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HIT Trends Summary for February 2011

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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

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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)

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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

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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

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

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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.

Fixing America’s Health Care Reimbursement System

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By BRIAN KLEPPER, PHD

A tempest is brewing in physician circles over how doctors are paid. But calming it will require more than just the action of physicians. It will demand the attention and influence of businesses and patient advocates who, outside the health industrial complex, bear the brunt of the nation’s skyrocketing health care costs.

Much responsibility for America’s inequitable health care payment system and its cost crisis is embedded in the informal but symbiotic relationship between the Centers for Medicare and Medicaid Services and the American Medical Association’s Relative Value System Update Committee — also known as the RUC. For two decades, the RUC, a specialist-dominated panel, has encouraged national health care reimbursement policy that financially undervalues the challenges associated with primary care’s management of complicated patients, while favoring often unnecessarily complex, costly and excessive medical services. For its part, CMS has provided mostly rubber-stamp acceptance of the RUC’s recommendations. If America’s primary care societies noisily left the RUC, they would de-legitimize the panel’s role in driving the American health system’s immense waste and pave the way for a more fair and enlightened approach to reimbursement.

As it is, though, unnecessary health care costs are sucking the life out of the American economy. Over the past 11 years, health care premium inflation has risen nearly four times as fast as the rest of the economy. Health care costs nearly double those in other developed nations have put U.S. corporations at a severe competitive disadvantage in the global marketplace.Continue reading…

The Value of a Life

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By BENJAMIN GEISLER

A recent NYTimes article on how to value a life drew almost two-hundred heavy-handed comments. It discussed how different governmental agencies such as the Food and Drug Administration (FDA), the Environmental Protection Agency (EPA) or the Department of Transportation (DoT) place a monetary value on each life saved.

In many public policy areas, Cost-benefit Analysis (CBA) is being used to assess whether an investment in a particular area is worthwhile. CBA uses an “exchange rate” in which the consequences are monetarized.

The article mentioned the following values: The DOT value each life saved at or around $6 million 2010 USD$; $9.1 million 2010 US$ was the corresponding value of the EPA; and the FDA put a figure of $7.9 million 2010 USD$ (increased from $5 million in 2008 USD$) on eachlife saved from cancer death caused by cigarettes.

I did not know that the FDA considered efficiency measures such as money per life saved at all.

What I find fascinating is how arbitrary the approach of the different agencies can be. They could have just funded certain policies by how cheaply they can save a life up to a certain threshold (e.g. when thebudget is exhausted).

Instead, the EPA uses a methodology derived from logging industry (yes, you heard right). $1,000 worth of extra-work for the lumberjacks each year is generally accepted to save 1 in 1,000 lumberjacks. This was apprently developed by a Professor Viscusi who wrote his firstpaper on CBA as an undergrad at Harvard in the 1970s.

Other governmental agencies seem to survey citizens. In economics, this could actually be considered a valid approach if done right.

There were interesting comments by the readers. Some did not want to put any value of life. It was controversial if the value was too high or too low. One reader mentioned that the Federal Aviation Administration might have had a value of $450,000 per life in the late 1970s.Continue reading…

THCB @ HIMSS11

By JOHN IRVINE & MATTHEW HOLT

This years HIMSS drew the largest crowd in history (31,000). That should be a tip off that something is going on. That something is the national drive for health IT launched by the Obama administration with a whole boatload of ARRA stimulus money being paid out starting this year.

Health Information Exchange (HIE)

While the evolving meaningful use standards for Electronic medical records remained a logical focus for many vendors and the subject of a mindblowing number of panels, there is a sense that the conversation is moving to the world of health information exchanges (HIE). As always, there is spirited disagreement about exactly how the term of the hour should be defined (see the debate over just what exactly the term Health 2.0 means for an example of a good controversy). Is health information exchange a central database, kind of like the old Community Health Information Network. Is it a new peer to peer network, linking hospitals and health systems in a more useful and fundamentally practical way?  Or is it about a new economic model, based on the business models that go along with the free flow of clinical data. We heard the term Accountable Care Organization a lot! Or – more likely – a little bit of all of the above? See Mark Frisse’s excellent blog post on THCB for an in depth look.

Innovation

Sure, nobody has yet come up with the world changing, completely disruptive, industry transforming Facebook for doctors that some pundits had predicted, but there are signs we’re getting closer. Lots of people are trying and social network-ish features are everywhere, with vendors giving their systems the ability to communicate with the outside world. That includes some of the “traditional” EMR vendors like Allscripts that are now linking their users.Continue reading…

Health 2.0 Spring Fling–preview interviews

By Emily Ebert

At Health 2.0 we are getting very excited for the Spring Fling this March 20-21, and in preparation, we’re doing a series of interviews with some of the speakers and panelists. Below is a list of all the interviews we’re already done, and stay tuned for two more coming this week.

Check them out and catch our Spring Fling fever!

  • Rushika Fernandopulle talked with us about the challenges and rewards in creating his new healthcare delivery model, Iora Health. Listen here.
  • Preston Maring, founder of the Kaiser Permanente Farmer’s Market, talked about the evolution of the KP farmer’s market. Listen here.
  • Brian Witlin of ShopWell gave us the details on his mobile application that allows users to scan products and see how well they fit into the user’s health and wellness goals. Listen here.
  • Amy Romano of Childbirth Connection told us what she hopes to see come from the intersection of health IT and maternity care. Listen here.
  • Eric Zimmerman of RedBrick Health gave us a peek into the new social engagement platform they’ve created for the Alliance for a Healthier Minnesota. Listen here.
  • Hemi Weingarten, founder of the Fooducate app, told us how a simple barcode scan can inform and educate consumers in the grocery store. Listen here.

Want to hear more? Come see all of these speakers and more at the Health 2.0 Spring Fling this March 21-22, 2011. Sign up here!

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