Above the Fold
Shutting Down Social Media? Not Here.
By
Paul Levy is the President and CEO of Beth Israel Deconess Medical Center in Boston. He blogs about his experiences at Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive and where this post first appeared.
The following email message was broadcast last week in a Boston hospital. Of course, you can guess my view of this: Any form of communication (even conversations in the elevator!) can violate important privacy rules, but limiting people’s access to social media in the workplace will mainly inhibit the growth of community and discourage useful information sharing. It also creates a generational gap, in that Facebook, in particular, is often the medium of choice for people of a certain age. I often get many useful suggestions from staff in their 20’s and 30’s who tend not to use email. Finally, consider the cost of building and using tools that attempt to “track utilization and monitor content.” Not worth the effort, I say.Continue reading…
Op-Ed: Our Misplaced Faith in High-Tech Medicine
By MERRILL GOOZNER
The following essay appeared on the website of the Hastings Center, which is running a colloquium on the values behind health care reform.
“One could make a good case that improvements in education and job creation could be a better use of limited funds than better medical care.” – Daniel Callahan, “Medical Progress: Unintended Consequences”
The president emeritus of the Hastings Center opens his insightful essay with the observation that the American people’s faith in medical progress is boundless. In this short comment, I want to expand on his thoughts by reexamining the cardinal tenets of that faith, since they embody a set of values that distract us from building a society that promotes good health, an infinitely more difficult task than building a better sick care system.Continue reading…
Around the Web in 60 Seconds: Health 2.0 San Francisco
All Things Digital "Keas' Adam Bosworth speaks about new health care startup" by Kara Swisher
Fast Company "The Future of Healthcare is Social" Forbes "Must Read Health Blogs"
Official Google Blog "Fall update on Google Health"
NY Times.com "A White House Message to Healthcare Start Ups"
NY Times.com "Startups Aim to Transform Visits to the Doctor"
TechCrunch "Google Health signs 2 insurers. Only has 267 to go"
VentureBeat "Two Dozen of the Most Innovative Healthcare Apps"
VentureBeat "Will Health 2.0 startups usher in consumer-driven healthcare?"
iHealthbeat "FDA's growing role regulating Health 2.0, Health IT" by George Lauer
iHealthbeat "Federal CTO: Health 2.0 'Key Pillar' of Health Care Innovation"
American Public Media / Marketplace "Health care Meets and Greets Health 2.0"
Reuters "Kaiser Permanente joins Health 2.0 accelerator"
Eliza "Eliza Has Quite a Happening at Health 2.0"
Our Misplaced Faith in High-Tech Medicine
The following essay appeared on the website of the Hastings Center, which is running a colloquium on the values behind health care reform.
“One could make a good case that improvements in education and job creation could be a better use of limited funds than better medical care.” – Daniel Callahan, “Medical Progress: Unintended Consequences”
The president emeritus of the Hastings Center opens his insightful essay with the observation that the American people’s faith in medical progress is boundless. In this short comment, I want to expand on his thoughts by reexamining the cardinal tenets of that faith, since they embody a set of values that distract us from building a society that promotes good health, an infinitely more difficult task than building a better sick care system.
What are the core values driving our belief in high-tech medicine?
At their root, they are the values of good old-fashioned American individualism. This is the land of opportunity, where everyone has the God-given right to thrive and prosper. It’s also the land of the second chance, a place for the self-made and remade man – like President Ronald Reagan or Don Draper of the award-winning new drama “Mad Men.”
Death in this value system is not the end of a journey, but a rotten break. It’s the end of our chance to make a mark in the world, thus a fate to be avoided at all cost. Ray Kurzweil, the nonpareil Baby Boomer inventor, is the faith’s high priest, gobbling dozens of pills and supplements daily in his quest to remain on his “Fantastic Voyage: Live Long Enough to Live Forever,” to use the title of his 2005 book.
These values have been written into the laws that govern the delivery of health care, especially Medicare. That universal, single-payer system was designed to provide health care for our oldest and therefore most vulnerable citizens. But in setting up that system, Congress said the government (i.e., all of us) would pay for any medical intervention deemed “reasonable and necessary” to return a person to health, and it could never consider cost when making those determinations. How deeply ingrained are those values? So deeply ingrained that it was child’s play this past summer for right wing demagogues to stir up passionate outrage over nonexistent efforts to “pull the plug on grandma.”
The public religiously believes there will be a technological fix for the hundreds of diseases that may hit us as our bodies degenerate, and tithes accordingly. Any effort to limit prices for what must be paid for new technologies is met with cries from industry that it will stifle innovation. The taxpayers provide the seed corn for new technology by investing nearly $30 billion a year in basic research through the National Institutes of Health and other government health-related programs (this year supplemented with $10 billion in stimulus act funds).
