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Fantastic job: HHS ONC subject matter expert on consumer e-health

Josh Seidman has written from ONC telling us about a fantastic job opportunity. You get to work with the brilliant folks at ONC on fun stuff regarding consumer e-Health. What does that mean? From the posting.

  • Forge alliances with consumer organizations, technology and care delivery innovators and consumer advocates to further the consumer e-health agenda.
  • Develop consumer oriented strategies across the Office of the National Coordinator for Health Information Technology (ONC).
  • Serve as Project Officer providing project management oversight for contracts, including designing, developing and coordinating project management plans for policy initiatives in conjunction with the Division Director and the Office of Policy and Planning Director.

We’ve been very impressed by everything we’ve seen about ONC’s commitment to patient communication—not least the “sneaking-in” to the meaningful use requirements in Phase 1 of patient education materials (what Don Kemper calls Christmas in July). I can’t think of a more fascinating job for anyone who cares about online health.

So if you’re interested here’s the link to apply

Innovation and Absence of Evidence vs. Evidence of Absence

Congress

Jon Gabel from the National Opinion Research Center has an excellent op-ed piece in today’s New York Times. The basic argument is summarized in his conclusion:

“The Congressional Budget Office’s integrity is beyond questioning. But the record shows that it has substantially overestimated the cost of health care reform three times out of three. As Congress now works on its greatest push for reform in generations, the budget office needs to revise the methods it uses to make predictions about costs.”

Far from being an arcane methodological debate, CBO’s approach has profound consequences for health care reform and for the long-term health and economic conditions of the country. As Gabel puts it:

“The budget office’s cautious methods may have unintended consequences in the current health care reform effort. By underestimating the savings that can come from improved Medicare payment procedures and other cost-control initiatives, the budget office leads Congress to think that politically unpopular cost-cutting initiatives will have, at best, only modest effects. This, in turn, forces Congress to believe it can pay for reform only by raising taxes, which then makes reform legislation more difficult to pass.”

The reason that CBO has underestimated savings from past reforms of Medicare is that it makes the assumption that — without convincing empirical evidence of an initiative’s cost impact — it basically “scores” it as delivering zero savings. No doubt that CBO is consistent and conservative, but that doesn’t necessarily produce the most accurate budgetary forecast.

Perhaps more so than any other area in the federal budget, there are an enormous number of unknowns in health care. CBO has historically built its model on the premise that absence of evidence equates with evidence of absence.

But there is a major distinction. “Evidence of absence” means that we have an empirical reason to believe that there is no effect of an intervention (in this case on cost). In that case, it makes sense to score zero savings.

In contrast, “absence of evidence” simply means that we do not have sufficient evidence that an intervention produces any effect.  The problem is that, by definition, any true “innovation” (defined by Merriam-Webster as “the introduction of something new”) has no evidence. Which is to say: CBO has effectively ruled out scoring savings for true innovation.

Perhaps some would argue that’s an overstatement in that we certainly commonly use the term innovation to describe something that has been around long enough to be tested. Yes and no. There’s no doubt that new and innovation are relative terms, but there are still important reasons why that approach for CBO remains flawed.

First, evaluation takes time. To design a study, appropriately manage it, collect and analyze data, submit to peer review, and publish often takes many years.

Second, the level of evidence that CBO typically requires takes A LOT of time.

Third, innovation often comes from combining different initiatives and strategies that create a combined effect greater than the sum of their parts. Information therapy, patient decision aids, comparative effectiveness research, and other delivery system reforms may have a powerful impact when thoughtfully and appropriately combined together.

Fourth, the pace of innovation and the greatest innovative impacts can be dramatically robust. There is no way, in its current model, for CBO to capture those things that will have the most important effects on the federal health budget.

Like Jon Gabel, I don’t question the CBO’s integrity or analytical capacity, but I do believe that its methodological approach requires amendment. As I have written before, we — as health services researchers (and I admit to being one myself) — need to maintain our analytical rigor while being as creative in our research methods as the innovators are at innovating.

We should not shy away from the empirical idiosyncrasies that innovative care delivery initiatives create. Rather, we should rise to the challenge by employing a broader set of research and analytical skills to tackle these compelling research questions about new innovations. Indeed, the new care delivery strategies create opportunities for health services researchers to develop their own innovative research techniques.

I hope that health services researchers out there are up to that challenge.

If we aren’t, we will continue to create perverse public policy incentives.

