The Health Care Blog – Page 604 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

OpenNotes: Great News for Patient Engagement!!

Oct 2, 2012

By Dave deBronkart

Regular readers know that we’ve long anticipated the result of the OpenNotes project. Our first post about it was in June 2010: OpenNotes project begins: what happens when patients can see the physician’s visit notes? It tied the issue all the way back to the birth of the Web, in 1994:

The opening anecdote of the e-patient white paper 20th page of this PDF; 23rd page in the Spanish edition tells of a patient who impersonated a doctor in 1994, to get his hands on an article about an operation he was about to have. He got busted.

Two years later episode 139 of Seinfeld had something similar. Kramer impersonates a doctor to try to get Elaine’s medical record.

Now, the Robert Wood Johnson Foundation (RWJF) is funding a study called OpenNotes to explore taking it a big step further: what happens if patients can see, online, every last bit of what their doctors wrote?Do doctors get overwhelmed with questions? Do patients freak out when they read the yucky medical words that doctors write? Does the world go to hell in a handbasket, as some have worried aloud?

The results were released yesterday, in a new article in the Annals of Internal Medicine. (See the OpenNotes website.) Co-lead authors Tom Delbanco MD and Jan Walker, RN, MBA shared a pre-release copy with e-patients.net. They describe the study’s intent:

Drawing on existing literature, including small studiesĸof patients with chronic illness, we developed 3 principalĸhypotheses.

Continue reading…

The Health 2.0 Top 10 List

Oct 2, 2012• 1

By Indu Subaiya

THCB and Health 2.0 are sister companies, but we don’t do too much cross promotion. Time to break that rule! With just five days left, Health 2.0 Co-Chairman & CEO Indu Subaiya shares her ‘Top 10 Reasons’ to love and attend Health 2.0’s 2012 Annual Fall Conference, October 7-10. It you haven’t registered yet and want to meet 1,500+ at the best health care meeting of the year do it here before we sell out!—Matthew Holt

TOP 10 REASONS

SIX pre-conferences: Health Law 2.0, Employers 2.0, Research 2.0, Doctors 2.0, Patients 2.0, & iPharma.
23andMe will discuss the CureTogether acquisition and share the stage with Sproutel, the creators of the diabetic bear.
Jillian Michaels (The Biggest Loser, Everyday Health) talks about the cross section of entertainment and health.
We’ll be showcasing tools that automate doctors’ handwriting and do voice capture — all on mobile devices.
Sensors for everything (movement, breathing, heart rate, and sleep) that are leading to clinical integration and impact!

Strengthening Primary Care With A New Professional Congress

Oct 2, 2012• 48

By Brian Klepper, et al.

Three months ago a post argued that America’s primary care associations, societies and membership groups have splintered into narrowly-focused specialties. Individually and together, they have proved unable to resist decades of assault on primary care by other health care interests. The article concluded that primary care needs a new, more inclusive organization focused on accumulating and leveraging the power required to influence policy in favor of primary care.

The intention was to strengthen rather than displace the 6 different societies – The American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), the Society for General Internal Medicine (SGIM), the American Academy of Pediatrics (AAP), the American Osteopathic Association (AOA), the American Geriatrics Society (AGS) – that currently divide primary care’s physician membership and dilute its influence. Instead, a new organization would convene and galvanize primary care physicians in ways that enhance their power. It would also reach out and embrace other primary care groups – e.g., mid-level clinicians and primary care practice organizations – adding heft and resources, and reflecting the fact that primary care is increasingly a team-based endeavor.

We came to believe that a single organization would not be serviceable. Feedback on the article suggested that several entities were necessary to achieve a workable design.
Continue reading…

Five Reasons Americans Should Want Electronic Health Records

Oct 2, 2012• 15

By Will Saunders

Although healthcare providers are making progress in adopting health IT, Americans seem to be resistant to change to Electronic Health Records (EHRs). In fact, only 26 percent of Americans want their medical records to be digital, according to findings from the third annual EHR online survey of 2,147 U.S. adults, conducted for Xerox by Harris Interactive in May 2012.

Last month the Institute of Medicine issued a seminal report entitled “Best Care at Lower Cost: The Path to Continuously Learning Health in America.” The report estimates the American healthcare system suffered a $750 billion loss in 2009 from inefficient services and administrative expenditures. The report is grounded on the principle that effective, real-time insights for providers and patients which result in collaborative and efficient care depend on the adoption and use of digital records.

As people are naturally resistant to change, education will be key in gaining support among Americans for the transition to EHRs. If providers can help patients understand “what’s in it for me,” that will likely go a long way in making Americans feel more comfortable with the switch to digital.

