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Failure is Not an Option

Dec 30, 2010• 78

By MARGALIT GUR-ARIE

2010 is drawing to an end amongst a flurry of activities in the Health IT field. In a few short days 2011, the year of the Meaningful Use, will be upon us and the stimulus clocks will start ticking furiously. In addition to the yearlong visionary activities from ONC, December 2010 brought us two landmark opinions on the future of medical informatics. The first report, from the President’s Council of Advisors on Science and Technology (PCAST), recommended the creation of a brand new extensible universal health language, along with accelerated and increased government spending on Health IT. Exact dollar amounts were not specified.

The second report from the Institute of Medicine (IOM) is a preliminary summary of a three-part workshop conducted by the Roundtable on Value & Science-Driven Health Care with support from ONC, and titled “Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care”. The IOM report, which incorporates the PCAST recommendations by reference, is breath taking in its vision of an Ultra-Large-System (ULS) consisting of a smart health grid spanning the globe, collecting and exchanging clinical (and non-clinical) data in real-time. Similar to PCAST, the IOM report focuses on the massive research opportunities inherent in such global infrastructure, and like the PCAST report, the IOM summary makes no attempt to estimate costs.

Make no mistake, the IOM vision of a Global Health Grid is equal in magnitude to John Kennedy’s quest for“landing a man on the moon and returning him safely to the earth” and may prove to be infinitely more beneficial to humanity than the Apollo missions were. However, right now, Houston, we’ve had a problem here:

The nation spent upwards of $2.5 trillion on medical services this year
Over 58 million Americans are poor enough to qualify for Medicaid
Over 46 million Americans are old enough to qualify for Medicare
Another 50 million residents are without any health insurance
The unemployment rate is at 9.8% with an additional 7.2% underemployed
This year’s federal deficit is over $1.3 trillion and the national debt is at $13.9 trillion

Value (Outcomes/Cost) ‚ÄìA Unifying Concept for Health Reform?

Dec 30, 2010

By RICHARD REECE, MD

In health care, stakeholders have myriad, often conflicting goals, access to services, profitability, high quality, cost containment, safety, convenience, patient-centeredness, and satisfaction.

-Michael Porter PhD, Professor, Harvard Business School

Those who support the new health reform law and those who seek to repeal it look at the new law through vastly different ideological lenses. Each ideological camp has its own implacable, rarely movable spin on what‚Äôs important.

But, according to Thomas Lee, MD, associate editor of the New England Journal of Medicine and networks president for Partners Healthcare System in Boston, the search for value (outcomes relative to cost) unites and provides a path forward for competing ideological interests.

In Lee's words, ‚ÄúThe value framework offers a unifying framework for provider organizations that might otherwise be paralyzed by constituents‚Äô fighting for bigger pieces of a shrinking pie (‚ÄúPutting the Value Framework to Work," New England Journal of Medicine, and December 23, 2010).

As an ideological and idealistic concept, I would like to think a utopian vision focusing on value is achievable. But I remain dubious because of the nature of American culture. I am also skeptical partly because the concept originates in Boston, which has the highest health costs in the nation but which has scanty evidence that its outcomes are superior. Finally, I am leery because it takes large organizations with interoperable and expensive electronic systems that communicate with each other to measure value (outcomes/costs) for a bewildering number of different diseases with different outcome dimensions (survival, degrees of health recovery, time to return to work, side effects, pain, complications, adverse effects, sustainability, long term consequences) all measured over a longitudinal time frame among diverse stakeholders. Bringing such scattered data points into a single focus with a common understanding among diverse participants over a long time frame strikes me as nearly impossible.

Value (Outcomes/Cost)–A Unifying Concept for Health Reform?

Dec 30, 2010• 5

By RICHARD REECE, MD

In health care, stakeholders have myriad, often conflicting goals, access to services, profitability, high quality, cost containment, safety, convenience, patient-centeredness, and satisfaction.

-Michael Porter PhD, Professor, Harvard Business School

In Lee’s words, “The value framework offers a unifying framework for provider organizations that might otherwise be paralyzed by constituents’ fighting for bigger pieces of a shrinking pie (“Putting the Value Framework to Work,” New England Journal of Medicine, and December 23, 2010).

