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What ONC Got Wrong in their Guidance on Telehealth

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By ROY SCHOENBERG, M.D.

Screen Shot 2015-09-24 at 1.38.45 PMTelehealth – which lets patients see a doctor immediately, anytime, anywhere – shows no signs of slowing.  We are seeing this cross-industry, as more health plans make telehealth a benefit to members, and hospitals fold these services into new or expanded offerings for patients.  Consumer-facing products are also on the rise.  Patients can download an app and in minutes, have a FaceTime-like visit with a doctor for faster, more convenient care.

It was great then to see this week that the Office of the National Coordinator for Health IT (ONC) is picking up telehealth as a new focus – by issuing guidance for consumer companies in the design and delivery of these technologies.  The problem is ONC issued guidance without learning first how telehealth is actually being used in the industry today, leading to some basic… let’s just call them “misunderstandings.”

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A Parasite meets Wall Street

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By SAURABH JHA, MD

Screen Shot 2015-09-24 at 9.23.55 AMToxoplasma gondii is a parasite that causes opportunistic infection in helpless people. It may have met its match. The cost of treating Toxoplasmosis, a rare but extant infection, just shot up exponentially. Drug-resistant strain, you ask? Have physicians in Infectious Disease gone mercenary, you wonder? No. A change in ownership.

Daraprim (pyrimethamine) is a nifty drug which kills parasites. It’s been around for eons. I still recall its name from my medical school pharmacology exam. The price of Daraprim, whose production barely costs a dollar, may rise from $13.50 a pill to $750 a pill, after the rights to distribute the drug were acquired by Turing Pharmaceuticals.

Why? The answer is best told by Michael Shkreli, the CEO of Turing, and former hedge fund manager. The reason why Shkreli has acquired a generic drug lying in a forgotten backwater, and raised the price of a magnitude more suited to the hyperinflation of the Weimar Republic, is to make profits. Lots of profit. If this answer seems inane, ask yourself why a former hedge fund manager would be interested in a rare disease of devastating consequences. Penitence is the wrong answer.

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Uncle Sam, Yelped

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By NIAM YARAGHI

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Yelp recently announced it had reached an agreement with the U.S. General Services Administration (GSA) to allow agencies to claim their pages and read and respond to reviews. This is yet another move by the current administration to become more transparent and effectively communicate with the public through new information technology opportunities. I believe transparency almost always leads to net positive outcomes and thus have been a fierce supporter of government’s efforts towards this end. However, creating Yelp pages for government agencies may not be the best way to increase transparency and communicate with the public.

You may not like the policy, but you should love the way the GSA is implementing it. Rather than spending millions of dollars of taxpayer money to create a dedicated website, which would have most likely faced the same challenges of Healthcare.gov, GSA decided to take advantage of the reliable, readily available and, most importantly, free platform offered by Yelp. While the benefits of this policy are yet to be shown, at least its implementation cost is very minimal.

The feedback provided through Yelp can potentially help the administration to assess the current level of quality its services at different locations and potentially monitor the effectiveness of its improvement policies.

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How I Use P4 Medicine to Maximize Patient Engagement

By MOLLY MALOOF, MD                         SPONSORED CONTENT

Molly MaloofThe healthcare industry is changing as new models of care and reimbursement emerge. One of these approaches is P4 Medicine. P4 Medicine stands for predictive, preventive, personalized, and participatory. This approach deeply resonates with me because the philosophy is aligned with how I have been developing my medical practice, which is focused on optimizing health and avoiding disease. In my opinion, P4 Medicine is one of the best models for maximizing patient engagement.

The earliest manifestation of P4 Medicine began eight years ago at the Institute of Systems Biology when Dr. Lee Hood, MD, PhD, a physician scientist and creator of the automated gene sequencer, recognized that the application of systems biology to medicine would fundamentally alter our understanding of health and disease. This model has merged three powerful aspects of science and technology:Continue reading…

Health 2.0 announces Launch! and Traction Finalists

Health 2.0

By DEEPA MISTRY

Big news for the Health 2.0’s upcoming 9th Annual Fall Conference!

Launch!

Our annual Launch! competition is on the last day of the conference, Wednesday, October 7th. Ten digital health companies will demo their products for the first time. The audience votes for their favorites. Previous Launch! winners have included Castlight Health, Basis, and OM*Signal. This year’s finalists:

Bloom Technologies will debut their discrete, wireless wearable for expecting mothers to track contractions and other changes to improve maternal and neonatal outcomes.

Flow Health connects consumers, providers and payers around shared patient data including Patient Check-In, an iPad app replacing the standard medical clipboard.

Sensentia is a fully-automated inquiry using natural language processing and more to empower patients to make better health care decisions.

