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HIT Trends Summary for May 2011

Jun 9, 2011• 1

By MICHAEL LAKE

This is a summary of the HIT Trends report for May 2011. You can get the current issue or subscribe here.

E-prescribing scale and innovation. Surescripts reports dramatic growth for e-prescribing with a third of office-based physicians on its network and 20% of all scripts now going electronically to pharmacies and mail order. Yet formulary and prescription history data are underutilized by practices. This according to a study by Center for Studying Health System Change who finds that while most physicians have access to formularies and about half to medication histories, many don’t utilize it because they don’t see the value or systems are too cumbersome. However, there continues to be innovation in this area. CVS Caremark is piloting electronic prior authorization and Medco released a consumer pharmacy app for Verizon phones that alerts consumers to lower cost alternatives that Medco hopes will be discussed with prescribers. This is a terrific model for supporting the provider-patient dialog around medications. The key is the personalization to the member’s specific benefit information and the application’s ease of use. Perhaps these innovations can help address the utilization issues.

EHR market dynamics. There is also market growth and adoption of EMRs. According to report by Kalorama Research it’s a $15.7B U.S. market in 2010 with predicted market growth of 18%-20% per year for the next two years. California Health Care Foundation is reporting that over half of California’s primary care physicians using an EHR, and of the largest practices, adoption is over 80%. EHR is increasingly a global issue with new reports on the European experience highlighting that 81% of hospitals there have electronic patient records. This is a comprehensive European study of 909 hospitals in 30 countries. Larger public and university hospitals are more advanced than smaller private ones. Nordic countries are leading. Individual spider-charts give readers a summary at-a-glance. Still all is not rosy. England’s National Audit Office reports its National Health Service EHR project is failing.

Online Communities & Attrition from Health Intervention Programs

Jun 9, 2011• 1

By GLENN LAFFEL, MD

Provider-centric, face-to-face health intervention programs that help people quit smoking, lose weight and increase activity levels have been shown to work, but they are expensive, don’t scale, and inconvenient. By contrast, Internet-based programs with similar goals can be disseminated widely and inexpensively, and can be accessed by consumers at a convenient time and place.

Although many of the latter programs have been shown in clinical trial settings to be efficacious, attempts to commercialize them have been plagued by attrition. People stop using the programs because they lose motivation, can’t find the time, or become frustrated by clunky interfaces and data entry requirements.

In one study for example, only 26% of participants in a randomized trial of a free physical activity website dropped out of the study before it was completed, whereas 67% of registered open access users dropped out during the same course of time. The open access users also spent less time on the site.

The lower attrition rate in the trial was likely driven by the emotional, cognitive and logistic support provided by trial personnel. It follows that the commercial success of online health intervention programs hinges on their ability to support users in the same way as trained personnel do in clinical trial settings.

Health 2.0 will be running challenges & scanning innovation for ONC

Jun 9, 2011

By Indu Subaiya & Matthew Holt

We’re delighted to tell the Health 2.0 Community that all of your great work in the Health 2.0 Developer Challenge has received tremendous backing of the highest order. Today HHS confirmed officially that ONC is getting into the challenges business, and–working with our partner Capital Consulting Corporation–Health 2.0 will be managing a $5m 2 year program called Investing in Innovation or i2.

There are lots more details in the press release from HHS, but expect to soon hear from us about many more public sector challenges across the board in information technology in health with some considerably larger prizes than we’ve seen in the 22 challenges we’ve already managed.

We are incredibly excited about both our role in working with ONC and the opportunity that this gives all the innovators in the Health 2.0 community. Please keep your eyes open for both more private sector challenges, and major announcements about HHS challenges starting in July. And of course we’ll be saying more about this at the Health Data Initiative Forum on Thursday.

In addition Health 2.0 (and our Health 2.0 Advisors’ service) will be working on a contract for HHS/ONC to track and scan the overall level of innovation in health technology. Please stay tuned as we’ll be releasing more information about our scanning and advisory work in the near future, or you can of course contact us directly.

The Unbridgeable Gap between Left and Right on Health Reform

Jun 8, 2011• 57

By JEFF GOLDSMITH

Though thoroughly smothered under 2900 pages of well meaning but poorly focused, expert-driven “good works”, the core of the Affordable Care Act was providing 30 million people subsidized health insurance coverage. As the country continues to decide how it feels about this monumental legislation, a major ideological divide persists over whether the aggressive coverage expansion in health reform was really needed or not.

