The Health Care Blog – Page 727 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Quest for Price Transparency

May 7, 2011• 48

By ERIC LESPIN

A torn meniscus. It did not disable but it impaired, and unpredictably. My stomach learned quickly to tighten at the sound of A’s peculiar whimper in response to a crippling pain that would shoot through her at seemingly innocuous movements of the afflicted leg. We have health insurance of sorts, the type that will help you keep your home if tragedy strikes, but that does not shield you from the brunt of what most of day-to-day health care cost is about. We’re well practiced in deferring and foregoing care. Here however, we reluctantly acknowledged that a hospital would need to be visited and a doctor consulted.

Tests and a physical examination made clear that an operation was unavoidable. The doctor was a thoughtful man who conscientiously went through what the operation would entail. Surgery would take half a day, then back home by afternoon, convalescence over the following few weeks, with complete recovery the usual outcome. While not painless, the procedure seemed reassuringly routine. His tone was caring and his outlook about our case optimistic.

The admirable candor with which medical personnel have learned to speak about difficult topics concerning our bodies and our care did not extend to the costs involved. The question of what the procedure would cost, gently broached, initially baffled the staff, eliciting answer-deflecting counter-questions about the adequacy of our insurance coverage, but resulted in no quotes or estimates. Continue reading…

Hockey Teams and AED’s Save Lives

May 6, 2011• 7

By VIPAN NIKORE, MD

I’ve played over a thousand ice hockey games in my life, but I had no idea that last month’s adult men’s league game in Cleveland would be the most memorable. I grew up in Canada, three blocks from Wayne Gretzky, the greatest hockey player ever, but I wouldn’t be surprised if my recent game was more important than any game that my former neighbor played. This game was literally a matter of life or death.

I almost didn’t show up to the game. I had just landed in Cleveland from New York City after attending a close friend’s wedding. I’d landed at 8:15pm, jumped in my car and dialed into a conference call for my organization uFLOW, arriving and finishing my call barely in time for the 9:30pm puck drop. I didn’t plan my schedule around the game; the timing just happened to work out.

It was close to the end of the 2nd period when I heard our captain, Brandon Dynes, yell something and race off the ice. I soon realized he skated off to call 911. I looked down at the end of the bench and saw that our teammate Harley was unresponsive. Harley is 69 years old (though could pass for 50) and as the eldest player in our men’s league has been an inspiration to many of us. I quickly went over to assess him and found he had no pulse, was not breathing, and not responding to verbal or physical stimuli. I was fortunate that the opposing team had a physician playing as well, Dr. John Wood, an orthopedic surgeon. John quickly came over and could not find a pulse either. Knowing end organ damage such a anoxic brain injury can occur quickly, I grabbed Harley and layed him on the bench and started compressions, pressing his chest extra hard knowing I was going through a layer of hockey pads. I later quickly ripped off his pads off to assure better compressions.Continue reading…

I Wish We Were Less Patient

May 5, 2011• 7

By PAUL LEVY

The sad case of Kimberly Hiatt, a Seattle nurse who committed suicide months after being disciplined for administering a fatal dose to an infant, is starting to make the rounds. Josephine Ensign, for example, concludes her blog post on this by saying:

I am left with many questions. Why was the nurse treated so differently from the dentist or physician at the same hospital for similarly serious medication errors? If one in three hospital patients in the US experiences serious preventable adverse events and we know that it’s “the system, stupid,” why are most of our efforts put into educating patients to advocate for safer care? If nurses are simultaneously being told by hospital administrators to report errors and then facing serious retribution for making honest unintentional mistakes . . . what do I teach my students to do?

We can never know, of course, whether the suicide was related to the incident itself, the disciplinary action, or indeed, some other aspect of Hiatt’s life. But the sequence of events will cause many to draw the connection between the way Hiatt was treated after the accident and her death. In any event, though, the ambiguity as to whether or not it was connected does not take away from the kinds of questions raised by Ensign.Continue reading…

Yes, Thanks — We’ve Heard About Google Health

May 5, 2011

By SEAN NOLAN

Seems like everybody on the web (or at least in our little Healthcare corner of it) has an opinion on the news that Google Health is shutting down. Just in case you’re thinking about sending me the link — yes, I’ve heard. 🙂

First off — sincere thanks to Aaron, Adam, Missy, Paul, Marc, Crutcher, Alan, Eric, Alfred, and all the others over at Google who built a great service and fought hard for the idea that the only way to really fix healthcare is to consumerize it. There will continue to be plenty of short-term debates about privacy, data ownership, standards, etc., but ultimately it’s inevitable — we’ll get there, and Google Health moved the ball forward.

Second — what does this mean for HealthVault? The “buzz” online ranges wildly, but the real and simple answer is: nothing. As I said a few months ago, HealthVault is a key piece of our overall approach:

HealthVault is a critical component in our broader project strategy — which is to (1) connect care across the ecosystem, from the home to the clinic to the hospital to the research lab, and (2) do so in a way that includes and encourages innovation from as many different organizations as possible.

Solving only the consumer side isn’t enough — that’s why we have Microsoft Amalga on the enterprise side. Our two platforms combine to enable the transformative all-up story: enabling clinical integrations like mynyp.org and MedPlus, home monitoring programs with Kaiser, CCF and UMass, and so on.Continue reading…

CABG in Decline

May 5, 2011

By MERRILL GOOZNER

The number of Americans with serious heart disease in need of hospital treatment is on the decline. A new study in today’s Journal of the American Medical Association shows the overall rate of coronary revascularizations — ranging from the coronary artery bypass graft (CABG) surgeries to in-and-out catheter-based procedures like angioplasties and stent insertions — fell from just under 1,500 per million adults a quarter in 2001 to less than 1,250 per million adults a quarter in 2008, a 15 percent decline.