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Diagnostic Error: The IOM Talks Trash (But Not Cash)

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By MICHAEL L. MILLENSON 

flying cadeuciiTo understand how a landmark new report on diagnostic error breaks the mold, go past the carefully crafted soundbite ­(“Most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences”) and rummage around the report’s interior.

You can’t get much more medical establishment than the Institute of Medicine (IOM), also called the National Academy of Medicine, author of the just-released Improving Diagnosis in Health Care. Yet in a chapter discussing the role played in diagnostic accuracy by clinician characteristics, there’s a shockingly forthright discussion of the perils of age and arrogance.

“As clinicians age, they tend to have more trouble considering alternatives and switching tasks during the diagnostic process,” the report says. Personality factors can cause errors, too: “Arrogance, for instance, may lead to clinician overconfidence.”

Wow. Sure, both those assertions are extensively footnoted and hedged later with talk of the importance of teams (see below). Still, given the source, this practically qualifies as “trash talking.”

Of course, those quotes didn’t make it into the press release. There, inflammatory language was deliberately avoided so as not to give opponents any easy targets. (Disclosure: I was an advocate of an IOM report on this topic while consulting to an organization that eventually helped fund it. After testifying at the first committee meeting, I had no subsequent involvement.)Continue reading…

A Small EHR Vendor’s Emotional Open Letter to Users

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By HAYWARD ZWERLING, MD

flying cadeuciiOver the last few years, we have seen large EHR vendors purchase the moderate size EHR vendors, while moderate-size EHR vendors acquire smaller EHR vendors. We can expect to see a further decline in the number and diversity of EHRs as the IT mandates of Meaningful Use 2 and 3 are technically unachievable for all but the most well-endowed EHR vendors.

Along with the decreasing diversity of EHR options, an increasing number of physicians have lost the ability to choose the most important tool in their black-bag, their EHR, as many are now employed by large organizations which tell the physicians which EHR/HIT tools they are allowed to use.

If there was data that “Certified” EHRs, “Meaningful Use,” ICD10 and PQRS mandates had an impact on the cost or quality of healthcare which was commensurate with the IT costs and logistical disruptions, I would be the first to encourage physicians to use the new and proven technology. Unfortunately, we still do not know if “more” HIT is good for the healthcare system and society in general, or if it is only good for the IT industry.

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This Is Your Brain On Wellness

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By AL LEWIS

flying cadeuciiAs a CEO of a company in a competitive industry, I cross my fingers that my competitors will implement wellness programs.

Indeed, the more comprehensive their programs, the better it is for me. Those competitors will suffer increased healthcare costs, compounded by declines in productivity. Best of all, these programs’ negative morale impact may lead some employees to quit, thus facilitating our own recruiting efforts. (This is especially true for overweight employees, whom wellness vendors really seem to dislike. We, on the other hand, find employee weight makes no difference in either productivity or health spending.)

So hopefully my competitors will disregard the rest of this posting.

As background for those readers who are mercifully still unfamiliar with workplace wellness programs, they generally consist of four components (called “pry, poke, prod and punish” programs as shorthand):

1. A “health risk assessment,” or HRA, that pries into your employees’ personal lives, often asking about their drinking habits, marriage etc.

2. A “biometric screen” where technicians in white coats come to your workplace and poke your employees with needles to test them for diseases that in many cases, the government’s clinical guidelines say they shouldn’t be tested for. A small but increasing number of programs demand employee DNA, which isn’t in any clinical guideline.

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Why Chris Borland’s Retirement Makes Sense, And Does Not Make Sense

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By JEFFREY WARE, MD


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Being an ardent football fan I was quite surprised by Chris Borland’s announcement that he would retire from the NFL. He is 24. I was still a fledgling medical student at 24.

Borland has decided to retire sooner rather than later because of a medical issue. Not a medical condition he has. But a medical condition he may acquire should he continue playing football. Borland has made a judgment call. He has decided that the risks of repeated head trauma outweigh the benefits and $$$$ of being an NFL player.Continue reading…

Big PopHealth: Healthcare Analytics Summit 15

By THCBist

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THCB congratulates (FD: content partner and corporate supporter) HealthCatalyst in the wake of last week’s sold out Healthcare Analytics Summit (HAS15) in Salt Lake City.

The Utah-based startup widely-rumored to be headed for the Hot IPO List  drew a crowd of over a thousand attendees, including vendors, clients, c-suite healthcare types, data geeks and industry observers.    

If you want to wrap your brain around what sets Health Catalyst apart from the growing number of pretenders in the red-hot analytics space, you had only to look at the jaw-droppingly impressive client list: Partners Health Care, Stanford Health System, Kaiser Permanente Colorado, Texas Children’s, Allina Health,  and many, many more.

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