As Anonymouse insightfully commented, the Harvard team’s RHIO study in Health Affairs is very telling
about the barriers facing do-gooder health care projects. That said, I wanted to add two comments.
First, while RHIOs are unquestionably good public policy, what they might accomplish can be seen as counter to their interests of many organizations expected to support them. (The same can be said for EHRs, by the way)
Second, this is why health care reform will emerge not from within health care and not from policy, but from the marketplace, driven by non-health care interests.
He is right, of course. There is no question that Medicare must rein in
cost. But the cuts are approximately the same across specialties and
therefore regressive. Insensitive to its distinct role, its lower
revenues and its high operational costs, they hit primary care harder
than they do specialties. Given its already battered status, the cuts’
impact on primary care could translate to real consequences this time.
In an extraordinary move earlier this week, the politically-appointed Fulton-DeKalb Hospital Authority, the governing body over Atlanta’s Grady Health System, unanimously and voluntary stepped aside, to be replaced by a new non-profit corporation. Projecting a $55 million deficit this year, the hospital had just three weeks of cash on hand. It needs $300 million immediately for sorely needed renovations, and must deal with $63 million in accumulated debt to its biggest creditors, Emory University Medical School and Morehouse School of Medicine. New oversight was the predicate for a hoped-for financial bailout from business, philanthropies and financial institutions.
Other Atlanta hospitals are undoubtedly concerned that Grady will fail, and will probably do everything possible to support a bailout. The last thing they want is for Grady’s patients to come to their facilities. Now would be a good time to rally business leaders and legislators, who nearly always go to fancier hospitals, which of course has been a big part of the problem.
Grady’s turmoil should be recognized as the first small shock of much larger seismic event, long in the making, a concrete sign of America’s relentlessly intensifying health care crisis. The wrath falls on our most vulnerable – those with health problems or with few financial resources – as well as on the institutions and professionals that care for them.
There are people who call for market solutions as the answer to every societal problem, but who then work to restrict the information that markets (and societies) must have to function effectively. Often, the truth is that these supposed market advocates need secrecy and opacity to protect their current advantages. If markets were to work as they claim they want, their actual behaviors (or pricing, or performance) would become known, and their positions compromised.
of the most fascinating and moving experiences at the Aspen Health
Forum – Given the quality of the content there, this is saying
something. The audience was rapt – was a talk by Neen Hunt, Executive
Director of the Lasker Foundation.
Each year this organization bestows a hugely prestigious prize to
individuals who have made significant contributions to scientific
medicine, clinical medicine and public service.
Dr. Hunt’s talk
focused on combating the geeky stereotypes that often are associated
with people with dedicated passions, and on conveying their broad
humanity. Her vehicle was a character portrait of Dr. Charles D.
Kelman, an ophthalmologist practicing in Manhattan during the latter
half of the 1900s, who in an incredibly bold stroke, blew past
convention, inciting the wrath of those tied to the established order,
and revolutionized the way that cataract surgeries are performed.
One of the attributes of a great image is its ability to convey vast amounts of information and meaning quickly and simply. Here’s a terrific example.
In one of his typically astute comments, Barry Carol alerted us to a wonderfully clever graphic by Wellington Gray – the image needs more space to be viewed properly than this blog allows, so you’ll have to click on the link – displaying the percentage of people older than 15 in different developed countries with a Body Mass Index greater than 30. In other words, the percentage of fat adults.
lingering doubts that America’s cavalier attitude toward lousy food and
obesity is draining the nation’s health and economic vitality should
have been laid to rest a couple weeks ago. Two important studies were released
that quantified just how much our inability to resist fast food is
In Health Affairs, the premier journal of
health care market dynamics, economics and policy, Professor Ken Thorpe
and colleagues from Emory reported on a study comparing incidences of chronic disease in the US and in 10 European countries.
They found strong evidence that Americans have much higher levels of
lifestyle-related chronic disease than do Europeans – in other words,
we’re sicker – that American medicine tends to identify and treat
disease more aggressively than does European medicine, and that our
more excessive lifestyles and aggressive treatment patterns undoubtedly
contribute significantly to our much higher per capita health care
spending, which can be twice what Europeans pay.
Laptop-attached ultrasound units that produce startlingly clear internal images for five dollars in the field. Organs that re-generate inside scaffolds. Drugs tailored to an individual’s biology. Micro-images of cancerous cells lit up by bio-chemical markers. Decision support tools that scan the physiological values in electronic health records for patterns too complex to be detected by an unaided clinician.
The advances available from dramatic improvements in computational capabilities were a recurring theme at the Aspen Health Forum, with experts from each discipline describing where the technology was leading us. I attended two sessions featuring Star Trek clips that predicted realities now within at least theoretical reach. (Prescient and corny, audiences nodded nostalgically.) Sessions on biotechnology, imaging, electronic health records (EHRs) and the hospital of the future highlighted the power that is being leveraged to improve care.
At one of the opening sessions of the Aspen Health Forum, Peter Agre and Michael Bishop, both physician researchers and Nobel laureates, recounted their childhoods, their families, their likes and dislikes, their school experiences, and the barriers, successes and lucky breaks that led them into lives of discovery. Dr. Agre won the award for identifying the mechanisms that allow water to cross the cell membrane. Dr. Bishop won for discovering how certain defects in genes can lead to cancer.
Those of us in the audience were struck by the commonness and good humor of their stories, but also by these individuals’ profound humility and, most of all, their passion. What Neen Hunt, Director of the Lasker Foundation, the third speaker on that panel, in her description of Dr. Charles Kelman, an ophthalmologist who revolutionized the way cataract surgeries are performed (more on that in another post), called “a rage to know.”
Before you start reading, download the document above. It’s a single PowerPoint slide that’s animated to build. Go into presentation mode, then read along with the narrative below.
The term Health 2.0 refers to the concept, described by O’Reilly in September of 2005, of Web-based platforms that allow users to reformulate data for their own purposes. The Health 2.0 movement is rapidly gaining steam and traction, propelled by established and startup firms. The efforts displayed at the recent Health 2.0 meeting in San Francisco, convened by Matthew Holt and Indu Sabaiya, were both wide-ranging and narrowly focused. Even so, several end-of-day panelists noted that, at this early stage, Health 2.0’s definitions and translations into practice remain murky and fragmented.
We thought it might be useful to try to develop an image of how Health 2.0 MIGHT develop: what its working parts were, what kinds of information it would receive and generate, who its users would be and what its impacts might be. The image that has resulted is simplistic; it doesn’t try to explore any of the underlying mechanisms necessary to pull this off. But it does try to convey a vision of how innovators might come together to aggregate and reformulate large data sets from disparate sources to create tremendous new utility in the marketplace for patients, clinicians and purchasers of all types.