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That Vitamin There Could Kill You

• 20

By James Salwitz, MD

Once-upon-a-time, when a patient said they were taking a vitamin, most doctors would simply shrug their shoulders and say, “well, I guess its OK, it couldn’t hurt.”   There was little research to judge the affect of vitamin supplements, so there was no reason to take a stand.  That is no longer true.

Now we have published data on many vitamins and we can say that for most people they do not work.  More importantly, there is increasing research that says manufactured, chemically synthesized nutriment compounds in a pill, can be deadly.

For this reason, I am likely to ask my patients if they are taking a vitamin and, if so, which fabricated additive and how much.  Therefore, I asked Bill, while he was in the office receiving chemotherapy for Hodgkin’s disease, what alternative therapies he was using.

When he informed me that he swallowed a multivitamin (MVI), large doses of Vitamins C and E, as well as a B complex preparation, I advised him to stop.

To my astonishment he responded, “Well, you only want me to do that because you make a lot of money on chemotherapy, and vitamins might put you out of business.”

Bill’s response, he lack of trust in my advice, disturbs me at several levels.  He fails to understand and does not wish to learn the present state of science regarding nutrition. In addition, there is a major problem regarding his perception of my motivations and therefore the veracity of my guidance.

Let us be clear; in the absence of malnutrition, malabsorption and a few uncommon medical conditions, there is absolutely no reason to take a multivitamin.  They do not prevent or fix anything.  Originally developed for starving populations and hungry soldiers during the Second World War, they have no place in a society with access to a broad range of foods.

More importantly, there is increasing data that people taking a multivitamin may become less healthy.

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HxRefactored: Win Complimentary Passes During HIMSS 2014!

In the spirit of HIMSS 2014 and improving the health experience, we want to give two attendees the chance to take what they have learned from HIMSS and take it to the next level. That’s why we are giving away TWO FREE passes to the HxRefactored conference!

All you have to do is:

Doctors Without State Borders: Practicing Across State Lines

• 18

By Robert Kocher, MD

In the United States, a tangled web of federal and state regulations controls physician licensing.  Although federal standards govern medical training and testing, each state has its own licensing board, and doctors must procure a license for every state in which they practice medicine (with some limited exceptions for physicians from bordering states, for consultations, and during emergencies).

This bifurcated system makes it difficult for physicians to care for patients in other states, and in particular impedes the practice of telemedicine. The status quo creates excessive administrative burdens and like contributes to worse health outcomes, higher costs, and reduced access to health care.

We believe that, short of the federal government implementing a single national licensing scheme, states should adopt mutual recognition agreements in which they honor each other’s physician licenses.  To encourage states to adopt such a system, we suggest that the federal Center for Medicare and Medicaid Innovation (CMMI) create an Innovation Model to pilot the use of telemedicine to provide access to underserved communities by offering funding to states that sign mutual recognition agreements.

The Current System And Its Drawbacks

State licensure of physicians has been widespread in the United States since the late nineteenth century.  Licensure laws were ostensibly enacted to protect the public from medical incompetence and to control the unrestrained entry into the practice of medicine that existed during the Civil War.  However, it no longer makes sense to require a separate medical license for each state.

Today, medical standards are evidence-based, and guidelines for medical training are set nationally through the Accreditation Council for Graduate Medical Education, the Centers for Medicare and Medicaid Services’ Graduate Medical Education standards, and the Liaison Committee on Medical Education.  All U.S. physicians must pass either the United States Medical Licensure Examinations or the Comprehensive Osteopathic Medical Licensing Examination.

Although the basic standards for initial physician licensure are uniform across states, states impose a patchwork of requirements for acquiring and maintaining licenses. These requirements are varied and burdensome and deter doctors from obtaining the licenses required to practice across state lines.

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What A Green Three Ring Binder Says About the State of Meaningful Use and Health Information Exchange

• 5

By Rob Cronin

The photo says it all.

The green notebook and pen represent the latest and greatest health IT innovations used by the hospital nurse to record my wife’s health information in the hours before her surgery to re-attach a fully torn Achilles tendon.

(Apologies for the cheeky intro and to my wife and anyone else for any HIPAA violations I may have committed in the capturing of this image).

It’s not that the hospital does not have an electronic health record.

They do – from a vendor widely considered a leader in the industry: Meditech. Same goes with the physician practice where she receives all her care and where her surgeon and primary care doctor are based.

They too have an EHR from another leading vendor: NextGen.

The problem? These systems are not connected. Thus, confirming the not so surprising news that health data interoperability has yet to make its debut in our corner of the NYC burbs.

