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Health Datapalooza Exclusive Interview: Dwayne Spradlin, CEO, Health Data Consortium

May 30, 2014

Interview by Matthew Holt, Co-Chairman, Health 2.0

In just two days, Health 2.0 will be attending Health Datapalooza in Washington, D.C. from June 1-3. In this exclusive interview, Dwayne Spradlin, CEO, Health Data Consortium will highlight the new sessions, panels, workshops, and speakers you can look forward to at Health Datapalooza! As an additional bonus, Spradlin gives insight on how data is driving health care innovation, and sheds light on new and on-going projects of the Health Data Consortium.

Three Reasons AstraZeneca Were Right to Reject Pfizer

May 30, 2014• 4

By BECKY BAINES

The transatlantic stand-off between the two pharmaceutical giants, Pfizer and AstraZeneca, is over; possibly for good. With Pfizer having failed to conclude a £69bn deal with the British-Swedish multinational pharmaceutical firm, almost £7bn was wiped from AstraZeneca’s share value.

AstraZeneca’s board, which decided that Pfizer’s bid was inadequate, has subsequently been criticised by major shareholders for “failing to engage”. Pfizer meanwhile, has been accused of being driven purely by the lure of lower taxes, job cuts and budget reductions. We have rounded up the reasons why we think that Astra Zeneca were right to reject the takeover bid from Pfizer.

Jobs Threatened

The proposed takeover had major implications for several sectors. From major health and pharmaceutical recruiters to manufacturers and research companies, all would have been affected by Pfizer’s huge takeover bid. Despite repeated initial assurances from Pfizer’s CEO, Ian Read, both AstraZeneca and Pfizer finally acknowledged in last week’s parliamentary select committee meeting that there would be cuts to both jobs and research.

Indeed, even before the failure of the bid, many academics, scientists and even union leaders were accusing Pfizer of being driven purely by the possibilities of a lower taxes and reductions to the research budget. Pfizer had already been described by a former boss of AstraZeneca as a “praying mantis” ready to “suck the lifeblood out of their prey”.

However, AstraZeneca’s current chairman, Leif Johansson said that the deal represented “a significant risk to shareholders.”

Samsung Throws Kitchen Sink onto the Wrist

May 29, 2014

BY MATTHEW HOLT

Yesterday phone and electronics giant Samsung rushed out its next step in health related hardware. Samsung was clearly trying to get this out the door and in the press before Apple’s forthcoming announcement of something health-related –or I assume that’s what their industrial espionage told them Apple was about to reveal (just kidding guys!). And some people (well, Techcrunch) were clearly unimpressed.

The most compelling moment which I captured (poorly) in the video above was the demo of the new SIMBAND–albeit a concept rather than an available product. (In fact a couple of their partners told me that no-one outside the company has one). In the SIMBAND are a stack of new sensors which attempt to use the wrist to monitor not only heart rate, but blood pressure, temperature, EKG and do it all continuously. You can see a rather better video of the demo from Gizmodo, which I cued up to start at the right place.

They also announced a fully open platform (what at Health 2.0 we dub the Data Utility Layer) called Samsung Architecture Multimodal Interactions (SAMI) to accept and spit out all types of health related data.

This is all potentially very impressive. Samsung’s first two attempts at Smart Watches have fizzled, but they tend to keep coming back, and now are pretty much the best at Smart Phones. (You fan bois can keep your teeny iPhone screens!) But can they make the health related smartwatch work? I’ve three quick assessments/questions.

Socialized or Not, We Can Learn from the VA

May 29, 2014• 27

By ART KELLERMANN, MD

In a post on the New York Times’ Economix blog not long ago, Princeton economics professor Uwe E. Reinhardt addresses the common characterization of the British health care system as “socialized medicine.” The label is most often used pejoratively in the United States to suggest that if anything resembling Great Britain’s National Health System (NHS) were adopted in the U.S., it would invariably deliver low-quality health care and produce poor health outcomes.