Let’s take a look at five ways EHRs directly impact the patient. For these examples, we’ll use a fictitious patient named “Joe”:

Health Information Exchanges (HIE): HIEs work on the principle of a network – they grow stronger as more participants join. If Joe’s primary care doctor switches to digital, that’s a great step in the right direction. However, it isn’t truly meaningful until his primary care doctor joins an HIE and begins sharing Joe’s patient health history, medication history, lab results, family and social history and vital statistics with his specialists, emergency care providers, and so on. This sharing of information helps ensure that Joe gets the best quality of care, because all of his providers will be in sync and have the most up-to-date information. It also helps reduce the amount of duplicate exams and labs Joe will be asked to give.

OpenNotes: The Results Are In

Oct 1, 2012• 10

By Stephen J. Downs

A few years ago, Tom Delbanco and Jan Walker pitched us with a simple idea: Patients should routinely be able to see the notes that physicians write about them. Now it’s true that we all have the legal right to see these notes, but obtaining them is anything but routine. The process involves phone calls, faxes (sic), duplicating fees and all sorts of other demoralizing steps. The net result is that reviewing your doctor’s notes about you is a rare experience.

Tom and Jan said that the physicians with whom they had spoken about this idea were split. Some were interested, some were resigned: They recognized that transparency was an increasingly powerful wave and that the world seemed to be heading this way, and the others thought they were crazy―notes were for documentation and communication among doctors and were never intended for patients. The arguments were of a religious quality―they were about belief and values. The obvious solution was to test the idea and let data help sort it out. Today, with the publication of the study results in the Annals of Internal Medicine, that debate is now illuminated.

One hundred and five primary care doctors, more than 19,000 patients and 12-months of testing at three sites has brought us to some striking findings: Patients overwhelmingly support open notes; they report significant benefits from it; and doctors reported that the effects on their practice have been minor. I encourage you to read the full paper so you get the full context (and do pay attention to the limitations section). You’ll find a number of interesting results. Here are three that I think are especially worth reflecting upon:

1. 60-78% of patients (depending on the study location) reported that they took their medications better. This is self-reported data, so the numbers might be exaggerated, but this finding, along with other results related to taking better care of oneself and understanding one’s health conditions better, suggests there’s a significant potential for clinical benefit.

Can Personalized Care Survive ObamaCare’s Assembly Line Medicine?

Oct 1, 2012• 7

By John Goodman

Previously, I wrote about some wondrous developments that are taking place in medical science. Implantable or attachable devices already exist — or soon will exist — that can monitor the conditions of diabetics, asthmatics, heart patients and patients with numerous other chronic conditions. These devices will allow patients and doctors to modify therapeutic regimes and tailor treatments to individual needs and responses. Genetic testing is reaching the point where patients can be directed to take certain drugs or avoid other drugs, based solely on the patient’s own genes.

Almost all HIV treatment these days involves therapy cocktails tailored for each individual patient. The FDA has approved a breast cancer drug only for women with a particular genetic makeup. Patients are being advised to steer clear of an ADHD drug and certain blood thinners if they have particular genetic variations.

We are entering the age of personalized medicine, where the therapy that’s best for you will be based on your physiology and genetic makeup — and may not be right for any other patient.

Yet standing in the way of this boundless potential is an Obama administration whose entire approach to health reform revolves around the idea that patients are not unique and that bureaucrats can develop standardized treatments that will apply to almost everybody with a given condition. When former White House health adviser Ezekiel Emanuel told CNN recently that “personalized medicine is a myth,” he was fully reflecting the worldview of the authors of health reform.

Medical Malpractice – What Obamacare Misses

Oct 1, 2012• 37

By JOHN LYNCH

Medical malpractice in America remains a thorny and contentious issue, made no less so by its virtual exclusion from the Affordable Care Act (ACA, or Obamacare) governing healthcare reform in America.

Which is why I was glad to see the former head of President Obama’s Office of Management and Budget, Peter Orszag, now with the liberal Center for American Progress, cite it as his second top priority for gaining control of our out-sized medical spending – an implicit criticism of its omission from Obamacare.

