The Health Care Blog – Page 234 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Super Mobile Doctor Uses Smartphones and Tablets in Patient Care

Dec 1, 2018

By JANE SARASOHN-KAHN

Physicians who have adopted smartphones and tablet devices access online resources for health more than less mobile physicians. Furthermore, these “Super Mobile” doctors are using mobile platforms at the point of care.

Physicians adoption and use of mobile platforms in health will continue to grow, according to a survey from Quantia Communications, an online physician community. This poll was taken among 3,798 physician members of QuantiaMD’s community in May 2011. Thus, the sample is taken from the community’s 125,000 physicians who are already digitally-savvy doctors. QuantiaMD calls physicians with both mobile and tablet devices “Super Mobile” physicians.

The most common mobile devices among the Super Mobile doctors in QuantiaMD are iPhones, used by 59%; iPads, used by 29%; and, Android smartphones, used by 20% of the physicians surveyed. Blackberry devices are used by 14% of the doctors in the poll.

Just under one-half of these doctors plan to purchase a mobile device in 2011, notably an iPhone, an iPad, or an Android.

The Effectiveness of Online Health Intervention Programs

Dec 1, 2018

By GLENN LAFFEL, MD

In recent posts on Web-based and mobile behavioral intervention programs, we reviewed evidence suggesting that social support, in one form or another, can improve participants’ adherence and engagement with the program. That didn’t always mean however, that participants achieved better outcomes as a result. In one study for example, an online community increased engagement with and utilization of a Web-based activity program, but it did not increase participants’ actual activity levels.

Another study, slightly older than the ones reviewed above, did show that a Web-based program improved outcomes. In this case, the intervention was an online videogame known as Re-Mission. Since I haven’t touched previously on outcome studies for automated lifestyle intervention tools or videogames as an example of such programs, I’ll do that here.

Re-Mission is intended improve medication compliance in teens and young adults with a history of cancer. In the game, players control a nanobot within a 3-dimensional body of a young person that has cancer. Play involves destroying cancer cells and managing chemotherapy-related adverse effects like vomiting and bacterial infections by using antiemetics and antibiotics. The game purports to help users understand their disease and its treatment and improve their sense of self-efficacy: they can take control of their disease.

It Looks Like the Head of HIMSS Likes Us

Dec 1, 2018

By JONATHAN BUSH

The headline said that the chief of HIMSS sees “seismic shifts” in the health IT landscape.

I sure hope so because I’m betting on it.

As many of our employees know, HIMSS is a massively important leader in our space, and their annual conference—this year it was held in Orlando and set an attendance record of over 30,000 people and 1,000 vendors—is our chance to feel small and uninvited. It is a club of large vendors and large buyers. Very large deals, you might say ‘seismic’ deals, requiring long-term multimillion dollar commitments in EHR and practice management systems, go down at the HIMSS conventions.

Obviously, our consistent criticism has been that the balance sheet impact of such investments is not sustainable by any health care institution for long, BUT ALSO, the information that comes from such investment…well…sucks.

It doesn’t suck because the IT departments that buy and run these EHR andpractice management systems are bad (they may or may not be, I have no idea, but that isn’t the problem). It isn’t because the systems being purchased don’t work as advertised (I have no idea if they do, but I assume the answer is ‘yes’).

Do Kaiser Cardiologists Need More Pharmacist Consults to Keep Their Patients Alive?

Dec 1, 2018

By AL LEWIS

A study by a team consisting mostly of Kaiser clinical pharmacists published in Pharmacotherapy[1] finds that a very inexpensive pharmacist consult for cardiac patients reduces the cardiac death rate by more than 80% and — even though it’s a cardiac-specific drug regimen consult — also reduces the non-cardiac death rate by more than 95% vs. what Kaiser’s doctors achieved with usual care. Plus, even though it increases drug use, it earns a 56:1 ROI while reducing drug costs.

