The Health Care Blog – Page 711 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Why we need an independent health data utility

Jun 27, 2011• 19

By MATTHEW HOLT

This is another in the numerous “death of Google Health” stories that have been appearing since Friday when the Google blog announced the pulling of the plug. I must admit to being more than a little pissed off with Larry Page or whomever it was within Google that made the decision. After all, Google Health was only introduced a tad more than 3 years ago (premiered at HIMSS in Feb 2008; launched officially later that year). And just nine months ago they hired a new product manager and debuted some interesting new features connecting to the new wave of personal sensors. I know that Wall Street has been telling Google to focus on fewer products and that Page as new CEO has decided to do that but for a company as rich as Google the effort involved in keeping Google Health alive would be trivial. And props here to our friends at Microsoft who are integrating HealthVault into their wider health care business.

The sunsetting of Google Health has meant an outpouring of articles from the factual (Deb Linton at Health 2.0 News), to the historical (John Moore at Chilmark) to the winners/losers assessment (Fred Trotter) to the mega-quotes including mine (Marshall Kirkpatrick at ReadWriteWeb). There’s also been a steady stream of both sad and (sadly) happy people commenting on the Society for Participatory Medicine listserv, and Mr HISTalk was his cynical self–basically saying that tech know-nothings should stay out of our complicated health care business. He’s wrong and now Google is wrong, and here’s why.

With the very notable exception of HealthVault and (hopefully) some new innovation from Dossia, we are now dependent on a number of small companies to maintain the emerging data utility layer. The data utility layer in health is the place that is going to collectively store all the data that is being generated. Apparently Google didn’t have the real patience for two rapid developments.

First, with a combination of the Direct Project and the stipulation in the meaningful use regulations that EHR users share data with other providers and with patients, individuals are going to find that more and more data about themselves is available and easily accessible. Whether or not it’s a Farmville-type hit, the ability to capture all that information in one place is very important. Currently it’s also very time consuming to put together so very few people do it. But I do know of instances where people have laboriously entered lab values into Google Health just to store them. Sooner rather than later that data will be available much more easily in machine readable format, and as those barriers to use fall so the desire to look at that data will increase.

Google Health, can it be only mostly dead?

Jun 24, 2011• 1

So the rumors are true and Google Health is being sunsetted. I’ll have more to say about this soon, but as someone who has a lot of data in Google Health and who doesn’t really want to move it anywhere else–even though I don’t go in and look at it that often–I think that that answer might be to have some open source co-operative take it over. That was the original idea behind Dossia and there’s a budding open source community in health care that might be able to do something similar. In fact the biggest and most successful EMR (VISTA) was built by such a method (albeit within the VA). This is just a thought at the moment, but part of the issue is that we need to connect data from the health care system with data from the consumer device ecosystem without being beholden to either (especially the former). It is though ironic the Google Health is throwing in the towel when data liberacion, including the very successful Blue Button, and suggestions of open APIs from health care tech vendors, are just starting to come true. But perhaps there’s a way to get a Billy Crystal in the room and resurrect it from its planned end.

What About Personal Responsibility?

Jun 24, 2011• 76

By JOE FLOWER

A reader writes to ask: What about personal responsibility? “I see no movement afoot to require the public to accept or meet norms of behavior that would reduce the need for medical treatment—smoking, excess drinking, use of drugs, over weight, etc. What ever happened to ‘You reap what you sow’?”

Good question. I answered:

Thanks for writing. This is a common concern. It’s often expressed something like, “Why are we paying for all this healthcare for people who won’t take care of themselves?” This seems, at first blush, an obvious question with an obvious answer. After all, as I constantly point out in what you read, vast amounts of healthcare dollars are spent to correct what we might call “self-inflicted lifestyle damage.” Why should the rest of us pay for that? Where is the responsibility?

On inspection, the question is more complex and the answer is not so obvious. Let me try to parse it out. I can think of four related aspects of the question.

1. Their health affects ours. My wife and I had a lovely dinner at a very nice French restaurant on the waterfront here in Sausalito last night. The staff was all French, with those endearing accents. The busboy who set our table, poured the water, took away dirty plates and all that, was Mexican. I talked with him a bit in Spanish about the nice weather. I have no way of knowing his immigration status. Now, if I had my ‘druthers, just as a customer, would I rather that he have good access to healthcare and healthcare advice, be up on his flu vaccinations, be aware of the importance of washing his hands frequently, or would I rather he be a seething mass of communicable disease, compounded by ignorance?

