Above the Fold
Unconscious in the Emergency Department
By JOHN HALAMKA, MD
As State Health Information Exchanges and Federal efforts (NHIN Connect/NHIN Direct) implement the data sharing technology that will enable all providers in the country to achieve Meaningful Use Stage 1, I’m often asked “but when will this healthcare information exchange technology be able to retrieve all my records from everywhere when I’m lying unconscious in the Emergency Department and cannot give a history?”
Here are my thoughts about the trajectory we’re on and how it will lead us to supporting the “Unconscious in the ED” use case.
Meaningful Use Stage 1 is about capturing data electronically in EHRs. Getting healthcare data in electronic form is foundational to any data exchanges. By 2011 we should have medication lists, problem lists, allergies, and summaries available from EHRs.
The data exchanges in Stage 1 are simple pushes of data from point A to point B – from provider to public health, from provider to provider, and from provider to pharmacy. There is no master patient index, no record locator service, and no centralized database containing everyone’s lifetime health record.
THCB Recommends …
Health 2.0 Developer Challenge Winners/ Code-a-thon /Conference
Some of the first six winners will be announced later today….hang tight! Here are the Challenges
Meanwhile any developers or people who want to meet developers, or who want to play with some really cool government data sets OR data drug data from First Data Bank and amazing health survey data from Gallup/Healthways, should sign up for the Health 2.0 Developer Challenge Code-a-thon at Google this coming Saturday. Not a bad place to come network, but a great place to get coding.
Oh, and today is the FINAL day you can get the regular rate to the Health 2.0 Conference before the price goes up! Conference is next Thursday & Friday, October 8–9
ClearPractice’s Nimble brings a comprehensive EMR to the iPad
While over 500 medical apps have been created for the iPad since its launch in April of this year, few attempt to bring an entire electronic medical record system onto the device. Today, St. Louis-based medical software company ClearPractice is releasing Nimble, which the company says is “the first comprehensive EMR solution developed in iOS to run natively on the iPad”.
With Nimble, ClearPractice aims to use the iPad to address several commonly cited issues about EMRs. They emphasize the iPad’s potential for removing barriers in EMR use and physician workflow by integrating the device and software in the care delivery process. The hope is that the iPad’s portability and accessibility will allow it (and thus Nimble) to be present wherever the doctor is—from the clinic to the hospital to the home—and make having an EMR more appealing, especially to doctors in small practices. Given that the app was built as a native iPad application, it attempts to take full advantage of the iPad’s unique interface and user experience.
Another Devastating Diagnosis to Face
By
I have stomach cancer and will undergo surgery to remove part or all of my stomach today.
While a truly expert blogger would have documented the facts and his perceptions from the moment of discovery, I have been preoccupied with absorbing the shock, weighing my options and managing the logistics. I have been short on insight, long on anxiety.
But I have regained some composure since finalizing the plan for my immediate future, so I thought I’d try to capture some of my observations about this wild period this time around. After all, I listen all the time to people talk about how they experience these few weeks between a serious diagnosis and the beginning of treatment and, having gone through it repeatedly myself, I have a lot to compare it to.
A little background: This is my fourth different cancer-related diagnosis. My stomach cancer was discovered due to the vigilance of my primary care doctor who treats adult survivors of childhood cancer and who leaves no symptom – regardless of how minor – unexplored. I had dismissed my insignificant symptom once it disappeared after a few days. However, my doctor didn’t, and it turned out to be a small gastric tumor, probably a result of the high doses of radiation that were the standard of treatment for my stage of Hodgkin’s disease in the early 1970s. The tumor will be removed Monday, along with as much of my stomach as is necessary to prevent its recurrence. While the size of the tumor and its staging leave me optimistic that I won’t need chemotherapy and radiation, I won’t know for certain until a week after surgery.
Consumer Groups Shut Out of Comparative Effectiveness Board
By MERRILL GOOZNER
The Government Accountability Office last week appointed two “faster cures” patient advocates and a former insurance company executive now on the AARP board to the three slots reserved for patient and consumer representatives on the Patient-Centered Outcomes Research Institute board, which will oversee comparative effectiveness research under health care reform.
The reform legislation passed last March gave GAO the job of appointing the 17 public members, which also includes five representatives of private payers, five physicians, and three industry representatives (one each for drugs, devices and diagnostic manufacturers). A full list can be found here.
The three “patient and consumer” representatives are:
- Ellen Sigal, chair, Friends of Cancer Research.