Although speaking in the context of criticizing Rep. Paul Ryan’s (R-WI) plan to offer vouchers so Medicare enrollees could purchase private health insurance, his comments about the need to address malpractice reform are a departure from the liberal talking points on Obamacare. Here’s what he had to say…

Former Obama Budget Head Challenges Paul Ryan To Demonstrate How His Budget Would Lower Health Costs

“Rep. Paul Ryan’s (R-WI) proposals to control health care spending by slashing the federal government’s contribution to Medicare and Medicaid and shifting that spending on to future retirees or the states, has dominated Washington’s conversation about entitlement reform. But…a group of health care economists and former Obama administration officials laid out an alternative approach that could achieve health savings by encouraging providers to deliver care more efficiently…

“‘Mr. Ryan has had too much running room to go out with proposals that neither will reduce overall health care costs nor will help individual beneficiaries simply because there has not been enough of an alternative put forward by those who believe that we really need to focus on the incentives and information for providers…If I had to pick out two or three things to do immediately, I would pick the accelerated (trend) towards bundled payments and non fee-for-service payment…

Continue reading…

Destination Unknown

Oct 1, 2012• 2

By Rob Lamberts, MD

I cleaned out my office yesterday. I gathered up the outdated pictures of my family, handwritten notes from my children when they were much younger, pictures of patients, notes from patients, and the knick knacks that accumulate over 18 years of being in one place. Most of them were dusty or worn with the tarnish of time; things that sit in the office unnoticed until a moment like this.

I also went through the files of old information – information I seldom if ever used – detailing the financial struggles it took to build a successful practice. Here’s what we collected in 1998. Here are the notes from an office administration meeting in 2002. Here are handwritten flow diagrams I made to figure out a way to improve workflow. Here’s a list of patients from 2000 who were eligible flu shots with a sticky note affixed to the folder saying: “give to Angie.” I’m not sure I ever gave it to her.

The majority of paper, however, was spent on spreadsheets. There are spreadsheets of productivity, of income, of expenses, projected income, effects of adding new partners, of quality measures and of the ever ominous accounts receivable. These are numbers my distractible brain always had difficulty wrapping around, yet they stand as a testament to the myriad of details that work in the background of life. They mean even less to me now than they once did, like the dates on gravestones for people long forgotten, yet their existence reminds me that these days were not the dusty pictures sitting on the shelves of my memory; they were days of many small details and struggles. Life looks like a movie from the outside, but its reality is found in the spreadsheets it leaves behind.

CancerLand – The Undiscovered Country

Sep 30, 2012• 2

By James Salwitz, MD

Diagnosed with metastatic esophageal cancer on June 8, 2011 Christopher Hitchens found that he had been transported to a foreign place. Until his death 18 months later the award winning author picked up pen and wrote about his travels in a “new land” where everyone “smiles encouragingly,” “where the cuisine is the worst of any destination” and where a language is spoken that “manages to be both dull and difficult.” The recently published book “Mortality” is his voyage into “sick country,” a place we will call CancerLand.

The idea of moving far away is also described in Chet Skibinski’s 2012 diary-like book, “Cancer Country. “ “On May 15, 2008, I stepped into a foreign country” with freakish rules and disturbing customs. Skibinski takes the reader along on his journey though several years of complex care and metamorphosis, not only medical, but also social, spiritual and personal.

CancerLand is a place not only of a body which visits hospitals, clinics, subjected to knives, drugs, x-rays and deconstruction by machine, but it is a destination of mind, where confusion, isolation, and fear transform knowing, growing and comfort in a bizarre, painful, spinning world which tries to break down the soul to yield suffering. As both patient authors note, it is a transit from which it is difficult to return.
Cancer patients are cast out from safety, stability and control to a state of danger, chaos and subjugation. Understanding the disease process as a distinct place, with strange language, customs and goals provides clues to the survival of body and mind. Seeing CancerLand as an unwelcome Kafkaesque journey may help us fight the disease and adjust to the changes that occur.

Better Than Pandora for Cats

Sep 28, 2012

By David Shaywitz, MD

Health VCs: Desperate…

As a tech VC recently told me, refuting the latest flimsy rumor of a huge tech-dominated fund contemplating significant new investment in life science, “Wow, you healthcare guys are really desperate for some good news!”

It’s true; not only are LPs looking ever more critically at VC as an asset class – especially since the publication of the Kauffman report – but the life science sector, in particular, has been devastated, and health VCs have been hurting. (Added Sept 27: See this fascinating, just-posted Xconomy profile of Avalon’s Kevin Kinsella and discussion of the current sorry state of healthcare VC.)

Part of the issue, as Bruce Booth and Bijan Salehizidah have described previously, and as Sarah Lacy summarized nicely this week in PandoDaily, is that the return profile of life science venture investments looks very different than tech in general, and consumer web (the focus of Lacy’s article) in particular.

The sex appeal of tech investing is that a relatively small initial investment can blossom very quickly to yield huge returns; the catch, of course, is that this happens very rarely, and much like at a casino, and the tremendous attention lavished upon these winners can almost make you forget how infrequently they occur.