out of ten in 2000.

The End of Civilization and the Real Donald Trump

Mar 15, 2016• 17

By ART CAPLAN

Screen Shot 2016-03-15 at 9.13.00 AM The pandemic started quietly. In the spring of 2017 A few hundred dead chickens appeared in markets in Hong Kong and a few other cities in China. Public health officials in China were slow to respond. They did not want to panic the public about an avian flu outbreak. Nor were they eager to take the steps necessary to contain such an outbreak—the killing hundreds of thousands of chickens and poultry with devastating economic consequences. While the delay went on a few cases began to occur on Canadian and American poultry farms. Department of Agriculture experts traced the outbreak to waterfowl migrating from Northern flyways, probably from Asia. Inquiries were made about avian flu outbreaks in Asian nations. Then the unthinkable happened. Humans in Hong Kong began to get sick. Very sick. Some died. Those who died were in their twenties.

The avian flu virus had mutated. H7N9m had transformed into an agent that not only could infect humans but did so with a transmissibility and lethality that had not been seen since the Spanish flu outbreak of 1918.

Then the first American died. A young man back from a business trip to Hong Kong. The media, already primed for hysterical coverage following the severe Zika outbreak in the Southern United States in the summer and fall of 2016, went into full panic-dispensing mode. ‘Experts’ began to appear on the cable channels who suggested that the outbreak was the result of irresponsible genetic research in China. Still others suggested that it was the bioterror work of North Korean scientists. One or two pointed toward ISIS arguing that they had grown desperate in the face of the massive air war that the new administration had launched. Still others saw the hand of right or left wing domestic terrorists. And an accident at an American lab was put into the boiling cauldron of speculation and conspiracy.

The 5 Stages of EMR Acceptance (With Apologies to Kubler-Ross)

Mar 15, 2016

By FRANK MEISSNER

DENIAL

I can’t believe they are making me use this system!

ANGER

I CAN’T BELIEVE THEY ARE MAKING ME USE WHAT
THEY LAUGHINGLY CALL A SYSTEM!

BARGAINING

‘Look if I agree too willingly and cheerfully use this system, can you ask for and fund these change orders, add these features, re-engineer this screen…..blah! blah! Blah!, etc. ‘

DEPRESSION

I can’t beeeelieeeeeeve (sob, sob, sob, sob) theeeey (sob, sob, sob) are making meeeee (pouring tears from both eye tear wells) use this system!’

ACCEPTANCE

I believe they are making me use this system.

(Resigned Sigh)

And just as in the original Kubler-Ross model, our only release from EMR agony is death……. an eventuality that I used to accept stoically as inevitable, but now positively look forward to its release (as do my carpal-ly tunneled wrists!). Continue reading…

Xerox–Tamara StClaire interview

Mar 15, 2016

By MATTHEW HOLT

Another interview from the HIMSS conference earlier this month. The idea behind these interviews is that they give you a quick overview of the companies, and a sense of where the system as a whole is going.

Today is an interview with Tamara StClaire, chief innovation officer of Xerox Healthcare. She not only has some information on what Xerox is up to (including a hint about its new population health management platform) called Health Outcomes Solutions. But also some data from a study Xerox did on the readiness of providers to move to value based care (Hint: not very!) I also want to know what inspired the eyeroll in the video still below? Not me, surely!

The Paradox of Evidence-based Medicine

Mar 15, 2016• 5

By MICHEL ACCAD, MD

Anish Koka recently wrote a great piece entitled “In Defense of Small Data” that was published on The Health Care Blog.

While many doctors remain enamored with the promise of Big Data or hold their breath in anticipation of the next mega clinical trial, Koka skillfully puts the vagaries of medical progress in their right perspective. More often than not, Koka notes, big changes come from astute observations by little guys with small data sets.

In times past, an alert clinician would make advances using her powers of observation, her five senses (as well as the common one) and, most importantly, her clinical judgment. He would produce a case series of his experiences, and others could try to replicate the findings and judge for themselves.

Philips — Interview with Carla Kriwet

Mar 14, 2016

By MATTHEW HOLT

Now I’ve got them uploaded and semi edited I’ll be running the interviews I did at the HIMSS conference earlier this month. They will hopefully give you a quick overview of the companies, and give you a sense of where the system is going.

Today is an interview with Carla Kriwet, CEO of Patient Care and Monitoring Solutions at Philips. The Dutch electronics giant has a huge footprint in the hospital and big ambitions outside it.

Retail Clinics Raise Medical Spending: So What?

Mar 13, 2016• 1

By DEVON M HERRICK

flying cadeucii New research published in Health Affairs finds that retail clinics don’t save money. Many health policy analysts had hoped that retail clinics would reduce medical spending by replacing more costly physician office visits. The article did confirm that retail clinics are less expensive than traditional physician visits for the same service. Yet retail clinic use was associated with an increase in medical spending of $14 per year by those who used them. The $14 per person-year increase was not a complete picture, however, because the study did not compare inpatient spending or prescription drug use.

The researchers looked at Aetna insurance claims for 11 low-acuity conditions to see if people were substituting cheaper retail clinic visits for more costly doctor visits. What they found was that patients tend to visit a retail clinic when they might otherwise forgo care. In other words, patients were adding visits for conditions that would have cleared up on their own rather than necessarily substituting cheaper visits for higher cost visits. Traffic at retail clinics tends to peak during off hours (evening and weekends) when physician offices are closed.

The research was reported by Kaiser Health News and also ran in MedCity News, where I found some of the comments especially interesting. One commenter asked if changing the term “utilization” to “engagement” might make a difference, as in:“clinics increase health ‘engagement’ to the tune of about $14/person.” Increasing patient engagement sounds like a positive benefit rather than the negative connotation of utilization.

As an economist, my knee jerk reaction is patients may want to visit a retail clinic when their traditional source of care is not available. They may be willing to spend a little extra in cost-sharing to take care of a medical need rather than suffer through it.