Category: Uncategorized

“I Smoke and I Am Not Going To Quit. My Physician Says I Need a CT scan. Do I?”

Jan 7, 2015• 5

By ROBERT McNUTT, MD

Case:

I get asked by many who smoke or who have just quit smoking for help making the decision to have/not have a CT scan to screen for lung cancer. The man responsible for the question above had been smoking his entire life, and, at age 62, he raised the question.

Screening is the term used when tests are done for patients without symptoms. The hope of screening is that a test will find lung cancer (or any other clinical situation for which screening tests are considered) early in the course of the condition so treatment may be beneficial. In the study above, 87 fewer people of the nearly 54,000 in the study died of lung cancer in the LDCT arm. In addition, the number of people dying of other conditions beside lung cancer was fewer (1526 died of other conditions in the LDCT group and 1557 in the CXR group). I did not present this data on the figure as the difference is small and it is unclear why LDCT would reduce other reasons for dying.

The harm of screening, as discussed in earlier blog posts, is that some people will have a positive test and not have cancer. This can cause worry, but in this clinical situation, additionally, the abnormalities found by the test are located in the lung. Getting to these lesions to provide assurance that cancer is not present may be dangerous and costly, and in this study, more people did die early in the LDCT arm.

Since I believe only patients can decide for their tests/treatments, a person would have to trade-off the potential 0.4% added chance of not dying of lung cancer in the future against the potential 40 fold greater chance of a false positive finding and a potential 0.24% added chance dying early or having a major complication by following a LDCT strategy.Continue reading…

THCB Marketplace

Jan 7, 2015

(Big) Garbage In. (Big) Garbage Out.

Jan 7, 2015

FROM THE TECH DESK

In December, THCB asked industry insiders and pundits across health care to give us their armchair quarterback predictions for 2015. What tectonic trends do they see looming on the horizon? What’s overrated? What nasty little surprises do they see lying in wait? What will we all be talking about this time next year? Over the next few weeks, we’ll be featuring their responses in a series of quick takes.

Joe DeSantis, Vice President of HealthShare Platforms, InterSystems

Information Exchange is dead. Long live Information Exchange: There was a lot of talk in 2014 about the failure of information exchange. When people take a closer look, they are going to see there are actually some good examples of this working and changing how care is delivered. We’ll see lots more examples in 2015.

(Big) garbage in, (big) garbage out: People are looking to big data and analytics to tackle population health and other problems. They will soon find that without addressing data quality and conditioning up front, the results will be disappointing at best. This will be the year of clean data.

Keep it simple: The mobile revolution has not yet had the impact on healthcare that it has had in other sectors. Recreating desktop applications on a phone is not the answer, nor are retreads of messaging standards. We will have to rethink how healthcare information is presented and used.

One portal, please: Everyone agrees that patient engagement is essential – but giving me four separate portals, six more for my wife and three more for my mother makes me enraged, not engaged! Thought leaders will begin to realize that patient engagement must be built atop true information sharing.Continue reading…

Does Restricting Physician Duty Hours Improve Patient Care?

Jan 6, 2015• 8

By RICHARD GUNDERMAN, MD

Do physicians in training take better care of patients or perform better on their exams when their work hours are restricted? Two recent studies in the Journal of the American Medical Association suggest that the answer is no. In one, patients of surgery residents showed no difference in morality or postoperative outcomes after duty hour restrictions were implemented. Their test scores did not improve either. In the other, hospitalized Medicare patients being cared for by physicians working shorter hours experienced no improvement in mortality or readmission rates.

US resident duty hour restrictions were born in 2003, when the ACGME, the organization that accredits medical residency programs, capped the work week at 80 hours. It also mandated that residents have 10 hours off between duty periods and a 24 hour limit on continuous duty, with 1 day in 7 free from patient care. In 2011, the organization revised its policy, further restricting the total number of continuous duty hours for physicians in the first year of training to 16.

How could well-intentioned attempts to ensure that hardworking young physicians get sufficient rest fail to benefit patients? To begin with, simply restricting duty hours does not guarantee that residents will use their extra off-duty time to sleep. They might, for example, use it to study, exercise, or socialize. It is also possible that the outcomes being assessed by these studies are influenced by so many factors that merely changing duty hours is insufficient to cause a change. Yet if such changes do not benefit patients, how strong is the case for their implementation?

Some educators worry that duty hours restrictions are undermining the quality of medical education. For example, a survey of surgery program directors published last year showed that 21% believe that residency graduates are unprepared for the operating room, 30% believe they cannot independently remove a gallbladder, and 68% believe they cannot perform a major procedure unsupervised for more than 30 minutes. Another survey showed that 38% of residents themselves lack confidence in their preparation even after 5 years of training.

Do You Really Know What’s in That Cracker? Tellspec Does

Jan 6, 2015• 2

By KIM KRUEGER & MATTHEW HOLT

There’s a lot we don’t know about food and our health. Butter in your coffee, eat like a caveman, or no animal products: you name it and there’s an expert backing it. Even the nutritional labels placed on the majority of food items can be misleading and inaccurate. Fortunately, Isabel Hoffman is tackling this problem head on with her company Tellspec. Motivated by a personal history of allergies and ill health, Hoffman has developed a hand-held food-scanning spectrometer that immediately tells users the exact chemical composition of their food.