Ironically, Reinhardt notes, the U.S. already has a close cousin to the NHS within our borders. It’s the national network of VA Hospitals, clinics and skilled nursing facilities operated by our Veterans Healthcare Administration, part of the Department of Veterans Affairs. By almost every measure, the VA is recognized as delivering consistently high-quality care to its patients.

Among the evidence Reinhardt cites is an “eye-opening” (his words) 2004 RAND study from in the Annals of Internal Medicine that examined the quality of VA care, comparing the medical records of VA patients with a national sample and evaluating how effectively health care is delivered to each group (see a summary of that study).

RAND’s study, led by Dr. Steven Asch, found that the VA system delivered higher-quality care than the national sample of private hospitals on all measures except acute care (on which the two samples performed comparably). In nearly every other respect, VA patients received consistently better care across the board, including screening, diagnosis, treatment, and access to follow-up.

Vendor Management Systems and the Commoditization of Physicians and Nurses

May 29, 2014• 3

By Val Jones, MD

In a policy environment where quality measures and patient satisfaction ratings are becoming the basis for reimbursement rates, one wonders how VMS software is getting traction. Perhaps desperate times call for desperate measures, and the challenge of filling employment gaps is driving interest in impersonal digital match services? Rural hospitals are desperate to recruit quality candidates, and with a severe physician shortage looming, warm bodies are becoming an acceptable solution to staffing needs.

As distasteful as the thought of computer-matching physicians to hospitals may be, the real problems of VMS systems only become apparent with experience. After discussing user experience with several hospital system employees and reading various blogs and online debates here’s what I discovered:

1. Garbage In, Garbage Out. The people who input physician data (including their certifications, medical malpractice histories, and licensing data) have no incentive to insure accuracy of information. Head hunter agencies are paid when the physicians/nurses they enter into the database are matched to a hospital.

To make sure that their providers get first dibs, they may leave out information, misrepresent availability, and in extreme cases, even falsify certification statuses. These errors are often caught during the hospital credentialing process, which results in many hours of wasted time on the part of internal credentialing personnel, and delays in filling the position. In other cases, the errors are not caught during credentialing and legal problems ensue when impaired providers are hired accidentally.

Personal Tech

May 29, 2014• 17

By ROB LAMBERTS, MD

My 87 year-old father broke his hip this past weekend. He was in Michigan for a party for his 101 year-old sister, and fell as he tried to put away her wheelchair. The good news is that he’s otherwise pretty healthy, so he should do fine.

Still, getting old sucks.

During the whole situation around his injury, surgery, and upcoming recovery, one thing became very clear: technology can really make things much easier:

I communicated with all of my siblings about what was going on and gave my “doctor’s perspective” to them via email.
I updated friends and other family members via Facebook.
I have used social media to communicate cousins about what is going to happen after he’s discharged from the hospital and coordinate our plans.

All in all, tech has really made things much easier.

This reality is in stark contrast to the recent headline I read on Medscape: “Doctors are Talking: EHRs Destroy the Patient Encounter.” The article talks about the use of scribes (a clerical person in the exam room, not a pal of the Pharisee) to compensate for the inefficiencies of the computer in the exam room. Physician reaction is predictable: most see electronic records as an intrusion of “big brother” into the exam room.

To me, the suggestion to use a scribe (increasing overhead by one FTE) to make the system profitable is ample evidence of EMR being anti-efficient.

Despite this, I continue to beat the drum for the use of technology as a positive force for health care improvement. In fact, I think that an increased use of tech is needed to truly make care better. Why do I do so, in face of the mounting frustrations of physicians with computerized records? Am I wrong, or are they?

Neither. The problem with electronic records is not with the tech itself, it is with the purpose of the medical record. Records are not for patient care or communication, they are the goods doctors give to the payors in exchange for money. They are the end-product of patient care, the product we sell. Doctors aren’t paid to give care, they are paid to document it. Electronic records simply make it so doctors can produce more documents in less time, complying with ever-increasingly complex rules for documentation.

