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Above the Fold

Dispatch from India: Tyranny of the IIT

Jun 3, 2008• 2

By Jay Srinivasan

Can one institution hold the key to all innovation? Could it be that one very tiny minority is the brain trust of a whole nation, and the font of all knowledge, insight, wisdom, entrepreneurial energy, and superior practices? Iitlogo

If this sounds silly to you, that is what Indians promote and practice. As a culture, we are obsessed to wear the badge of such alma maters as the Indian Institutes of Technology or Indian Institute of Management on our sleeves. Those diplomas have become the yardstick by which we evaluate and weigh a person’s worth, personality, effectiveness, capabilities, capacity to achieve, and integrity.

I should acknowledge that I do not belong to that club — that elite band of super men and women, who have been annointed by the Western media as capable of the most incredible feats. Does it bother me? It used to, but no longer as I’ve grown more comfortable in my own skin. It has prompted me, though, to reflect on our middle-class need to identify with and project an exclusive membership.

In Indian hospital care, the past and future co-exist

Jun 3, 2008• 8

By Sarah Arnquist

Walking through the government-run Gandhi Hospital in Hyderabad, India feels like stepping back 50 years in time. The nurses wear white dresses with those funny paper napkin hats. Exhausted people overflow the stuffy waiting rooms. Family members sleep and eat on the hallway floors while waiting for their sick loved ones, who lie on thin cots crammed together like sardines in the dim wards.

Before you get the impression that this scene depicts all health care in India, follow me to Rainbow Children’s Hospital or Apollo Health City located an hour away in the most affluent neighborhood of this city of 7 million. These corporate hospitals offer sparkling clean facilities, the latest technologies and even luxuries like flat-screen televisions in the super-deluxe patient rooms.

Apollo is the largest hospital corporation in Asia and a significant player in the international medical tourism industry. On a recent sweltering afternoon, Radhey Mohan, general manager of international patient services, gave me a tour of Apollo’s Hyderabad campus and told me about future plans to expand Apollo’s medical tourism business.

While these corporate hospitals offer state-of-the-art medical services
to foreigners seeking a bargain, such care is a dream for most
Indians.

Readers respond to Google Health launch

Jun 2, 2008

By THCB StaffGoogle’s recent launch of its Health Beta personalized health records provoked great commentary from THCB’s expert contributors and thoughtful comments from readers. Generally, readers acknowledge Google’s system is not flawless, they are enthusiastic something tangible finally exists.

But the privacy concerns persist.

In response to Matthew’s "Serious test drive," E-patient Dave wrote,"The privacy issue is simply huge. I don’t know why the advocates don’t get it. The lay people I talk to *all* express concern about it; some flat-out say "No WAY I’m giving them my data."

He continued,"I’d feel a lot better if all the enterprises that want to get into this great opportunity (and it is one) would work to get HIPAA updated to cover their case."

Keith Schorsch’s post on whether consumers care about Google Health also generated a lot of comments — mostly from people who shared his skepticism.

"While I agree that there certainly is and can be value in a PHR for
consumers, I think this is the right discussion. Do consumers even know
what a PHR is and that it is an option for them? I think Forrester’s
data shows that something like 75% of consumers don’t," George Van Antwerp wrote

Interview with Kerry Hicks, HealthGrades CEO

Jun 2, 2008• 2

By Matthew Holt

HealthGrades has been busy. The publicly traded, pure-play provider ratings company is changing the way it offers ratings, it’s publishing a book, and it’s starting to rate drugs. It’s not alone. Last week, Consumer Reports announced it also is getting into the business of rating hospitals and using a model developed in conjunction with the Dartmouth crowd. Plus, there’s the CMS effort.

Given the way that ratings are evolving and HealthGrades’ partnership with Google, (more to come on Google from me separately soon) last week was a great time to talk with HealthGrades Chairman & CEO Kerry Hicks. (Sadly it was before the Consumer Reports announcement but fascinating nonetheless).

Listen to the Kerry Hicks interview.

Why diagnostic errors don’t get any respect and what can be done about it

Jun 2, 2008• 3

By Bob Wachter

I gave a keynote yesterday to the first-ever meeting on "Diagnostic Error in Medicine." I hope the confab helps put diagnostic errors on the safety map. But, as Ricky Ricardo said, the experts and advocates in the audience have some ‘splainin’ to do.

I date the origin of the patient safety field to the publication of the IOM report on medical errors (To Err is Human). It is the field’s equivalent of the Birth of Christ (as in, there was before, and there is after). But from the get-go, diagnostic errors were the ugly stepchild of the safety family. I searched the text of To Err… and found that the term “medication errors” is mentioned 70 times, while “diagnostic errors” appears twice. This is interesting because diagnostic errors comprised 17 percent of the adverse events in the Harvard Medical Practice Study (from which the IOM’s 44,000 to 98,000 deaths numbers were drawn), and account for twice as many malpractice suits as medication errors.

What I call “Diagnostic Errors Exceptionalism” has persisted ever since. Think about the patient safety issues that are on today’s public radar screen (i.e., they are subject to public reporting, included in “no pay for errors,” examined during Joint Commission visits, etc.). It’s a pretty diverse group, including medication mistakes, falls, decubitus ulcers, wrong-site surgery, and hospital-acquired infections. But not diagnostic errors. Funny, huh?

