The Health Care Blog – Page 349 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Statin Wars: Less-is-More versus Unlimited Medicine

Sep 20, 2016• 8

By SAURABH JHA, MD

flying cadeucii It is the beauty of evidence-based medicine (EBM) that a scientist can at once be a Pope and a Galileo. His transmutation is as effortless as it is discretionary. If you think you’ve met Galileo – a rebel, a free thinker, a rocker of the establishment – the following week he is a Pope, castigating detractors, censoring critics, and celebrating uniformity. He changes by a roll of the dice. His change is decided by a quirk in hypothesis-testing known as statistical significance. If the p value is 0.051 he is Galileo, if the p value is 0.049 he becomes the cardinal. He is one day a raging skeptic and another day a true believer.

The latest fight between orthodoxy and free inquiry is about the benefits and harms of statins for primary prevention. A review, and an editorial, in the Lancet said the benefits of statins are real, the harms are exaggerated, and skepticism of benefits of statins should be censored because doubt can harm the public who may not take their statins and thus die prematurely. Stated differently, skepticism kills. The lead author of the review once asked the BMJ to retract a study which he felt overplayed the harms and denied the benefits of statins. The editor compared the fear about statins to fear about vaccination. Statin skeptics, like vaccine deniers, are now medicine’s truthers.

The Rest of the Story About the Economic Good News

Sep 19, 2016• 1

By PAUL KECKLEY

Legendary radio commentator Paul Harvey ended his daily report with a final story introduced by the tease “Now for the rest of the story.”

Last Tuesday, the U.S. Census Bureau announced that median household income increased 5.2% in 2015 to $56,516—the first increase in inflation adjusted income since the start of the downturn in 2007.

The Bureau also noted that the U.S. poverty rate decreased to 13.5% in 2015, down from 14.8% in 2014 and those lacking health insurance coverage shrank to 9.1% from a high of almost 16% in 2007. According to the Center for Budget and Policy Priorities, that’s the first time all three have improved in 20 years which it attributes to a lower unemployment rate (5.3% vs. 6.2% in 2014) representing an increase of 3.3 million in the workforce. That’s the story, but here’s the rest of the story.

Accessing & Using APIs from Major EMR Vendors–Some Data at Last!

Sep 19, 2016• 8

By MATTHEW HOLT

Today I’m happy to release some really unique data about a pressing problem–the ability of small tech vendors to access health data contained in the systems of the major EMR vendors. There’ll be much more discussion of this topic at the Health 2.0 Provider Symposium on Sunday, and much more in the Health 2.0 Fall Annual Conference as a whole.

Information blocking, Siloed data. No real inter-operability. Standards that aren’t standards. In the last few years, the clamor about the problems accessing personal health data has grown as the use of electronic medical records (EMRs) increased post the Federally-funded HITECH program. But at Health 2.0 where we focus on newer health tech startups using SMAC (Social/Sensor; Mobile OS; Cloud; Analytics) technologies, the common complaint we’ve heard has been that the legacy–usually client-server based–EMR vendors won’t let the newer vendors integrate with them.

With support from California Health Care Foundation, earlier this year (2016) Health 2.0 surveyed over 100 small health tech companies to ask their experiences integrating with specific EMR vendors.

The key message: The complaint is true: it’s hard for smaller health tech companies to integrate their solutions with big EMR vendors. Most EMR vendors don’t make it easy. But it’s a false picture to say that it’s all the EMR vendors’ fault, and it’s also true that there is great variety not only between the major EMR vendors but also in the experience of different smaller tech companies dealing with the same EMR vendor. All the data is in the embedded slide set below, with much more commentary below the fold.

Health 2.0 EMR API report
Continue reading…

Closer to a crisis

Sep 17, 2016• 4

By FRED TROTTER

Fred_Trotter How close to we need to get to cybersecurity crisis in healthcare before we, as an industry take deliberative action?
Should we approach cybersecurity in healthcare differently? What approaches will work best? What commonly repeated advice about cybersecurity is actually wrong in healthcare settings? What ideas that would be effective in healthcare cybersecurity are being ignored? What is being missed from discussions about healthcare cybersecurity? What are we too concerned about? What threats do not get enough attention?

These might sound like rhetorical questions, designed to engage the reader before the author knowingly reveals the “answer”. Sadly, these questions are no rhetorical device. No one has definitive answers, and we all desperately need them.

I sit on the Health Care Industry Cybersecurity Task Force and we are currently taking comments on these issues on this blog post. I cannot to presume speak for the Task Force as a whole, and the comments below represent only my personal perspective on the issues involved. Right now the only thing that the Task Force as a whole is comfortable saying is “we are asking for advice”, which is the purpose of the blog post. If you have a reaction to the personal opinions here, please comment on the blog post so that the whole Task Force can hear what you have to say.