The implication: Kaiser’s doctors need Kaiser’s pharmacists to prevent their cardiac patients from dying, in general, but especially from non-cardiac causes…and that Kaiser is losing huge amounts of money if they don’t do this.

However, the study’s conclusions violate every “rule of plausibility” and are invalid. This study, unless its invalidity becomes more widely recognized, could also be used to justify expanded reimbursements for clinical pharmacist consults. Clinical pharmacists may or may not deserve expanded reimbursement, but justification for that reimbursement cannot be made based on studies like this one.

Quite a number of findings deserve mention. First, not getting the $1/patient-day of clinical pharmacist support given to the study group had apparently cost 30% of the retrospective control group patients their lives, vs. 3% of the intervention group.

GAO: FDA Can’t Monitor Device Recalls

Dec 1, 2018

By MERRILL GOOZNER

The Government Accountability Office has weighed in on the failure of the Food and Drug Administration to properly monitor medical device recalls. Its review of the 3,510 recalls between 2005 and 2009 — 40 percent of which were cardiovascular radiological or orthopedic devices — found:

Several gaps in the medical device recall process limited firms’ and FDA’s abilities to ensure that the highest-risk recalls were implemented in an effective and timely manner. For many high-risk recalls, firms faced challenges, such as locating specific devices or device users, and thus could not correct or remove all devices.

“The gist of this report is that the FDA can’t tell if recalls of high-risk devices were carried out successfully because it lacks criteria for assessing device recalls and doesn’t routinely review recall data,” said Sen. Charles Grassley, R-Ia., who along with Sen. Herb Kohl, D-Wis., called for the report. “Recalls are typically voluntary, and patients would be better served if the FDA took a thorough approach to post-market surveillance of medical devices.”

Google Health: What Did We Learn About PHRs?

Dec 1, 2018

By SHAHID N. SHAH

As I mentioned by way of the Wall Street Journal back at the end of March, Google Health was supposed to get less support under the new CEO. We learned today that “less support” meant that it would be retired on January 1, 2012 and eventually shut down on January 1, 2013. Basically this means that the grand experiment didn’t work out, but it was valiant and worthy try.

The folks at Google raised the bar for PHRs and I for one was a fan; however, if Google couldn’t make it work, does it mean that Personal Health Records (PHRs) in general aren’t worthwhile or won’t be successful? I don’t think so, but what we learned from the Google experiment is that there’s little or no demand from the general consumer to store their personal medical records — at least in numbers that would matter. Here’s what Google said in their retirement letter:

There has been adoption among certain groups of users like tech-savvy patients and their caregivers, and more recently fitness and wellness enthusiasts. But we haven’t found a way to translate that limited usage into widespread adoption in the daily health routines of millions of people.

PHRs managed and maintained by patients themselves has been sort of a holy grail for years — but no one has been able to figure out how to make enough money from them or keep the data accurate enough to make PHRs useful enough to clinicians. And, it’s not for a lack of trying; in fact, Microsoft’s got a nice offering (HealthVault) that’s still in good shape so far. But, it’s not clear how long even they can last without a sustainable business model. It’s not like Google didn’t have the money to continue the experiment — they just realized that there were not users in quantities high enough for them to be able to monetize it sometime in the future.

TMI, Dude!

Dec 1, 2018

By LISA SUENNEN

If you are a baseball fan like I am, it is not unusual for you to spend time with your fellow sports fanatics comparing statistics. A player’s batting average, on base percentage, runs batted in, earned run average, home run stats and how those compare to their team mates’ stats–all fair game for friendly conversation. The personal analysis of players’ worth doesn’t stop there, as each of them has their height, weight, age and home town displayed on the screen as they step up to bat. Can you imagine if every time you went to work a big Jumbotron screen with all your vital statistics followed you around for all to see. “Look, there’s Lisa on deck. Man, she really is that short.”

