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Does America Want Apple or Android for Health Care?

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BY DAVIS LIU, MD

The future direction of American health care is unclear.  Certainly the cost trend as it exists is unsustainable with health care costs being a major concern of the private sector, the government, and individuals.  How does the nation manage costs while ensuring high quality medical care, access, and service?  Proposals include increasing competition among insurers, providers, and hospitals to drive down prices or giving more financial responsibility to patients via higher deductibles and co-pays with the belief that they will demand price transparency, shop around for the best price, and as a result slow health care costs.

What if both ideas are wrong?

While it is possible these plans might work, I cannot help but notice the similarities in the challenges for patients in navigating the health care system and consumers figuring out how to purchase and use technology.  Walk into your neighborhood electronics store.   Individuals are overwhelmed with the number of product choices, manufacturers, differences in technical specifications and features.  In the majority of situations, consumers are unsure of what they are purchasing.  They want something that just works, whether surfing the internet, making home movies, or being connected with loved ones.  The gap in knowledge between an expert and a consumer is great and often unintentional and unapparent.

Within the technology world, there are two groups of thought.  The first group offers technology in a closed system, like Apple, where the focus has been on just making things work.  There are a limited number of product types and designs.  For example, its current smartphone, the iPhone 4 comes in only two types.  Aside from the base memory of 16 GB or 32 GB and two different prices, the phones are otherwise identical in features with the same apps, cameras, and ability to record video.  Although the specifications are available for anyone to see, the focus is rarely on the technical elements of the products themselves and more on what they can do for you.  Walk into any Apple retail store and the products are situated by function.   Staff ask not how much computing horsepower, storage space, or CPU speed one needs, but what one plans on using the smartphone or computer for.Continue reading…

Why Direct is a Hit and PCAST is an Outcast

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By VINCE KURAITIS

Regular readers know that I find Professor Clay Christen’s theory of disruptive innovation to be a useful lens to explain industry evolution. Let’s look at two recent health IT initiatives and see why one is working and the other is stalled.

Characterizing the Direct Project — why it’s working:

  1. A low-end industry disruption. The Direct Project takes transactions that are routine but inefficient — fax, telephone, mail exchanges between health care providers — and specifies standardized, Internet based technologies to conduct them electronically.
  2. Incremental change — a few specified transactions.
  3. Bottom up — ONC hired a capable project manager (Arien Malec) who choreographed a small team of volunteers working under short deadlines.
  4. Implementing “better, faster, cheaper” technology on the fly (i.e., Internet transactions replace fax, phone).
  5. Under the radar — invoking little response from incumbents. Direct was seen as focusing on transactions that were peripheral to the core EHR.Continue reading…

The messy TEDMED divorce

By Matthew Holt

Yesterday I got a fun mass email–reprinted here at Medgadget–from Richard Saul Wurman. He founded TED, and later lost control of it to Chris Anderson who has stewarded it to being a giant among conferences. Then he founded TEDMED which ran once in the early 2000s and after Mark Hodosh approached him they restarted it together in 2009.  Now I’m not one for paying $4,000 to go to a conference but luckily RWJF did it for me and I went in 2010. It’s great fun, as you might expect, but pretty elitist and (warning: rival conference organizer envy alert ahead!) I don’t think it did much to advance the conversation on the core issues of improving health (and yes I think Health 20 does…). On the other hand it’s not TEDMED’s stated intent to do that, much as the RWJF crowd wanted into. Instead it’s about showcasing advances in medicine — which we all know is in general unrelated to health.

But yesterday it got fun. Hodosh sold the company to Jay Walker (a major & very good presenter at the last TEDMED) and Saul Wurman sent an email out blasting him & Walker and telling the price–$16m with $9m more to come! So Hodosh sold out and at that price who the hell can blame him!

But why did Walker pay that much? Eyeballing the crowd TEDMED had 500-ish attendees. Assuming even 400 paid the $4K rack rate (for $1.6m) and that sponsors kicked in another $2m, we’re only talking about a $4m revenue business. 4-6 times revenues is a nice number indeed!

And Saul Wurman is critical of Walker & Hodosh for wanting to make it even more elite like Davos–and in his email he links to a NYTimes article which says that it costs $200k  to get into Davos. Is there an appetite for that level of pricing in medical care? We’ll see!

I guess the smaller question is, will TEDMED sans Saul Wurman lose any credibility? His departure from TED didn’t exactly hurt it, although I’m sure Walker and Hodosh would rather it hadn’t happened this way.

My guess is that so long as the branding relationship with the main TED is rocksolid. TEDMED will be fine & I guess we’ll just have to wait to find out if Walker will sit on the stage next to Hodosh like Saul Wurman through every presentation–which I thought was the oddest part of the whole conference.

THCB Live: Microsoft

A few weeks back at HIMSS Matthew Holt caught up with Microsoft Health Solutions’ Sean Nolan (Chief Architect) and Nate McLemore (VP, Business Development) to chat about the technology and business of NHIN Direct, HealthVault and much more.

Bad Medicine: TriCare’s Noncoverage of Evidence-based Opiate Maintenance Therapy

• 1

By KEITH HUMPHREYS & HAROLD POLLACK

This week, The New York Times gave heart-wrenching accounts of newborn babies enduring opiate drug withdrawal because of their mothers’ addictions. The story provided only one cause for optimism: Both babies and their painkiller-dependent mothers can benefit dramatically from being maintained on medications such as methadone or buprenorphine.

Unless, of course, these mothers were members of a military family, in which case such essential, life-saving care would be denied to them.

