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POLICY: Not Too High on The Hog

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My, hopefully, final reply to the “we spend more because we do it better” argument from the free-marketeers is up over at Spot-on, called Not Too High on The Hog—a reply to David Hogberg. As ever come back here to comment.

I have my research, analysis and data. And the free marketeers, like David Hogberg, have theirs. Jonathan Cohn, whom I defended from another free-marketeer David Gratzer a few weeks ago here, has his views–belief in the need for what’s called a single-payer system–most of which I agree with. And Hogberg, who recently responded to the rhetorical questions I asked of the free-marketeers in the American Spectator, has his.The free health care market crowd claim that, compared to other nations, Americans are buying better care with all the extra money spent on doctors and hospitals and medicines and care. I say that the differences between care in different nations are a wash and are basically dependent on cultural factors anyway. So the important point is the consequence of spending all that money, and who’s suffering because of the way that we spend it. More

TECH: Fotsch talks sense on PHRs (let’s hope someone’s listening)

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There’s a whole lot of rubbish talked by various MDs quoted in an article in Modern Physician called PHR liability, data overload making docs a little queasy. Essentially they’re all saying that they’re gong to be overrun by patients with printouts of their PHRs and because they’ll miss something on page 97 they’ll get sued. And one MD in particular Joseph Heyman (with whom THCB has had its run-ins before) is quoted as saying

there is a risk of ‘garbage in, garbage out,’ and if the record is populated by the patient, there are errors of understanding that can be inputted by the patient.”

It’s just the same as saying that if you give patients email access they’ll abuse it. Lots of doctors talked about that in the past. Several studies have shown it’s not true. You have to truck through a lot of rubbish in the article to get to someone who knows what he’s talking about. Luckily dog-owning Medem CEO Ed Fotsch does, and it’s worth reading:

Edward Fotsch, M.D., CEO of PHR-provider Medem, says that was something he rarely experienced during his years as an emergency medicine physician, ending in the early ’90s. “I saw 10,000 ER patients, and I can remember on one hand the number of patients who had any documented information when they came in,” he says. Fotsch says much of the confusion surrounding PHRs stems from a misunderstanding of what they are.“A disk with a mishmash of information is not a PHR, because I could call my dog a ‘Ferrari’ if I wanted to, but that doesn’t make him one,” Fotsch says. “A personal health record is, by definition, an online collection of structured data.” <SNIP>While agreeing that standards are needed, the AAFP’s Waldren disagrees that PHRs need to be Web-based. Although he thinks that Web-based models will eventually dominate the field, Waldren says there are desktop PHRs available “that are networkable.” But Fotsch wonders if the models mentioned by Waldren allow secured online communication between physicians and patients. Without that, Fotsch says a PHR is like an automated teller machine with no money in it that only allows you to check your balance. Fotsch says a PHR should resemble a continuity-of-care record or continuity-of-care document—two vetted and accepted formats for transmitting basic patient-care data. The PHRs should have defined fields where particular types of data should be entered and displayed, and they also should feature a secure e-mail connection between patient and physician. “There’s a structure around a personal health record,” Fotsch says. “So, if you say you accept a personal health record, you know what you’re accepting.”

So a structured useful PHR should be a good thing for doctors. And surprise surprise that’s what patients want to. So can we have a little less kvetching about this wave that‘s coming and a little more helping patients get these things?

HEALTH2.0: Health2.0 for professionals, by Jos Bakker

Jos Bakker is a Senior Director, Global Strategic Mkt & Business Dev’t, Healthcare Informatics, Philips Medical Systems, and a regular correspondent with THCB on the important topics of international health care and European soccer. He sent me an email the other week about Health2.0 that I think is very interesting, so I got his permission to share a slightly edited version with you all.

In case you plan to unravel the myths versus realities on Health2.0 some day in the not too distant future, I respectfully offer you a few of my observations and suggestions.

Please, please avoid the confusion caused by mixing up two totally different takes on Health2.0. Scott Shreeve and others tend to position Health 2.0 (companies) as the enabler to transform healthcare– using the bible du jour ( Redefining Healthcare by Porter et al). Others, including me by the way, simply look at it as the evolution in web space finally hitting the health care domain, and yes, web geeks love to put stakes in the ground like web 1.0 , 2.0 , 3.0 coming up. I suggest you refer to O’Reilly’s "Web 2.0 doc for dummies” like me ( and you ?!), in which the attributes/competencies for ”Web 2.0 ” compliance are depicted in a straightforward laymen’s manner:

Core Competencies of Web 2.0 Companies

In exploring the seven principles above, we’ve highlighted some of
the principal features of Web 2.0. Each of the examples we’ve explored
demonstrates one or more of those key principles, but may miss others.
Let’s close, therefore, by summarizing what we believe to be the core
competencies of Web 2.0 companies:

  • Services, not packaged software, with cost-effective scalability
  • Control over unique, hard-to-recreate data sources that get richer as more people use them
  • Trusting users as co-developers
  • Harnessing collective intelligence
  • Leveraging the long tail through customer self-service
  • Software above the level of a single device
  • Lightweight user interfaces, development models, AND business models

The next time a company claims that it’s "Web 2.0," test their
features against the list above. The more points they score, the more
they are worthy of the name. Remember, though, that excellence in one
area may be more telling than some small steps in all seven.

