The Health Care Blog – Page 768 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Critical Review of Medical Literature

Jan 1, 2011• 4

By MARYA ZILBERBERG

Today I am launching a series of posts on how to read medical literature critically. The series should provide a solid foundation for this task and dove-tail nicely with some of the more dense themes that occur on this blog. Who should read the series? Everyone. Although the current model of dissemination of medical information relies on a layer of translators (journalists and clinicians), it is my belief that every educated patient must at the very least understand how these interpreters of medical knowledge (should) examine it to arrive at the information imparted to the public.

At the same time, both journalists and clinicians may benefit from this refresher. Finally, my own pet project is to get to a better place with peer reviews — you know how variable the quality of those can be from my previous posts. So, I particularly encourage new peer reviewers for clinical journals to read this series.

First, a conflict of interest statement. What comes first — the chicken or the egg? What comes first — expertise in something or a company hiring you to develop a product?

Well, in my case I would like to think that it was the expertise that came first and that Pfizer asked me to develop this content based on what I know, not on the fact that they funded the effort. At any rate, this is my disclaimer: I developed this presentation about three years ago with (modest) funding from Pfizer, and they had it on a web site intended for physician access. Does this mere fact invalidate what I have to say? I don’t think so, but you be the judge.

The Tea Party Conservative Strategy for 2011

Dec 31, 2010• 39

By ROBERT REICH

Next week starts the new Congress, and with it the Tea Party conservatives. What’s their strategy? What will they rally around?

They’ll grouse endlessly about government spending but I don’t think they’ll use any particular spending bill to mobilize and energize their grass roots. The big bucks are in Social Security, Medicare, and defense, which are too popular. And their support for a permanent extension of the Bush tax cuts will make a mockery of any argument about taming the deficit.

Nor will they focus on the debt ceiling. Their opposition to raising it will generate a one-day story but won’t rally the troops or register with the public. Most Americans aren’t particularly interested in the debt ceiling, don’t know what it means, and don’t feel affected by it.

Instead, I expect their rallying cry will be about the mandatory purchase of health care built into the new healthcare law. The mandate is the least popular, and least understood, aspect of that law. Yet it’s the lynchpin. Without it, much of the rest of the law falls apart: It’s impossible to cover all high-risk Americans, including those with pre-existing conditions, unless those at far lower risk are required to buy insurance.

Knowing they don’t stand a chance of getting a direct repeal of the mandate (even if they could get a majority in the House for it, they won’t summon 60 votes in the Senate, and have no possibility of overriding a presidential veto), they’ll try to strip the federal budget appropriation of money needed to put the mandate into effect. This could lead to a standoff with the White House over government funding in general, and a possible government shutdown.

2011 beckons; Matthew’s personal end of year letter

Dec 31, 2010• 4

By Matthew Holt

This is my personal end of year letter. I used to send it to my personal email list but in the Facebook/Twitter era, it doesn't make much sense. I hope THCB readers will indulge me by taking a look and maybe even thinking about some of the charities and causes I support–feel free to add your own in the comments. I'll be back with a more health care featured forecast next week–Matthew

I'm determined to make this the end of 2010 letter, not "well into 2011" letter. But as I've also got tons to do of an unfortunate work nature on NYE even though it's a holiday, so I am going to be quick–or at least a little quicker than in years past.

I do these letters about charity and politics every year and moved them onto a blog a while ago (here's 2010 2009s, 2008s and you can search back), and now it's all I use my personal blog for, given that my Twitter account @boltyboy & Facebook page contain most of my very limited rantings. Of course I started these partly because I didn't have the wife & kids that most people send out their end of year missives about. Then in 2007 I added the wife part, and this year's big news is that next year Amanda and I are expecting a daughter. Little Colette should be here around the end of April, and I'm sure she'll have her own Facebook page and 529 account very soon if I know Amanda! The other family news this year is that my sister Dordy had a baby boy called Alex in February. Sister-in-law Lyn has a baby girl called Talia in 2009 but as it was Dec 26 you can count her in the most recent crop!

But enough about babies (for now!). I'm still running the Health 2.0 Conference with my partner Indu Subaiya and now (gulp) four other full time staff (Hillary, Lizzie, Bianca & new recruit Emily). It's still growing (4 conferences last year including one in Europe) and much more besides. Somehow none of this has translated into more time off for me and Indu! I still own The Health Care Blog but basically now that's a group blog I contribute to very occasionally! Other than getting a little plumper around the middle, Amanda is still being a big time star running HR at her company PRN.

This letter is, though, about stuff I care about on a slightly more altruistic level. This annual missive usually breaks down into my views and suggestions for donations about health care, poverty in developing world, poverty at home, torture, and drug prohibition. Feel free to comment, ignore, delete or whatever. But hopefully at least some of you may pay attention to some of it or even write a check.

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.