The most effective treatment for opiate addiction — long-term buprenorphine or methadone maintenance — is not covered by the Department of Defense’s TRICARE insurance program. The program limits methadone and buprenorphine prescriptions to short-term detoxification, and its regulations state, “Drug maintenance programs when one addictive drug is substituted for another on a maintenance basis (such as methadone substituting for heroin) are not covered.” The premise that prescribing opiate substitutes is no different from uncontrolled opiate abuse goes back to the anti-methadone hysteria of the 1970s. Since then, opiate-substitution treatment has become a staple of modern addiction medicine, particularly with the addition of buprenorphine in 2002. Unlike methadone, burenorphine can be prescribed for maintenance by patients’ regular primary physicians, outside traditional venues of addiction treatment, which had long posed forbidding barriers for many patients.

In fact, many of the best clinical trials of methadone and buprenorphine were conducted in Veterans Health Administration studies with former military personnel as patients. The treatment is so established that in 1997, the National Institutes of Health called for an end to the unnecessary regulation of these medications and for these medications to be included in public and private insurance coverage. These treatments are now standard within the addiction field, are FDA-approved and have been used to treat opiate dependence disorders for several decades. Long-term methadone and buprenorphine maintenance are now available to patients through Medicaid, through many state-funded programs, and, increasingly, through private insurance.Continue reading…

The Tufnel Effect

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By PSYCH GRIPE

In This Is Spin̈al Tap, British heavy metal god Nigel Tufnel says, in reference to one of his band’s less successful creations:

“It’s such a fine line between stupid and…uh, clever.”

This is all too true when it comes to science. You can design a breathtakingly clever experiment, using state of the art methods to address a really interesting and important question. And then at the end you realize that you forgot to type one word when writing the 1,000 lines of software code that runs this whole thing, and as a result, the whole thing’s a bust.

It happens all too often. It has happened to me, let me think, three times in my scientific career and, I know of several colleagues who had similar problems and I’m currently struggling to deal with the consequences of someone else’s stupid mistake.

Here’s my cautionary tale. I once ran an experiment involving giving people a drug or placebo and when I crunched the numbers I found, or thought I’d found, a really interesting effect which was consistent with a lot of previous work giving this drug to animals. How cool is that?

So I set about writing it up and told my supervisor and all my colleagues. Awesome.

About two or three months later, for some reason I decided to reopen the data file, which was in Microsoft Excel, to look something up. I happened to notice something rather odd – one of the experimental subjects, who I remembered by name, was listed with a date-of-birth which seemed wrong: they weren’t nearly that old.

Slightly confused – but not worried yet – I looked at all the other names and dates of birth and, oh dear, they were all wrong. But why?

Then it dawned on me and now I was worried: the dates were all correct but they were lined up with the wrong names. In an instant I saw the horrible possibility: m ixed up names would be harmless in themselves but what if the group assignments (1 = drug, 0 = placebo) were lined up with the wrong results? That would render the whole analysis invalid… and oh dear. They were.

As the temperature of my blood plummeted I got up and lurched over to my filing cabinet where the raw data was stored on paper. It was deceptively easy to correct the mix-up and put the data back together. I re-ran the analysis.

No drug effect.

I checked it over and over. Everything was completely watertight – now. I went home. I didn’t eat and I didn’t sleep much. The next morning I broke the news to my supervisor. Writing that email was one of the hardest things I’ve ever done.Continue reading…

Personal Health Records: Will Doctors Connect?

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By JANE SARASOHN-KAHN

What doctors are most likely to use patients’ personal electronic health records? Fewer than 1 in 2 are willing to. Those who most likely would include Hispanic physicians, doctors who practice in rural areas, those employed in hospitals, and surgeons.

As part of the HITECH Act included in the American Recovery and Reinvestment Act (ARRA) 0f 2009, U.S. physicians have the opportunity to receive a portion of the $20.8 billion carved out as incentive payments to those who adopt and “meaningfully use” electronic health records (EHRs).

Many EHRs include portals which allow patients to access a slice of their personal health information. Some patients create their own personal health records that might be as simple as an Excel spreadsheet or as robust as Kaiser Permanente’s My Health Manager or the VA’s MyHealtheVet.

The format of the personal health record (PHR) aside, researchers from the AMA, University of Chicago and the Markle Foundation wondered how willing physicians would be to use patients’ PHRs. The results of their survey are published in the February 2011 issue of Health Affairs.

The bottom line is that physicians’ willingness to connect with patients’ PHRs varies by the doctor’s gender, clinical specialty, race, geographic location, size of the practice, and whether they are already using an EHR. The chart details these findings by physician characteristic.

The physicians who would least likely embrace patients’ would most likely practice in suburban geographies, in solo or duo practices, be female, and be in primary care or pediatrics. And those who don’t use an EHR currently are much less likely to be unwilling to use a patient PHR.Continue reading…

Health 2.0 Show TODAY

Don’t forget that there’s a Health 2.0 Show, our free online hour long show at 10 PST/1pm EST. Today (Thursday). Register here for FREE.

We’ll be taking a look back at some highlights from the Health 2.0 Spring Fling, and have brought back some live product demos:

IOM Health Data Initiative Forum is June 9

Health 2.0 is supporting and I’m attending The Health Data Initiative Forum on June 9, 2011 at the National Institutes of Health in Bethesda, MD, and you should too. The Forum aims to accelerate momentum for the public use of data and innovation to improve health as part of The Health Data Initiative, a collaborative project of the Institute of Medicine and the Department of Health and Human Services.  The Forum will feature more than 45 fast-paced demonstrations of cutting-edge health apps that developed using health data, a series of panel discussion sessions on important health topics, and a data and apps expo.  You’ll be able to interact with developers, as well as investors, venture capitalists, and federal, state and local government officials. A provisional agenda is available online.  Space is limited and the registration is filling up fast!  Take a moment to register today, and let me know if you have any questions….and yes this was written by an IOM PR person not me, but it’s all true!

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