Fortunately for my wife, she is well on her way to recovery (a bit more reluctant to juggle a soccer ball with her son in airport passenger lounges, but nevertheless feeling much better…and mobile). By everyone’s estimation – hers, mine, friends who suffered the same injury and friends who happen to be doctors – she received high quality care.

What’s more, we feel the overall patient experience at our physician practice and the hospital was quite good. That said, I cannot help but ask myself a series of ‘what ifs?’

What if…we forgot to mention a medication she was taking and there was a bad reaction with medication they administered as part of the surgery or afterwards?

What if… the anesthesiologist or surgeon couldn’t read the nurse’s handwriting?

What if the next time we go to the hospital, it is a visit to the emergency room and the attending clinicians have no ability to pull any of my family’s health records and we are not exactly thinking clearly enough to recall details related to medical history?

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Seven Reasons Why Your Doctor Is Still Using Technology That Sucks

• 8

By Charlene Ngamwajasat

Did you ever walk into a doctor’s office and then have to fill out a long paper intake form with the same information you’ve filled out multiple times before (name, date of birth, insurance etc)? Or notice that your doctor is writing notes on pieces of paper that remind you of your days in school? Did you ever see someone carry a pager around? Was that person wearing a white coat?

You can bank and pay for your Etsy/Amazon/Target/Apple “gotta have that now” stuff online. You can Skype with your family who lives thousands of miles away. You can order a pizza & know the exact moment it comes out of the oven. You can interact with @Oreo, @TacoBell @Grumpycat online.

So why can’t you easily see your health charges online? Why can’t you get a quick text or email that you’ll be seen by your doctor in 10 minutes? Why can’t you Skype with your doctor?

1. Until recently, your doctor has probably had little to no training or exposure to the world of digital health.

If you do a quick and dirty poll and ask the MD’s in your life what it is, you’ll likely get a ?-mark look or an answer related to apps, electronic medical records, or meaningful use. How can that be? Don’t most doctors have smartphones & tablets? Yes, a lot do but their use in a professional capacity isn’t 100% yet.

Until recently, there were no courses in med school or noon lectures in residency related to health information technology, wearables, personalized medicine, medical apps etc

It’s hard to use something or integrate it into your daily life if you’ve never heard of or really used it before.Continue reading…

CVS Caremark Enters CommonWell

• 4

By John H. Hammergren

One of the most critical issues facing our healthcare system is the fact that the IT systems we’ve put in place have not yet led to a more connected, intelligent approach to patient care.

While we have made notable headway toward interoperability through health information exchange solutions, we must dramatically accelerate our progress to support the transition to value-based care and realize our full potential as an industry.

With this vision in mind, McKesson, Cerner and other leading healthcare IT companies announced the CommonWell Health Alliance last year at HIMSS13. Members of the Alliance are united by a shared commitment to develop a core set of interoperability services and standards that will enable patient data to be shared securely across care settings and electronic health record (EHR) platforms.

In the twelve months since, tremendous progress has been made in making this aspiration a reality. CommonWell is running robust initial projects and collaborating with a myriad of practices. We’re also continuing to expand with new members who share our ideal of the trusted exchange of patient data, regardless of vendor, system, or setting.

Now, the Alliance is welcoming its first pharmacy member in CVS Caremark. This is a watershed event for several reasons.

CVS Caremark is one of the nation’s largest retail pharmacy chains and pharmacy benefit management companies. Few organizations in any segment of healthcare have more access to patient data and more trusted influence.

But CVS Caremark’s role in driving innovation in our healthcare system, and its importance to the goal of interoperability, is vital for other reasons.

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Are Payors Changing What They Pay For Medical Billing Codes To Adjust For Supply and Demand?

• 8

By THCBist

Startup Mojo from Rhode Island writes:

Hey there, maybe THCB readers can weigh in on this one. I work at a healthcare startup. Somebody I know who works in medical billing told me that several big name insurers they know of are using analytics to adjust reimbursement rates for  medical billing codes on an almost daily and even hourly basis (a bit like the travel sites and airlines do to adjust for supply and demand) and encourage/discourage certain codes.  If that’s true, its certainly fascinating and pretty predictable, I guess.

I’m not sure how I feel about this. It sounds draconian. On the other hand,  it also sounds cool. Everybody else is doing the same sort of stuff with analytics: why not insurers? Information on this practice would obviously be useful for providers submitting claims, who might theoretically be able to game the system by timing when and how they submit. Is there any data out there on this?

Is this b.s. or not?

Lost in the health care maze? Having trouble with your health Insurance? Confused about your treatment options? Email your questions to THCB’s editors. We’ll run the good ones as posts.

