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Petitioners Ask OSHA to Regulate Resident Physician Work Hours

Sep 21, 2010• 17

By KATHERINE MATOS

On September 2, Assistant Secretary David Michaels for Occupational Safety and Health received a petition requesting that OSHA regulate resident physician and subspecialty resident physicians. “Depending on the type of residency, physicians-in-training can work anywhere from 60 to 100 or more hours a week, sometimes without a day off for two weeks or more.” The petition requests that OSHA exercise the authority granted under §3(8) of the Occupational Safety and Health Act to implement the following federal work-hour standard:

(1) A limit of 80 hours of work in each and every week, without averaging;

(2) A limit of 16 consecutive hours worked in one shift for all resident physicians and subspecialty resident physicians;

(3) At least one 24-hour period of time off work per week and one 48-hour period of time off work per month for a total of five days off work per month, without averaging;

(4) In-hospital on-call frequency no more than once every three nights, no averaging;

(5) A minimum of at least 10 hours off work after a day shift, and a minimum of 12 hours off after a night shift;

(6) A maximum of four consecutive night shifts with a minimum of 48 hours off after a sequence of three or four night shifts.

More information about the petition can be found at the Public Citizen-run website, WakeUpDoctor.org.Continue reading…

Diffusion of EHR Innovation

Sep 20, 2010• 5

By MARGALIT GUR-ARIE

No matter what your opinion of Electronic Health Records (EHR) is, you would probably agree that the concept of computerizing medical records represents an innovation of sorts. The spread of innovation, or its diffusion, has been researched and modeled by Rogers[1] as a bell shaped advancement through populations of Innovators, Early Adopters, Early Majority, Late Majority and Laggards (the blue curve in the figure below). At some point during this spread of an innovative solution a Critical Mass of adopters, or Tipping Point, is reached and the innovation is assured widespread diffusion (Gladwell[2]). Adoption is usually described by an S-shaped curve of adopters vs. time, and the rate of adoption is the slope of the S-shaped curve at any given time (the red curve in the figure).

The Tipping Point occurs right after the rate of adoption assumes its largest value which will be maintained throughout most of the adoption process. It is worth noting that the diffusion of innovation model is not predictive. Many innovations linger and die within the Innovator circle. Another important aspect of the model is that the time variable is not constrained. Depending on the rate of adoption, it may take weeks, months or many years for an Innovation to spread throughout a given population. There is no question that EHR adoption is slowly moving up on the ascending side of a classic diffusion model bell curve, but is it moving fast enough? Is the tipping point visible? Are we there yet?

Because it’s on the Interwebs, it must be true

Sep 20, 2010• 4

By Matthew Holt

Locally we’re supposed to diss the SF Weekly because it’s been trying to put the “genuine independent” local free weekly the SF Bay Guardian out of business and has lost a major lawsuit against it. But SF Weekly reporter Ashley Harrel has written an excellent article figuring out that one San Francisco plastic surgeon has paid a marketing company to plaster good reviews about her all over the web, and to make her the number 1 result on Google for “San Francisco Plastic Surgery”. The marketing agency unsubtly used the same name in all its reviews–the actual shortened version of the owner’s name–and has a video up on its site featuring the doctor as a happy client. Not exactly bright. Harrel also reminds us of the case of the chain plastic surgery center LifeStyle Lift that conducted a huge astroturfing operation and eventually settled with the NY Attorney General promising to stop.

Only one person on the San Francisco consumers bible Yelp seems to have noticed about this article but the person who died from a minor procedure hasn’t posted–although a few grumpy others have. (So apparently you either like this doctor or she kills you. My dad the surgeon always said he buried his mistakes!). And frankly that’s true for many patients and many doctors. In any event, the doctor is on probation from the state medical board–although that seems like a slap on the wrist.

The answer is twofold. First, get state medical boards to be more pro-active and aggressive in dealing with bad doctors. But realistically we know where that’s been going for years and its unlikely to change.

The second answer is to get better information in specialized places on the web, and elevate those.

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Sep 20, 2010

Vic Fuchs Speaks!

Sep 19, 2010• 14

By Matthew Holt

I was absolutely delighted that after several polite “maybe later” responses I was able to recently interview Victor Fuchs, the Henry J. Kaiser Professor Emeritus at Stanford University. Vic is best known as the “Father of Health Economics” and perhaps less well known (but more importantly to me!) the professor who taught the first health economics class that I ever took.

Matthew Holt: Victor, thanks so much for agreeing to come on THCB. I must admit Vic when I joined your class I had no idea about your background and reputation in health economics. So, I was just delighted to figure out that I blundered in right at the top. It’s a real pleasure to have you on the line

Victor Fuchs: I think you’re doing a great job and therefore I’m glad to spend some time with you.

Matthew Holt: Fantastic! You’ve, obviously, been observing and commenting on– and more recently sort of promoting ideas around –health reform for quite a while now, so let’s jump into a couple of things that you’ve published very recently, in fact just these past few weeks.

The first is a paper in The New England Journal of Medicine about a conceptual future for new biomedical innovation and I’d be grateful if you could just explain just a little bit what your general concepts are here. You’ve been working on this for quite a while. In fact, back when I was in your class, you were publishing some stuff with Alan Garber about technology assessment and this is sort of a continuation to that in some ways. So, I’d love to hear your thoughts.

Victor Fuchs: Well, I think there were two key elements here, one of them better understood by a larger audience and one of them I think rather new. Let me do the new one first. The new one is that we are going through what I call the second demographic transition.