Generally, there are two types of issues that we would like advice on:

“What are the best practices and correct strategies to defend healthcare technology from cybersecurity attacks?” and “What is the best way for US government agencies to coordinate with the healthcare industry to respond quickly and effectively to cybersecurity threats?”

Improving Diversity in Health Technology

Sep 16, 2016

By MATTHEW HOLT

I am thrilled that Health 2.0 is today announcing a new program aimed at improving diversity in the field of health technology. This will run all year (and hopefully beyond) and will start at the Health 2.0 10th Annual Fall Conference on Sept 25-8, where we will host a group drawn from populations that are underrepresented in the health technology field. There’ll also be a dedicated session on the topic on Sept 26 at 12.15pm that has been generously supported by the Robert Wood Johnson Foundation. Matthew Holt

The Problem: There is a lack of diversity among health technology innovators and a shortage of technologies that meet the needs of minority audiences. Technology is a powerful tool that can help improve health outcomes and alleviate problems within our current health system. As our society grows increasingly diverse and gaps in health among different populations increase, there is an urgency to develop solutions for underserved communities and diversify the population of innovators who are creating these solutions.

The Conference Support Program: The Diversity in Health Technology Conference Support Program, supported by the Robert Wood Johnson Foundation, encourages individuals interested in diversifying the health technology field and who are interested in, or currently engaged with, health technology, to attend Health 2.0’s 10th Annual Fall Conference (Sept 25-8). Individuals from populations that are underrepresented in the health technology field are particular encouraged to apply. The conference support will include complimentary access to the annual conference. Conference support recipients will be required to attend the “Diversity in Health Technology” workshop. The workshop will serve as the formal kickoff to a year-long campaign focused on engaging more diverse voices in health technology. Conference support recipients must also attend and participate in two webinars hosted by Health 2.0 to further review the diversity in technology issue, submit a post-conference summary to Health 2.0 of the individual’s conference experience that Health 2.0 may use for a white paper on the diversity issue and a summary about specific activities the individual plans to do over the next year to address diversity in technology.

For more information and to apply to join the program, visit the Diversity in Health Technology site.

The Levers We Have at Our Disposal to Reduce Spending on High Cost Claimants

Sep 16, 2016• 10

By CINDI SLATER

CindySweb

A new report out from the American Health Policy Institute and Leavitt Partners further quantifies what we already know: a handful of employees are responsible for the bulk of employers’ health care spending. The new report documented that among 26 large employers, 1.2 percent of employees are high cost claimants who comprise 31 percent of total health care spending. Interestingly enough, the report was released on the heels of news yet again that high deductible health plans continue to be more popular than ever as a strategy for employers to control costs, with employee cost sharing expected to rise yet again this year.

And yet high deductible health plans may do more to bend the cost trend for healthy employees by reducing spending on items like pharmaceuticals and lab testing but not on inpatient care.

The least heathy employees quickly blow through their deductible, and their health issues are so acute and their bills so large, they don’t shop around for care. So what is a large employer or any purchaser concerned about these high cost claimants to do?

Consumerism in how we typically think of the concept doesn’t seem to be working. For example, according to McKinsey,most healthcare consumers are not doing their homework – they aren’t researching costs or their choice of providers. And even for the handful that do use price transparency tools, new research shows this doesn’t result in savings. It’s not that patients with serious health conditions don’t want to understand their condition, the latest evidence-based treatment options, who are the best physicians, and treatment costs. It’s just that they need assistance curating and interpreting this complex information.Continue reading…

The Politics of Hillary’s Pneumonia

Sep 14, 2016• 7

By SAURABH JHA, MD

Screen Shot 2016-09-14 at 3.15.10 PM

It is selfish of a leader of a nation to drop dead during office. Jawaharlal Nehru, India’s first prime minister, died suddenly at 74, apparently from a ruptured aneurysm. His aneurysm, allegedly, had something to do with Edwina Mountbatten – the wife of Lord Mountbatten, the last Viceroy of India. Shortly after Nehru’s death, Pakistan attacked India. Nehru’s replacement, Lal Bahadur Shastri, died mysteriously in Tashkent two years after Nehru’s death, and was succeeded by Indira, Nehru’s daughter. India’s future was forever changed by a burst aneurysm or, if rumors are to be believed, by a flagellating spirochaete which left the Raj in bliss.