But that’s just the start of the process. Those researchers are encouraged to patent their findings and start companies to bring their inventions to market, a reflection of another core American value – entrepreneurialism. The government refuses to limit prices so these companies will have “incentives” to leap the regulatory barriers to entry. And even when it invests in comparative effectiveness research to determine if these new inventions are any better than older interventions, the government will insist that those findings cannot be used to determine payment policy.
Smoking and Mental Illness
At last weeks Health 2.0 Conference Maggie Mahar, author of HealthBeatBlog got more than a little feisty about Al Waxman’s suggestion that we make people with bad health behaviors pay more. She said that 95% of smokers had some form of mental illness, and therefore we were punishing the mentally ill. Really? Read on for Maggie’s explanation (lifted at her request from a comment elsewhere).—Matthew Holt
According to the New England Journal of Medicine,
“The link between smoking and anxiety also helps explain why smoking is so strongly correlated with mental illness. “smoking rates have been reported to be over 80 percent among persons suffering from schizophrenia, 50 to 60 percent among persons suffering from depression, 55 to 80 percent among alcoholics, and 50 to 66 percent among those with [other] substance-abuse problems.”
Poverty is highly correlated with smoking because poverty is stressful. U.S. soldiers also smoke in greater numbers than the population as a whole–even if they didn’t smoke before joining the army The NEJM reports:
“Serving in the military is a risk factor for smoking even for those who did not start smoking prior to the age of 18. Smoking is the number-one health problem for vets,” says Dr. Steven Schroeder, former President of the Robert Wood Johnson Foundation, where he focused on smoking cessation. “And reports are showing that many US soldiers serving in Iraq are turning to smoking to relieve their stress.”
At the Health 2.0 conference, Al Waxman asked the audience how many thought that smokers should be “penalized” for smoking, presumably by paying more for insurance. I pointed out that the vast majority of adult smokers are poor; many suffer from some form of mental illness.Do we really want to punish people who are living in poverty and are mentally ill?
The Senate Finance Health Bill Has No Clothes
Readers of this blog know that I have lots of concerns for the Senate
Finance health bill primarily because it does not so much represent
health care reform as just an expensive entitlement expansion.Readers also know the insurance lobby–AHP–is not one of my favorite organizations.But
I will tell you the report by Pricewaterhouse Coopers (PwC)
commissioned by the AHP and released this morning is accurate. The
Senate Finance bill would do nothing short of blowing up the insurance
market.You don't need to be Einstein or a PwC actuary to come to that conclusion. Common sense is all the credential you need.
Cool Technology of the Week
In many crime solving police procedural programs (NCIS, CSI, Criminal Minds etc), the perpetrator has used an untraceable, disposable cell phone.
But what is a disposable cell phone and where do you buy one? I’ve never seen one in my travels.
The answer – Walmart
The vendor – TracFoneContinue reading…
The ugly, the bad, the very good and the great at the Health 2.0 Conference
So the Fall Health 2.0 2009 conference in San Francisco at the Concourse Exhibition Center is over. The bunting is down, the cocktails are drunk, and everyone can get back to the sanctity of the WiFi enabled office or home. (Yes, we’re sorry about that problem and need to stress that it was NOTHING to do with AT&T who graciously sponsored the conference but were NOT providing Internet access).
But it doesn’t detract from the fabulous experience of seeing perhaps the most amazing line-up of health technology ever in one hall together–not to mention some of the biggest names in the Health IT world going toe to toe. Health 2.0 had over a hundred speakers and nearly 80 live demos and technologies on display on stage–not to mention 30 more in the exhibit hall. We featured Health 2.0 Tools for doctors, ePatients telling us what they needed, and a stirring address from CTO of the US, Aneesh Chopra. Then there was some remarkable integration over unplatforms in the tools panel–(I don’t know how often Esther Dyson gives standing ovations but that was great to see). And there was so much more.
Congrats to Remedy Rx Ventures and Unity Medical–joint winners of Launch! But honestly we believe that everyone who presented had something important to show and say. Thanks to everyone who came, demoed, sponsored, spoke, volunteered and worked so so hard (especially the volunteers who stayed late on Wednesday to move tables and chairs).
We had a great time and we made a difference. There’ll be videos and more up here next week. For now, take the weekend off!
My more detailed comments are below the fold.
Health Internet – The New Consumer-Friendly NHIN
By
Consumer directed HIE will become the most visible aspect of health IT stimulus and could lead a shift to consumer-directed health plans, increased interest in wellness programs and family-centered collaboration for the young, old and seriously ill.
