Above the Fold
OrganizedWisdom storms the waiting room!
OrganizedWisdom is one of the more innovative Health 2.0 content and search companies, and the dynamic duo of Steven Krein and Unity Stoakes just pulled off an interesting coup by getting OW's wisdom cards into the ubiquitous Readers' Digest magazines that fill every doctor's office.
I caught up with Steve and Unity and they told me about the deal, their new board member (ex Time-Warner CEO Jerry Levin) and what they're expecting to come next.
THCB Recommends …
Things Are About to Get Ugly
Word is that House Republicans will attach an amendment to the latest federal spending bill that will cut-off funding for the health care bill.
The last Congress never finalized a budget for the current fiscal year—the feds have been operating under a series of continuing resolutions. The most recent one will expire on March 4th. If another resolution is not agreed to, much of the government has to shutdown.
House Republicans, under heavy pressure from their base, have decided to take the Democrats on over the new health care law by cutting all remaining funding for implementation of the law in the current 2010 fiscal year (October to October).
Democrats, under the same heavy pressure from their base to protect the bill, aren’t about to let them do that. While the Republicans can accomplish this in the House—and will next week—they don’t have the votes in the Senate and they don’t have the President’s pen.
Where Doctors Locate
Pop quiz. How many doctors are at the top of Mt. Everest? None, actually. Yet, think about how many people get sick up there. Think about how many die? Do you think extra bonus payments could coax a few doctors to relocate up there? What if we waived their student loan debt? If you find these questions interesting, there’s clearly something wrong with you. But cheer up. As the map below shows, there is a lot of variation in the number of people per doctors across Texas counties. [Thanks to Jason Roberson and his colleagues at The Dallas Morning News for making the data available.] At one extreme, Bandera County in the Texas Hill Country has 21,266 people and only one doctor. At the other extreme, Baylor County, near the Oklahoma border, has 666 patients per doctor.
Should we care about any of this? If so, why?
Before getting into specifics, let me address a cultural issue that I believe greatly prejudices all discussions of doctor location.
Bandera County bills itself as “The Cowboy Capital of the World.” It clearly promotes tourism. But the online reviews of its eight area restaurants don’t make me want to visit any time soon. Ditto for the online reviews of its 10 hotels, motels and dude ranches. Still, a lot of people visit there and it has a growing population.
Ethical Blinders?
By PAUL LEVY
Is this a case of ethical blinders?
Today's New York Times has an important story about the ineffectiveness of removal of lymph nodes for certain women with breast cancer. That is a significant result of clinical research. But read this:
Experts say that the new findings, combined with similar ones from earlier studies, should change medical practice for many patients. Some centers have already acted on the new information. Memorial Sloan-Kettering Cancer Center in Manhattan changed its practice in September, because doctors knew the study results before they were published.
And they felt no need to spread the word quickly to other hospitals and to breast cancer patient advocacy groups and help women across the world avoid the surgery and its after-effects? (As noted in the article, "It can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.")
Paul Levy is the former President and CEO of Beth Israel Deconess Medical Center in Boston. For the past five years he blogged about his experiences in an online journal, Running a Hospital. He now writes as an advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement at Not Running a Hospital.
Transmogrifying California Healthcare
By LISA SUENNEN
I’m really looking forward to this coming Friday, February 4th, as I get to moderate a panel on “The Impact of Health Reform on California.” The panel, which was organized by UC Berkeley’s Institute for Governmental Studies is being held in Sacramento and will take place before a sold-out crowd of nearly 200, in large part because it has a meaty topic and some really top-notch participants, including:
- Diana Dooley
Secretary, Health and Human Services Agency - Cindy Ehnes
Director, California Department of Managed Healthcare - Paul Markovich
Chief Operating Officer, Blue Shield of California - Saumya Sutaria
Director, McKinsey & Co.
Sacramento Mayor Kevin Johnson (who I went to college with) and Congresswoman Doris Matsui will also make some remarks.
This should be a great event because each of the panelists has a pretty significant role to play in how the State of CA adopts and adapts to health reform, and there is a remarkable amount at stake.
Saul Bellow once said, “California is like an artificial limb the rest of the country doesn’t really need.” That may be true, but in our healthcare economy we can’t afford to amputate.
A Multi-Layered Defense for Web Applications
The internet can be a swamp of hackers, crackers, and hucksters attacking your systems for fun, profit and fraud. Defending your data and applications against this onslaught is a cold war, requiring constant escalation of new techniques against an ever increasing offense.
Clinicians are mobile people. They work in ambulatory offices, hospitals, skilled nursing facilities, on the road, and at home. They have desktops, laptops, tablets, iPhones and iPads. Ideally their applications should run everywhere on everything. That's the reason we've embraced the web for all our built and bought applications. Protecting these web applications from the evils of the internet is a challenge.
Five years ago all of our externally facing web sites were housed within the data center and made available via network address translation (NAT) through an opening in the firewall. We performed periodic penetration testing of our sites. Two years ago, we installed a Web Application Firewall (WAF) and proxy system. We are now in the process of migrating all of our web applications from NAT/firewall accessibility to WAF/Proxy accessibility.
We have a few hundred externally facing web sites. From a security view there are only two types, those that provide access to protected health information content and those that do not. Fortunately more are in the latter than the former.
Patient Privacy and PCAST
By JEAN STANFORD, PETER MORK, PhD, and ARNON ROSENTHAL, PhD
The President’s Council of Scientific Advisors (PCAST) report on health care IT points out that “A patient cannot make meaningful privacy choices unless he or she understands the flows and uses of information and can therefore make informed choices. That is not the reality today… While facetoface counseling on privacy choices should be available whenever choice is either required by law, policy or practice, most patients will probably educate themselves on the issues and make privacy choices through a web interface, where they will also be able to change their choices at any time… An important point is that, when patients have a meaningful opportunity to choose, a patient’s choices will be persistent, that is, continuing until changed. Most patients ideally will have elected privacy choices at a time when they are healthy and competent. This is truer to the principal of informed consent than is a rushed signature at thetime of a medical emergency, or when the patient’s physical or mental competency is compromised.”[i]
We have developed a proof of concept prototype (http://sourceforge.net/projects/kaironconsents/) for such a patient privacy preference management system that could be implemented nationwide.
Why This Primary Care Doctor Loves His EHR
By
A recent post in the Wall Street Journal Health Blog noted that a study found electronic medical records don’t improve outpatient quality. The authors of the Archives of Internal Medicine article, Electronic Health Records and Clinical Decision Support Systems, correctly points out that we should be skeptical and “doubt [the] argument that the use of EHRs is a “magic bullet” for health care quality improvement, as some advocates imply.”
This should surprise no one. Were we that naive to think that simply installing health information technology (HIT) in the medical field would generate significant improvement in outcomes? Does simply installing computers in our classrooms improve educational test scores?
Of course not.
The excellent commentary after the article makes some plausible reasons why the clinical decision support (CDS) didn’t seem to improve outcomes on 20 quality indicators. First, it isn’t clear that the CDS implemented across the various doctors’ offices and emergency rooms actually addressed the indicators studied. Second, the data studied is already dated (from the 2005 to 2007 National Ambulatory Medical Care Survey), a long time in technology terms (iPhone first debuted in 2007). The authors of the original article also point out that there is some evidence that institution specific use of CDS actually improves quality. Whether this can be scaled to the national level is the question.