Will Tech Revolutionize Health Care This Time?

May 28, 2014• 66

By JOE FLOWER

After decades of bravely keeping them at bay, health care is beginning to be overwhelmed by “fast, cheap, and out of control” new technologies, from BYOD (“bring your own device”) tablets in the operating room, to apps and dongles that turn your smart phone into a Star Trek Tricorder, to 3-D printed skulls. (No, not a souvenir of the Grateful Dead, a Harley decoration or a pastry for the Mexican Dia de Los Muertos, but an actual skullcap to repair someone’s head. Take measurements from a scan, set to work in a cad-cam program, press Cmd-P and boom! There you have it: new ear-to-ear skull top, ready for implant.)

Each new category, we are told, will Revolutionize Health Care, making it orders of magnitude better and far less expensive. Yet the experience of the last three decades is that each new technology only adds complexity and expense.

So what will it be? Will some of these new technologies actually transform health care? Which ones? How can we know?

There is an answer, but it does not lie in the technologies. It lies in the economics. It lies in the reason we have so much waste in health care. We have so much waste because we get paid for it.

Yes, it’s that simple. In an insurance-supported fee-for-service system, we don’t get paid to solve problems. We get paid to do stuff that might solve a problem. The more stuff we do, and the more complex the stuff we do, the more impressive the machines we use, the more we get paid.

A Tale of a Wasteful Technology

A few presidencies back, I was at a medical conference at a resort on a hilltop near San Diego. I was invited into a trailer to see a demo of a marvellous new technology — computer-aided mammography. I had never even taken a close look at a mammogram, so I was immediately impressed with how difficult it is to pick possible tumours out of the cloudy images. The computer could show you the possibilities, easy as pie, drawing little circles around each suspicious nodule.

But, I asked, will people trust a computer to do such an important job?

Oh, the computer is just helping, I was told. All the scans will be seen by a human radiologist. The computer just makes sure the radiologist does not miss any possibilities.

I thought, Hmmm, if you have a radiologist looking at every scan anyway, why bother with the computer program? Are skilled radiologists in the habit of missing a lot of possible tumors? From the sound of it, I thought what we would get is a lot of false positives, unnecessary call-backs and biopsies, and a lot of unnecessarily worried women. After all, if the computer says something might be a tumor, now the radiologist is put in the position of proving that it isn’t.

I didn’t see any reason that this technology would catch on. I didn’t see it because the reason was not in the technology, it was in the economics.

Years later, as we are trending toward standardizing on this technology across the industry, the results of various studies have shown exactly what I suspected they would: lots of false positives, call-backs and biopsies, and not one tumor that would not have been found without the computer. Not one. At an added cost trending toward half a billion dollars per year.

Do We Really Need the VA?

May 28, 2014• 16

By PAUL KECKLEY

Last Wednesday, President Obama called the much-publicized problems in the Veterans Affairs health system “disgraceful” as delays in care in at least 26 facilities grabbed media attention. In testimony before Senate and House Congressional committees, VA officials disclosed systemic misrepresentations about the timeliness of treatments in VA primary care clinics: rather than getting care within 14 days of request, many veterans appear to have waited 6-12 months to see a doctor, and some are alleged to have died while waiting.

In referencing a special report due this week that assesses the scope of the problem in the Department of Veterans Affairs, the President’s commitment to fix the problem was unequivocal: “I want to see what the results of these reports are and there is going to be accountability.”

As I have watched the VA storyline play out over the course of the past few weeks, I found myself asking questions the reporters weren’t:

Why do we need to operate a separate system of 820 clinics and 151 hospitals for Veterans?

Might the system of care for the 21 million it currently serves not be better coordinated through the U.S. health care system of 5200 public and private hospitals, 820,000 physicians, 1200 federally qualified health centers, 2000 community mental health clinics, 56,000 pharmacies and 1700 retail clinics? In most communities, there’s a surplus of beds.

In most communities, those with insurance can get doctors’ appointments and receive treatment. Veterans who lack private coverage, like those who are uninsured, have fewer choices. It is not a capacity issue: it is an economic issue.

