Above the Fold
Nursing a Health 2.0 Hangover
So it’s the morning after the big Health 2.0 bash and the hangover is awful. My head is awash with flashing screens of medical alerts, rainbow-colored demos of virtual patients flitting from one personal health app to the next, and a blur of snappy, almost sneering answers to the same old questions about user adoption, ROI, and business models. I just spent two days getting high on health care’s highest high-concept, I can’t log into my own health plan’s portal to look up a simple eligibility thing, and it’s dull, gray cloudy morning in San Francisco.Whither the 2.0 revolution you’ve been reading about all week? Was the blueprint unfurled before the cognoscenti by Matt Holt and the NorCal health care keiretsu? Was there an exhibitor booth handing out the magic bullets, along with the usual pens and mugs? Um – no.Perhaps it’s my own perennial impatience with health care’s miserable status quo; perhaps it’s a sign of the inevitable coming of age for the 2.0 community, or space, or ecosystem, or whatever the corporate concept jockeys are calling a market this year. But at the risk of offending Matt and my other good friends in the keiretsu, this year’s conference felt for the first time oddly normative, almost reminiscent of other conferences like HIMSS and the World Health Congress, where Big New Health Care Ideas run headlong into The Great and Powerful Health Care Inertia Machine.
Medicare and Health Reform: Part II
By THOMAS GREANEY
In his closing remarks to the Senate Finance Committee last week, Senator Baucus pointed with special pride to the effect the Committee’s reform bill will have on shaping the health care system in the longer run:
One point I want to make… is about delivery system reform. We are starting here in this bill to finally reform our delivery system so it’s based much more on quality and patient focus, moving ever so slowly, but inexorably, from fee for service….which causes a lot of the waste in our system. We’re not going to see savings, the benefits, to the system for a while… but after four, five, six years from now, we’re going to see the real benefits of reform.Continue reading…
The Long Tail of the EMR
In the fall of 2008 I had the opportunity to do some research on the, then dormant, EMR marketplace. The results came as no surprise. Most physicians did not have an EMR and were not interested in adopting an EMR due to cost and usability barriers.
Much has changed in one short year. Spurred by ARRA and its HITECH portion, there is a renewed interest for technology in the physician community. Some of it came from the promise of stimulus funds and some stems from the perceived inevitability of the need to have technology in one’s office. There is no feverish anticipation of the great things an EMR will bring to a medical practice. Instead, there seems to be a somber resignation to the upcoming demise of a trusted friend: the paper chart.Continue reading…
Health 2.0 Accelerator Demonstrates Integration of Consumer Web Apps and EHRs
SAN FRANCISCO, Calif. – October 7, 2009 – Health 2.0 Accelerator member companies today joined together at the Fall 2009 Health 2.0 Conference to demonstrate a streamlined, consumer-centric integration among nine separate technologies creating a more streamlined user experience.
During the conference “Tools Panel”, eight Health 2.0 Accelerator members MediKeeper, change:healthcare, Sage, Kryptiq, MedSimple, Polka, ReliefInsite, PharmaSURVEYOR and Kinnexxus worked together to demonstrate a seamless, end-to-end user experience across disparate Health 2.0 applications. The demonstration enabled a consumer persona to sign into their personal health record and utilize their personal and clinical health information across several applications while using Microsoft’s HealthVault data sharing platform without having to re-enter information. The demonstration also utilized the Drug Code Lookup Service being piloted by member companies First DataBank and PharmaSURVEYOR that provides easy online access to First DataBank’s standardized drug codes to promote interoperability among Internet-based healthcare services.Continue reading…
Op-Ed: Robot-assisted Surgery – The Leading Treatment for Prostate Cancer
Prostate cancer surgeons around the world are using surgical robots to assist in the most delicate operative procedures. Across the country, nearly 1,000 of these robots have entered hospital operating rooms, including our institution: Swedish Medical Center in Seattle, Wash.
These minimally invasive devices, called daVinci surgical robots, offer patients substantially less pain, short recovery time and quicker return to normal activities than traditional open surgery. And because of this, the da Vinci and I have done more than 900 procedures together.
