Category: Uncategorized

The Tufnel Effect

Apr 14, 2011• 1

By PSYCH GRIPE

In This Is Spin̈al Tap, British heavy metal god Nigel Tufnel says, in reference to one of his band’s less successful creations:

“It’s such a fine line between stupid and…uh, clever.”

This is all too true when it comes to science. You can design a breathtakingly clever experiment, using state of the art methods to address a really interesting and important question. And then at the end you realize that you forgot to type one word when writing the 1,000 lines of software code that runs this whole thing, and as a result, the whole thing’s a bust.

It happens all too often. It has happened to me, let me think, three times in my scientific career and, I know of several colleagues who had similar problems and I’m currently struggling to deal with the consequences of someone else’s stupid mistake.

Here’s my cautionary tale. I once ran an experiment involving giving people a drug or placebo and when I crunched the numbers I found, or thought I’d found, a really interesting effect which was consistent with a lot of previous work giving this drug to animals. How cool is that?

So I set about writing it up and told my supervisor and all my colleagues. Awesome.

About two or three months later, for some reason I decided to reopen the data file, which was in Microsoft Excel, to look something up. I happened to notice something rather odd – one of the experimental subjects, who I remembered by name, was listed with a date-of-birth which seemed wrong: they weren’t nearly that old.

Slightly confused – but not worried yet – I looked at all the other names and dates of birth and, oh dear, they were all wrong. But why?

Then it dawned on me and now I was worried: the dates were all correct but they were lined up with the wrong names. In an instant I saw the horrible possibility: m ixed up names would be harmless in themselves but what if the group assignments (1 = drug, 0 = placebo) were lined up with the wrong results? That would render the whole analysis invalid… and oh dear. They were.

As the temperature of my blood plummeted I got up and lurched over to my filing cabinet where the raw data was stored on paper. It was deceptively easy to correct the mix-up and put the data back together. I re-ran the analysis.

No drug effect.

I checked it over and over. Everything was completely watertight – now. I went home. I didn’t eat and I didn’t sleep much. The next morning I broke the news to my supervisor. Writing that email was one of the hardest things I’ve ever done.Continue reading…

Personal Health Records: Will Doctors Connect?

Apr 14, 2011• 4

By JANE SARASOHN-KAHN

What doctors are most likely to use patients’ personal electronic health records? Fewer than 1 in 2 are willing to. Those who most likely would include Hispanic physicians, doctors who practice in rural areas, those employed in hospitals, and surgeons.

As part of the HITECH Act included in the American Recovery and Reinvestment Act (ARRA) 0f 2009, U.S. physicians have the opportunity to receive a portion of the $20.8 billion carved out as incentive payments to those who adopt and “meaningfully use” electronic health records (EHRs).

Many EHRs include portals which allow patients to access a slice of their personal health information. Some patients create their own personal health records that might be as simple as an Excel spreadsheet or as robust as Kaiser Permanente’s My Health Manager or the VA’s MyHealtheVet.

The format of the personal health record (PHR) aside, researchers from the AMA, University of Chicago and the Markle Foundation wondered how willing physicians would be to use patients’ PHRs. The results of their survey are published in the February 2011 issue of Health Affairs.

The bottom line is that physicians’ willingness to connect with patients’ PHRs varies by the doctor’s gender, clinical specialty, race, geographic location, size of the practice, and whether they are already using an EHR. The chart details these findings by physician characteristic.

The physicians who would least likely embrace patients’ would most likely practice in suburban geographies, in solo or duo practices, be female, and be in primary care or pediatrics. And those who don’t use an EHR currently are much less likely to be unwilling to use a patient PHR.Continue reading…

Health 2.0 Show TODAY

Apr 14, 2011

Don’t forget that there’s a Health 2.0 Show, our free online hour long show at 10 PST/1pm EST. Today (Thursday). Register here for FREE.