Far from “selling itself,” as a overconfident White House aide suggested it would back on March 23, 2010, health reform remains strikingly unpopular. Only 37% of the public thinks the country will be better off as a result of health reform, and only 28% think their families will be better off, according to the May Kaiser Family Foundation tracking poll. There is a stark partisan divide over health reform. While 72% of Democrats have a favorable opinion of health reform, a substantial minority believes the bill could have done more (covered more people, provided a public option or path to single payer). Alternatively, 74% of Republicans have an unfavorable opinion of health reform; the same percentage favors repeal. Independents tend to break toward the Republican view of the bill (49% unfavorable vs. 35% favorable). Those opposed feel more intensely about health reform than those in favor.

The Ryan House Budget for 2012 zeroes out all new spending for health reform (while keeping ACA’s Medicare cuts, devoting them to deficit reduction!). The conservative narrative is that the problem of the uninsured was liberal mythology, not meriting major new spending. In the blogosphere, an analysis surfaced suggesting that the real uninsured problem is only about 4 million people. This apparently originated in a Heritage Foundation blog posting from late August, 2009. Other conservative analysts charitably suggest there may be as many as ten to twelve million uninsured worthy of federal help. To take care of this smaller number, you do not need a major coverage expansion, but merely to apply the familiar market oriented remedies: selling insurance across state lines, high deductible health plans, malpractice reform, high risk pools, etc.

Defining Quality in the Health Insurance Industry

Jun 8, 2011• 19

By VIPAN NIKORE, MD

My patient, whom I’ll call Jane, had a neurologic disorder that prevented her from emptying her bladder properly. She required a permanent urinary foley catheter to help her urinate. Jane landed back at the hospital with yet another urinary tract infection – her third in one month. She had pus draining from her catheter and was infected with a multi-drug resistant strain of the bacteria Proteus. Our lab ran tests (sensitivities) to determine which antibiotics would be required to eradicate the infection, and it turned out the only oral drug that could destroy the infection was fosfomycin. Giving her fosfomycin would allow her to avoid intravenous antibiotics and be treated at home. This would prevent a lengthy expensive hospital stay. Thank goodness for fosfomycin, I thought.

One problem though: The insurance company wouldn’t pay for her 3 day fosfomycin prescription. It took several calls by our case manager and senior resident physician before, finally, the insurance company agreed to pay. And even then the insurance company decided to place a restriction on her purchasing of fosfomycin — they only allowed her to purchase only one dosage at a time. Did I mention that her neurological disorder prevented her from walking? Yes, a lady from a low-income area of Cleveland who cannot walk was required to find her way to the pharmacy three times in order to eradicate a dangerous infection. Was this just cruel, or was I missing something here?

We had to delay discharge two days, which was troublesome for Jane. Plus, the cost for two more nights in the hospital negated any savings that the insurance company gained by refusing to pay for her medicine. The time lost by our team members on the phone arguing with insurance companies easily could have been spent providing care to other patients. I’m struggling to find the winner in this equation!

The Doctor is In (and Using an iPad)

Jun 8, 2011• 3

By JANE SARASOHN-KAHN

The past year has seen a huge jump in the number of hours that physicians spend online; at the margin, the increase is due to physicians’ use of online via mobile platforms.

Meredith Abreu-Ressi, President of Manhattan Research, shared her insights into the firm’s study, Taking the Pulse (v. 11), with me today. The top-line finding of the annual survey is that health professionals have quickly adopted mobile platforms in health — with special attention paid to Apple products, the iPhone and the iPad.

Manhattan Research has tracked physicians’ use of online health resources for over a decade. They’ve found “plateaus” and “jumps” over the years, largely related to changes in bandwidth. In the early days of doctors’ use of online health sites, they spent two to three hours a week seeking information online. As faster speeds became available to physician offices, such as T1 lines, those hours increased to five, then to 8 as more doctors accessed the Internet via cable and DSL.

This year, the survey found that 30% of doctors have an iPad. In the firm’s 2010 survey, the device hadn’t even been released. This is tremendous adoption in the first year of any device, particularly among the user group of physicians.

The Great Wellness Revolt of 2011

Jun 7, 2011• 3

By MICHAEL TURPIN

The scene opens with a fit, thirty-something man running down the hallway of an office building. His white shirt is stained on right side by what appears to be orange juice. He frantically looks behind him to see if anyone is following him and knocks over a female colleague – spraying papers into the air. He spins, tumbles, hesitates and then runs through a door marked, “ Human Resources – Compensation and Benefits”

He bursts into an inner office where a 50ish woman is on the phone – laughing. She frowns glancing at him as he shuts the door and peers between her Levolor blinds.