Matthew Holt, Co-Chairman at Health 2.0, interviewed Hoffman, who performed a live demo of the Tellspec device, shared her thoughts on Tellspec’s path to widespread consumer adoption, and the future possibilities for Tellspec.

You don’t need to be a rocket scientist to understand the excitement around Tellspec. The device would demand transparency and accountability from the food industry, help refine the connection between diet and health, and answer a wide variety of consumer concerns from general nutrition to chronic disease to allergies. Of course, this all depends on Tellspec delivering on its claims, something the company has failed to do in recent history.

Critics jumped on Tellspec for not being able to deliver on its crowdfunding campaign, but it remains unclear whether that was a production issue or if there are bigger concerns with the technology Tellspec depends on. As some may recall, other crowdfunded devices with lofty claims, like the passive calorie tracker GoBe, have turned out to be bogus. So is Tellspec the real deal? It’s hard to tell at this point. Hoffman scanned a cake on stage at TED, Health 2.0 staff saw a live scan of Wheat Thins, and you can watch a scan below, but don’t hold your breath for the day you can take the device down to In-N-Out to see what’s really in those Animal Fries.

Kim Krueger is a Research Analyst at Health 2.0 where Matthew Holt is the Co-Chairman.

RingMD: The Newest Entrant in the US TeleMedicine Market

Jan 5, 2015• 2

By Prerna Anand

At 22 years old, Justin Fulcher looks like an average, newly graduated, young entrepreneur. But don’t be mistaken by his humble appearance. He is the Founder and CEO of RingMD, one of the fastest growing patient-provider communication platform, granting quality and affordable health care to people worldwide.

Founded in 2012 in Singapore, RingMD is a mobile based platform that connects patients with doctors via video or phone. Users input their symptoms, chose the format for the call, provide a mode of transaction, and get access to a list of providers based on location, price, ratings, insurance coverage, availability etc. Provider profiles have detailed biography, and feature dynamic pricing, making it an active health care marketplace. Patients can upload files in real time to share with the consulting doctor, and their EMR history is shown in a split screen on the provider side. Doctor notes are shareable, in both text and video formats.

RingMD has been an active telehealth provider in Singapore, Hong Kong, and other Asian countries, and is now ready to enter the US market. Mr. Fulcher visited Health 2.0 headquarters recently and shared his story with us.

Following is an excerpt from the interview:Continue reading…

Black Turtlenecks, Data Fiends and Code. An Interview with John Halamka

Jan 5, 2015• 36

By ROBERT WACHTER, MD

Of the nearly 100 people I interviewed for my upcoming book, John Halmaka was one of the most fascinating. Halamka is CIO of Beth Israel Deaconess Medical Center and a national leader in health IT policy. He also runs a family farm, on which he raises ducks, alpacas and llamas. His penchant for black mock turtlenecks, along with his brilliance and quirkiness, raise inevitable comparisons to Steve Jobs. I interviewed him in Boston on August 12, 2014.

Our conversation was very wide ranging, but I was particularly struck by what Halamka had to say about federal privacy regulations and HIPAA, and their impact on his job as CIO. Let’s start with that.

Halamka: Not long ago, one of our physicians went into an Apple store and bought a laptop. He returned to his office, plugged it in, and synched his e-mail. He then left for a meeting. When he came back, the laptop was gone. We looked at the video footage and saw that a known felon had entered the building, grabbed the laptop, and fled. We found him, and he was arrested.

Now, what is the likelihood that this drug fiend stole the device because he had identity theft in mind? That would be zero. But the case has now exceeded $500,000 in legal fees, forensic work, and investigations. We are close to signing a settlement agreement where we basically say, “It wasn’t our fault but here’s a set of actions Beth Israel will put in place so that no doctor is ever allowed again to bring a device into our environment and download patient data to it.”

The Anesthesiologist’s Story: New Details Emerge In the Joan Rivers Case

Jan 4, 2015• 31

By KAREN SIBERT, MD

New York Post reporter Susan Edelman revealed on January 4 the name of the unfortunate anesthesiologist allegedly present on August 28 at Yorkville Endoscopy, during the throat procedure that led to the death of comedian Joan Rivers. She is reported to be Renuka Reddy Bankulla, MD, 47, a board-certified anesthesiologist from New Rochelle, NY.

Having her name made public will be a nightmare for Dr. Bankulla, as investigators will certainly target her role in Ms. Rivers’ sedation and the management — or mismanagement — of her resuscitation.

When the news of Ms. Rivers’ cardiac arrest and transfer to Mt. Sinai Hospital became public, many of us guessed that there might have been no qualified anesthesia practitioner — either anesthesiologist or nurse anesthetist — present during the case. The gastroenterologist and then medical director of the clinic, Dr. Lawrence Cohen, argued famously that the sedative propofol, which Ms. Rivers received, could be safely given by a registered nurse under his supervision, and that no anesthesiologist is necessary.

