The Health Care Blog – Page 743 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Ultimate Sacrifice

Mar 6, 2011• 29

By JOHN MAA, MD

An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle’s tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured.

The 2008 recession claimed my uncle’s job, health benefits, and assets, except for a small inheritance. By 2009 he found work (but not health coverage) as a consultant.

One day he noticed that his eyes were yellow. He emailed a photograph, and I immediately recognized jaundice. I calmed him by suggesting benign causes such as hepatitis, gallstones, or liver cirrhosis. But I secretly dreaded a liver or pancreas cancer, given his recent weight loss and itching.

Laboratory and x‐ray tests, which he charged to his credit card, all suggested cancer. His doctor in New Jersey indicated urgent surgery was necessary. An appointment was unavailable for weeks at the county hospital, and private surgeons wouldn’t see him without a cash deposit. Time was ticking. Cure was already unlikely, and delays were allowing the tumor to grow. He decided to travel to the West Coast to expedite surgery.

My uncle arrived around midnight, glowing yellow; he had worn sunglasses to avoid frightening other airline passengers.Continue reading…

Third Place Health Care

Mar 6, 2011• 23

By EVAN FALCHUK

Media reports on misdiagnosis continue to mount.

A recent study on patients with Alzheimer’s found that half had been misdiagnosed. Half.

Another headline blared “4 out of 10 patients being misdiagnosed.” The article encouraged patients to “see another doctor” if they are worried about their diagnosis.

You know what it makes me think about?

Starbucks.

Why?

Because the way Starbucks revolutionized coffee drinking shows a way forward for health care.

Starbucks realized that since our lives focus on two places – home and work – most of us don’t have a “third place” to go. A place where we can be free of everyday distractions and take care of ourselves. Starbucks set out to create that “third place,” by making its stores comfortable, inviting places. It works. “Third place” makes customers’ lives better – and Starbucks has almost 20,000 stores to prove it.

It’s time for a kind of “third place” in health care.Continue reading…

Doctors Love iPads. What Does it Mean? What Does it Mean?

Mar 6, 2011• 21

By VINCE KURAITIS

After attending HIMSS 11 the largest annual health IT conference of the year, John Moore reported that “nearly every EHR vendor has an iPad App for the EHR [electronic health record], or will be releasing such this year.”

Doctors love iPads…not surprising? But, how might you explain this?

There are at least two different possibilities:

Coincidence Theory
Conspiracy Theory

The Coincidence Theory

So doctors want to access EHR software through the iPad…what’s the big deal?

Apple has built a great new hardware platform with the iPad. There’s nothing else like it in the marketplace. While other companies are building competing tablets, Apple’s has been the only viable option in the market for over a year.

The iPad is intuitive, easy to use, reasonably priced, easy to carry around, and has a lot of apps that have been developed for the platform. People — not just doctors — love the experience of using an iPad.

Doctors just happen to be one group of zillions buying iPads. Why wouldn’t they? Doctors are smart, affluent, and many are opinion leaders. Doctors like cool new technologies just like anyone else.

Doctors also are mobile. They want to access EHRs in different exam rooms, from the hospital, from their homes. The iPad is the perfect hardware platform to take with you as as a doctor goes about their day.

Why are nearly all EHR vendors making their software work on the iPad?

Because doctors are demanding it.

The Conspiracy Theory

The iPad is Apple’s Trojan horse to create new revenues in an industry in which the company has had minimal presence — health care.

Apple has developed a very appealing hardware platform in the iPad. Recognizing the market strength and lock-in to their walled garden they are creating with consumers, Apple is targeting key market segments to create new revenue streams and business models. Health care is the next target for Apple’s aggressive smarts.

Health 2.0 Spring Fling

Mar 6, 2011

HIT Trends Summary for February 2011

Mar 6, 2011• 1

By MICHAEL LAKE

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

Innovations in provider and patient solutions. DrFirst announced that it acquired AdherenceRx to integrate e-prescribing and care management. This is an innovative combination that helps smaller practices and EMR vendors that support them.

Emdeon is repositioning as a HIE, while combining its web EMR with LabCorp, and working with AAFP on benchmarking. It is stepping up its game with a SaaS EMR, access to de-identified clinical data and major national partners.

Epocrates completed its IPO this month banking on its future mobile EMR. It has the opportunity to leverage its industry-leading brand and reach into its new EMR for small practices. The company will now need to execute on its new vision to keep Wall Street satisfied.

And smartphone health apps leader, iTriage, gets appointment scheduling by acquisition. This is innovative in that it makes scheduling from the provider point of view asynchronous. It replaces the real-time phone conversation.Continue reading…

Visualizing the Threat Posed by Antibiotic Resistance

Mar 4, 2011• 18

By JOHN LUMPKIN and RAMANAN LAXMINARAYAN

For the first time, researchers and policymakers can visually track the rise in “superbug” infections over time and identify regions of the country with rapidly spreading rates of resistance.