At a recent Boston meeting on health records infrastructure, key stakeholders recognized the potential of patient control as a strategy to address privacy concerns that could otherwise limit ongoing health networking initiatives. MedCommons proposes one possible approach to making the national health information network (NHIN), currently conceived as a provider-to-provider exchange, consumer-friendly and consumer-accessible. We illustrate the need with a true story, propose a novel addition of independent identity service providers to the NHIN and then illustrate how this could be used to transfer the soldier’s CT to the US for a second opinion even as he’s being transported.
On the morning of the Boston meeting, a friend of mine called to say that his son was seriously wounded in Afghanistan and was being stabilized for transport via Germany to the US. He knew that his son had a CT in the field clinic and wanted to get it before the son was transported over four days through to Bethesda. Could the Health Internet be used to help this family?
The NHIN does not have to run like Big Brother. We propose a voluntary identity principle that distributes trust among multiple private and public institutions and gives consumers a choice of who controls their medical identity. Some might pick a particular hospital, others might choose their regional HIE while others could choose a private service such as a bank or telecom that is not a health care business at all.
The institution that manages a patient’s ID on the Health Internet is referred to as the IDP. To authorize health records exchange on the NHIN, an IDP would have to meet strict requirements and receive a NHIN Certificate. A NHIN Certificate is analogous to the SSL certificates issued to banks and other corporations on the Internet. Larger hospitals, military, VA and integrated delivery networks on the NHIN also hold a NIHN Certificate.
The issue and administration of NHIN Certificates could be handled by state or federal agencies or privatized to Verisign and similar services that already do this for the Internet.
We propose a Health Internet consisting of two kinds of certified entities, health care providers and identity providers. Both are chosen and trusted by the consumer but the identity providers are the key to effective competition and innovation.
Small group practices, insurance companies, web personal health records services and search engines would likely not carry NHIN Certificates and would participate in the Health Internet only under the control of the patient trough their IDP.
Substitutability, the central concept of the Boston platform meeting, is a key benefit of this proposal. An IDP that disappoints a patient could be swapped out without impacting the health care providers and a health care service that disappoints could be ignored or disconnected with a simple message to the IDP.
Public health and research users of the NHIN would not be affected since all entities that carry NHIN Certificates could still interact with each other directly under whatever rules and regulations the Certificates represent.
How would this have worked in the case of a soldier shot in Afghanistan and on his way to Bethesda?
– Before entering the service, the son might have picked Verizon as his IDP because they hold an HNIN Certificate and offer a family member override. He would have established the father, who also has a Verizon account as health care proxy.
– Upon induction, the health service saved the serviceman’s IDP selection (their Verizon health ID, possibly in OpenID format – see references below) along with the rest of his personal contact information.
– The father, when notified of the injury, is unsure which doctors will be available to consult on his son’s case, but needs to have the son’s CT scan at the ready as a first step.
– The father decides to do a transfer using a personally controlled health record service because it will give him control of the CT and make it easy to deliver the images to any physician that offers to help. Neither the father nor the health record service has a HNIN Certificate.
– The father goes to the military health service EHR portal. Without logging in, he goes to a form that requests his son’s Verizon health ID along with the MedCommons-type account ID where the CT is to be delivered.
– The EHR portal contacts Verizon for authorization on the basis of shared trust under the NHIN federation.
– When Verizon’s text message to the son goes unanswered, Verizon contacts the father as Health ID proxy. The father reviews the correctness of the familiar-looking MedCommons-type ID as a the destination and authorizes the transfer.
Note that the military health service does not actually know whether the son or the father actually authorized the request but they trust the transaction because the military health service knows that Verizon holds a valid NHIN Certificate.
In summary, the introduction of certified identity providers into the NHIN together with simple and commercially established OpenID protocol can transform the NHIN into the consumer-friendly Health Internet and bring simple regulation and market forces to bear on solving difficult privacy problems.
CODA: As of 10/4, the the soldier is stable, conscious and out of the ICU in Bethesda. A second opinion is in the works at a Boston hospital. The parents and collaborators are able to see and share 1.75 GB of imaging about their son. Let’s all hope for a good outcome and a speedy recovery.
Adrian Gropper is a physician and the CEO of MedCommons
References:
Patient ID on the Internet; October 12, 2007; Blog; http://agropper.wordpress.com/2007/10/12/patient-id-on-the-internet/
Web leaders initiate govt open identity pilot program; September 30, 2009; Health Imaging Editorial; http://www.healthimaging.com/index.php?option=com_articles&view=article&id=18927