Joshua Seidman is the president of of the Center for Information Therapy that aims to provide the timely prescription and availability of evidence-based health information to meet individuals’ specific needs and support sound decision making.  He frequently blogs for THCB and the Center for Information Therapy Blog, where this post first appeared.

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From Health 2.0 meets Ix: A Breathtaking Display of Possibilities

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(Boston) Jane Sarasohn-Kahn and I were quickly comparing notes this morning. Our impression is that, compared to past meetings, this one seems more characterized by doers than observers.

This conference brings together a dizzying array of tools and experiences, which is testament to the organizers’ encyclopedic handle on the vast diversity of activity in this sector. Josh Seidman, Indu Subaiya and Matthew Holt have done yeomans’ jobs in putting these impressive presentations together.

Mingling, I’ve spoken to person after person actively involved in mostly consumer-oriented ventures, leveraging science and user-generated information to facilitate a more favorable patient experience. There are some real steps forward, like the demo that Mayo and Microsoft showed, that takes information entered into Health Vault and applies the rules that Mayo has developed through many years of experience. Or the work that groups like Up-To-Date and HealthWise are doing, that continually, organically update descriptive information throughout medicine and health care.

Continue reading…

CAP’s Blueprint for reform

The Center for American Progress (CAP) released a new “Blueprint for Reform” that focuses on how to fix the delivery system. This well-constructed
document and provocative forum was spearheaded by CAP CEO John Podesta (former Clinton White House Chief of Staff) and Jeanne Lambrew.

There are a few things that really show good progress in the
national debate. First, the fact that CAP has chosen this critical time
at the precipice of the national health care reform debate to focus
attention on reforming care as well as coverage will be helpful to
facilitating that discussion in 2009 policy debates (they, of course,
support coverage initiatives as well but those aren’t addressed in this
document).

Second, the quality and thougtfulness of the work and recommendations is high. Not surprising given the exceptional collection of authors with each chapter co-authored by a physician and a policy expert. These
include: Don Berwick, Tom Lee, Judy Hibbard, David Blumenthal, Bob
Berenson, Paul Ginsberg, Steve Schroeder, Dora Hughes, Chiquita
Brooks-LaSure, Karen Davenport, and Katherine Hayes.

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Baseball and Health Care: Only One Is a Spectator Sport

It’s fascinating when two of my passions collide in the opinion pages of the New York Times like they did over the last week. On Friday, October 24, some seriously strange bedfellows came together to write about, “How to Take American Health Care from Worst to First.” Strange enough that Newt Gingrich and John Kerry joined together, but
the lead author was Billy Beane, often thought to be the pioneer in the
trend toward data-driven major league baseball general managers.

I’ve been studying the health care system for nearly two decades,
but I’ve been studying sabermetrics (complex baseball statistics) since
a decade before that. So you’d think that their argument would resonate
with me and, to some extent, it does.

Their thesis is rational in many ways. Much of what is done in
health care has no evidence basis, and we end up spending a lot of
money on things that are unnecessary or even detrimental (or, at the
least, things for which we just don’t know). By developing a better
evidence base and encouraging more use of it, we could improve quality
and lower cost.

Continue reading…

Everyday Health & Revolution Health merger staying in 1.0

Everyday Health and Revolution Health have announced their merger, creating a consumer health Web site designed to challenge WebMD. The new company will operate under the name Waterfront Media.

There’s no doubt that they will get a lot of consumer traffic to their network of sites. One of the things that remains unclear for both Waterfront and WebMD is to what extent they will serve primarily as reference sources versus playing a greater role in consumers’ own health management. The answer may very well lie in the degree to which they provide information therapy (Ix), not just health information.

As 1.0 as it is, there’s certainly no shame in being a valuable reference tool. I’m a big fan of information democratization. But it’s impact on care management has limitations.

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2.0 takes off but benefits are not yet fully realized

A new report in McKinsey Quarterly on “Building the Web 2.0 Enterprise” suggests that companies around the world continue to deploy more Web 2.0 tools, but they have not yet figured out how to realize desired benefits yet.

Web20toolsOn average, the typical company responding to the McKinsey survey uses 3.4 Web 2.0 technologies including Web services, blogs, RSS, wikis, podcasts, social networking, peer-to-peer, and mash-ups (Web application that combines multiple sources of data into a single tool).

However, only 21% of respondents expressed overall satisfaction with Web 2.0 tools and an equal portion were dissatisfied. It wasn’t entirely clear from the data why that’s the case–though there was some suggestion based on data related to barriers to success of 2.0 initiatives–but there clearly is a long way to go (not surprisingly, given the nascent nature of 2.0).

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