Researchers at Extending the Cure, a nonprofit project funded by the Robert Wood Johnson Foundation’s Pioneer Portfolio, have developed ResistanceMap—an online tool that tracks changes in resistance levels. These maps show us how the problem of antibiotic resistance has gotten worse–with some regions of the country experiencing a significant and worrying increase in drug- resistant microbes.

Infections like those caused by MRSA (methicillin-resistant Staphylococcus aureus) kill an estimated 100,000 people in the United States each year. Progress toward solving this emerging public health crisis has been slow, an important reason why the Robert Wood Johnson Foundation has funded this research through its Pioneer Portfolio. We share a common view that the best way to prevent an epidemic from occurring may lie in dramatically reframing how we approach the problem.

This is exactly what Extending the Cure has done with ResistanceMap, a web tool that presents scientific data in a user-friendly way, allowing policymakers and researchers to quickly identify regions in urgent need of better infection control, enhanced surveillance, more vigilant antibiotic stewardship, and comprehensive methods to curtail the spread of resistant microbes.Continue reading…

Medicaid and Health Outcomes (again)

Mar 4, 2011• 14

By AUSTIN FRAKT

Avik Roy has read and posted about the papers I reviewed as part of my Medicaid-IV series. If you’ve forgotten, the purpose of that series of posts was to examine studies that use proven, sound methods to infer the causal effect of (as opposed to a correlation between) Medicaid enrollment on health outcomes. From that series, I concluded that there is no credible evidence that Medicaid is worse for health than being uninsured. Considering only studies that show correlations (not causation), Avik disagrees.

Avik’s post is long, but you can save yourself some trouble by skipping the gratuitous attack on economists in general, and Jon Gruber in particular, as well as the troubled description of instrumental variables (IV).* About halfway down is his actual review of the papers; look for the bold text.

The point I want to drive home in this post is why an IV approach is necessary in studying Medicaid outcomes. People enrolling in Medicaid differ from those who don’t. They differ for reasons we can observe and for those we can’t. An ideal study would be a randomized controlled trial (RTC) that randomizes people into Medicaid and uninsured status. Thats neither practical nor ethical. So we’re stuck, unless we can be more clever.

The next best thing we can do is look for natural experiments. That’s what IV exploits. In this case, the studies I examined use the state-level variation in Medicaid eligibility (and related programs). That variation obviously affects enrollment into Medicaid (you can’t enroll unless you’re eligible), though it is not determinative. Importantly, state-level variation in Medicaid eligibility rules does not itself affect individual-level health. Other than figuratively, do you suddenly take ill when a law is passed or a regulation is changed? Do you see how Medicaid eligibility rules are somewhat like the randomization that governs an RTC, affecting “treatment” (Medicaid enrollment) but not outcomes directly? (If this is unclear, go here.)Continue reading…

Realizing Value from Health IT: A BCG Response to the PCAST report

Mar 4, 2011• 2

By BENJAMIN BERK, MD, SIMON KENNEDY, & BCG HCIT Team

If we are to achieve the aims of health insurance reform/PPACA, let alone eventual health delivery reform, the US needs coherent, comprehensive federal health IT policy. In late December, PCAST, the President’s Council of Advisors on Science and Technology, issued its perspective on how HITECH has (and hasn’t) moved the needle and where we need to go from here. PCAST is an influential group. It is chaired by Eric Lander, President, Broad Institute of Harvard and MIT and John P. Holdren, Assistant to the President for Science and Technology and Director of the Office of Science and Technology Policy. The council includes heavy hitters from the technology and business worlds including Eric Schmidt, Chairman of Google, Craig Mundie, Chief Research and Strategy Officer of Microsoft, and Christine Cassel, President and CEO of the American Board of Internal Medicine. PCAST’s report, entitled “Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward” makes several important additions to the health IT policy conversation, but fails to hit the mark in two critical areas.

On the positive side, we agree with PCAST that IT can contribute to lower costs and higher quality in health care, and that current national HCIT programs, while an enormous improvement over the last forty years of neglect and disincentives, are insufficiently radical to fully realize that value.

We agree that separation of data from applications, liberating the data from the proprietary databases and applications that typically imprison it today is core to unleashing the power of healthcare information (think: free-text patient note vs. reportable and trend-able lab results). Doing so creates value by allowing the right information to be delivered to the right individuals, at the right time, in the right format for the relevant context (e.g. trending of A1c values over time for population health management). Furthermore, freeing data from specific applications would enable greater innovation than is available today and is critical to certain types of data uses such as population-level research, comparative effectiveness research, and biosurveillance.Continue reading…

Health 2.0 News Bites are up

Mar 4, 2011

Over on our sister site, the Health 2.0 News Blog, MEDecision, Human Health Project and many more are on this week’s extensive list of news bites–with cool new icons!

Xerox Blog Talk Radio: Personal Health Information

Mar 4, 2011• 2

Check out Xerox Blog Talk Radio to learn about protecting personal health information. This morning, Mark Tripodi, chief innovation officer, government healthcare solutions group for ACS, A Xerox Company, explained why data can easily be put at risk and what can be done to ensure organizations meet privacy standards. You can access the recording here: http://bit.ly/eyv65U. For more on Xerox: http://xrx.sm/news.