Twas the Night Before [HIT] Implementation

Dec 30, 2010• 1

By LISA SUENNEN (stealing liberally from Clement Clarke Moore)

An ode to healthcare information technology modernization

‘Twas the night before Christmas, in the ER of St. Strauss,

Not a doctor was working, not even House;

The IVs were hung by the bedsides with care,

In hopes that some pain meds soon would be there;

The patients were nestled all snug in their beds,

While visions of discharge danced in their heads;

And nurses in scrubs, washed their hands at the taps,

And checked out the charts to ensure no care gaps,

When out on the unit there arose such a clatter,

Everyone raced to see what was the matter.

To the nurse station they flew like a flash,

And witnessed the CFO counting his cash;

The IT incentives came with a red, white and blue bow,

And the luster of ARRA coin twinkled and glowed.

When, what to our wondering eyes did appear,

But a wild-eyed CIO and eight engineers.

With an old printer driver, and mice that go click,

They knew in a moment it was likely Epic.

Or McKesson or Cerner or Meditech to name

just a few companies that played the CIO’s game.

“Now, EMR! Now, EHR! Now, CPOE and Billing!

By Friday I’ve got to get all of you working!

From the OR to the pharmacy to the ward down the hall!

We must figure out interoperability for all!”

Health IT: The Year In Review

Dec 29, 2010• 22

By MICHAEL LAKE

This is a summary of the HIT Trends Report for December 2010 (The Year in Review). You can get the current issue or subscribe here.

Out of 325 stories we covered in 2010, and a few new ones, we picked about 30 that best tell the story of the past year.

Tracking HITECH in 2010: The Year’s Top Stories

federal ARRA HITECH strategy

2. In July the federal rules for meaningful use were unveiled; a core set of 15 required elements and a menu set of 10 optional elements among which 5 are selected. Providers will attest to meeting these measures. In the next stage in 2013, all measures will be mandatory and providers must demonstrate real meaningful use for most patients.

3. There are now 5 companies designated as authorized to certify EHR technology. The federal government is keeping an updated list of products that have been certified. At the end of 2010 the count of different certified product versions was over 200.

4. NHIN Direct is a concept that grew out of a blog by Wes Rishel, at Gartner. It’s meant for simple communications between parties who know each other. Its focus is on meaningful use, specifically, summary care records, referrals, discharge summaries and others. It’s also being used as the foundation for the clinical messaging service recently announced by Surescripts.

5. The federal government also began work on comparative effectiveness research (CER), which it now refers to as “patient-centered outcomes research.” $435 million has been awarded by AHRQ across dozens of companies and projects focused on developing patient registries, clinical data networks, and other forms of electronic health data systems in order to generate data about treatment outcomes and options that can be compared by patients.

6. Todd Park, CTO at HHS, summed up the federal strategy as “incentives plus information equals transformation.” He connects the dots between the provider incentives in HITECH, provider payment reform in the Affordable Care Act, and Data Liberación, making federal data available for innovation.

The Difficult Science, Part II

Dec 28, 2010• 19

By KENT BOTTLES, MD

“Despite their great explanatory powers these laws [such as gravity] do not describe reality. Instead, fundamental laws describe highly idealized objects in models.”

— Nancy Cartwright, “Do the Laws of Physics State the Facts?”

In Part I the limitations of science in helping us make wise choices and decisions about our health were examined.

Because of an inherent difficulty in establishing causation, absolute certainty is unattainable even in science. Medical knowledge follows Karl Popper’s theory of science because the right answer, whether about what causes ulcers or if you should take hormone replacement therapy, keeps changing with the publication of new studies. And most depressingly of all, a respected expert on evidence-based medicine concludes, “The majority of published studies are likely to be wrong.”

Part I ended with some suggestions that seemed to imply that savvy patients should enroll in a graduate level statistics class and understand the subtleties of observational studies, meta analysis, and randomized controlled clinical trials. Being an informed health care consumer is evidently difficult indeed.

Part II explores how we all have to change if we are to live wisely in a time of rapid transformation of the American healthcare system that everyone agrees needs to decrease per-capita cost and increase quality.

PATIENTS

When I talk to physicians about pay for performance programs, I am always asked why should doctors be responsible for patient behavior that they cannot control. Even if we were able to have health care access for all and eliminate every error in medicine, we would only account for 10% of whether an individual stays healthy. Environment and genetics account for about 35%, but the remaining 55% of whether one stays well depends on behavior (exercise, smoking, diet) and social support systems (families, communities, places of worship).

