Both Boston Scientific and J&J are printing money every time they send another drug-eluting stent off the factory floor. In fact neither of them can keep up with the demand. J&J recently had some production quality problems which may limit its ability to meet demand but that hasn’t stopped its Cordis unit which makes the Cypher stent playing a big part in its recent rise in Q1 profits. Yahoo reports:

“Cypher, which revolutionized the stent market when it was launched last April, had first-quarter sales of $562 million and held 57 percent of the entire stent market until Boston Scientific’s Taxus coated stent was approved March 4. That forced J&J’s price down to about $2,675 from an original list price of about $3,200.”

Boston Scientific’s Taxus stent has had a stellar launch, and contributed to its stock price going up like a rocket ship in the last 6 months.

However, there are two sides to this picture, and if you are a hospital the other side is not pleasant. Forget for one moment the data that suggests that stents are not cost-effective compared to other types of heart surgery. Everyone’s ignored that and the use of PCTA (angio) and stents has been increasing for years. Of course, if you’re going to have a stent, why wouldn’t you want the latest and greatest, especially if its going to avoid the restenosis and the need for more procedures that’s plagued their use in the past? Well let me suggest who might not want one or sometimes more $3,000 drug-eluting stents to be used in that angioplasty. I’m referring of course to the hospitals that in general are paid a flat fee for each procedure, and are not being given extra money to cover the new and more expensive stents they are buying.

A new report out from the Society for Cardiovascular Angiography and Interventions makes very sobering reading for hospital executives in light of the demand from doctors and patients for the new drug-eluting stents.

“The authors found that the average hospital loss per initial DES patient was $1,389 when all sources of payment were considered, whereas BMS and CABG procedures generated $285 and $1,283 in profit respectively. As DES adoption increases and/or the average number of stents per procedure increases, hospital profits decrease. Profits may be maintained until the average number of DES (drug-eluting stents) per procedure reaches 1.8 and the conversion from BMS (metal stents) and CABG are over 80% and 15% respectively.”

You read that right. If the new stents become the standard, hospitals are going to find that if only 15% of CABGs and 80% of traditional stents go over to drug-eluting stents, they are going to find one of their major profit-centers turning into a loss-center.

Needles to say, this is not considered good news in the executive suites of the nation’s hospitals. But who are they to say that the latest and greatest technology should be denied to patients? And will the Congress help? Unlikely according to the other story I’m posting today.

Pretty interesting technology column from Robert Mittman over at iHealthbeat. This one focuses on the growing internal interaction between man and machine known as cyborgs. Given that I live in a state run by a guy who imitated a machine better than the previous governor imitated a human, and that anyone with any implanted medical device in some definitions qualifies, I guess we should be paying attention. I particularly like the story of the two batty college professors attempting to live as cyborgs–somehow you get the impression that they weren’t the cool kids in the back of the school bus. But the forecast is that the implantable devices and wearable exoskeletons are going to have a big impact in the next five to ten years.

Meanwhile, in a related field the Health Technology Center had a report out last week on the impact of sensors in the future. The report says:

In the next five to ten years smart sensors should be able to do such things as automatically activate an implanted insulin pump, release heart medications or regulate the heart rate by real-time monitoring of blood pressure and oxygen saturation, according to the report. The study also examines three other categories of sensor technology: biometric monitoring, point-of-care testing and environmental monitoring.

Showing that all of this stuff is related to the scribblings of obscure (and not so obscure) forecasters, here’s Paul Saffo’s excellent essay on Sensors from 1997.

These are two issues close to my heart. I have limited time to write on them now, maybe more next week. However if you’re interested go look at the ehealth intiative’s report on Electronic Prescribing (here’s the press release) and look at the AMA’s endorsement of an XML-based portable consumer health record.

Much to the chagrin of GE, Phillips, and Siemens (as well as patients who don’t want “garden hoses” shoved up their rear ends) a new study in JAMA shows that virtual colonoscopy doesn’t work as well as advertised.

Harris Interactive is out with its latest analysis of how many adults are online and who’s using the Internet for health information. After massive growth through the last decade, the number of adults online has stalled at around 69%, with 3/4 of those being online health seekers or “cyberchondriacs”–equating to around 51% overall. (The number of kids online is much greater–it tends to be the over-65s who are not online as frequently).