Carol: (Covering the phone) What the hell are you doing, Johnson ? Aren’t you supposed to be downstairs conducting the annual benefit enrollment meetings?

Johnson (Terrified, turning to show his stained shirt) : Are they coming? Did you see anyone? Those five women – you know the ones who go walking every day at lunch – one of them threw an orange at me right in the middle of my presentation.

Carol: (Swivels in her chair, turning her back on Johnson and is about to speak into the phone when she sees all her phone console lines blinking at once. Her cell phone begins to vibrate in her purse. She speaks into the phone)

Tim, let me get back to you. Something seems to be going on here at Corporate. (she hangs up and let’s her phone start to ring. )

Continue reading…

All the Care that Money Will Buy

Jun 7, 2011• 8

By JOHN GOODMAN

I believe we could spend our entire national income on health care. Not by frittering money away, but by spending it on goods and services that even in small ways could improve the odds of better health. (Examples below.)

I find that most people in health policy agree with that assessment, but rarely do they see its logical (and I would say obvious) implication. If we spent all our income on health, we would have nothing to eat, nothing to wear, no place to sleep. There would be only health care. Since that’s clearly an undesirable state of affairs, it must be good for people to refrain from obtaining all the useful care that money will buy. Further, such restraint needs to be exercised quite often.

What brings this to mind is a new RAND study finding that people with Health Savings Account plans consume less care than people with conventional insurance and have lower health care costs. The people who were studied cut back on such “useful care” as mammograms, screenings for cervical and colorectal cancer and even childhood vaccinations.

Some critics pounced on this result and claimed that consumer-directed care is bad for patients. The critics are, of course, very wrong.Continue reading…

Making Hard Decisions Easier

Jun 7, 2011• 5

By AMY BERMAN

Shortly after I was diagnosed with inflammatory breast cancer a scan showed a hot spot on my lower spine. Was it the spread of cancer? My oncologist scheduled a bone biopsy at my hospital, Maimonides Medical Center, in order for us to find out.

A few days before the procedure, I went in for preadmissions testing. As part of my formal intake, in addition to collecting my insurance information and poking and prodding me a few times, the nurse asked me if I would like to fill out an advance directive. This was not because she was a miraculous oracle who knew the outcome of my biopsy, which would leave me with a Stage IV diagnosis. No, her question was merely standard procedure. I said yes, and shortly, a specially trained social worker arrived to walk me through the process.

A cheerful young woman reminiscent of camp counselor sat down next to me with papers neatly attached to her clipboard. The first step, she explained, is appointing a health care proxy, someone you trust to make health decisions for you should you become incapacitated. Being a nurse, I knew this, but it was comforting having someone there with me while I filled out the form. I chose my mother. Since my diagnosis, she and I had had numerous conversations about what I wanted should my disease progress and take away my quality of life. I trusted that she would respect my wishes, even if that meant making painful decisions as my disease progresses.

There is another form of advance directive that I haven’t completed yet—but will—with the assistance of that same social worker. It is nationally known as the POLST or Physician Orders for Life Sustaining Treatment. Developed in Oregon and disseminated by the California Healthcare Foundation, POLST turns the treatment wishes of seriously ill individuals into physician-signed medical orders that the health care team must follow.

Inconvenient Facts (For Both Republicans and Democrats)

Jun 7, 2011• 6

By ROBERT LASZEWSKI

I call your attention to Ezra Klein’s column in the Washington Post this morning.

In it he cites data that has been out there for a long time but Ezra puts some perspective on it that never occurred to me before.

Examining the Kaiser Family Foundation brief, “Health Care Spending in the United States and Selected OECD Countries” he points out, “Our government spends more [as a percentage of GDP] on health care than the governments of Japan, Australia, Norway, the United Kingdom, Spain, Italy, Canada, or Switzerland.”

The data would seem to indicate that even our single payer government-run American health care programs, Medicare and Medicaid, cost way more than similar health plans in these nations.

The argument is often made that we should adopt a single payer—or perhaps a “public option”—health plan in the United States in order to control costs and cover everyone. But it would appear that even those programs in America are way too expensive when compared to similar programs in other industrialized nations.

As for the Republican market-based approach, Klein also points out that those programs have been ineffective at cost control. House Republican Paul Ryan often cites the Medicare Part D drug benefit as proof his proposals to privatize Medicare would work better than what we have. But as Klein points out, Part D premiums have risen 57% since 2006 and the program is on track to see nearly 10% growth in annual costs over the next decade.Continue reading…