Tag: Startups

Using virtual reasoning to redefine health care

Jul 1, 2008• 2

By Marlene Beggelman

Dr. Marlene Beggelman is the CEO of Enhanced Medical Decisions, which is the company behind DoubleCheckMD.com.

The Internet is redefining the health care industry. Major transformations can be expected because Internet-based technology will deliver certain health care services more effectively and at lower costs. In the near future, much of the information that is currently imparted to consumers by clinicians will be delivered through and by web-based technology. If the web-based tools that deliver this information mature to the point of becoming reimbursable, beyond their current usefulness as value add-ons, the health care industry could experience a dramatic shift.

Today’s news today, doctors, Peel, and individual insurance

Jun 30, 2008• 4

By Matthew Holt

I just noticed that THCB today is all about last week and Sunday’s news—including Merrill Goozner and me jumping separately on the same magic quote in the NY Times CT piece. So how about three little pieces of news about stuff reported today.

First off, in a desperate attempt to keep the Republicans from losing all 33 Senate seats in November, CMS is freezing the cuts in Medicare fees which were due to go automatically into effect this week. Bob Laszewski has a just excellent explanation of how the Dems finally seem to have figured out how to play hardball with the Republicans and AHIP. Perhaps they’ve taken on Tom Delay as an advisor, now he’s not so busy. Meanwhile Bob thinks that the 7 missing Republican votes will return from July 4 and the Medicare Advantage and PFFS plans will get their comeuppance. Wall Street isn’t so sure, and those health plan stocks are trading higher today.

A classic from a cardiologist

Jun 30, 2008• 5

By Matthew Holt

The NY Times has a long piece on the fast spread of 64 slice CT scans and their using in cardiac imaging. This is all pretty much taken straight from Shannon Brownlee’s fabulous book Overtreated which has a whole chapter on the topic. But it’s good to get the debate out there.

It appears that essentially there’s no real reason to use these scanners for the vast majority of patients. And in fact they’re use probably leads to more unnecessary angioplasties and stenting (which in itself doesn’t seem to reduce the number of heart attacks). But of course once a practice buys a 64 slice CT it’s an ATM machine sitting in the corner—not much good if you don’t use it, but very profitable if you do. Of course, the more conservative approach gets short shrift and those waiting for evidence to justify all this spending get ignored in the rush by both doctors, hospitals and manufacturers to get at the taxpayer’s coffers.

I was though vastly amused by this quote from an Manhattan cardiologist which will bring joy to the ears of those fuddy-duddies in the pay for performance movement:

Cardiologists like Dr. Brindis hurt their patients by being overly conservative and setting unrealistic standards for the use of new technology, Dr. Hecht said. “It’s incumbent on the community to dispense with the need for evidence-based medicine,” he said. “Thousands of people are dying unnecessarily.”

Of course he just knows that thousands are dying due to lack of these scans, so why do we need any evidence!

Markle promotes a privacy standard

Jun 26, 2008• 1

By Matthew Holt

The Markle Foundation put together a group creating a road map over the last few years and today they announced their new policy framework for privacy in PHRs and personal health information. In general this is a great framework, and hopefully will help gain more consumer confidence in PHRs and other uses of personal health information online by consumers and doctors. (The AMA was on the call and was a “supporter” if not an “endorser”).

Overall I’m not sure that privacy is that big a deal (as I’ve written elsewhere). Given the choice between being private and being useful, most people pick useful. (You’ll give out your Social Security Number to just about anyone to make a credit check). So I think that PHR and consumer online services need to be useful first. It was a little telling that when someone asked if this would change any of the PHR vendors actual activity, they all said that they’d been adhering to these processes all along! But there is something to being publicly and loudly transparent about it.

Universal access to high speed Internet

Jun 26, 2008• 6

By Sarah Arnquist

Achieving universal Internet access may happen well before we see universal access to health care — at least if the advocacy group Internet for Everyone has its way.

The Mercury News reports that a "broad coalition of Internet business leaders, online gurus, community organizers and advocates across the political spectrum launched a campaign Tuesday with the lofty goal of universal high-speed Internet service."

The group is driven by the ideals that "Everyone must be connected to a fast, affordable and open Internet connection to prosper in today’s economy and participate in our democracy. The Internet is no longer a luxury. It’s a lifeline."

