Tag: Uncategorized

Gaming for health

Aug 8, 2008• 10

By James A. Cooley

James Cooley works for a big Texas state agency doing health care policy analysis and research, with a specialty in health care IT. His research and analysis projects cover e-prescribing, telemedicine, EHR & PHR and beyond. That is his way-cool day gig. At night, he is a passionate computer gamer who builds his own custom rigs and struggles to squeeze out a few more frames per second with everything maxed out.

I admit to a fascination with Health 2.0. I see it as the place where a lot of the things that look promising in health care and technology are all mashing together. Xbox

As a follower of developments in both the health 2.0 movement and the gaming industry, I came across the following article that piqued my interest. It deals with the deal reached between Netflix and Microsoft to facilitate movie downloads to those using the XBOX Live network.

Reading this, I got to thinking it might have implications for Health 2.0. The question: Why not use these emerging gaming and movie delivery platforms to deliver interactive health care and fitness content.

Hmm, I wondered further: Would Netflix consider a deal with Microsoft to permit XBOX 360 users access to free download of certain interactive health care information content? I could see modules for management of certain diseases (including those that impact young people, such as asthma). There could also be modules with health and fitness activities that incorporate interactive video and gaming elements.

Using 2.0 tools to improve health communication by 2020

Aug 7, 2008

By Sarah Arnquist

2010

Recognizing that in the two decades since Healthy People 2000 first laid out the nation’s health objectives, the internet has revolutionized how people seek and share health information, U.S. health officials are updating the nation’s health goals for the next decade and want to harness the power of e-health and Health 2.0 in their data collection and goal setting.

On Social Marketing and and Social Change is hosting a series of bloggers and discussions about the future of health communication and its role in the Healthy People 2020 goals.

"This is where talking about health and inspiring people to get involved in national health promotion and disease prevention policy meet," says blog host Craig Lefebvr. "If you’d like to contribute a post, or want to cross-post on relevant topics, please let me know and let’s work something out."

Health Wonk Review is up

Aug 6, 2008

Robert Laszewski hosted the review over at Health Care Policy and Marketplace Review.

Dear Medicare: Happy birthday!

Aug 6, 2008

By Richard Propp

Since I first met you on July 31, 1965, I have been smitten with your looks, your fairness, your support of the elderly without regard to social or economic status, skin color, ethnicity, intellectual IQ, emotional IQ, address, clubs, choice of transportation, hobbies, reading list, or favorite restaurant. You took care of our grandparents, our parents, and now you are taking care of us!

Your birth was not without pain. Some of the Southern congressmen could not stand the idea of people with differing skin colors being in the same hospital room. Eventually President Lyndon Johnson, his staff, and senior citizen groups, wore down Congress, the insurance industry, the unions, and the American Medical Association, and Medicare, health care for all Americans aged 65 and over, became law. It was implemented in July of 1966. Health care was not just a necessity, it was now a right for these folks.

NICE job. Cost-effectiveness in the UK

Aug 5, 2008• 18

By Matthew Holt

Yesterday I went to a high powered lunch put on by HealthTech, with a high powered crowd attending (including the head of the California Dept of Managed Health Care, lots of Kaiser Permanente people, Arnie Milstein from Mercer, et al).

The speaker was Andrew Dillon, the head of the National Institute for Clinical Excellence (NICE), the UK’s technology assessment agency. But unlike the late and somewhat lamented Congressional OTA that the Republicans killed in 1995, NICE has teeth. NICE is only well known in the US as being the agency that stops new wonderful treatments getting to blighted Brits who are instead left to die in the streets.

The way this works, as Dillon explained to the somewhat incredulous head of the California Dept of Managed Healthcare (and I paraphrase) was that if NICE says something’s off limits (such as a new drug) a doctor won’t prescribe it. And if they did, the pharmacy wouldn’t fill it. And if they tried to, well they wouldn’t find it because the hospital wouldn’t have bought it. Such power! And I’m sure the envy of the many regulators and payers in the room.

However, Dillon explained that contrary to popular belief there isn’t a straight cut off point for approving new technologies.

The Healthcare MacGuffin?

Aug 4, 2008• 9

By Bob Wachter Robert_wachter

Last week’s ABIM Foundation Summer Forum focused on patient-centered care… and who could be against that? But is patient-centered care just a healthcare MacGuffin?

What’s a MacGuffin, you ask? In a spectacular talk at the Forum, Michael Richardson of Chicago’s Hines VA reminded us that the MacGuffin was one of Alfred Hitchcock’s favorite directorial strategies. Hitchcock defined the term this way:

MacGuffin:
a plot device that motivates the characters or advances the story, but
the details of which are of little or no importance otherwise.

I
loved Richardson’s analogy when I heard it, but its utter aptness
became clear only as the conference proceeded. Let’s start with the
areas of general agreement (thanks to Jim Naughton, Chair of the ABIM
Foundation, for articulating these points):

Patients’ preferences should be respected.
We should attend to patients’ emotional needs, context, comfort and meaning.
Patients should be engaged and empowered.
There should be shared decision-making that promotes patient autonomy.
Family and friends should be involved in care decisions where appropriate.
Care should be coordinated within and across systems.