Most or all of the core competencies listed do apply to the proclaimed Health2.0 companies (Scott’s list, Tony’s list , your favourites)….

While a lot of buzz and hype is generated on the consumers/patient web portals (Revolution, MSFT, WebMD), I think the use of Web 2.0 technology as of today by clinical professionals is much more interesting – and able to deliver results much more quickly. You yourself highlighted Sermo once more but I want to draw your attention to a similar physician driven scoop in Radiology. It’s got a well defined target community with a well defined goal: annihilating the old economy overpriced/always outdated diagnostic image reference books/CD’s sold by the Springer’s of the world. Please spend some time to surf MyPACS.net and its wiki competitor Radiopedia.org.

Staying even closer to my own backyard: we (Philips) are using the same tools to let our customers educate their peers in an interactive way. We coined it NetForum. The result is deploying best practices globally in using a complicated beast as MRI much more effectively,and getting an order of magnitude improvement in consistency/quality. Even better from a vendor’s perspective, it’s accelerating development of new protocols with solid FDA approval data and tracking proper use of MR buttons in real time–both big pleasers for the engineers. For Philips’ salesfolks this is a great tribe-building/customer retention asset. I am sure GE and Siemens are not stupid either.The key secret and magic of NetForum is of course the online connection of its web content plus intelligence with the actual software running Philips MR’s in the field.

To get a glimpse what this is all about see http://netforum.medical.philips.com/Home.aspx. If you have the time, go to the NetForum guided tour in the web services box. It’s a bit snail speed,and it spends just a few words at the very end of the tour for obvious competitive reasons about the options you have to ”contribute” to the NetForum community. It just goes a lot further than one way training, PR or remote service monitoring. The ”contributors” have been opened up recently.

A humble, down to earth example of a relatively small user community as co-developers, harnessing collective intelligence with a smart (Philips)  back office to add more value.

The point I want to make is that, in parallel to the ”disruptive/top down” Web 2.0 inspired Health2.0 startups, the established vendors are starting to dip their toes in the same water, but in a more bottom up/organic way. They will meet each other someday in the middle.

TECH/CONSUMERS: Mental Health–Bloggers Prefer Web Over Therapist by James Harris

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James Harris a marketing consultant for WebTribesInc.com, an operator of MySpace-style websites for individuals with mental health concerns. wrote to me about the results of a new survey the company made of its members. Now it’s a small survey of current users, so strictly speaking it may not be too generalizable, but it confirms a lot of other research saying that patients prefer talking to computers rather than humans about sensitive health topics. The survey was made available to 1,600 members of the company’s websites in April 2007. Seventy-eight members, or 5%, responded to the questionnaire. Founded in 2006, WebTribesInc.com now has 8,100 registered members on its four sites. WebTribesInc.com operates four MySpace-type sites: DepressionTribe.com, OCDTribe.com, AnxietyTribe.com and Addiction.Tribe.com. You can see more at the WebTribesInc.com home page. Here’s James’ take:

Can the Internet play a positive role in addressing an individual’s mental health needs? A new survey of members of three popular social networking websites suggests that many bloggers prefer these online communities to seeking professional therapy. WebTribesInc.com recently surveyed members of its sites about their preferences when sharing thoughts and feelings. The survey found that members feel more comfortable discussing their conditions with their online community rather than with a private therapist. In the survey, members were asked "Where do you feel most comfortable expressing your issues?"

The survey found:

–68% said "an online community;"–23% said "my therapist;"–9% said "family and friends;"

According to Ryan Fitzgerald, president of WebTribesInc.com, "Although a number of celebrities including Brooke Shields and Tipper Gore have shared their stories of coping with depression, there is still a very large stigma attached to seeking formal treatment for mental health conditions." Fitzgerald said many of the site members have reported avoiding seeking professional help because they are afraid of being diagnosed as depressed or anxious and are worried the information will be shared with their employer or health insurer. "A safe online mental health community site offers anonymity and sharing in a nonjudgmental atmosphere. Journaling about troubling thoughts and feelings has been shown to be therapeutic. Online communities are also a welcome option for individuals who can’t afford professional treatment or live in remote areas," said Fitzgerald.