Looking at Healthcare Through Payer Lenses

Jun 24, 2011• 11

By JOHN MOORE

Payers, as with the rest of the healthcare industry, have a lot on their plate right now. Healthcare reform, via the Affordable Care Act (ACA) continues its march forward despite legal and political uncertainty. Struggling to define the payer role in Accountable Care Organizations (ACOs), understanding the impact of Health Insurance Exchanges (HIXs) on their business (McKinsey survey results likely have many payers wondering how to market to what may be an enormous uptick in individual purchasers of coverage – something that most are ill-prepared for), and how to better engage consumers/members in proactively managing their health are a few of the top issues that were addressed at the AHIP Institute last week.

But when one sits back and reflects on the AHIP Institute – all of the sessions, all the discussions, the chatter in the halls, underlying messages within the message, the exhibit hall – it boils down to three key themes that this sector of the healthcare industry is grappling with, which much like the three stages of meaningful use, build upon one another:Continue reading…

Hacking Your Heart

Jun 23, 2011• 7

By ALEX EPSTEIN

implanted pacemaker xray

If they can hack your home computer, your mobile phone, apps, your store, your social networks, your bank account, your gaming system, your medical records, your school records, the government and its records, and pretty much anything anyone sets their mind to – isn’t it is only a matter of time until someone finds a way to hack your heart?

Not through a musical hook or melody that you can’t shake. Or a well timed smile by someone your soul connects with. Or a box of chocolates. Or a poem. People have been penetrating the human heart with those Luddite-ish tools since the beginning of civilization.

I was thinking more about that electronic device your doctor might have implanted into your chest to keep your heart beating. Or the little box stuck in your gut to help you and your pancreas regulate your diabetes. Or the mini-computer surgically inserted to keep your neurological systems on track.

Hacking the medical miracles put inside people to let them live longer with more normal lives.

While to my limited knowledge nobody has reported a single case and the likelihood is extremely low, it is a real enough concern that the New England Journal of Medicine published a paper about the need to improve security last year.

Twice Told Tale

Jun 23, 2011• 3

By PAUL LEVY

Back in 2008, Charlie Baker, then CEO of Harvard Pilgrim Health Care, and I, then head of a hospital, claimed that the market power displayed by the dominant provider system in the state and supported by the state’s largest insurer resulted in a large disparity in health care payments. We argued that this disparity contributed to unnecessarily high health care costs in the state. We both did this publicly, willing to put our assertions to the test. The quotes in response to this in a Boston Globe story were notable, but they did little to undercut our premises.

About a year later, the Attorney General of the Commonwealth published an investigation of this situation, which had the effect of validating our assertions.

Then, the largest insurer in the state said that the solution to the problem was to move towards a capitated, or global, payment regime. This would control the cost trend.

Again, knowledgeable observers, like the Inspector General, raised concerns. What if the global payment regime also created disparities and locked in higher rates? He noted, “[M]oving to an ACO global payment system, if not done properly, also has the potential to inflate health care costs dramatically.”

I pointed out that, while a global payment plan might have certain theoretical advantages, without a transparent exposition of its effects, how could we know if it had been successful?Continue reading…

Essential Health Benefits: The Secretary’s Joystick

Jun 23, 2011• 3

By Robert Graboyes

Beginning in 2014, the Patient Protection and Affordable Care Act (PPACA) hands the Secretary of the U.S. Department of Health and Human Services a joystick – the Essential Health Benefits (EHB) package – with the potential to rocket small-business health insurance premiums skyward. EHB is the menu of goods and services that must be covered under all exchange-purchased insurance plans and non-grandfathered small-group and individual insurance plans. By vesting one set of hands with control over EHB, small business faces permanent administrative uncertainty. At the same time, the brunt of EHB appears largely to bypass big business, unions, and governments.

The EHB requirements apply to policies purchased both in exchanges and in non-exchange small-group or individual markets. In the small-group and individual markets, annual or lifetime coverage limits on all EHB items are forbidden. And plans must have an actuarial value (AV) of at least 60 percent, meaning the plan’s total reimbursements must be at least 60 percent of the total qualifying health care costs incurred.

Section 1302 empowers the Secretary of HHS to define EHB, but gives little specificity beyond requiring that EHB include 10 general categories (e.g., ambulatory patient services) and “the items and services covered within the categories;” the Secretary is to also assure that EHB includes “benefits typically covered” by a “typical employer plan.” The meaning of these words in quotation marks is left to the Secretary (and future Secretaries) to define and redefine. The fluid definitions and concentrated discretion mean uncertainty, which carries a financial cost for small business.
Continue reading…

A New Hope? (…But What About That Pesky Death Star?)

Jun 22, 2011• 10

By MICHAEL PAINTER, MD

Picture a version of the Star Wars opening crawl:

A long time ago in a galaxy far, far away…. It is a period of enormous change and worry. The challenges are great. The status quo of poor health care quality and crushingly high costs is bearing down on the people—but that enemy is also under attack. A growing band of folk from all parts of the galaxy are attempting to bring every imaginable force—technology, market, government, people power—to the cause. No one’s certain how it will all turn out…

Now, cue ominously Darth Vader’s imperial march theme… (Fade out).

