The Health Care Blog – Page 1002 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Why no e-Prescribing in the ED?

May 22, 2008• 1

By PAUL LEVY

As previously reported,
we have a wonderful system that permits doctors to order prescriptions
online, allowing patients to pick them up directly from their preferred
pharmacy. Recently a friend of mine went to our BID~Needham Emergency
Department, and came home with a script to get her prescription from
our pharmacy. So I inquired. Our ever helpful CIO, John Halamka,
explained:At present, e-Prescribing in the US is generally
limited to primary care practices and specialists who act as primary
care givers, i.e. cardiologists, ob/gyns, pulmonary docs, etc.
Massachusetts is the number one e-Prescriber in the country, yet only
13% of the routable prescriptions in the state go electronically. BIDMC
ambulatory clinics use it, and they are routing 35% electronically,
increasing every month.At BIDMC and BID~Needham Emergency
Departments, prescriptions are written electronically and printed to
tamperproof paper on laser printers in the department. To my knowledge,
there are no Emergency Departments in the state using e-Prescribing.
Here’s the challenge1. It is currently illegal to e-Prescribe
any controlled substance — pain killer, sedative, anti-anxiety drug
etc. Approximately 1/3 of all Emergency Department prescriptions are of
this type. Recently, the Massachusetts Department of Public Health was
able to get a DEA exemption to test one site (Berkshire Medical Center
using Meditech software) to e-prescribe controlled substances. The DEA
wants this to be a three year pilot , which illustrates how resistant
to change the DEA can be. I’ve just signed a letter along with many
health care standards and pharmacy leaders urging Congress to get
involved and accelerate the ability to e-Prescribe controlled
substances as a modification to Medicare Part D standards.

Penalties are like kissing your sister

May 22, 2008

By Matthew Holt

The LA Times said it best: John Terry’s late slip-up ruins night for Chelsea’s fans. Another perfectly good football/soccer match ruined by a penalty shootout. It used to be that important finals that ended in a draw produced a replay. Penalties were only used in tournaments when there was a need to produce a winner for the next round.
Now many, if not most, big finals are ended that way and it sucks.

It particularly sucks when the team I’ve supported since I was 5 — including all the way through the very lean years in the 1970s & 80s and long before any Russian billionaire bought it — finally gets to the European Champions League Final, and then loses on penalties. Especially when the player who is the local boy and the rock of the team misses the vital one.

So donât expect much cheerieness around here today!

American Cancer gets hip on uninsurance

May 22, 2008

By Matthew Holt

The American Cancer Society is focusing all its marketing budget this year on the issue of uninsurance and is trying to get the message out in new ways to new audiences. Here’s one using rap/poet MIKE-E.

Against Obama, polls show McCain lags on health care

May 21, 2008• 4

By Robert Laszewski

The latest Washington Post-ABC News poll on health care should give John McCain reason to be concerned.

The early May poll asked voters, "Regardless of whom you may support, whom do you trust more to handle health care?" The answer was Obama by 55 percent and McCain by 31 percent. And this poll was done a few days after his much publicized week-long health care tour.

McCain also did poorly on the other economic issues, although not as
badly. On gas prices, it was Obama 48 percent and McCain 28 percent. On the economy
in general, it was 48 percent to 38 percent.

McCain did better on the war on terror — 55 percent to 34 percent. The two tied over who would do the best in Iraq. It is still early and polls are notoriously unreliable this far out.
But my sense is that McCain has some big work to do on health care.

Google Health finally up and open for business

May 20, 2008• 3

After a long time in discussion, Google publicly launched Monday its free online personal health records. The operation first made headlines a couple of months ago when Google announced it at the Healthcare Information and Management Systems Society (HIMSS). I was invited to the Googleplex, but due to a prior engagement, had to miss the chance to get it from the horses mouth.

Much like the "non-PHR" HealthVault, Google now allows consumers to download records from its eight initial partners and store them for free.

As the WSJ Health Blog points out, only a minority of medical practices keep records electronically. But the good news is that Google has been thinking not just about EMRs, but also about the rest of data that’s most useful (Rx and lab results) and has some big players, such as Medco, Walgreens and Quest on its list of initial partners.

Google will also have to spend more time now dealing with the privacy zealots and not just leaving it all to, well, me!

