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Above the Fold

Why Obama Made the Right Call on Berwick

Jul 8, 2010• 54

By BOB WACHTER, MD

The recess appointment of Don Berwick to lead CMS can be seen as a cynical act of political opportunism, sidestepping the Congressional approval process using a tactic worthy of Machiavelli, or Karl Rove. Or it can be viewed as a pragmatic decision by Obama to avoid a lengthy and exasperating re-litigation of the healthcare reform debate.

Death Panels. Been there, done that. So I’m going with Choice #2.

The right side of the blogosphere has erupted, painting Berwick as an effete academic who would have withered under the Klieg lights and piercing questions of the likes of John Ensign and Jim Bunning. Those of us who know Don have no doubt that he would have more than held his own in debating the lessons of England’s healthcare system and the necessity of clear-headed rationing choices. Don is serious, hyper-articulate and intellectually nimble; in a real debate with members of the Senate Finance Committee, all my money would have been on him.Continue reading…

The Health 2.0 Developer Challenge–It’s On!

Jul 8, 2010• 3

By Indu Subaiya & Matthew Holt

Today is the formal kick-off of the Health 2.0 Developer Challenge. The challenge was first announced by Federal CTO Aneesh Chopra on June 2 at the Community Health Data Initiative (CHDI) meeting, and it’s partly a continuation of the great work done within CHDI, and partly an expansion of the code-a-thon/developer camp effort to the whole Health 2.0 community. The challenge is supported by HHS. It’s being run by the Health 2.0 Conference, with partners O’Reilly, Internet2, Sunlight Labs, Healthtap & the Health 2.0 Accelerator.

Anyone can submit a challenge or join a team to solve a challenge. But the goal is to get the health care and developer communities working on building new innovative applications in rapid-fire time.

The Challenge has two parts: online and offline. The online challenge process officially begins today—there are four challenges up already and we have several others in the queue, but we’re looking for more!

Whyville challenges game developers to build tools for their arcade to help kids understand and apply health data. The kids will vote on the winner!
Move your apps; a challenge to develop an app for the Android platform that helps users burn calories, brought to you by Snaptic & Hopelab
Practice Fusion‘s Real Time Patient-Driven Data Challenge invites developers to build applications that connect to the Practice Fusion EMR platform.
The Szollosi Healthcare Innovation Program wants to see whether a lightweight EMR can be built with blog and wiki software.
And……Your challenge here!!

Here’s the link to the challenges page

Teams will be working on challenges over the course of the summer. Selected winners from the challenges will be showcased at the Fall Health 2.0 Conference, and we’ll be building an online community of challengers and teams in the coming weeks.

Durenberger: Health Insurance Chickens Come Home to Roost

Jul 8, 2010• 1

By DAVE DURENBERGER

Former Republican Senator Dave Durenberger was always the sensible Republican on health care. He now hangs out in a small institute called the National Institute of Health Policy at a small Minnesota college called the University of St. Thomas. Every so often he puts out great commentary emails. His most recent one contains a really a great description of what happened to health insurance in the late 1990s. You can sign up here. Well worth a read and I’ve reprinted the part about insurance below—Matthew Holt

I’ve watched the ups and downs of health insurance products and “markets” since involving myself as an employer in the 70s in a community-wide effort by large employers to provide employees with a choice of health insurance plans, including the nascent HMO. Our goal was reducing health care costs through informed employees and accountable health plans, creating, in effect, new forms of insurance and competitive markets for insurance and medical services at the community level by using available information and consumer choices to facilitate behavior change.

While experiments like this across the country have been tried with varying success, we are now on the verge of doing a “back to the future” adaptation of our lessons learned. The health reform law (ACA) provides for state-based health insurance regulation, health insurance exchanges and a new emphasis in assisting “smart buys” by employees. Recall what happened to the HMO: It became large national “managed care organizations” like UnitedHealth Care (UHC) who lost community support for their behavior change because savings never stayed with those who earned them.

Esther Dyson – “Health, Not Healthcare!”

Jul 8, 2010• 2

By Matthew Holt

At the Health 2.0 Goes to DC conference Esther Dyson gave a powerpacked 3 minute rant about how the Health ecosystem really works — dividing it into three markets: Healthcare, Bad Health and Health 2.0.

In a Surprise Move, Administration Appoints Berwick to Head CMS

Jul 7, 2010• 43

By MAGGIE MAHAR

Tuesday night the White House Blog explained: “In April, President Obama nominated Dr. Donald Berwick to serve as Administrator of the Centers for Medicare and Medicaid Services (CMS). Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points.

“But with the agency facing new responsibilities to protect seniors’ care under the Affordable Care Act, there’s no time to waste with Washington game-playing. That’s why tomorrow the President will use a recess appointment to put Dr. Berwick at the agency’s helm and provide strong leadership for the Medicare program without delay.”

A “recess appointment” means that the president is putting Berwick in place while Congress is on recess (i.e. is taking a vacation). As a result, Berwick won’t have to go through a Senate confirmation hearing. Senate conservatives had made it clear that they hoped to defer this hearing for as long as possible.

The White House Blog notes that “CMS has been without a permanent administrator since 2006, and even many Republicans have called on the Administration to move to quickly to name a permanent head.”

Leapfrogging CPOE

Jul 7, 2010• 11

By MARGALIT GUR-ARIE

Last week, yet another alarming Computerized Physician Order Entry
(CPOE) study made headlines. According to Healthcare IT News, The Leapfrog Group, a
staunch advocate of CPOE, is now “sounding
the alarm on untested CPOE” as their new study “points
to jeopardy to patients when using health IT”. Up until now we had
inconclusive studies pointing to increased and also decreased mortality
in one hospital or another following CPOE implementation, but never an
alarm from a non-profit group who made it its business to improve
quality in hospitals by encouraging CPOE adoption, and this time the
study involved 214 hospitals using a special CPOE evaluation tool over a
period of a year and a half.