However, with the publication of the Centers for Medicare & Medicaid Services (CMS) report of September 5, it became clear that an anesthesiologist was definitely present. The anesthesiologist was identified only as “Staff #2″ in the report. She was interviewed by the CMS surveyors four days after the event, but said she was “advised by her legal representative not to discuss the case.”

Key pieces of information about what happened still haven’t been made public. Nonetheless, the surveyors gathered enough information to reach this conclusion: “The physicians in charge of the care of the patient failed to identify deteriorating vital signs and provide timely intervention during the procedure.”

By any standard of care, the anesthesiologist clearly would be one of the physicians in charge.

Continue reading…

Commentology: The Real Professor Baicker

Jan 4, 2015• 5

By THCBist

Influential RAND researcher Soren Mattke had this to say in support of Al Lewis and Vik Khanna’s latest post on the Wellness story “Would the Real Professor Katherine Baicker Please Stand Up?”

“Gentlemen. Great post. Like you, I am disappointed that researchers of the caliber of Kate Baicker and David Cutler do not respond to the mounting debate about their paper. They should defend or disown their work rather than hope that the debate goes away.

In my mind, their paper is a product typical of high-end academic research. Two brilliant professors spot a gap in the evidence on a hot policy topic and decide to go after it. But the actual work gets done by a graduate student in his cubicle without windows or guidance, and then hastily published.

Then the problem arises that the paper becomes hugely influential and people start having a closer look. For our paper on the PepsiCo program, we reviewed in detail the seven publications that Baicker and colleagues called “high quality evidence”. We found that five of those analyzed programs that operated over 20 years ago and most of them had severe methodologic flaws. (John P. Caloyeras, Hangsheng Liu, Ellen Exum, Megan Broderick and Soeren Mattke. Managing Manifest Diseases, But Not Health Risks, Saved PepsiCo Money Over Seven Years. Health Affairs, 33, no.1 (2014):124-131)

Unfortunately, many defenders of the industry continue to take the Baicker paper at face value, while closely scrutinizing or ignoring more nuanced and scientifically sound findings.

So I herewith support your motion!

HIT Newser: Accenture Tapped to Continue Work on HealthCare.gov

Jan 4, 2015• 2

By MICHELLE RONAN NOTEBOOM

Accenture Tapped to Continue Work on HealthCare.gov

Accenture, the consulting firm that was hired a year ago to fix the troubled HealthCare.Gov insurance exchange, is awarded a five-year, $563 million to continue its work on the federal site. The government hired Accenture Federal Services to repair the online marketplace after dropping its original contractor, CGI Federal.

The long-term contract with Accenture also signals CMS’s acknowledgement that a task as large as HealthCare.Gov is best run with leadership from an experienced, private-sector vendor.

Connecticut HIE Dissolves After Wasting Millions

A former board member for The Health Information Technology Exchange of Connecticut blames management for the failure of the entity, which was tasked to create statewide HIE but dissolved by the legislature last summer. The HITE-CT “wasted” $4.3 million in federal grants over four years “without accomplishing anything,” according to Ellen Andrews, who served as the board’s consumer advocate. State auditors also found deficiencies in state controls, legal problems, and a “need for improvement in management practices and procedures.” The state’s legislature is now developing a new exchange strategy.

Prediction: look for more HIEs to falter this year due to mismanagement and lack of sustainability.

Electronic Prescribing of Controlled Substances on the Rise

Electronic prescribing of controlled substances (EPCS) increased from 1,535 to 52,423 between July 2012 and December 2013, according to a study published in the American Journal of Managed Care. The percentage of pharmacies enabled for EPCS jumped from 13% to 30% during the same period.

The next task: figuring out how to get more than the current one percent of physicians to participate.

ONC Shares Lessons Learned from State HIEs

An ONC report on state HIEs finds that many exchanges lack a critical mass of data and are struggling with data sharing. The case study also found that the technical approaches, services enabled, and use of policy and legislation varied across states; collaboration among HIE participants is critical for success; and states are leveraging a variety of policy and regulatory levers to advance interoperability and data exchange.

CMS Seeks ICD-10 Testers

CMS is seeking approximately 850 volunteers for ICD-10 end-to-end testing in April, according to a CMS bulletin. Volunteers have until January 9to submit applications to participate in the April 26-May 1, 2015 testing week.

Pediatrics Report Increased EHR Use

Seventy-nine percent of pediatricians reported using an EHR in 2012, compared to 58% in 2009, according to a study published in the journal Pediatrics. Only eight percent of physicians say their EHRs include pediatric-specific functionality.

Modernizing Medicine Buys RCM Vendor Aesyntix

EMR developer Modernizing Medicine acquires Aesyntix, a provider of RCM, inventory management, and group purchasing services.

Presumably Modernizing Medicine was most interested in Aesyntix’s RCM component, which may create some concern among Modernizing Medicine’s current RCM partners, which include ADP/AdvancedMD, CareCloud, and Kareo.