The first transition was when every country had high mortality and high fertility and then the mortality especially of young people started to drop, but fertility did not drop right away, so you had a divergence there and in some cases it lasted for a couple of decades and during that time the population soared because there was this discrepancy between mortality and fertility.

You see the high fertility made sense when mortality was high because you wanted to have at least a couple of children survive to adulthood, but when mortality dropped it didn’t sink into people’s consciousness right away, so it took quite a bit of period which the historians and the demographers referred to as the demographic transition, okay. I don’t know if you’re familiar with it or not, but —

Matthew Holt: Yeah, I get the concept and there’s been some stuff written about that in terms of the impact on social security and healthcare.

Victor Fuchs: And some of the third world countries are going through it now, but now the second demographic transition is the one that I talk about in the NEJM piece a little bit. It has the following elements.

First is that a very large and increasingly large percentage of the population cohort lives until age 65, whereas at the beginning of the 20th century only a small percentage lived until 65. Now we’re going to 80% and we’ll eventually approach close to a 100% living till 65.

The second element is that life expectancy at 65 is increasing and it’s increasing at a quite brisk pace in recent decades. You put those two things together and you find out a very large and growing percentage of all the additional years that are lived if you have increasing life expectancy will be lived after 65.

Health 2.0 Europe: Alensa Demonstration

Sep 19, 2010

By Bianca Grogan

Alex Savic from Alensa AGA presented a demonstration on the main stage of the at the Health 2.0 Europe Conference, April 6-7, 2010, in Paris, France. He introduced a new product called NextWidgets which is a tool which health publishers can use to create a store inside a widget.

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Five Big Ideas that Shaped Health Reform

Sep 18, 2010• 6

By BILL KRAMER

During the Great Health Reform Debate of 2009-10, much of the public discussion and media analysis focused on the political battles, the legislative process and specific elements of the health reform bill. We talked a lot about daily public opinion polls, the futile search for bipartisanship, the political implications of the Massachusetts special election and the impact on the upcoming mid-term elections. We also learned more than we probably wanted to about filibuster rules, reconciliation bills and CBO scores. And we were inundated by detailed descriptions and analyses of the public option, abortion, payment reductions to Medicare Advantage plans, excise taxes on “Cadillac” health plans, and many other specific policy issues.

Future historians, however, will want to look more deeply for the policy frameworks and political forces that shaped the health reform bill. From a high level vantage point, there are Five Big Ideas that established the fundamental framework for the bill. With some exceptions, these ideas were not the subject of much public discussion or formal debate in Congress, but each of them shaped the reform bill in fundamental ways. As Ezra Klein and others have observed, much of the form of the health reform bill was established long ago.

1. Managed competition

Why didn’t we go down the path of a single-payer health system?

For many years, a single-payer system was the holy grail of the liberals, and it was the driving force behind the campaigns of many of the current reform advocates. To the disappointment and frustration of those advocates, however, the battle had already been fought and lost long before the 2009-10 debate. In 1978, Alain Enthoven published a two-part article in the New England Journal of Medicine entitled “Consumer Choice Health Plan: A National Health Insurance Proposal Based on Regulated Competition in the Private Sector.” The title said it all. It was a proposal for national health insurance (i.e., providing coverage to everyone) through a structured marketplace of private insurers and providers. As Enthoven described it in a 1993 Health Affairs article, “The History and Principles of Managed Competition,” his concept built on earlier work by Paul Ellwood, Walter McClure and Scott Fleming, as well as the experience of the Federal Employees Health Benefits Plan (FEHBP). In the 1992 Presidential campaign, both of the candidates endorsed this approach to health reform, and it was one of the foundation elements of Bill Clinton’s reform proposal in 1993. In the work of many policy experts since then, it became the de facto consensus approach.

Health 2.0: The Pew Internet and American Life Project

Sep 18, 2010

By Bianca Grogan

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The Pew Internet Project's Susannah Fox discusses the research group's latest healthcare findings at Health 2.0. Europe. The Pew Internet project is a non-profit research organization based in Washington DC that studies the social impact of the internet.

Google Hits Reset Button on Google Health

Sep 18, 2010• 3

By JOHN MOORE

Google Health has seemingly been stuck in neutral almost from the start. Despite the fanfare of Google’s Eric Schmidt speaking at the big industry confab, HIMSS a couple of years back, an initial beta release
with healthcare partner Cleveland Clinic and a host of partners
announced once the service was opened to the public in May 2008, Google
Health just has not seemed to live up to its promise.
Chilmark has looked on with dismay as follow-on announcements and
updates from Google Health were modest at best and not nearly as
compelling as Google’s chief competitor in this market, Microsoft and
its corresponding HealthVault. Most recently we began to hear rumors
that Google had all but given up on Google Health,
something that did not come as a surprise, but was not a welcomed rumor
here at Chilmark for markets need competitors to drive innovation. If
Google pulled out, what was to become of HealthVault or any other such
service?

Thus, when Google contacted Chilmark last week to schedule a briefing
in advance of a major announcement, we were somewhat surprised and
welcomed the opportunity. Yesterday, we had that thorough briefing and
Chilmark is delighted to report that Google Health is still in the game
having made a number of significant changes to its platform.

Health 2.0 Europe: Deep Dive by Pfizer

Sep 17, 2010

By Bianca Grogan

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Pfizer’s Vincent Varlet talks about the pharma giant’s e-initiatives for mobiles for both patients and doctors and the different services that Pfizer provides.