There are lots of reasons for this. Here are just a few:

JOB POST: A.D.A.M. – Vice President of Healthcare Marketing

Jun 1, 2008

A.D.A.M., Inc. is a leading provider of health information and benefits technology solutions to healthcare organizations, employers, consumers, and educational institutions. A.D.A.M.’s portfolio of products includes its award-winning Health Illustrated Encyclopedia and Benergy™, the leading benefits communication and healthcare decision support platform for small and mid-sized employers. A.D.A.M. content and technology solutions equip consumers to better understand their health, wellness and benefits, while helping healthcare organizations and employers reduce the costs of healthcare and benefits administration.

The position of Vice President of Healthcare Marketing will be focused on the product marketing, pricing, positioning and sales lead generation for A.D.A.M.’s content and applications for the healthcare and consumer portal target markets. In collaboration with other key stakeholders, you will be responsible for defining differentiated product marketing strategies for each of A.D.A.M.’s target industry markets as well as for our major distribution partners. Our ideal candidate will be measured by the ability to create an enhanced value proposition and competitive differentiation for our products and services, ability to increase A.D.A.M.’s brand awareness, and increased revenue as a result of successful marketing programs to drive leads. This position will report to the Chief Executive Officer and is based in Atlanta, GA.

Defending the benefits of prevention

May 31, 2008• 7

By Merrill Goozner

Last February, the New England Journal of Medicine ran a potentially misleading review of the cost-effectiveness of illness prevention strategies that may have led many casual readers (such as the editors of the Washington Post Health section) to conclude that most health-improving measures — such as aggressive counseling for people who are either overweight or smoke — cost more in the long run than they are worth. This week’s Journal of the American Medical Association carried a proper antidote by Steven H. Woolf of Virginia Commonwealth University, who is fast becoming a leading expert on prevention techniques for improving the nation’s health.

Woolf admits that personal behavior is difficult to change, and many intervention strategies for preventing disease cost more money for the health care system than they save. But he takes direct aim at the NEJM article claim that "drew similarities between the cost-effectiveness ratios of prevention and disease treatments, all but ignoring the much lower cost-effectiveness ratios of the preventive services that guidelines advocate."

E-patients can and will revolutionize health care

May 30, 2008• 18

By Susannah Fox Epatients

By taking advantage of new online health tools, e-patients and health professionals
now have the ability to create equal partnerships that enable individuals to be equipped, enabled, empowered and engaged in their health and health care decisions.

That was the vision of Dr. Tom Ferguson, who coined the term e-patients and launched e-patients.net in 2006. Ferguson intended to upload his book-length overview of the online health revolution, “E-patients: How They Can Help Us Heal Health Care.” But unfortunately, he died a month later 2006, after losing a fifteen-year battle with multiple myeloma.

Following Ferguson’s death, a group of his friends and colleagues completed the paper and adopted the blog to carry on his work, as well as our own. Each blogger brings a different perspective when commenting on Health 2.0 developments.

We think the “E-patients” paper remains relevant in 2008 (PDF, wiki) and we hope to extend the findings into the future. To that end, we are also working on the creation of the peer-reviewed Journal of Participatory Medicine with the help of Sarah Greene of the New York Times; Bruce Shriver, PhD, of the Liddy Shriver Sarcoma Initiative; and George Lundberg, MD, of Medscape. We welcome your comments and suggestions.

Analyzing the benefits of PatientsLikeMe social network site

May 30, 2008• 6

By John Grohol

Two research papers were published this month on the Health 2.0 Web site, PatientsLikeMe. PatientsLikeMe is arguably the only "real" health social network online today, because it allows patients to share actual data that matters with one another — their personal health data.

(Other supposed health social networks seem more focused on the "social" than the "health," allowing for little integrated data sharing.)

The two research papers provide some interesting data points and insights into the disease process itself and how e-patients are using Web-enabled tools, such as PatientsLikeMe, to improve their own care.

Real transparency in a socialist nirvana? UK releases hospital death rates

May 30, 2008• 1

By Michael Millenson

In yet more evidence that the transparency revolution is worldwide and not merely a product of American capitalism, comes news that in the UK death rates for specific types of surgery at NHS hospitals are to be revealed. Can this be happening in the single-payer government morass that we’ve been warned off for years? Michael Millenson, one of America’s leading experts in patient safety and quality, gives us his reaction.

This is mind-boggling, if, alas, short on some crucial detail: Is this based on claims data (high-school-graduate-coded administrative information) or clinical claims? If the former, it is impressive, if the latter, extraordinary. For those who believe in the superiority of American medicine, here are a few observations.

First, he who pays the piper calls the tune. If NHS decides to
collect this data, it’s done. One also presumes they don’t need an act
of Parliament to do so, thereby avoiding at least some degree of
political interference.Second, a leading physician, who
actually pioneered releasing clinical data to the public, went on to
serve in the Cabinet and continue leading this effort on behalf of the
broader public interest. By comparison, our equivalent of a cardiac
database, the Society of Thoracic Surgeons database, has strict
confidentiality requirements that don’t even allow city-city or
state-state comparisons. The exception: a physician can release his own
information for marketing purposes.Third, and most interesting, are these seemingly innocuous sentences. “There were initially fears
raised that releasing the information would lead to surgeons avoiding
difficult cases which could impact their rates. But agreement was
reached on a method to take into account the difficulty of cases and
mortality rates are released against the number of deaths expected. Sir
Bruce has been working with hospital specialists on a way of rolling out
a similar scheme across all areas of surgery and medicine to help
patients choose where to be treated.”