Clearly, the death of a leader creates turmoil for a republic. So it is understandable that a nation obsessed with health is obsessed with the health of its presidential runners. Mr. Trump’s doctor declared he’s the healthiest presidential candidate ever. Mr. Trump has drawn attention to his super health by pointing to the size of his hands – by Mr. Trump’s standards a rather decorous allusion. It matters not what has hypertrophied Mr. Trump’s hands, what matters is that Mr. Trump’s large hands signal vigor and imagination. The American Psychiatric Association, to their credit, in ruling out a new diagnostic code for Mr. Trump’s colorful soundbites in the next edition of their Diagnostic and Statistical Manual, ended all hopes of banning Mr. Trump from the presidential race on health grounds.

Launch! at Health 2.0

Sep 14, 2016

Launch

By MATTHEW HOLT

Launch! is always one of the most fun and most exciting sessions at Health 2.0. Ten new companies demo their product on stage for the very first time during at the 10th Annual Fall Conference. Previous Launch! winners have included Castlight Health, Basis, and OM*Signal and last year’s winner MedWand, which just beat out Gliimpse–itself since bought by Apple.

This year’s finalists are:

Valeet Healthcare‘s platform gives patients personalized health information while allowing providers to have a rounding tool and giving healthcare systems a dashboard to track metrics.
gripAble is an innovative mobile technology that bridges the gap between functional therapy and objective measurement of upper-limb function.
Cricket Health works with payor and provider customers to slow the progression of chronic kidney disease (CKD), manage the transition from CKD to End Stage Renal Disease, and improve ESRD care.
Qidza is a population health mobile platform that enables parents work with their physicians to track their children’s developmental milestones
Docent Health guides health systems to embrace a consumer-centric approach to healthcare by curating patient experiences.
Albeado builds Healthcare prediction and optimization solutions based on proprietary data science platform which combines clinical AI and Graph-Based Machine Learning.
Siren Care offers temperature-sensing smart socks which provide health data on foot ulcers, hot spots, and more to prevent future injuries.
MDwithME integrates soft and hardware components in a suitcase enabling full remote physical exams with an option of instant or delayed physician’s consult with quality of testing that equals or exceeds the current state of art.
DayTwo maintains health and prevent disease utilizing a microbiome platform, starting with personalized nutrition based on gut bacteria, aiming to normalize blood sugar levels and cultivate a healthy gut microbiome.
Regeneration Health is a health ecosystem powered by artificial intelligence that collects and monitors health in real time and curates free personalized health info and recommendations based on integrative medicine.

You can see them on Wednesday, the last day of the Health 2.0 10th Annual Fall Conference Sept 25-8 in Santa Clara, CA.

Jess Jacobs, POTS & her bio

Sep 14, 2016• 1

By MATTHEW HOLT

As part of Health 2.0’s 10 Year Global Retrospective Awards (yes, winners to be celebrated at Health 2.0’s 10th Annual Fall Conference September 25-8), I wrote a bunch of bios. One patient and friend of mine Jess Jacobs has (as many of you know) recently died. Fellow POTS patient Greg Norman didn’t much care for the brief bio I wrote about Jess. So below the fold please read his tweet storm about it! And of course please comment.
Continue reading…

Cybersecurity Check In

Sep 13, 2016• 12

By the CYBERSECURITY TASK FORCE

No one likes to think about the possibility that patients might be hurt or killed as a result of cyber attacks. But all signs indicate that this is a real possibility and a serious problem. Attacks on Health IT systems such as EHRs or patient portals, electronic medical devices, or on standard healthcare digital systems can be a threat to patient safety.

To combat the cybersecurity threat, Congress and the Obama administration passed the Cybersecurity Information Sharing Act of 2015, which established mechanisms for the US Government to collaborate with private industry to respond to cybersecurity threats. Lawmakers recognized the unique problems with cybersecurity in health technology and created the Health Care Industry Cybersecurity Task Force, charged to make recommendations to Congress regarding specific cybersecurity issues. To paraphrase, we are to investigate:

What can the healthcare industry learn from other industries about cybersecurity?
What are the special challenges that we face with cybersecurity in healthcare?
What are the difficulties protecting electronic health record (EHR) systems and networked electronic medical devices?
What cybersecurity study materials should the healthcare industry be exposed to?
How should an organization designed to coordinate the sharing of cybersecurity threats between healthcare industry players and the US Federal Government operate?
Finally, we were asked give Congress a written report summarizing all of the above.

Our Task Force is asking the healthcare, patient and technology communities for help in this assignment. We are asking for discussion on these issues to be on platforms like The Health Care Blog, Reddit and Twitter, so the community may contribute new ideas as well as refine the ideas contributed by others. We are taking a crowdsourcing approach to cybersecurity ideation so we can aggregate and assess what people have to say about these issues.