And common sense suggests we might redeploy some the VA health administration’s $60.3B budget for better coordination with the private systems that already operate in our communities while reducing duplication of services and their associated costs.

Why don’t we get serious and fix the problem of access to primary care shortage once and for all? It’s not just a veterans’ problem. Those who live in poorer neighborhoods lack access.

The Cheeseburger Study

May 28, 2014

By VIK KHANNA & ALAN CASSELS

Two weeks ago, Vik wrote a column for the The Health Care Blog on the now infamous meat-and-cheese study done by a team of researchers led by folks from USC. You can read the column, and the hilarious comments, here. I sent the column to one of the researchers, using the messaging available at LinkedIn. Here is that researcher’s response in its entirety:

I feel no need to get into a debate with someone who doesn’t understand basic statistics, how research is conducted, and has written a statement that is blatantly wrong. It does worry me that you are propagating yourself as an “expert” when you can’t seem to critically evaluate or understand a study. I know that this study is not perfect, hardly any are, especially in epidemiology, but the points you bring up in your blog are completely misconstrued and show very poor understanding of research methodology.

If you had actually read and understood the paper you would see that we controlled for waist circumstance [sic] and BMI. Also, this isn’t some random population of fat, low educated, American smokers, it is a nationally representative sample–unfortunately this is what the American population looks like. Finally, the idea that you think our supplemental tables house the real results illustrates your lack of understanding about statistics or how mortality models are run.

That being said, if you come up with a legitimate critique, I would be happy to engage in a friendly debate. When you attack something, I would suggest you make sure you understand it first, otherwise it is hard to legitimize anything else you say. I find it ironic that most of the push back from this paper has been from the general public who don’t have experience doing these types of studies, while for the most part, the scientific community (at least from people at R1 universities) has been fairly receptive.

We are glad to offer this legitimate critique, beginning with what we find in the very first sentence of the Results discussion that is not in the paper itself, but in the supplementary materials: “Using Cox Proportional Hazard Models, we found no association between protein consumption and either all-cause, CVD, or cancer mortality (Table S2).” Table S1 makes the point even more clearly: all-cause mortality in the low protein group was 42.9%. All-cause mortality in the high protein group was 42.9%, meaning that there is ZERO impact on overall mortality from protein variation at the extremes.

Download Two of These And Call Me In the Morning

May 28, 2014• 5

By BRIAN LEVINE, MD

When it comes to discussing exercise with friends, family and patients, it seems that many of us are at a loss for words. What kind of exercise should we recommend? How much exercise is enough? How much is too much? How do I know that my patient is actually exercising? How do I prescribe exercise?

According to the U.S. Department of Health and Human Services, U.S. adults should engage in moderately intense physical activity for a minimum of 150 minutes each week; this is equivalent to 30 minutes a day, 5 days per week [1]. While it is relatively easy to keep track of the duration and frequency of exercise, it is much more difficult to quantify the intensity of an activity, let alone ensure that the activity is “moderate” for the entire 30 minutes.

In fact, in a 2008 study of women’s understanding of “moderate-intensity” of physical activity as presented in the popular media, the authors found it is not enough to simply hear and read a description of physical activity, but that it requires practice [2].

So, what are we to do? Should we have our patients log their daily activities? Should we have our patients show us sign-in sheets from the local gym?

It turns out that the dilemma of how to quantify physical activity has been a hot topic for more than 50 years. In 1965, a Japanese inventor developed the first pedometer to give people the opportunity to meet measurable goals and, thus, increase their physical activity. The device was called the Manpo-Kei (meaning “10,000 steps meter”) and it was based on research by Dr. Yoshiro Hatano that demonstrated that 10,000 steps per day allowed for a proper balance between the traditional Japanese caloric intake and the activity-based caloric expenditure of walking approximately five miles per day (the average person’s stride length is approximately 2.5 feet long, therefore 2,000 steps/mile) [3].