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Inappropriate ER use across the board

• 16

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health
Care. This post first appeared on his blog, Lets Talk Health Care.

A few months ago, the New England Healthcare Institute (NEHI) issued a report on non-urgent use of Emergency Departments. It didn’t get that much public attention, which is too bad. It offered some interesting insights.

First of all, inappropriate — or non-urgent — use of the Emergency Room was not limited to uninsured populations. It showed up across the board. People covered by private insurance, Medicaid and Medicare were just as likely to use the ER for non-urgent care as people without health insurance. About 20 percent of all ER visits by privately insured and Medicare patients were for non-urgent purposes. About 24 percent of all ER visits by Medicaid beneficiaries and people without any insurance were for non-urgent purposes.

Second, another 25 percent of all ER visits for each group were for primary care treatable/preventable maladies. In other words, almost half of all ER visits were either for conditions that could have waited at least 24 hours to be addressed, or could have been solved in a doctor’s office.

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Prescribing a dose of healthy skepticism

By Sarah ArnquistHealthyskeptic

Headlines declare wine is good for your health. So is a small bit of dark chocolate. Then, they say it’s not. One day coffee is bad for you and the next it’s good.

We’re bombarded with health messages daily from companies selling things, advocacy groups promoting their agendas and journalists trying to sift through it all.

Who are you to believe? Unless you have a degree in epidemiology, it’s very difficult to discern the valuable information from all the garbage.

In his new book, “The Healthy Skeptic,” journalist Robert Davis gives readers some quick tips to become better consumers of health care information.

“A healthy skeptic carefully and critically evaluates each piece of advice taking into account not only its source but the science behind it,” Davis writes.

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Finding the best balance in health reporting

• 5

By Sarah Arnquist

Starting with the first article they write, journalists learn to seek balance, objectivity and facts in their reporting. Balance often is translated into giving various viewpoints equal weight in an article.Scale

But do journalists always have to give equal weight to discordant opinions
on a subject even when there is no/minuscule scientific credibility for
it?

I’ve been wondering lately if that traditional idea of balance best serves the public, or would journalists better serve the public by weighting their reports based on the credibility of the research available?

Examples of where this could be important that easily come to mind are stories on the vaccine-autism connection and water fluoridation.

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Health 2.0 for cancer trials

• 7

By Greg Pawelski

Greg is well known to THCB readers as a long term commentator on the oncology scene with a  keen interest in chemotherapy assay testing. Here he writes about a new type of clinical trial — Matthew Holt

The traditional meaning of Health 2.0, according to Jane Sarasohn-Kahn’s "Wisdom of Patients" has been the use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals and other stakeholders in health.

An example of this in cancer medicine is Individualized Online Clinical Trial Protocol Version 1.0 by the Weisenthal Cancer Group, a Phase II evaluation of individualized cancer treatment with traditional cytotoxic chemotherapy, targeted anti-kinase drugs and anti-angiogenic agents.

With most clinical trials, investigators never give out information as to how people are doing. Most trials are failures with respect to actually improving things. The world doesn’t find out what happen until after a hundred or 500 or 2,000 patients are treated and then only 24 hours before the New England Journal of Medicine publication date.

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The call for government EHR unification

• 2

By Scott Shreeve

While on my VistA kick (here and here), I need to respond to several important errors of understanding in the recent press release hailed with a “Bravo!” from Fred Trotter. I also wanted to take the opportunity to mention a significantly broader and more meaningful opportunity that the open source community should be rallying around.

First, so people are clear – the Department of Defense does NOT currently use VistA. They haven’t since their 1988 decision to have SAIC fork the code. The only reason that VistA is mentioned as part of the DoD’s selection process is that their own physicians are clamoring to throw away the current system in favor of VistA. While the DoD is correct in identifying some of the weakness of VistA, they also appear to recognize many of its outstanding clinical attributes.

Comments from a July 21 letter from Principal Deputy Assistant Secretary of Defense for Health Affairs Stephen Jones seem to indicate a ray of hope for a VistA compromise: “There is a strong feeling here and at the VA that the best approach is a convergent evolution of the two systems. This approach optimizes the strengths of both systems while creating interoperability that will drive more universal information exchange.“

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Personalities drive prescribing

• 4

By Merrill Goozner

PharmaLive, the website that bills itself as the "Pulse of the Pharmaceutical Industry," recently ran this press release from PeopleMetrics, a marketing research firm. The group surveyed physicians to measure the effectiveness of sales representatives pushing atypical antipsychotics for five leading US-based pharmaceutical companies: AstraZeneca, Bristol Myers Squibb, Janssen, Lilly and Pfizer.