THCB Sponsorships

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THCB welcomes aboard our latest sponsor: HCA Healthcare.  HCA-National Patient Account Services . www.npasweb.com- The largest provider of early out collection services in the US. Help support THCB. Give them a click.

PHARMA/POLICY: Part D Costs–Shurely shome mistake, Ed?

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An article called West ‘on verge of medical crisis’ on how health care is all screwed up in the UK conservative newspaper The Daily Telegraph has this rather interesting subheader.

Western nations are on the brink of a crisis in medical services, according to the man credited with curbing the rise in health care spending in America.

Given that health care costs in America have been rising fast for the last 40 years apart from a brief period in the mid-1990s, I was very keen to find out who this hidden genius was. I initially suspected that Mark McClellan would be a little surprised to find out what the Torygraph thinks he’s responsible for! But reading down in the article, it appears that the boaster is McClellan himself.

Dr McClellan has taken a leaf from the Altman book. After years in which the Medicare budget exceeded projections, he managed to keep drug spending 40 per cent below projections. This "unprecedented" improvement followed moves to encourage patients to take generic rather than brand-name prescription drugs. The key was information, giving patients the wherewithal to see for themselves that generic drugs were as effective as their pricey counterparts, he told the meeting. Dr McClellan has taken a leaf from the Altman book. After years in which the Medicare budget exceeded projections, he managed to keep drug spending 40 per cent below projections. This "unprecedented" improvement followed moves to encourage patients to take generic rather than brand-name prescription drugs. The key was information, giving patients the wherewithal to see for themselves that generic drugs were as effective as their pricey counterparts, he told the meeting.

Continue reading…

POLICY: What about a fair shake for home care workers? by Mary Kay Henry, SEIU

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SeiuMary Kay Henry is an Executive Vice President of the SEIU, the nation’s largest health care
union where she’s the head of the union’s Health Systems Division. The SEIU has been very active in health care generally, not least in their “alliance” with Wal-Mart and others on national reform. But there are other issues too that they care about. Here’s another issue that concerns her and probably given where we’re going we should all be concerned about them. What about fair share for the poorest care givers—home care aides?

Seventy-three-year-old Evelyn Coke worked for 20 years as a home care attendant for the elderly for sometimes as many as 24 hours a day, four days a week,. She occasionally even slept overnight at her clients’ homes so she could be there for them if they needed her. Unfortunately, because of the “companionship exemption” under the Fair Labor Standards Act, she rarely ever received overtime pay for the extended hours she put in. Today Evelyn stands alone as the sole plaintiff awaiting a Supreme Court decision. How the justices rule on Long Island Care at Home Ltd v. Coke might mean larger paychecks, overtime coverage, and ultimately a reduction in high turnover, which could go a long way to reducing shortages in one of the nation’s fastest growing occupations — home care workers.

As SEIU continues promoting new health care solutions, we must
remember the contributions of health care industry workers — especially
in the midst of a looming “care gap” and an aging elderly population
expected to grow 40% by 2030. This “care gap” is present in nursing
homes, assisted living facilities, and home and community-based care
across the country. As the number of elderly Americans increases
dramatically, the long-term care industry is not keeping pace. We are
barreling toward a crisis, and it is going to take some innovative
thinking and some radically different ways of doing things to avert
what could be a disaster for a generation of Baby Boomers who will all
too soon hit their “golden years.”

Continue reading…

POLICY/POLITICS: The cautious approach

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I have another of my occasional pieces up at the Guardian’s Comment is Free site, trying to make sense of American health care for an international audience. I take aim at how the cautious nature of the main Democratic front-runners health care proposals doesn’t match their fiery rhetoric — Comment is free: The cautious approach.

Even though Iraq seems to have sucked all the oxygen out of American
political life at the moment – even Cindy Sheehan has given up and gone
home – healthcare does remain the largest domestic issue.

Several weeks have passed since the Democratic candidates for
president had a debate about healthcare. It’s interesting that despite
an attempt by probable Republican candidate Fred Thompson to take on
documentary filmmaker Michael Moore over the topic, none of the front
runners on the Republican side have made much mention of healthcare at
all. This is doubly curious as one of them, former Massachusetts
Governor Mitt Romney, left office having at least partially helped
make his state the most advanced healthcare reform " laboratory" of
them all. But apparently among the conservatives and evangelicals who
dominate the Republican primaries, the issue of universal healthcare is
not seen as a great vote-getter – a worldview the Republicans might
come to regret.  Continue. 

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