Increasing access to broadband Internet is obviously important to
expand the use of personal health records and other health 2.0
technologies, but on a more basic level it’s key to eliminating health
disparities.

Communicating and informing people about their health and major health care issues are integral parts of eliminating
health disparities. And that communication increasingly occurs
electronically on the Web. So expanding access to affordable Internet
and improving public health go hand in hand.The coalition will
hold forums around the nation and try to build support for plans that
improve access, choice and innovation. To learn more about the movement
or participate in upcoming hearings, you can email the organizers at co*****@*****************ne.org.

Internet expert fields questions on participatory medicine

Jun 26, 2008• 1

By Susannah Fox

I always suspect that audience members have as much to share as I have to say. So when Mary Madden and I received an invitation to speak at the National Institutes of Health we created a participatory talk about participatory medicine: 35 minutes of our findings; 45 minutes of discussion.

It was a blisteringly hot day, so we ended up having 50 people in the room and about 50 more watching the videocast from the cool of their offices on the NIH campus. The video is a little blurry, so I recommend treating it like a podcast and downloading the slides separately, but you might enjoy hearing how we wove together our research on digital footprints, Web 2.0, and health.

Here is a sample of the excellent questions we were asked and our attempts to answer them:

Online bullying care management works

Jun 25, 2008• 2

By Matthew Holt

So says a study out in JAMA today from Group Health of Puget Sound. They randomly divided high blood pressure patients into three groups. Being Group Health members they all had online access to the MyGroupHealth site and services, but the second group got blood pressure cuffs and training on the site. That made no difference. But the third group got all that and online counseling from pharmacists about every two weeks.

After 12 months, about one-third of the patients in the first two groups achieved normal blood pressure. However, with the Internet-based pharmacist care, more than half the patients got their blood pressure down to normal.

Which is both good and bad news. Good news because it’s somewhat scalable to have online counseling from clinicians, in that it’s more convenient for patients and clinicians. Bad news because it’s much, much more scalable to have computers do all the work. But currently computers alone, even when the patients are given more training and services don’t do much better than general medical treatment.

Much of what needs to be done to make care management effective is to figure out how to replace and augment the most precious resource (skilled humans) with a cheaper one (less skilled humans, possibly a long way away, and computers). But at least this combination has been shown to be effective.

Can Connected Health survive the political economy of health care?

Jun 25, 2008

By Matthew Holt

Jennifer Priester & Joe Kvedar over at Partners’ Center for Connected Health asked me to step in and be the guest host of their discussion group for the month. I wrote a piece called, Can Connected Health survive the political economy of health care?

Please go take and look and of course feel free to join in the discussion there.

Health care is not recession-proof

Jun 23, 2008• 10

By Jeff Goldsmith

It is often accepted as conventional wisdom that health care is recession proof.

People get sick regardless of economic cycles, and the publicly funded safety net programs insure that people who need care get it. Yet if you look around the health system, what you see looks suspiciously like a recession: low single digit pharmaceutical cost growth, a collapse in high tech imaging and cardiovascular sales and clinical volumes, declining hospital admissions and rising bad debts. Is it possible that health care isn’t recession proof after all?

Untangling the electronic health date exchange

Jun 23, 2008• 12

By David Kibbe Kibbe

The purpose of this post is to help a non-technical audience untangle some of the confusion regarding health data exchange standards, and particularly come to a better understanding of the similarities and differences between the Continuity of Care Record (CCR) standard and the CDA Continuity of Care Document
(CCD). But what I’m most interested in is getting beyond the technical, political, or economic positions and interests of the proponents of any particular standard to arrive at some principles that demonstrate in plain language what we are trying to achieve by using such standards in the first place.

Frankly, I don’t give a hoot about what standardized XML format for
capturing clinical data and information about a person becomes the norm
in the health care industry over the next several years. I do care
that the decision is made by the people, institutions, and companies
who use the standards, and not made by a quasi-governmental panel or a
group of "industry experts" whose economic or political interests are
served by the outcome, and dominated by a particular standards
development organization with whom they are very cozy.

In other words,
I do want free and open market forces to be able to operate freely and
openly as health information exchange evolves, in part because I
believe market forces will work in the direction of continuously
improving health IT, whereas in my experience top-down efforts are
often protective of established interests and discouraging to
innovation.

Editor’s note: When republishing Kibbe’s post today, we accidentally deleted the great conversation going on in the comments section. If your comment was deleted, we encourage you to submit again.