The da Vinci robot assists me during surgery by taking my movements and making them better: more precision, greater freedom of movement and no surgical tremor. These robots offer unmatched surgical precision – meaning my hand cannot compare to the dexterity of the robotic arms. We simply cannot turn our hands 540 degrees. Da Vinci has 4 robotic arms, which I control at all times at the surgeon’s console. I look through a 3-D viewfinder at the console, which gives me visual depth, and a magnified view 10 to 15 times closer than human vision allows. This magnified view gives me more precision as well. Better visibility, better instrument movement means better surgery.
Through my years using da Vinci surgical technology, I know that it offers several advantages over conventional open surgery. These include less pain, faster recovery, and less blood loss which means reduced need for blood transfusions. Because the surgery is performed through small incisions there is less internal scarring and less risk of bowel adhesions.
Most importantly, with regard to prostate surgery, using the robot has demonstrated improved outcomes over open prostatectomy. In my experience this has resulted in less urinary incontinence, less erectile dysfunction, and excellent cancer control.
Coincidentally, I was diagnosed with prostate cancer in April 2006, and like all of my patients, the news was devastating. I looked at all the available treatment options and decided to pursue the robotic surgery over radiation therapy or open surgery. For me, radiation was a shotgun approach and the nerves that control sexual function are potentially at risk from the radiation. Having the prostate removed gave me information about the amount of cancer and whether it was contained inside the prostate. This is important in predicting the future behavior of the cancer and I would not get this critical information if I radiated the prostate.
Another important factor in my decision is that once radiation is performed, and if the cancer were to come back, surgery is not an option after radiation due to the high complication rate and difficulty created by the effects of radiation on the tissues. Tissue just does not heal well after it has been radiated. Conversely, if I had surgery first, and the cancer came back, then radiation was still an option. Essentially, I would be eliminating one treatment option if I had chosen radiation first.
Robot-assisted surgery allowed me to return to my normal activities quickly and this was important for my patients and practice. Through five small incisions about a half-inch in length, the robotic instruments and cameras are inserted into the patient (in this case, me). Compared to the open surgical incision, these incisions are significantly smaller and for many patients this alone is reason enough to consider the procedure over traditional open surgery. I was at home in just one day and at work within two weeks.
The typical prostate surgery patient after a more traditional operation is in the hospital two to three days and is recovering for four to six weeks. Almost all my patients have gone home the day following surgery, and most are back to normal activities by two weeks. 90 percent of my patients don’t take narcotic pain medication once they leave the hospital.
Today, prostate cancer affects 1 in 6 men in America. A non-smoking man, for example, is more likely to develop prostate cancer than he is to develop colon, bladder, melanoma, lymphoma and kidney cancers combined.
Every man is at risk for prostate cancer. While the causes for prostate cancer are largely unknown, one thing is certain – the chance of developing prostate cancer increases in men over 50. While age is clearly associated, I am seeing more and more men with prostate cancer under the age of 50 and even under 40. Close relatives of men with prostate cancer are also more likely to be affected.
This means that annually more than 192,000 men will be diagnosed with prostate cancer, and more than 27,000 men will die from the disease. This ranks prostate cancer as the second leading cause of cancer death in men just behind lung cancer.
However, the future is no longer as bleak as it once was. If caught early, prostate cancer is a treatable disease, which many men have survived. Today about 85 percent of prostate cancer surgery is performed using the da Vinci robot – it has become the norm for the surgical removal of the prostate.
As a surgeon, I’m acutely aware that the location of the prostate gland deep inside the pelvis makes these surgeries a complex and delicate procedure. Removing the prostate is just part of the procedure. Preserving the integrity of the tissues surrounding the prostate is essential to maintain urinary control and sexual function. That is why the benefits of robot-assisted surgery can be so critical.
Many men elect a robot-assisted prostatectomy because it often provides the fastest return to normal daily activities. My experience as both a surgeon and as a patient is proof. If you are diagnosed with prostate cancer, be sure to make an informed decision about your course of treatment by doing your homework and researching the best approaches available, including robot-assisted surgery.
Dr. James Porter is director of surgical robotics at Swedish Medical Center in Seattle, Wash. and a prostate cancer survivor. Under his leadership, Swedish is one of the first medical centers in the Pacific Northwest to perform robot-assisted surgery. Swedish’s robot-assisted surgical program was first established at Swedish in 2005. Since then, Swedish-affiliated surgeons have performed more than 2,000 procedures using the da Vinci Surgical System, more than any other robot-assisted surgical program in the Pacific Northwest. Dr. Porter is the first medical professional in the country to perform a retroperineral robot-assisted partial nephrectomy using the da Vinci robot (removal of a kidney tumor). Dr. Porter trains surgeons from around the globe how to use the da Vinci robot.