Can Oscar Succeed In Making Health Insurance Fun? Maybe Not Just Yet. But the Startup Is Shaking Things Up …

• 3

By Kate Greenwood

Last week  I went to a panel presentation sponsored by the group NYC Health Business Leaders on the rollout of New York State’s health insurance exchange.  Among the speakers was Mario Schlosser, the co-founder and co-CEO of the venture-capital-backed start-up health insurance company Oscar Health, which offers a full range of plans through New York’s exchange.

As NPR reported last month in a story about Oscar, “it’s been years since a new, for-profit health insurance company launched in the U.S.”, but the Affordable Care Act created a window of opportunity for new entrants.

Schlosser began his talk by giving us a tour of his personal account on Oscar’s website, www.hioscar.com.  Among other things, he showed us the Facebook-like timeline, updated in real time, which tracks his two young children’s many visits to the pediatrician.

He typed “my tummy hurts” into the site’s search engine and the site provided information on what might be wrong and on where he might turn for help, ranging from a pharmacist to a gastroenterologist, with cost estimates for each option.

Additional searches yielded information on covered podiatrists accepting new patients with offices near his apartment and on the out-of-pocket cost of a prescription for diazepam (which was zero, since there is no co-payment for generic drugs for Oscar enrollees).

As an audience member noted, none of this is new exactly.  What is new is to have this kind of data-driven, state-of-the-art user experience being offered by a health insurer.  Schlosser told the audience that Oscar’s pharmacy benefit manager and other vendors are providing the company with real-time data that other insurers have not demanded.

 

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Box & Dignity Health Name Five Semi-Finalists in Patient Education App Challenge

By Kim Krueger

Back at the Seventh Annual Health 2.0 Fall Conference in September, Box launched a Patient Education App Challenge with Dignity Health and The Social+Capital Partnership.

It was an appropriate launch pad to say the least, being like-minded as we are when it comes to our opinions regarding the cloud. Yet, as we know, health care is still relatively new to the cloud, and the entry of major cloud (and now HIPAA compliant) vendors like Box is a big deal.

Phase one of Box’s entry into the health care vertical has been largely centered on getting a diverse client base securely onto the cloud. Device companies, big pharma, life sciences, biotech, and health insurance companies are using Box just as cloud tools should be used — for storing, sharing, collaborating, and enabling mobility.

As most of us know from varied personal and professional use of the cloud, easy access to every piece of collateral in a remote or collaborative working environment increases velocity and enables relationships.

The Patient Education App Challenge is part of Box’s move into a phase two of sorts: “strategic data liquidity or care coordination in the cloud” as Box’s Managing Director of Healthcare and Life Sciences Missy Krasner called it.

The challenge developed out of talks between Dignity Health, the nation’s fifth largest hospital system, and Box around how hospitals can better deliver the huge amounts of content generated within any given hospital division. It launched with the Box API as a foundation for innovative opportunities to deliver appropriate materials to patients in engaging ways.

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What You Need to Know About Patient Matching and Your Privacy and What You Can Do About It

• 4

By Adrian Gropper, MD

Today, ONC released a report on patient matching practices and to the casual reader it will look like a byzantine subject. It’s not.

You should care about patient matching, and you will.

It impacts your ability to coordinate care, purchase life and disability insurance, and maybe even your job. Through ID theft, it also impacts your safety and security. Patient matching’s most significant impact, however, could be to your pocketbook as it’s being used to fix prices and reduce competition in a high deductible insurance system that makes families subject up to $12,700 of out-of-pocket expenses every year.

Patient matching is the healthcare cousin of NSA surveillance.

Health IT’s watershed is when people finally realize that hospital privacy and security practices are unfair and we begin to demand consent, data minimization and transparency for our most intimate information. The practices suggested by Patient Privacy Rights are relatively simple and obvious and will be discussed toward the end of this article.

Health IT tries to be different from other IT sectors. There are many reasons for this, few of them are good reasons. Health IT practices are dictated by HIPAA, where the rest of IT is either FTC or the Fair Credit Reporting Act. Healthcare is mostly paid by third-party insurance and so the risks of fraud are different than in traditional markets.

Healthcare is delivered by strictly licensed professionals regulated differently than the institutions that purchase the Health IT. These are the major reasons for healthcare IT exceptionalism but they are not a good excuse for bad privacy and security practices, so this is about to change.

Health IT privacy and security are in tatters, and nowhere is it more evident than the “patient matching” discussion. Although HIPAA has some significant security features, it also eliminated a patient’s right to consent and Fair Information Practice.

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