Although I wasn’t there, a much more famous health IT person was. John Halamka is the Chief Information Officer at one of Google’s initial partners, Boston’s Beth Israel Deaconess Medical Center (and of course colleague of THCB regular Paul Levy, and more recently himself a blogger). BIDMC has offered its patients a PHR for more than 7 years, and now that data can be brought into Google Health (and I assume vice versa). John’s post about the launch is below — Matthew Holt

By John D. Halamka

Beth Israel Deaconess Medical Center is now live with Google Health. In the interest of full disclosure, I am a member of the Google Health Advisory Council and have not accepted any payments from Google for my advisory role. BIDMC is also working with Microsoft Health Vault and Dossia.

I’m now at Google Headquarters in Mountain View with the Google Health team – Roni, Missy, Maneesh, Jerry etc. and several dozen reporters.

Here’s the functionality we’ve launched.

When a user logs into Google Health and clicks on Import Health Records – the following choices appear:

BIDMC
Cleveland Clinic
Longs
MEDCO
Minute Clinic/CVS
Quest Laboratories
RxAmerica
Walgreens

They are all early integrators with Google Health.

At BIDMC, we have enhanced our hospital and ambulatory systems such that a patient, with their consent and control, can upload their BIDMC records to Google Health in a few keystrokes. There is no need to manually enter this health data into Google’s personal health record, unlike earlier PHRs from Dr. Koop, HealthCentral and Revolution Health. Once these records are uploaded, patients receive drug/drug interaction advice, drug monographs, and disease reference materials. They can subscribe to additional third party applications, share their records if desired, and receive additional health knowledge services.

Humana’s competition for change

May 20, 2008• 6

By Jen McCabe Gorman

Health benefits heavyweight Humana Inc. (HUM – 11.5M members) recently launched ChangeNow4Health, an ambitious, optimistic coalition inviting anyone to submit ideas to fix America’s ailing health care system.

The top three entries receive a $10k prize, and the top 20 get publication exposure galore, including a spot in Humana’s forthcoming e-book, “Tomorrow’s Health Care.” The big winning concepts have a chance to secure further funding and incubation support from Humana.

Full Disclosure: Shortly after this interview was conducted, ChangeNow4Health became a sponsor of The Health care Blog. However, if you think that in any way influenced the content of this article, you don’t know the Health 2.0 folks very well…

Cn4hds

On the second day of World Health care Congress 2008 in Washington D.C., I interviewed Elizabeth Bierbower, Humana’s Vice President of Product Innovation.

Bierbower, who has spent her career working with consumers, told me that ChangeNow4Health is looking for doable ideas that can quickly be put into play in the game as it is now, not how we wish it were.

They’re also harnessing the power of the semantic Web by partnering with Innocentive.com, an online community that posts projects from groups like the Rockefeller Foundation.

The contest has 4 categories:

Helping Consumers Make Smarter Health Care Decisions

Simplifying the Business of Health Care

Preventing Sickness and Maintaining Health

General Innovations in Health Care

The contest runs through July, and winners will be announced in August. Judges include industry experts, who are looking for “both an idea’s potential to bring about true change in a tangible way” and “feasibility for implementation now.”

Here’s a transcript of my conversation with Bierbower.

The Technology Hype Cycle: Why bad things happen to good technologies

May 19, 2008• 4

By Robert Wachter

Robert_wachter
Fresh on the heels of my recent bar coding epiphany comes another “unintended consequences” article. It turns out that the whipsawing that accompanies the adoption of new technologies is completely foreseeable, the “Why doesn’t this thing work right?” phase is as predictable as the seasons.

Thanks to Dr. Mark Wheeler, Director of Clinical Informatics of PeaceHealth, for introducing me last week to the “Technology Hype Cycle” concept. The Cycle, originally described by the IT consulting firm Gartner, is comprised of an all-but-inevitable series of phases that technologies tend to traverse after they are introduced. The five phases are:

Technology Trigger – The initial launch; a new technology reaches public or press attention.

Peak of Inflated Expectations – A few successful applications of the technology (often by highly selected individuals or organizations) help catalyze unrealistic expectations, often aided and abetted by hype driven by word of mouth, the blogosphere, or vendor spin.

Trough of Disillusionment – Virtually no technology can live up to its initial PR. As negative experience mounts, the balloon is pricked and air rushes out. The press moves on to cover another “hotter” technology, like a moth flitting to the light (see Phase II).