Well, you might be horrified to think that the intimate descriptive details of your being might be published and used to compare your value to others, but there is a growing cadre of people who willingly do exactly that despite the complete impossibility that they will ever be found sliding into home plate. In case you have missed it, there is a burgeoning movement built around “self-knowledge through numbers” generally known as “the Quantified Self.” The term Quantified Self refers to the actions that thousands and thousands of over-achievers, narcissists and the insecure are actively undertaking every day, aided by a giant leap forward in sensor and wireless technology, to measure, track and report their vital statistics in the pursuit of living forever, or at least until the Houston Astros win the 2011 World Series in a sweep. FYI if you’re not a baseball fan–that’s going to happen about 3 weeks after hell freezes over.

In a recent article in The Healthcare Blog, Scott Peppet writes:

Human instrumentation is booming. FitBit can track the number of steps you take a day, how many miles you’ve walked, calories burned, your minutes asleep, and the number of times you woke up during the night. BodyMedia’s armbands are similar, as is the Philips DirectLife device. You can track your running habits with RunKeeper, your weight with a WiFi Withings scale that will Tweet to your friends, your moods on MoodJam or what makes you happy on TrackYourHappiness. Get even more obsessive about your sleep with Zeo, or about your baby’s sleep (or other biological) habits with TrixieTracker. Track your web browsing, your electric use (or here), your spending, your driving, how much you discard or recycle, your movements and location, your pulse, your illness symptoms, what music you listen to, your meditations, your Tweeting patterns. And, of course, publish it all — plus anything else you care to track manually (or on your smartphone) — on Daytum or mycrocosm or me-trics or elsewhere.

Health Reform: Evidence-Based Medicine and the Real World

Dec 1, 2018

By RICHARD REECE, MD

The July 7 edition of the New England Journal of Medicine just arrived. It contains two back-to-back articles that illustrate the problems of transforming medicine into an evidence-based format.

• The first is “Lessons from the Trenches – A High Functioning Primary Clinic.” Its author, Thomas Bodenheimer, MD, a well-known University of California academic, describes the workings and make-up of Clinica Family Health Services, a Denver-based primary care community health clinic. The clinic serves 40,000 patients at 4 sites. Fifty percent of these patients are uninsured; 40% are on Medicaid. Clinica aspires to be one of the first Accountable Care Organizations. Each of its locations includes three primary care practitioners, three medical assistants, a RN, a case manager, a behavioral health professional, and medical-records and front-desk staff. The clinic “has moved boldly from a doctor-based model to a team-based model.” Patients are never turned away, and most are seen on the day they call. The 4 clinics have a linking EMR, and they concentrate on assembling data that show progress. These data includes time it takes to see a primary care doctor or to meet with “the team,” entry to care during 1st trimester, number of low birth rate infants and % of Cesareans, Pap test within last 3 years, number of patients with diabetes and their glycated hemoglobin levels, and number of patients with hypertension. The goal is to improve all these measures. The basic idea is to serve patients while retaining loyal clinicians. The next step will be to reduce ER visits and hospital admissions. This step “awaits a new funding stream, which requires participation in which Clinica will share savings from reduced downstream costs.” To which I say, “ Good luck.” Many observers, including myself, say Accountable Care Organizations are DOA.

Why Do Doctors Offer Credit Cards?

Dec 1, 2018

By DAVID E. WILLIAMS

Yesterday’s Wall Street Journal (When Your Doctor Sells Credit Cards) documented the growth in credit cards issued to finance elective procedures such as LASIK, plastic surgery and dental implants. The article covered the usual points but missed one important but little-known aspect of the industry.

Briefly, physicians offer the cards for procedures not covered by insurance. The cards have a zero percent interest rate and no fees, usually for the first 12 months. After that the interest rates spike and to make matters worse customers are also charged retroactive interest on their first year’s balance. Ouch! The article details the pitfalls you’d expect from cards like these, and of course there have been some abuses.

A card company spokesman quoted in the article says, “the vast majority of account holders pay off their balances before the promotion ends.” That statement doesn’t surprise me, because most people who have these elective procedures are relatively well off.