Sigal is an outspoken advocate for more money for cancer research. Her board is comprised largely of fellow executives in the research community, including staff from the American Cancer Society, Research America!, and the American Society of Clinical Oncology, which represents cancer docs. She serves on numerous non-profit boards, including the Reagan-Udall Foundation set up by the Food and Drug Administration to expedite drug development; and has served on numerous Institute of Medicine panels investigating new ways of conducting cancer research that can lead to faster access to new medicines.
The History and Future of Medical Technology
If you are curious about how the amazing technologies found in modern hospitals and clinics came about, check out Ira Brodsky’s entertaining new book, The History and Future of Medical Technology. The hardback tells the story of the people behind each technology—their dreams, their struggles, and their lucky breaks.
Told in you-are-there fashion, it gives you a front row view of the discoveries and inventions that led to today’s imaging systems, implants, prosthetics and more. The book also covers pioneering work in areas including personal health technology, robotic surgery, nanomedicine, and brain-computer interface chips.
The book contains fourteen chapters: Better Living through Biomedical Engineering / The Hidden World / Medicine’s First Power Users / Fantastic Voyage / Human Electricity / The First Cyborgs / Wireless Chemistry / The Nuclear Option / Listening to the Body / Repair or Replace? Part I / Repair or Replace? Part II / The Vision Thing / Technology with Real Teeth / Bodies in Cyberspace.
The History and Future of Medical Technology is 321 pages and includes 26 illustrations. Published in May of this year, the book is available from Amazon and other resellers. For more information, including sample pages, visit the publisher’s website: http://www.telescopebooks.com.
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How the Future of Healthcare Will Actually Work: Nuts and Bolts
By 
They are coming in fast under the radar, out of peripheral vision, in the magician’s other hand—and they will change everything. New ideas, surprising networks, stealth business models that may change health care profoundly, are bubbling up in pilot programs, experiments and full-on corporate transformations. There is something here that does not yet have a name, that no one is yet calling a movement, that no one is yet seeing as revolutionary.
While we have been mesmerized by federal health care reform, government intervention on behalf of the uninsured and government attempts to “bend the cost curve” to shave a few percentage points off medical inflation, things have been happening in the private sector for people who are already insured that result in outright medical deflation, drops in costs of 20 percent or more, all while giving people more care, not less.
Help me out here. This picture is just forming, the Ouija board is still in motion, but I think what we may have here is some truly big news about the future.
The Difference Is Integration
First, consider the huge regional differences in health care costs. Think about what it means that it costs twice as much for patients in the last six months of life to be involved with Cedars-Sinai in Los Angeles, UCLA Medical Center or New York University Medical Center than it does for them to be involved with Mayo Clinic in Minnesota or the Cleveland Clinic; or that Medicare spends half as much per patient per year in Temple, Texas, as in McAllen or Harlingen or Brownsville, Texas; or why Medicare spending per patient per year in the top and bottom quintiles of hospital catchment areas differ by 60 percent.
These are vast differences—and the more expensive areas show no better outcomes than the less expensive ones; in fact, for some conditions they show worse outcomes.Continue reading…
Why There’s An Enthusiasm Gap: An Illustration
By
Today (Monday) at a “town hall” sponsored by CNBC in Washington, the President took questions about the economy. When a hedge-fund manager complained that Wall Street executives “feel like we’ve been whacked with a stick” by the administration, Obama said most of his critics think he’s been too soft on the Street.
He noted he still hasn’t been able to end the practice of taxing some hedge fund and private-equity earnings at the capital-gains rates rather than the higher income-tax rates. “The notion that somehow me saying maybe you should be taxed more like your secretary when you’re pulling home a billion dollars…a year I don’t think is me being extremist or anti-business.”
Good as far as he went. But that’s as far as he was willing to go. It was a golden opportunity for Obama to connect the dots — to make the case that
(1) super-rich financiers on Wall Street and top corporate executives have grown even richer than they were before the Great Recession, even though most Americans are getting poorer or losing their jobs and homes and savings, and more Americans are in poverty.
(2) Yet the lobbyists for the financiers and top corporate executives, and their Republican allies have blocked or tried to block every effort of the Administration to widen the circle of prosperity, including enacting a major jobs program, providing major relief for mortgage holders who are under water, helping working families afford college for their kids, making sure states and cities have enough money to pay our classroom teachers, and cutting taxes on average working people.
(3) They almost scuttled the effort to make sure health care would be affordable to average Americans.
(4) The super-rich say the nation can’t afford any of this because of budget deficits. Yet at the same time their platoons of lobbyists are fighting off efforts to treat their income as taxable earnings rather than capital gains. So last year the 400 richest families in America, with an average income of $300 million each, were taxed at an average rate of only 17 percent. That’s the same tax rate paid by a family earning $30,000.Continue reading…
