The Health Care Blog – Page 600 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

How to Stop a Future Cancer Epidemic

Oct 29, 2012• 5

By Paul Levy

The theory of preventative care, including inoculations, is that we spend a little money now to offset big expenses later in life. But sometimes behavioral friction keeps this from happening, even when the technologies and approaches are proven. We are witnessing such a failure right now with regard to Human Papilloma Virus (HPV).

Here’s the story, from MGH’s James Michaelson, PH.D., arguably one of the most thoughtful, trustworthy, and sensible researchers in the field of analysis of cancer survival. Jim and his team develop sophisticated mathematical methods for predicting the risk of local, regional, and distant recurrence. He says:

There are a couple of good papers about Human Papilloma Virus (HPV), and the coming epidemic (yes, an overused term, but truly applicable here) of head and neck cancer. As Chaturvedi et al say in a recent paper: “If recent incidence trends continue, the annual number of HPV-positive oropharyngeal cancers is expected to surpass the annual number of cervical cancers by the year 2020.”

I get to see this problem from two angles: From my work as the the manager of the MGH/MEEI Head and Neck Cancer Database, and from my experiments in using computer telephone messages to get patients in for preventive health services, such as the fabulous HPV Vaccines: Cervarix (from GlaxoSmithKline) and Gardasil (from Merck). The vaccines are incredibly underutilized. Only about 1% of eligible boys and only 50% of eligible girls get one shot. Only about 25% of girls get all three shots.

Continue reading…

The Good Doctor Learns to Fly

Oct 26, 2012• 37

By Rob Lamberts, MD

This is my new office. I signed the lease for this property yesterday – another big step in the process of getting my new practice off the ground. I should feel good about this, shouldn’t I? I’ve had people comment that I’ve gotten a whole lot accomplished in the 4 weeks since I’ve been off, but the whole thing is still quite daunting. Yes, there are days I feel good about my productivity, and there are moments when I feel an evangelical zeal toward what I am doing, but there are plenty more moments where I stare this whole thing in the face and wonder what I am doing.

I walked through the office today with a builder to discuss what I want done with the inside; it quickly became obvious that there was a problem: I don’t know what I want done, and nobody can tell me what I should do. Yes, I need a waiting area, at least one exam room, an office for me, a lab area, bathrooms, and place for my nurse, but since I don’t really know which of my ideas about the practice will work, I don’t know what my needs will truly be. How much of my day will be spent with patients, how much will be doing online communication, and how much will be spent with my nurse? I want a space for group education, but how many resources should I put toward that? I also want a place to record patient education videos, but some of my “good ideas” just end up being wasted time, and I don’t know if this is one of them.

I come across the same problem when I am trying to choose computer systems. I know that I want to do that differently: I want the central record to be the patient record, not what I record in the EMR. I want patients to communicate with me via secure messaging and video chat, and I want to be able to put any information I think would be useful into their PHR. So do I build a “lite” EMR product centered around the PHR, or do I use a standard EMR to feed the PHR product? Do I use an EMR company’s “patient portal” product, or do I have a stand-alone PHR which is fed by the EMR? I have lots of thoughts and ideas on this, but I don’t really know what will work until I start using it.

How Bundled Payments Just Might Save Health Care From Itself

Oct 26, 2012• 5

By Wes Champion

In the 1960s, Texas Instruments developed the first handheld calculator. It could display up to 12 digits while performing addition, subtraction, multiplication and division. And it cost $2,200.

Since then, the calculator has come a long way. Competition forced continuous innovations, and today’s models are more lightweight, have longer battery life, are capable of performing more complex computations –all at a dramatically reduced price point.

That’s the typical cycle in virtually every sector of the American economy. Innovations are introduced, competition forces design improvements and cost reductions and products are continually improved until the next big thing comes along to start the process over again.

But that’s not the way things work in healthcare.

Like the calculator, Medicare was first created in the 1960s.

But even though the practice of medicine has changed dramatically over the last 40 years, the Medicare program has stayed largely the same. And, since most commercial insurers tend to follow the government’s lead in terms of payments and benefit design, even private markets have played a role in limiting innovations in the way we pay for healthcare.