Tweetcasting @2011 : Health Reform Implementation, Mobile Health and Patient Safety

Dec 27, 2010• 8

By DAVID E. WILLIAMS

My crystal ball is a little foggy so I decided to ask my Twitter followers (@HealthBizBlog) to help compile a list of health care predictions for 2011. I’ve integrated my thoughts with theirs and organized the predictions into four themes:

Transparency will change from buzzword to reality
Information technology progress will be uneven, with the biggest breakthroughs in mobile
A culture of patient safety will begin to take root
Health reform implementation will advance despite some ugly battles

Transparency will change from buzzword to reality.

The health care industry is tremendously opaque. Patients and doctors don’t know the price of medical services, while pharmaceutical and medical device makers maintain secret financial arrangements with physicians.

Much is likely to change for the better in 2011.

Giovanni Colella, CEO of health care transparency company Castlight Health (@CastlightHealth) predicts, “Consumers will increase their demands for personalized information about health care cost, quality and convenience and will turn to innovative applications to address these needs.”

Bright lights will be trained on the interaction between industry and physicians.

The Affordable Care Act requires pharmaceutical and device companies to report payments to physicians starting in 2013; voluntary reporting is likely to pick up next year. Beyond that, @PharmaGossip predicts, “PharmaWikiLeaks will become a force for good,” citing a recent leak about Pfizer in Nigeria as Exhibit A.

Geolocate This

Dec 27, 2010

By DAVID HARLOW

As health care providers continue to wonder whether and how they should add social media to their mix of communications tactics, new tools — and new uses for those tools — continue to sprout up.

I’m quoted in the current edition of American Medical News in a story that looks at the question of whether and how health care providers should use geolocation services (e.g., Foursquare, Gowalla) as additional channels through which they may communicate with patients, colleagues and referral sources — or through which they may encourage patients and others to communicate among themselves.

I’ve touched on this issue in recent presentations on health care social media, and have noted that even “checking in” on line at an STD clinic — an activity discounted by Mark Scrimshire in the article — is something that people will do for a badge — check out this fall’s MTV/Foursquare Get Yourself Tested campaign. (Taking it to the next level, targeted sharing of STD test results is the idea behind start-up Qpid.me.)

Health care providers can leverage the general public’s interest in using geolocation services in a variety of ways. In the the article, Chris Boyer notes that his health system works to ensure that check-in data (addresses and phone numbers drawn from other online services) for each service location is accurate, but doesn’t necessarily encourage check-ins.

There are no HIPAA issues raised by patients “checking in” on line, since it’s a voluntary act by the patient, and doesn’t really involve the provider. Providers might decide to encourage check-ins (but not repeat visits — we want to keep people healthy, right?) as a way to drive patients to links to targeted health information, or even, perhaps, coupons for coffee or something (as long as we don’t bump up agianst limits on financial incentives … though I think that would not be an issue under most circumstances.

Playing Tetris Cuts Flashbacks in PTSD

Dec 26, 2010• 2

By GLENN LAFFEL, MD

Flashbacks are vivid, recurring, intrusive and unwanted mental images of a past traumatic experience. They are a sine qua non of Post-Traumatic Stress Disorder (PTSD). Although drugs and cognitive/behavioral interventions are available to treat PTSD, clinicians would prefer to utilize some sort of early intervention to prevent flashbacks from developing in the first place.

Well, researchers at Oxford University appear to have found one. Remarkably all it takes is playing Tetris. Yes, Tetris!Continue reading…

The Difficult Science

Dec 25, 2010• 21

By KENT BOTTLES, MD

“The mind leans over backward to transform a mad world into a sensible one, and the process is so natural and easy we hardly notice that it is taking place.” Jeremy Campbell

On the same day in November, headlines from the Wall Street Journal and the New York Times reported on the same story about a federal panel’s recommendations on consumer intake of vitamin D.

“Triple That Vitamin D Intake, Panel Prescribes” read the WSJ story;

“Extra Vitamin D and Calcium Aren’t Necessary, Report Says” stated the New York Times. (http://ow.ly/3tJMe) Since I had recently started taking vitamin D daily, I was interested in what the experts in Washington, DC were recommending.

How should you decide what advice to follow about the relationship between your diet, lifestyle, medications, health, and wellness?

Is this just another example of how the media does a terrible job? Many of us resonate with the view of media watchdog Steven Brill who said, “When it comes to arrogance, power, and lack of accountability, journalists are probably the only people on the planet who make lawyers look good.” (http://ow.ly/3tKdM)

The media does play a role here and needs to improve, but it turns out that it is really complicated to figure out what the “truth” is about diet, exercise, medicines, and your individual well being. Everybody (journalists, government panel members, scientists, patients, physicians, and nurse practitioners) needs to change.