The Big Day for Health 2.0
Yes, today is the big day for Health 2.0 or rather the first of two huge days. In less than 7 hours Indu and I will be stepping onto the stage and six months of work, rehearsals and excitement come to a climax. Many thanks in advance to all the speakers, sponsors, staff, exhibitors, volunteers and members of the Health 2.0 community for coming. We’re ready (or close as we’ll ever be!)
I can’t hope to capture all that’s happening, but here’s two big pieces of news. Myca just received an investment from Sandbox, the Blues venture fund. You can hear an interview I did with Nat Findlay, Myca CEO from a few days back here. You can see Myca both on the Clinical Groupware panel on Day 1 (today!) and in a sponsored Deep Dive on day 2.
And Keas, Adam Bosworth’s company, is formally launching on Day 2 and gets its own article in the NY Times today. You’ll be hearing more about this, and platforms and unplatforms throughout the conference!
Finally, THCB & Health 2.0 has its own little news. JD Kleinke (the Arriana Huffington of health care!) is emerging from a long period of seclusion and both pens his first article as a a THCB contributor today, but is also a very late addition to the “Can Health 2.0 Make Health Care More Affordable” panel at Health 2.0 today!
Podcast: Nathanial Findlay Tells Us What’s Next for Myca.
Download the audio interview here.
Pop the Cost Bubble: Unallot Medicare
By VICTOR SANDLER
Here’s a dirty little secret: Cutting health care costs is not that difficult, nor will it harm patients. That’s because it only involves giving up unnecessary medical care—tests and treatments patients may want but really don’t need because they don’t benefit their health.
How is this supposed to happen? In Minnesota we call it “unallotment.” When the state had to reconcile a projected multibillion dollar budget deficit this year, and the Republican governor and Democratic lawmakers couldn’t agree on how to do it, the governor simply “unalloted” billions of dollars of planned expenditures.
Medicare should do the same. All Congress has to do is pass the MedPAC Reform Act of 2009 (SF 1110) and give it teeth. We can then unallot the 30 percent of Medicare expenses that most health care experts believe are unnecessary. That’s the 30 percent that goes for tests, drugs, and devices that don’t have any proven benefit but sell like hotcakes anyway.
When Gov. Tim Pawlenty decided to cut medical expenditures during the unallotment process, he took no prisoners. More than 30,000 indigent adults will simply have their medical insurance eliminated starting next March. Medicare would take a higher road, eliminating unnecessary care and costs, not “unnecessary” people.Continue reading…
Let’s Not Lose Sight of the Goals
I love Daniel Schorr. I’ve never met him in person, but I love his voice and his insights about politics on NPR’s Weekend Edition. But this morning I was disappointed. After listening to his comments on the Olympics and Iran, I looked forward with anticipation to his thoughts about the Senate Finance Committee’s accomplishments earlier this week on health reform legislation. When asked whether a “real health care bill” is likely to pass later this year, he said, “Well, it begins to look more [likely] . . . that there will be a bill. The question is not whether there will be a bill . . . but what will be left in the bill, because so many things have been taken out.” I could almost hear him sigh. He went on to talk about the fact that the public option is not a part of the Senate Finance bill, although it might be restored in full or part (through a trigger mechanism or health cooperatives) as the bill moves through Congress. Let’s step back for a minute. (This is what I usually rely on Schorr to do for us.) Where were we a year ago? Although advocates of health reform were encouraged that the health care crisis was getting a lot of attention in the Presidential election campaign, the outlook was not rosy. Obama and McCain were neck and neck, and McCain’s reform proposal was so weak as to be laughable. The pundits and pollsters were predicting that the Democrats would get about 56 seats in the Senate – not enough to overcome a filibuster. And there was serious concern that even if Obama were elected, health reform would be crowded out by other major crises – the threat of a serious economic depression, the banking collapse, Iraq/Afghanistan/Iran, energy and global climate change, and who knows what else. In October 2008, the likelihood of serious comprehensive health reform was probably about 25%.