Slope of Enlightenment – A few hardy individuals and organizations, seeing the technology’s true potential, begin experimenting with it unencumbered by inflated expectations. Assuming that the technology is worthwhile, they begin to see and demonstrate its value.

Plateau of Productivity – As more organizations ascend the “Slope of Enlightenment,” the benefits of the technology (which by now has improved from its initial clunky phase) become widely demonstrated and accepted. The height of the plateau, of course, depends on the quality of the technology and the size of its market.

Going off the Grid – The Rise of ‘Direct Practice’ Medicine

May 19, 2008• 3

By Scott Shreeve

Grid (grĭd) n.

1. Something resembling a framework of crisscrossed parallel bars, as in rigidity or organization

2. An interconnected system for the distribution of electricity or electromagnetic signals over a wide area, especially a network of high-tension cables and power stations.

3. The interconnected system employed by the Medico-Industrial complex to create a third party payment systems which artificially creates complexity, increases costs, reduces quality, eliminates accountability, and destroys the patient-physican relationship.

As has been documented in this blog, I have been on a health care finance reform journey for the last six months. I was fortunate to be given the opportunity to work with Lemhi Ventures (outstanding group of health care innovators) on looking at new models of health care delivery, financing, and insurance. During the course of that project, I learned a ton about the nature of health insurance, current status of health plans (there has been plenty of interesting news the last six months on them here, here, here, and here), followed closely the presidential debates on health care reform and become familiar with many of the innovators within this space (Prometheus, Alan Goroll, etc)

A new article just published by MDNG Live (the same magazine that featured my cover story “Meet Your New Patients” last month) showcases Jay Parkinson with the catchy title, “Jay Parkinson Sells Out!” Catchy because one thing I don’t think you will be able to call Jay is a sellout. In fact, his “stick to my guns; this is how I believe medicine should be practiced” approach has enamored him to the public media and vicariously documented the groundswell of interest in this “new” health care delivery model. “New” in quotes, of course, because there is nothing new about this model of care delivery – a patient and a physician entering into a trusted relationship wherein the physician provides services that are valued by the consumer who pays cash for them. The millennial update is that physicians can now do this in new ways, with new devices that have become commonplace in every day life except for in the inane and archaic world of health care.

Malpractice premiums fall in Massachusetts

May 19, 2008• 3

By THCB Staff

Bay State doctors paid lower malpractice insurance premiums on average in 2005 than 1990, according to a new Health Affairs study. The study clashes with popular beliefs frequently touted by sponsors of legislative efforts to cap damage awards.

“If you don’t find a crisis here, you’re probably not going to find one nationally,” lead author and Suffolk University Law School scholar Marc Rodwin told The Boston Globe. “Clearly there are some increases in premiums and high premiums for a small percentage of doctors in three specialty groups, but that’s entirely different for the rest of doctors.”

Malpractice settlements in Massachusetts are the fourth highest in the nation, and the American Medical Association lists it as one of 21 states being in a crisis due to high medical malpractice payments and lack of laws to cap settlements, the Globe reports.

The Suffolk study found that most Massachusetts physicians paid an average of $17,810 in premiums in 2005, slightly less than the $17,907 paid in 1990, after adjusting for inflation.

The researchers analyzed data from 1975 to 2005 provided by ProMutual Group, the insurer for about half of the state’s doctors.

Rates for specialists in obstetrics/gynecology, neurological surgery, and orthopedics involving spinal surgery increased on average from $66,220 in 1990 to $95,045 in 2005.

So is malpractice reform a distraction from real health reform debate? Probably, but it is one that must be dealt with to get docs on the side of real health care reform.

Wishing for a smart health search

May 18, 2008• 4

By Dan Kogan Dankogan

Health care consumers today want to use the Web to find information online about doctors, specialists and care in general. And they want it to be useful.

Unfortunately, in the vast health search space based mostly on ad revenue and keyword densities, consumers often spend hours clicking links into dead ends and wind up with no more knowledge for their trouble.

A semantic Web promises more accurate and meaningful results, yet this technology is in its infancy. And most “trusted” health sites do not yet support semantic searches. Moreover, semantic search requires some knowledge of how to construct a search query as opposed to a simple Google-style search.