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Google Hits Reset Button on Google Health

Google Health has seemingly been stuck in neutral almost from the start. Despite the fanfare of Google’s Eric Schmidt speaking at the big industry confab, HIMSS a couple of years back, an initial beta release
with healthcare partner Cleveland Clinic and a host of partners
announced once the service was opened to the public in May 2008, Google
Health just has not seemed to live up to its promise.
Chilmark has looked on with dismay as follow-on announcements and
updates from Google Health were modest at best and not nearly as
compelling as Google’s chief competitor in this market, Microsoft and
its corresponding HealthVault.  Most recently we began to hear rumors
that Google had all but given up on Google Health,
something that did not come as a surprise, but was not a welcomed rumor
here at Chilmark for markets need competitors to drive innovation.  If
Google pulled out, what was to become of HealthVault or any other such
service?

Thus, when Google contacted Chilmark last week to schedule a briefing
in advance of a major announcement, we were somewhat surprised and
welcomed the opportunity.  Yesterday, we had that thorough briefing and
Chilmark is delighted to report that Google Health is still in the game
having made a number of significant changes to its platform.

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Sickening People

ROB LAMBERTS, MDLamberts

I found the discussion around my recent post about treating colds very interesting.  Sick people come to the office to find out how sick they are.  Most people don’t want to be sick, and when they are sick they want doctors to make them better.

Most people.

Some people want to be sick, and some doctors want to make people sick.  I am not talking about hypochondriacs – people who worry that they may have disease and become fixated on being sick.  I am not talking about malingerers – people who pretend to be sick so they can get medications.  I am talking about the slippery slope of defining disease.

“I lost my job and have felt depressed ever since.”

“My son won’t obey me.”

“I’m just tired and have no motivation.”

“My daughter’s having trouble in school.”

The definition of disease versus normal has become a big issue recently.  A recent study found that over 50% of Americans are taking regular medications.  In the eye of the hurricane of this controversy is the DSM-5, the new manual for the definition of mental illness.  John Gever, of MedPage Today explained in a recent article on KevinMD that the criteria seem, in the eyes of many, to shrink the definition of a “normal” person.  The motivation to put a label on normal people, he explains, has various motivating forces:

It’s true that drug companies often do little to discourage off-label use of psychiatric drugs and sometimes encourage it. It’s also true that many doctors throw medications at patients who might do better with other treatments or no treatments. (That’s true for many somatic conditions too, let’s not forget.)Continue reading…

Human Resources and Surviving Health Reform

As the first snowflakes of change fall on the eve of health reform, HR professionals may soon wake up to an entirely transformed healthcare delivery landscape.  The Patient Protection and Affordable Care Act (PPACA) clearly will impact every stakeholder that currently delivers or supplies healthcare in the United States.

While the structural, financial, behavioral and market-based consequences of this sweeping storm of legislation will occur unevenly and are not fully predictable, this first round of healthcare legislation is designed to aggressively regulate and rein in insurance market practices that have been depicted as a major factor in our “crisis of affordability” and to expand coverage to an estimated 30 million uninsured.  However, fewer than 30 percent of employers polled in a recent National Business Group on Health survey believe reform will reduce administrative or claims costs.

Yet, it is unlikely that reform will be repealed.  For all its imperfections, PPACA is the first in a series of storm systems that will move across the vast steppe of healthcare  over the next decade resulting in a radically different system.  Whether reform concludes with a single payer system or emerges as a more efficient public-private partnership characterized by clinical quality and accountability remains obscured by the low clouds and shifting winds of political will.  One thing is certain during these first phases – inaction and lack of planning will cost employers dearly.Continue reading…

NYC Train Station Bathroom Yields Cleaner Hands than Hospitals

Who can forget last year’s celebration of Global Handwashing Day, when it turned out that Brits wash their hands after using a gas station bathroom about as often as your doctor washes his hands before examining you? And that’s not a good thing.

OK, British researchers didn’t exactly come to that conclusion: I did, in this blog, after comparing what they found about motorists to what the academic literature says about doctors.

Now comes a survey of public bathroom hygiene in the US of A, and the good news is that even America’s worst washers are far more likely to have washed their hands than British drivers. The bad news is that the guy who just used the toilet at Grand Central Station is also way more likely to have clean hands than the guy walking up to your bed at the local hospital.

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The Health Insurance Purchase Mandate: Peeking Into Pandora’s Box?

Governors from most twenty mostly red states are suing to block the implementation of health reform. I have no idea whether they will win on the legal merits. But when it comes to the economics of the issue, they are on the wrong side. But even as my head says that the mandate is a good thing, my heart tells me otherwise.

Mandating the purchase of a good or service should be anathema to any card-carrying economist. But healthcare is unlike other goods and services in one critical way. No one will sell you food or clothing or anything else that you cannot pay for. But if you need surgery to save your life, someone will operate on you. Healthcare providers are trained to “treat now, bill later.” And while providers pursue (and sometimes harass) the uninsured for payment, the lion’s share of their costs end up as bad debt or charity write-offs. So the uninsured get their care while the rest of us pay for it. An insurance mandate is supposed to prevent such free riding. It is as if we are saying, “We can’t stop ourselves from taking care of everyone who needs medical care, so we will force everyone to pay their fair share.”

This concern about free riding is how we got health insurance in the first place. During the Great Depression, many patients couldn’t pay their bills. So hospitals and doctors encouraged individuals to prepay for their share of the community’s medical costs in exchange for guaranteed access. Even then, many remained uninsured and some had trouble getting medical care. By the 1950s, the new Hill-Burton program subsidized nonprofit hospitals in exchange for guarantees that they would take in the uninsured. A building spree of taxpayer funded county hospitals and community health centers further bolstered the safety net.Continue reading…

The Next Big Thing for Doctors

By

The Future Just Happened,
by Michael Lewis, 2001

As a consultant to the Physician Foundation, a not-for-profit 501 C-3 Organization representing physicians in state medical societies, as a sometime futurist, and as someone who has written extensively about innovation in Innovation-Driven Health Care (Jones and Bartlett, 2007) and in 1475 blogs in Medinnovation, I have been asked: What is the next big thing for doctors, and how should they react to it?

The next big thing for physicians will be Medicare fee cuts in the neighborhood of 50% by 2020 as mandated by the Affordable Care Act, and the next big clinical innovative response for doctors will be encouraging patients enter their own data, their own chief complaint, and their own medical histories before seeing the doctor to compensate for fee reductions.

Ceding a Traditional Physician Function to Survive Economically

Doctors will have to cede a traditional function – taking a history – to patients to become more efficient to survive. Payers – including Medicare, Medicaid, and private health plans- will demand standardization and restructuring of the medical history to achieve consistency in medical records. Patient-entered information may be disruptive. Doctors will have to change practice flow patterns to adjust to reality of lower pay. The need for greater productivity will drive this change.

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