The most intriguing finding in the data was that virtually all of the decline was in the most serious cases — those requiring CABG, which fell by about a third. The rate of percutaneous coronary interventions (where they snake a catheter through the thigh into the blood vessels feeding the heart, propping them open with either drug-eluting or bare metal stents) remained virtually unchanged.

The study authors, who hailed from the Philadelphia Veterans Affairs Medical Center, suspect the decline in CABG was driven by “a sizable shift in cardiovascular clinical practice patterns away from surgical treatment toward percutaneous coronary interventions” using catheters (so-called PCI). In other words, in recent years people with serious heart disease are more likely to be treated with the less invasive procedure.Continue reading…

Translation Needed

May 5, 2011

By DEREK LOWE

The “Opinionator” blog at the New York Times is trying here, but there’s something not quite right. David Bornstein, in fact, gets off on the wrong foot entirely with this opening:

Consider two numbers: 800,000 and 21. The first is the number of medical research papers that were published in 2008. The second is the number of new drugs that were approved by the Food and Drug Administration last year.

That’s an ocean of research producing treatments by the drop. Indeed, in recent decades, one of the most sobering realities in the field of biomedical research has been the fact that, despite significant increases in funding — as well as extraordinary advances in things like genomics, computerized molecular modeling, and drug screening and synthesization — the number of new treatments for illnesses that make it to market each year has flatlined at historically low levels.

Now, “synthesization” appears to be a new word, and it’s not one that we’ve been waiting for, either. “Synthesis” is what we call it in the labs; I’ve never heard of synthesization in my life, and hope never to again. That’s a minor point, perhaps, but it’s an immediate giveaway that this piece is being written by someone who knows nothing about their chosen topic. How far would you keep reading an article that talked about mental health and psychosization? A sermon on the Book of Genesization? Right.Continue reading…

Where is there mHealth, really?

May 4, 2011• 4

Health 2.0 aficionados will know that I’ve been railing against the term “mobile health” or “mHealth” for about three years. Health 2.0 is simply the next thing in health technology, and will remain so (whatever that might be). Sure we have a definition, but it’s about what’s happening not how it happens. Calling something mHealth traps it to a device, in particular a cell phone, and ignores the rest of the ecosystem of the technology and culture that the cell phone is but one part of–that’s the concept we call “unplatforms.” mHealth is like talking about cooking in the kitchen and only talking about the fridge. It’s damn important but you need a stove, a sink and more to make it all work.So if you have a mHealth strategy, as Susannah Fox might quote LOLcats, “URDoin it Rong”.

However, the place where it makes sense to talk abut mHealth is where there are only cell phones, and that place is large tranches of the rural developing world. This came up for me twice yesterday. once in a long chat with DataDyne‘s Joel Selanikio who has a really cool product called EpiSurveyor that works not via SMS but via an app on simple phones and enables very cheap and easy data collection. The other was in a high profile announcement by Johnson & Johnson (a major funder of text4baby btw), which via its Babycenter subsidiary is introducing–with USAID, State Department & the mHealth Alliance– $10m program supporting the use of cell phones for maternal health in developing countries.

So for the health worker in the rural Bangladeshi village, lets have an mHealth strategy. For those of us in the developed world, we need an overall strategy to deal with data and applications–whatever devices they are using.

A Mother’s Day Manifesto: Blood, Toil, Tears, and Sweat

May 3, 2011• 39

By AMY ROMANO

I’ve been writing about safe and effective maternity care for years and direct a coordinated national effort to transform maternity care, but this is a post where the political gets personal.

Last weekend, I attended the birthday party for the sweetest one year old. There were all of the typical rituals – hands and face covered in cake frosting, a pile of toys and new clothes, and a tuckered out babe falling asleep as the party wound down. But this birthday was bittersweet, because it also marks the anniversary of a crisis that very nearly cost the life of this child’s mother, my friend.

Nine days after giving birth, rather than gazing with equal parts sheer love and sheer exhaustion at her baby, my friend – we’ll call her Near Miss Mom – was unconscious in an ICU on a ventilator, recovering from the emergency hysterectomy and blood transfusion that had saved her life.

I’d say Near Miss Mom had become a “statistic” but we keep no statistics on near miss maternal events, even though multiple agencies and organizations have sounded alarm bells about the rising rate of maternal mortality and have cautioned that for every maternal death, there are many more near misses. Legislation just introduced in the House by Representative Conyers would, among other provisions, establish steps toward a standard definition and routine counting and reporting of maternal near misses.

Because if we’re not counting near misses, we’re not systematically learning what our health care system could be doing to avert them, and for that matter the deaths that do occur. A just-released report from a state-wide, multi-year investigation of maternal deaths in California found that 38% were likely to be preventable. Let’s take Near Miss Mom’s case, which almost certainly could have been averted far before she was so close to death.Continue reading…

THCB Live: SAP

May 3, 2011

Matthew Holt interviewed the leaders of enterprise software giant SAP at HIMSS 2011 back in late February. On the left it’s Andrew Flanagan, National Vice President – Healthcare, and on the right John Papandrea, Senior Vice President – Global Healthcare Sector Head.