Well, sure.

But then things became a bit fuzzier. The conference’s first talk was framed as an egregious example of what happens when care isn’t patient-centered. Margaret Murphy,
a soft-spoken, matronly Irish woman who now serves on the Patient
Steering Committee of the WHO’s World Alliance for Patient Safety, told
the tragic, infuriating story of her 19-year-old son Kevin’s needless
death. Somehow this young man with classic hyperparathyroidism
(“stones, moans, bones, and abdominal groans” – a constellation of
symptoms recognizable to any decent 3rd year medical student) was
misdiagnosed for the better part of a year, in a tragedy of cognitive
(he carried the presumptive diagnosis of leptospirosis for months) and
logistical (his hypercalcemia was noted on a Post-it Note that got
stuck to the back of a piece of his chart and went unseen for weeks)
errors.

This isn’t a lack of patient-centered care. This is
unconscionably bad doctoring, mixed with really awful systems, pure and
simple.

Dilemma of declining revenues and patient care

Aug 4, 2008• 3

By Jane Sarasohn-Kahn

Health providers want to provide quality care and improve patient satisfaction. Really, they do. It’s just that pesky problem of declining reimbursements getting in the way of meeting those two key business objectives.

This dilemma comes to you courtesy of a survey conducted by IVANS, Inc., the company that helps providers process health transactions. IVANS found that about 50 percent of providers derive over 50 percent of their income from Medicare. As Medicare continues to be fiscally challenged, providers’ fiscal pain from this payer will increase.

Readers respond to the primary care crisis

Jul 31, 2008• 6

By Sarah Arnquist

Two recent posts by Matthew and Bob Wachter on the crisis in primary care sparked great debates in the comment sections.

Matthew’s inference that Medicare’s bankruptcy will be fast upon us if everyone with brain cancer received an experimental surgery like Sen. Ted Kennedy recently had evoked this response from Bev. M.D. Tedkennedy

Kennedy’s case is an excellent example of why evidence-based medicine
will never translate into a "cookbook" of completely standardized
practice. As a pathologist who has looked at this nasty tumor under the
microscope too many times, glioblastoma is almost uniformly fatal
within, at most, a few years. But each patient’s tumor, and each
patient’s age and medical background, and each patient’s will to fight,
is different. Also, many medical advances are made by doctors
courageous enough to defy standard opinion who achieve good results and
then over time develop a track record to make their treatment an
accepted and evidence-based one. Therefore, one cannot apply a uniform
and permanent EBM rubric of – gonna die anyway, don’t operate – to all
glioblastoma patients for MEDICAL reasons. However, one COULD apply it
for social/political/economic reasons, and therein lies the basic
conundrum before us.

Deeper in the comments, Peter wrote:

Bev, I agree to a point, but why should there be only two people
involved in the decision – the doctor, who gets paid when he/she
operates using someone else’s money, and the patient, using someone
else’s money, and therefore has nothing to loose. If we went with this
thinking then who stops all the Mickey Mantle decisions? Is every Terri
Schiavo worth keeping on life support waiting for God to perform a
miracle? Would a Medicaid patient get to go to Duke and obtain the same
try? I know this discussion goes around in circles forever but there
must be a better way if we are going to avoid bankrupting the "system."

From Description To Action: The Future of Health 2.0 Tools

Jul 28, 2008• 1

By Brian Klepper

Last week, The Health Care Blog ran two articles about new wiki sites
that will develop
and continuously update medical information. A wiki
is a “content collaborative” that allows anyone (or anyone authorized
by the site) to contribute or modify content; Wikipedia is the best
known example. H20logo

In Medicine Meets Wiki, Jane Sarasohn-Kahn brought our attention to MedPedia, a
collaboration between major academic institutions and governmental
agencies to clearly describe the entirety of current medical knowledge.
Then Bob Wachter described Google’s new Wikipedia competitor, Knol, and
suggested sites like this could threaten the stranglehold that
traditional medical journals have had on emerging information.

If McCain chooses Romney as a running mate, Obama’s health plan is off-limits to attacks

Jul 28, 2008• 2

By Robert Laszewski

John_mccain
Mitt Romney seems to be at the top of the list when it comes to speculation over who John McCain will pick for his vice presidential running mate. I am not sure if that is what John McCain is thinking as much as the Romney people, trying to boost their guy, want us to think.

But if McCain picks Romney, it will make for an interesting health care debate this fall.

The Obama Health Plan is a virtual clone of the Massachusetts health law. Romney signed it and continues to support it–most recently a couple of weeks ago in an enthusiastic Wall Street Journal Op-Ed.

With Romney on the Republican ticket, how would McCain ever be able to criticize Obama’s proposal as just another Democratic government-run tax and spend health plan?