According to the brief Leapfrog
report, 52% of medication errors and 32.8% of potentially fatal
errors in adult hospitals did not receive appropriate warnings (42.1%
and 33.9% accordingly, for pediatrics). A similar study published in the
April edition of Health
Affairs (subscription required), using the same Leapfrog CPOE
evaluation tool, but only 62 hospitals, provides some more insights into
the results. The hospitals in this study are using 7 commercial vendors
and one home grown system (not identified), and most interestingly, the
CPOE vendor had very little to do with the system’s ability to provide
appropriate warnings. For basic adverse events, such as drug-to-drug or
drug-to-allergy, an average of 61% of events across all systems
generated appropriate warnings. For more complex events, such as
drug-to-diagnosis or dosing, appropriate alerts were generated less that
25% of the time. The results varied significantly amongst hospitals,
including hospitals using the same product. To understand the
implications of these studies we must first understand the Leapfrog CPOE evaluation tool,
or “flight simulator” as it is sometimes referred to.

Navigating Cancer

Jul 7, 2010• 2

By Matthew Holt

Gena Cook is the CEO of Navigating Cancer, a new Health 2.0 company aiming at getting cancer patients online with their care providers. Gena tracked me down in a Starbucks in Seattle (oxymoron I know) when I was up there last week, and she told me about the new company. Here’s the (short) interview

Todd Park on Health 2.0’s Role in a World of Data Liberation

Jul 6, 2010

By Matthew Holt

At the Health 2.0 June conference in DC Chief Technology Officer of the US Health & Human Services, Todd Park, participated in the panel discussion on Health 2.0’s role in a world of “Data Liberacion”. He spoke about the data libration movement and how the government has made great amounts of health data available to developers resulting in apps and tools that can provide new insights and improve healthcare.

Marooned in the Horse Latitudes

Jul 6, 2010• 15

By JEFF GOLDSMITH

More than a year after glimpsing “green shoots” of economic recovery, President Obama saw nothing but parched brown in June’s employment numbers. The continuing stream of bad economic news is a far greater threat to his Presidency than that sickening orange plume of oil furiously gushing into the Gulf of Mexico. The 9.5% June unemployment rate is essentially the same as it was a long thirteen months ago.. And support in Congress for more pump priming is essentially at an end. Despite a 59 vote Senate majority, an increasing number of Democrats as well as the Republicans appear unwilling further to increase the federal deficit, even to extend unemployment benefits.

In 2010 thusfar , the economy has replaced only 600 thousand of the 8 million jobs lost in the recession. Only a little more than 100 thousand new private sector jobs have been created in the past two months, while the labor force shrank by almost a million. If you add discouraged workers and those working part time involuntarily to the people officially unemployed, there are almost 26 million people out of work. A lot of those young people who fought to make Barack Obama President will have spent at least half of his term living in their parents’ basements.

President Obama is trapped between his increasingly angry core Democratic constituents- public sector unions, minorities, young people- and their muse, former economist/now political polemicist Paul “Jeremiah” Krugman, who believes we’re in a depression and need to throw yet more borrowed money from helicopters, and the rest of the country that is trying mightily to pay down their debts and is profoundly uncomfortable mortgaging our future to the Chinese. It’s not obvious that either formula for salvation- the traditional Democratic balm of more money for worthy causes or the traditional (pre-George Bush) Republican regime of austerity and balanced budgets- gets the economy out of the ditch. Captain Obama has not enough political support to pursue either course, so the Ship of State and his Presidency are becalmed, sails flapping, sweltering in the Horse Latitudes.

HIT Trends Summary for June 2010

Jul 6, 2010

By MICHAEL LAKE

This is a summary of the HIT Trends Report for June 2010. You can get the current issue here.

E-prescribing. Not much to report here other than some feedback to the DEA around its long-awaited proposed rule to allow e-prescribing of controlled substances. Other than the Surescripts rightful defense of its history as an industry certifier, these are largely requests for clarification and cautions from the pharmacy industry that smaller pharmacies may have some difficulties.

EHR. The big news this month is the Allscripts and Eclipsys combination. An integrated hospital and physician practice product will be increasingly important as hospitals reach out to affiliated practices with EMR solutions and plans to build clinically-integrated accountable care organizations. Also of note was the announcement by Dell and Practice Fusion to package up its software-as-a-service (SaaS) EMR for smaller practices. EMR suppliers are firming up their supply chains to make purchases as simple as possible. Dell has similar relationships with other companies including eClinicalWorks, Allscripts and others.

GE Healthcare also followed up on its recent acquisition of MedPlexus, a SaaS EMR, with the launch of its Centricity Advance product for smaller practices. According to Health Data Management it’s being priced at $4K-$9K start up and $300-$800 per month. The launch event included a demo by a solo doc using the software and commentary by Newt Gingrich, Peter Basch, MD and others.

HITECH. HITECH this month focused on safety-net providers with grants to boost IT use and funds to figure out how they participate in reimbursement incentives. One project is part of a $2B HRSA grant under ARRA to expand health services to low-income and uninsured. Each recipient was awarded between $500,000 and $3M for new and enhanced EHR implementations and other uses. The other is a small grant to encourage participation of safety net providers in government programs. It’s a reminder that health IT in poorer communities is particularly challenging. Also out this month is a comprehensive policy view of HITECH by Manatt from an impressive cross-section of industry leadership. Study was supported by CHCF, Colorado Health Foundation and UHF.