The survey’s questions measured physicians’ response to the salespersons who visit their offices. Depending on the answers, the docs were categorized as either Fully Engaged, Engaged, On The Fence and Disengaged. "Overall, 31% of physicians were Fully Engaged or Engaged, while the largest proportion of physicians (53%) were On The Fence," the research showed.

"Sales representatives must develop personal relationships with their
physicians to achieve the highest levels of engagement," the survey
concluded. "In fact, emotional components such as friendship with the
reps are the strongest indicators of Fully Engaged physicians. . . We
find that this emotional dimension is key in understanding physicians’
perceptions toward their reps and the pharmaceutical company as a
whole" and will be "the most impactful drivers of physicians’
prescribing behaviors."

Gee, and I thought it was the peer-reviewed literature they dropped off showing how well the drugs work. Silly me.

This post first appeared on Merrill Goozner’s blog, Gooznews.

Health 2.0 guerilla activity at SXSW

• 1

By Matthew Holt

In a fun piece of spontaneous local guerilla activity, Jay Drayer from CareFlash (based in Houston, Tx) who you’ll see at Health 2.0 this Fall, is also trying to get a Health 2.0 panel accepted at the media hipsters conference known as South by Southwest in Austin, Tx next spring.

Now I’m not a big fan of democracy and rabble rousing in these matters, but South by South West is. Apparently the way that works is for people who want to see Health 2.0 featured there to go to the 2009 SXSW Interactive Panel Picker and vote and leave enthusiastic comments. You know what to do!

Omnimedix still fighting Dossia owners

• 1

By Matthew Holt

KleinkeJD Kleinke and Omnimedix are still in business and still fighting a pretty serious lawsuit
about the Dossia breakup. I talked with JD yesterday. The team is working on several super secret client projects, but it’s tough to run a small consulting shop and keep a protracted lawsuit open, so they’re passing the hat! Why keep the lawsuit going?

Well, there’s obviously stuff that JD couldn’t tell me, so this is speculation but it’s clear that this is much more than an a “vendor didn’t deliver/client didn’t pay” dispute. JD was always very vocal about an open nonprofit being the protector of the Dossia members’ employees’ data, so I surmise that contractual disputes about who got access to what data are at the root of this. It would be interesting (if practicably impossible) to compare Dossia’s contact with Omnimedix in their contract with Indivo.

More generally, JD and I talked about whether there’s a need for a Dossia-type entity when there’s Google Health and HealthVault. Here’s what JD said about Microsoft and Google’s privacy stance.

“In both cases they’ve violated their own operating principles as businesses to do the right thing.”

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T-Shirt Health 2.0 conference ego surfing

• 3

By Matthew Holt

So this is how fashion insurgencies start…Brian Klepper sent me this email. I assume they felt like the two Hollywood starlets who show up at the Oscars wearing the same dress!

“So David Foster, Director of Product Management for Healthwise, visits Jax where he’s from. Because he reads THCB, he knows that I’m here, and so he drops me a note suggesting we meet at the Beaches Diner for breakfast this a.m. I’m in standard uniform, shorts and a t-shirt. I walk in and he’s wearing the same shirt. I think this means you’ve officially become a brand. We had the cashier take a picture to prove it.”

Health 2.0 Tshirts

Health spending disconnect

• 9

By Jane Sarasohn-Kahn

There’s a disconnect between who Americans believe is responsible for their personal health status, and who should pay for health care.

On the first question — personal responsibility for health choices — 82 percent of Americans believe that they alone are responsible for their health.

However, only 44 percent believe that they should bear no responsibility for paying for health care.

The Vitality Group, a subsidiary of Discovery Holdings Ltd., surveyed Americans and found that most people (59%) look to their employer to bear at least some responsibility for health costs. Nearly one in two (46%) see the government as a payer.

Only 56 percent of Americans see themselves as picking up any part of health care costs.

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