Patient Satisfaction: The New Rules of Engagement

Oct 26, 2012• 11

By Holly Korda, Ph.D.

Patient satisfaction has garnered new attention as an indicator of provider performance and an important dimension of value-based health care under the Affordable Care Act (ACA). Defined in any number of ways, it is often publicly reported to help patients choose among health care providers.

This month, patient satisfaction takes on even greater importance as ACA provisions set to begin October 1, 2012, tie patient satisfaction to Medicare reimbursement, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. HCAHPS scores reflect patients’ perspectives on several aspects of care: communication with doctors and nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, and quietness of the hospital environment—and are estimated to place at risk an average of $500,000 to $850,000 annually per hospital.(1)There’s a lot riding on patients’ perceptions of the health care experience, our satisfaction with the care we receive. But what do we really know about patient satisfaction, its relationship to patient outcomes and cost—and just what is it we are rewarding?Continue reading…

Is the Nurse Incompetent?

Oct 25, 2012• 22

By Paul Levy

This case is prompting a lot of comments, some of them taking issue with the concept of systemic failures and instead asserting that the young nurse was clearly incompetent, in that her error was inexplicable. So, let’s turn from a clinic in Brazil to a recent case in a hospital in the US, cited in this article on AHRQ’s Web M&M. A summary:

The order was written correctly in the electronic medical record (EMR) for phenytoin, 800 mg IV. The drug-dispensing machines stocked phenytoin in 250 mg/1 mL vials. The correct dose therefore would require 4 vials and be equal to 3.2 mL to be added to a small IV bag. The nurse misread the order as 8000 mg (8 g) and proceeded to administer that dose to the patient, which was a 10-fold overdose and 2 to 3 times the lethal dose. The patient died several minutes after the infusion.

This nurse had to work hard to make the error:

An audit of the pharmacy system revealed that the nurse had taken 32 vials out of 3 different pharmacy dispensing machines to accumulate 8 g of IV phenytoin. Moreover, the nurse had to use two IV bags and a piggyback line to give that large a dose.

Continue reading…

The Return of Counter-Conventional Wisdom

Oct 25, 2012• 8

By Dr. Wes

Diet and exercise: they were supposed to be the answer to all that ails America’s obesity and health care cost problem.

Signs of this Utopian vision are everywhere. From entire government departments encouraging healthy lifestyles through fitness, sports and nutrition, government websites that encourage “healthy lifestyles,” and entire community efforts to partner with health care organizations to fight obesity with the hope of cutting health care costs.

What if, believe it or not, when it comes to people with Type II diabetes, diet and exercise don’t affect the incidence of heart attack, stroke, or hospital admission for angina or even the incidence of death?

Suddenly, all health care cost savings bets are off. Suddenly, we have to re-tool, re-think our approach, understand and appreciate the limitation of lifestyle interventions to alter peoples’ medical destiny. Suddenly we have to come to grips with a the reality that weight loss and exercise won’t affect outcomes in certain patients. Suddenly, there is a sad reality that patients might note be able to affect their insurance premiums by enrolling in diet and exercise classes after all.

These thoughts are so disruptive to our most basic “healthy lifestyle” mantra that few can fathom such a situation. Nor would any members of the ever-beauty-and-weight-conscious main stream media be likely to report such a finding if it came to pass.

And yet, that is exactly what has happened.

Blue Button Mash-Up & EHR Accessibility Module Challenge Winners

Oct 25, 2012

By Chris Bernstein

HHS held an Innovation Challenge and patients were the winners! Winners for the Blue Button Mash-Up Challenge and the EHR Accessibility Module Challenge were announced during the Health 2.0 Sixth Annual Fall Conference in San Francisco.

The first Challenge required applicants to ‘mash up’ Blue Button data with other open health data and information. “Blue Button” data is personal health information a patient can download through their health plan, doctor, or hospital.