Earlier this month, I participated in the 2011 HHS/IOM Health Data Initiative Forum and self-styled “Data-Palooza”. It was exciting. Lots of dynamic leaders attended —from the government, the software development world and other industries—lots of Twitterati—social media personalities. The place buzzed, literally. (It was just missing the Tatooine bar music.)

I couldn’t help but flash back to last year’s markedly more freshman, inaugural meeting and compare. The differences one year later were striking—even startling at times. The obvious progress could make one pretty hopeful. The vision of creating tools that use previously moribund federal (and other) data in unique ways to solve real problems is already bearing some remarkable fruit.

During the “Data-Palooza” plenary session, a parade of app developers demonstrated technology that mines and harnesses data for very cool, practical purposes. High points: PatientsLikeMe; Asthmapolis; and Multistate Foodborne Disease Outbreak Investigation System (catchy name…). The whiz bang, jaw dropping technology of these, and other, examples was impressive. Last year, one really had to suspend to imagine how all this talk might actually have a major impact. This year it could seem as if the vision isn’t keeping up with the technology. In fact, perhaps we should be bolder, much bolder.

But, then, the enormity of the challenge brings one right back down to Earth—or rather—Endor.

Getting More Startups Focused on Health

Jun 21, 2011• 11

By MISSY KRASNER

Could it be true? Is venture funding on the mend after it’s collapse in 2008? Some would say that the amount of capital invested is on the rise, and new funding streams are providing an excellent opportunity for startups to start getting funded again. But is this also true for health or healthcare startups? After leaving Google recently, I have been spending time talking to various startups and VC firms that are interested in health and healthcare apps. I am encouraged by what I see.

There seems to be a handful of seed accelerators and government initiatives focused on stimulating innovation in the consumer and provider health tech space. New incubators like Rock Health and Startup Health, an arm of the Startup America Partnership are trying to encourage attention to this vertical. Other cool platforms such as the Quantified Self movement, ONC’s Investing in Innovations (i2) Initiative, and this week’s impending announcement of the SMArt (Substitutable Medical Apps, Reusable Technologies) Challenge Apps are creating some fresh buzz. But what I find even more interesting is that broader tech accelerators like YCombinator, and 500 Startups are also starting to fund some health startups (checkout drchrono.com and Evoz).

While I am making my rounds, I cannot help but make a shameless plug for some of my ex Googler friends at 500 Startups. In case you have not heard of them yet, 500 Startups is a $40 million Super Angel investment fund that was founded by former PayPal executive, Dave McClure and Christine Tsai, former Google Marketing pro who ran Google I/O. They provide early-stage seed funding ($10K to $250K) and have over 140 experienced startup mentors around the world that help with product design and data and customer acquisition. 500 Startups holds a series of events on all kinds of things relating to startup success. In fact, check out the event they are hosting this Saturday, June 25th from 1-6pm called “‘Design a Healthy Startup: Prevent Burn Out.” This event will feature 500 Startup founders and entrepreneurs from HealthTap, EcoFactor, Google, Facebook and Zynga. Demos from cool new startups in the wellness space like Dojo, Habit Labs, and FitSquid, will also be presenting. Read more about the event or sign up to attend this Saturday.

Missy Krasner spent several years helping getting Google Health off the ground, and before that was David Brailer’s right-hand woman at ONC.

Setting The Record Straight On Drug Shortages

Jun 21, 2011• 7

By TED SLAFSKY

John Goodman of the National Center for Policy Analysis (NCPA) says in a recent blog entry that the Public Health Service 340B drug discount program is part of a “web of [federal] regulations that are preventing life saving drugs from reaching the patients who need them.” More specifically, he says that the program, which provides discounted drugs to safety-net institutions such as hospitals and clinics that treat large numbers of indigent patients, is “contributing” to severe prescription drug shortages.

His essay, however, offers no factual support for its claim that the 340B program is somehow causing shortages. His entire case against 340B drug discounts rests upon his belief that “when prices are kept artificially low, shortages develop.”

Last month, the Pharmaceutical Research and Manufacturers of America (PhRMA) issued a statement on drug shortages and their causes. Citing the Food and Drug Administration (FDA) and other experts, the industry group says shortages can occur

for any number of reasons ranging from natural disasters; shifts in clinical practices; wholesaler and pharmacy inventory practices; raw material shortages; changes in hospital and pharmacy contractual relationships with suppliers and wholesalers that can cause fluctuations in the availability of certain products; adherence to FDA-mandated distribution protocols, which can impact patients’ timely access to medicines; individual company decisions to discontinue specific medicines; and manufacturing challenges.

The absence of any mention of 340B, or of government limits on drug prices more generally, is noteworthy given that PhRMA is not very fond of such programs.