We’ll be taking a look back at some highlights from the Health 2.0 Spring Fling, and have brought back some live product demos:

Hemi Weingarten of Fooducate
Tom Reilly of MyHealthDIRECT
Food Oasis by Team Maya
Maternity Care by Mapping Health

IOM Health Data Initiative Forum is June 9

Apr 13, 2011

Health 2.0 is supporting and I’m attending The Health Data Initiative Forum on June 9, 2011 at the National Institutes of Health in Bethesda, MD, and you should too. The Forum aims to accelerate momentum for the public use of data and innovation to improve health as part of The Health Data Initiative, a collaborative project of the Institute of Medicine and the Department of Health and Human Services. The Forum will feature more than 45 fast-paced demonstrations of cutting-edge health apps that developed using health data, a series of panel discussion sessions on important health topics, and a data and apps expo. You’ll be able to interact with developers, as well as investors, venture capitalists, and federal, state and local government officials. A provisional agenda is available online. Space is limited and the registration is filling up fast! Take a moment to register today, and let me know if you have any questions….and yes this was written by an IOM PR person not me, but it’s all true!

Unlucky Student

Apr 13, 2011• 28

By KIMBERLY SEELYE

Last  July,  I  found  myself  needing  to  visit  a  doctor  for  an  urgent  medical  issue.  My  period  had  started  in  April  and  never  stopped.  It  was  light,  so  it  wasn’t  too  much  of  an  annoyance,  but  after  three  months  I  figured  I  needed  professional  help.

I  had  started  graduate  school  in  Michigan  the  year  before  and  was  back  home  in  California  for  the  summer.  I  wasn’t  sure  if  the  new  insurance  that  I  paid  over  $2,000  per  year  for  through  the  school  would  cover  a  doctor’s  visit  in  a  different  state.  I  called  the  insurance  company  to  check  and  they  said  they  cover  any  doctor  in  the  country.  Happy  to  hear  this,  I  called  and  made  an  appointment  with  the  doctor  I  had  been  seeing  for  years.

Though  my  insurance  had  changed,  my  doctor’s  appointment  was  the  same  as  always,  I  just  had  a  slightly  higher  co‐pay.  I  had  a  routine  check‐up  and  the  doctor  ordered  some  blood  tests  to  help  diagnose  my  problem. Within  a  few  weeks, the  doctors  figured  out  what  was  wrong  and  cured  it.  I  returned  to  school  in  September  happy  and  healthy.  As  far  as  I  knew,  my  business  with  the  doctor  was  finished.Continue reading…

“Trust Us” Just Doesn’t Cut It

Apr 13, 2011• 1

By PAUL LEVY

I apologize in advance if some of you are tired of hearing about Massachusetts and its experience with different payment models for health insurance. I write about this, not only because it is interesting locally, but also because people around the US are watching to see how the experiments here might or might not be applicable to the rest of the country.

I have written before about the pro’s and con’s of capitated, or global, payments as an alternative to fee-for-service payments. There are arguments to be made in support of each. But the problem in this state is that the movement towards global payments has become a matter of religious dogma. The main practitioners of the system have not been willing to divulge the kind of information needed to evaluate it properly. That lack of transparency undermines the policy arguments that might be used to advocate for an expansion of this approach.

But, eventually, more and more of the story comes out, and it is less than pretty. A few weeks ago, I quoted a report by the state’s Inspector General in which he raises concerns about this issue. He noted, “[M]oving to an ACO global payment system, if not done properly, also has the potential to inflate health care costs dramatically.”

Now comes an article by Pippin Ross in Commonwealth Magazine, entitled “Piloting Global Payments.” It has some revelations that give credence to the concerns raised by the IG.

Ross quotes a Blue Cross Blue Shield official as saying:

Blue Cross padded first-year global payment budgets to entice hospitals and doctors to sign on…. [T]he current goal is not to actually reduce costs, but to cut in half the rate of growth in medical costs after five years.

[T]he outcomes after one year under global payment are where Blue Cross expected to be in three or four years. “The amount of money being spent hasn’t changed yet, but the outcomes are serious testimony to the fact that more—in tests and doctors and visits—isn’t always better,” she says. “We’re getting a lot more for our money than we expected.”

But, of course, we don’t really know, do we? We have no way to validate any of this. Sorry, but “trust us” just doesn’t cut it when it comes to this kind of significant change.Continue reading…

Why Medicare Isn’t the Problem, It’s the Solution

Apr 12, 2011• 200

By ROBERT REICH

I hope when he tells America how he aims to tame future budget deficits the President doesn’t accept conventional Wasington wisdom that the biggest problem in the federal budget is Medicare (and its poor cousin Medicaid).