So the fast growth is over, and any future growth in online usage will probably be an aging out effect. Don’t forget that you just witnessed the fastest technology penetration in history, and all because the Pentagon wanted to send messages to its missile silos in the 1960s.

So this gives me a neat opportunity to remember what a great futurist I was (ha, ha). I’ve recently fessed up to several forecasts made in the Health and Health Care 2010 publication that, at the least, have to turn around to come close to matching current reality (particularly the bit about aggressive health care payers working to reduce costs over the Zeros….). Well back in 1996 in an IFTF report called Telehealth (we wish we’d called it eHealth) we had a nearly right explanation about the growth of online activity based on access to in-home appliances like PCs. Some of the technology is wrong (the Network PC never made it) but look the numbers, and you’ll see we were pretty close:

In its potential for mass applications, then, telehealth clearly represents a new market that is likely to have new and far-reaching impacts on patient care, provider organizations, and even consumer-focused pharmaceutical provision. How important it becomes and how quickly it becomes important depends on partly on its acceptance by physicians, patients and others involved in health care, but more importantly on the information infrastructure needed to run them. The key piece is consumer access. If the home computer becomes ubiquitous, then health care functions will be found to run on it, and telehealth will have a chance to take hold and take off. Currently 38% of American households have PCs, while 20% of U.S. adults have accessed the Internet or used online services. The important question for telehealth is, how likely is the penetration of PCs and other information of appliances to grow and by how much?

We conducted an internal workshop at IFTF in order to forecast the penetration of information appliances with the capabilities of 1996 home PCs with modems into U.S. households over the next ten years. This definition obviously includes both cable modem systems and the coming Network Computer (NC), as well as anything else Silicon Valley’s late night pizza eaters dream up in the next few years. Our consensus forecast was that by 2000, 50% to 55% of American households would have these appliances, and that by 2005, 65% to 70% would be equipped. Some of our outliers felt that this was much too low and that the appliances would be as common as color TV (i.e., 95% plus by 2005).

PC penetration is now around 61% and other forms of access to the Internet (including access to appliances like web TV, PDAs, and access at libraries and internet cafes) take us to 69% of adults online), our forecast of 65-70% by 2005 looks pretty good. With the preponderance of cable modems and other new technologies, it’s a fair bet that even the 95% level of adults online will be reachable by 2010, even if many people won’t want or need to use the technology. The rest of the growth in this market will be the aging out effect as todays kids become tommorow’s consumers until, like the phone and the TV, the Internet is part of the fabric of modern life for everyone.

Well we haven’t even got CPOE systems in more than a small percentage of hospitals (4%-15% depending on who you believe) and their validity as a major weapon against medical errors is already being questioned. A study in Annals of Internal Medicine looked at all medication orders in a large hospital in Chicago, over the course of one week in 2002 and tried to figure out what difference a CPOE system would have made had one been in place:

A total of 1111 prescribing errors were identified (62.4 errors per 1000 medication orders), most occurring on admission (64%). Of these, 30.8% were rated clinically significant and were most frequently related to anti-infective medication orders, incorrect dose, and medication knowledge deficiency. Of all verified prescribing errors, 64.4% were rated as likely to be prevented with CPOE (including 43% of the potentially harmful errors), 13.2% unlikely to be prevented with CPOE, and 22.4% possibly prevented with CPOE depending on specific CPOE system characteristics.

As the authors note somewhat dryly:

Prescribing errors are common in the hospital setting

The implications are laid out in this article in Health-IT World. Some half of the serious medication errors would not be caught by a standard CPOE system unless it had high level decision support software combined with it. In fact most CPOE systems do, even if the authors study poo-poos them.

The issue in practice is that if you set the warning levels too low, the clinicians can make errors. If you set them too high, the physicians just hit over-ride all the time, and make errors. Physicians and hospital IT folks I’ve talked to about CPOE have tended to start on the lowest levels of “warnings” and slowly ratchet up. But any computer use needs intelligence, and CPOE is no exception. That doesn’t mean that it shouldn’t be tried, and slowly it will become more common.