The second Challenge asked solvers to create and test a tool that makes it easy for people with disabilities to access and interact with the health data stored in their electronic health records (EHR).

The Blue Button winner, iBlueButton, submitted by Humetrix of San Diego, is a dual-app system. The Patient version provides an intuitive, secure solution consumers can use to connect to their Blue Button and other health records. The Physician version transmits in-app generated Visit Summaries or Patient Records using Push technology to the patient. iBlueButton includes features such as patient-optimized and physician-optimized displays and dashboards, medication look-up, and new tools to download or print health information.

What HHS Might Look Like Under President Romney

Oct 24, 2012• 4

By Dan Diamond

The world may not be ready for a Romney presidency.

Or more specifically: world leaders may not have done enough homework.

An interesting Washington Post story this week suggested that because the foreign polls have been so bullish on President Obama — 82% of Germans in one survey expected Obama to be re-elected — lawmakers around the world may be scrambling to adjust to a new team of U.S. diplomats and set of policies.

Is the health sector better prepared?

Given the close race — as of press time on Wednesday, most polls had the presidential race neck and neck — there’s been growing scrutiny of Republican health proposals. For example, the Kaiser Family Foundation and the Urban Institute on Tuesday released another report on the GOP House Budget Committee’s Medicaid plan.

But there’s been much less examination of the people who would steer Romney’s Department of Health and Human Services and the policies they’d carry out.

Possible, if Unlikely Contenders

A handful of names — all veterans of the George W. Bush administration — have been repeatedly floated as potential HHS secretaries under Romney. National Journal suggested that former HHS Secretary Michael Leavitt could return to the role. Meanwhile, ex-FDA and CMS head Mark McClellan is “the first name that comes to mind for many Republican health policy folks,” Politico’s Jennifer Haberkorn wrote earlier this year.

A Coming Storm: FDA Regulation of Mobile Medical Applications

Oct 24, 2012• 14

By Ryan Minarovich

I recently had the great fortune of attending Health 2.0 in San Francisco. The conference was abuzz with new medical technologies that are harnessing the power of innovation to solve healthcare problems including many new mobile medical application companies showcasing their potential. As I walked and talked around the exhibit floor, one thing caught my ear, or I should say one thing didn’t catch my ear. Among the chatter about these products, the concern about FDA regulation of this product segment, or even FDA regulation in general was noticeably absent. While many of the application developers are well aware of potential FDA involvement, most would be hard-pressed to outline the impact this would have on their companies and products.

Being labeled a medical device, which is the direction the FDA is leaning, could have a significant impact on business model organization, top-line revenue, and product deployment. For unprepared start-ups, FDA regulation could signal an end for their company. This is in stark contrast to well informed developers who are preparing themselves for the change and would most likely be able to leverage these regulations to their advantage.

Training Future Physicians in Safety and Quality

Oct 24, 2012• 1

By Peter Pronovost, MD

Nearly a year ago, one of my blog posts bemoaned a gap in our training of future physicians—a lack of training in the skills needed to lead projects in patient safety and quality improvement.

I wrote the post after speaking to a group of medical students who were energized about this area of work. Yet, as I reflected on the talk:

“I had to confront the sad reality that most of them will graduate ill-prepared to lead the improvements of quality and safety our health care system needs. They no doubt will know chemistry, biology and physiology, but they may not know about human factors, implementation science or performance measurement—the language of quality improvement. They will know orthopedics and genetics but they won’t know teamwork and systems engineering. They likely know about German scientist Rudolph Virchow, the father of cell theory, yet they do not know John Kotter, the father of change theory whose model for leading change is highly effective and widely used.”

So how can medical students, residents and fellows make quality improvement and patient safety a focus of their clinical careers? On Nov. 10, the Armstrong Institute and the American College of Medical Quality will be hosting the National Workshop on Quality for Medical Education—affordable and open to anyone—that focuses on how medical students, residents and fellows can integrate safety and quality into their clinical careers. What career paths exist? What tools and skills are needed to carry out this work, and where do you get them? What kinds of quality and safety projects are residents and students taking on?