Medicare isn’t the problem. It’s the solution.

The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.

Americans spend more on health care per person than any other advanced nation and get less for our money. Yearly public and private healthcare spending is $7,538 per person. That’s almost two and a half times the average of other advanced nations.

Turf Wars

Apr 12, 2011• 6

By MICHAEL KIRSCH, MD

So many folks express views that are obviously self-serving, but they try to masquerade them as altruistic positions that benefit some other constituency. These attempts usually fool no one, but yet these performances are common and ongoing. They are potent fertilizer for cynicism.

Teachers’ unions have been performing for us for decades. Their positions on charter schools, school vouchers, merit pay and the tenure system are clear examples of professional advocacy to protect teachers’ jobs and benefits; yet the stated reasons are to protect our kids. Yeah, right. While our kids are not receiving a top flight education, the public has gotten smart in a hurry on what’s really needed to reform our public educational system. This is why these unions are now retreating and regrouping, grudgingly ‘welcoming’ some reform proposals that have been on the table for decades. This was no epiphany on their part. They were exposed and vulnerable. They wisely sensed that the public lost faith in their arguments and was turning against them. Once the public walked away, or became adversaries, established and entrenched teachers’ union views and policies would be aggressively targeted. Those of us in the medical profession have learned the risk of alienating the public. Teachers have been smarter than we were.

The medical profession is full of ‘performances’ where the stated view is mere camouflage. For example, there is a turf war between gastroenterologists (GI) and anesthesiologists whether GI physicians can safely administer the drug propofol to sedate our patients before colonoscopies and other glamorous procedures. This drug may be familiar to ordinary readers as it was involved in the death of a superstar pop music legend in 2009. GI doctors insist that with proper training we can safely administer this drug to our patients. Indeed, there are numerous scientific publications that support this view. Anesthesiologists have pushed back hard and they have prevailed. “It’s too dangerous,” they warn. “No one can use this drug unless you have advanced anesthesia training,” Of course, the only physicians who have ‘advanced anesthesia training’ are anesthesiologists. I’m not claiming that my anesthesia friends don’t have a legitimate point. But, let’s be clear. Their position is not merely an effort to protect patients, it is also meant to protect their turf. Continue reading…

The Science and Religion of Patient Safety

Apr 12, 2011• 3

By BOB WACHTER, MD

Earlier today, Secretary of Health and Human Services Kathleen Sebelius and Medicare chief Don Berwick announced the “Partnership for Patients,” a far-reaching federal initiative designed to take a big bite out of adverse events in American hospitals. The program – which aims to decrease preventable harm in U.S. hospitals by 40 percent and preventable readmissions by 20 percent by 2013 – marks a watershed moment in the patient safety movement. Here’s the scoop, along with a bit of back story (which includes a gratifying bit part for yours truly).

Last July, I attended the American Board of Internal Medicine’s Summer Forum in Vancouver. This confab has turned into medicine’s version of Davos, drawing a who’s who in healthcare policy. One of the attendees was an old friend, Peter Lee, a San Francisco lawyer and healthcare consumer advocate who had just been asked to lead a new Office of Delivery System Reform within the U.S. Department of Health and Human Services. Peter’s charge was to figure out how to transform the delivery of healthcare in America, challenging under any circumstances but Sisyphean given that he’d be pushing the rock up a mountain chock full of landmines comprised of endless legal and political threats to the recently-passed Affordable Care Act.

Fueled by the enthusiasm of being a new guy with a crucial task, Peter took advantage of some conference downtime to convene a small group – about 20 of us – to advise him on what he should focus on in his new role. After soliciting ideas from many of the participants around the table, he turned to me. I decided not to be shy.

I suggested that the topic of patient safety remained compelling and scary, and that it might be at a tipping point – with new success stories in reducing infections and improving surgical safety, more hospitals possessing the infrastructure to improve safety, and increasing penetration of IT systems due to federal support through the meaningful use standards. I also knew that Don Berwick, Peter’s new boss, would not be content to move around some bureaucratic chess pieces, or even a few hundred million dollars. Instead, he’d be looking to do Something Big – an initiative aimed at capturing hearts and minds, a federal version of his IHI 100,000 Lives and 5 Million Lives campaigns. What better target than patient safety?Continue reading…