Archive for October, 2008
by Malorye Allison
October 27, 2008 at 2:28 pm · Filed under Health IT, Electronic Medical Records
Newt Gingrich, John Kerry, Billy Beane and John Halamka are all waving the health information technology flag, trying to get the attention of both candidates so that, whichever one wins, health IT finally may get the attention it deserves.
In an unlikely collaboration, Oakland A’s general manager Billy Beane joined with politicians Newt Gingrich and John Kerry for an editorial that maintains medicine is light years behind baseball in terms of its use of IT. The trio writes in the New York Times that: “Remarkably, a doctor today can get more data on the starting third baseman on his fantasy baseball team than on the effectiveness of life-and-death medical procedures.”
While baseball managers have moved to a “statistics-based creed called sabermetrics” to improve their teams’ performances, doctors continue to rely on “Informed opinion, personal observation or tradition,” to guide their decisions, not statistics born of rigorous clinical studies, according to Beane et al.
Meanwhile, health IT champion John Halamka, who is CEO at Harvard Medical School, writes a letter to the next president in Technology Review, asking for:
(1) Incentives for adoption and use of EHRs, and crafted so that physicians share cost savings.
(2) Incentives for hospitals to adopt CPOE (computerized physician order entry) – “the most important tool hospitals can introduce to improve their safety, quality, and efficiency of care.”
(3) Continued federal funding for technology and policies encouraging interoperability.
Beane, Kerry and Gingrich point out that “a health care system that is driven by robust comparative clinical evidence will save lives and money.” Both candidates have shown an interest in using health IT to get there. Hopefully, that will be one of the promises whoever wins follows up on.
by Malorye Allison
October 24, 2008 at 2:21 pm · Filed under Health IT
The push for personalized medicine just got a boost with the launches of the Wisconsin Genomics Initiative (WGI) and Harvard’s www.personalgenomes.org. The Wisconsin initiative is notable because it builds upon Marshfield Clinic’s collection of 20,000 DNA samples, described as “the nation’s biggest biobank.” The Harvard Personal Genome project, meanwhile, stands out because it aims to dispel the notion that secrecy and genomics must go hand in hand.
The contrast is stark. Projects like the one at Marshfield typically guarantee privacy for the patients who donate their DNA, and many arguments have arisen about how realistic that is. Privacy fears are one of the main reasons there aren’t already more clinical genomics projects as far along as Marshfield’s. The ten people in the Harvard Genome Project, meanwhile, are baring their genomes and phenomes (i.e. physical traits) to all.
Both projects hope to accelerate medical research. The folks behind the Harvard project claim that bypassing the secrecy will help them find useful links between genes and disease faster.
Typically, DNA samples are gathered from patients with a particular condition and compared to those of normal controls, but the layers of privacy protection often limit what can be done with each sample. The Wisconsin project is looking at a range of diseases including Alzheimer’s and glaucoma. Marshfield Clinic is working on this project with University of Wisconsin School of Medicine and Public Health (UWSMPH), the Medical College of Wisconsin (MCW), University of Wisconsin-Milwaukee. The Wisconsin-based Clinic also boasts a “fully integrated electronic medical record and more than 20 years of medical history.”
The Harvard Genome Project’s first 10 participants all had to “demonstrate the equivalent of a master’s degree in genetics,” the New York Times reports, so they would fully understand the implications of putting so much information about their health out into the public domain. The recent passage of the Genetic Information Non-Discrimination Act should protect these pioneers from discrimination by employers or insurers, but there are plenty of other repercussions possible. Data on the health and genomes of those first ten people were posted this week, now the project is trying to recruit 100,000 new participants.
Personalized medicine seems like a good way to help hold down costs and greatly improve care. But at least for now, most patients will want to be assured that their genetic information cannot fall into the wrong hands.
Just as important, doctors will not be able to take meaningful action if health IT tools aren’t there to assist them. The new paradigm of personalized medicine is using tests to guide prescribing. With about 1,500 tests on the market, some that are complicated to interpret, physicians will surely need computer-based guidance to navigate the new path to personalized medicine.
See more about the WGI
Visit the Harvard Personal Genome Project
by Lola Butcher
October 21, 2008 at 6:03 pm · Filed under Podcasts + Videocasts, Business of Health
One of the people with the most hands-on health reform experience in America is losing confidence that much hoped-for federal-level reform will occur after the presidential election.
Jon Kingsdale, executive director of the Commonwealth Connector in Massachusetts, told me that America’s economic implosion may endanger the chances of health care reform proposals.
Clearly there’s a lot of interest and it’s a big domestic policy priority. Senator Obama has, in particular, identified that as a priority. However, the straightened financial circumstances are such that, on the one hand, there may be all the more need for it, but on the other hand, far fewer federal and state resources are available to finance reform. So, myself, I’m a little bit less optimistic than before the recent financial services meltdown and the accompanying federal bail-out. But I wouldn’t rule it out.
Kingsdale will speak at the 6th Annual World Health Care Congress in Washington DC. Check out his podcast on the WHCC website.
One of the “lessons learned” from the Massachusetts experience is that, while waiting for legislators to turn their attention to health reform, the private sector can take a lead. Kingsdale appreciates “the tremendous effort that went into it on the part of private sector groups to try to promote reform, really for two or three years before the legislature even enacted something.”
That coalition of support, which is very broad, has stayed actively involved in the implementation as well. And that’s just, I think, a critical lesson. You know, frankly, we did health reform here 20 years ago under Governor Dukakis by a slim, it passed by a slim, slim majority, and never really was implemented. By contrast, there’s a very broad consensus here, and we’ve done everything we can in a difficult implementation process to actually build on and enhance that consensus.
by Malorye Allison
October 10, 2008 at 12:25 pm · Filed under Consumer Engagement, Health IT, 4th WHCC, Business of Health
The biggest hurdle to building a social networking site for health care consumers is that “People worry that its just going to become a dumping ground for complaints,” says MaryAnn Stump, senior vice president and chief innovation officer at Blue Cross and Blue Shield (BCBS) of Minnesota, and president of Consumer Aware, which is a sister organization of BCBS. One year after launching in Minnesota’s metropolitan market, however, HealthcareScoop.com has three times as many positive comments as negative ones. The site is now officially going national, although Stump points out “Even before we promoted it nationally, we had comments coming in from more than 20 states.”
“That shows the opportunities are without boundaries,” Stump says. To join the site, patients don’t even have to be BCBS members, “These are anyone’s stories about physicians, health plans, anything health related,” she says. “The lens is the patient’s eye.”
Patients post their stories anonymously, and the site does have rules to discourage illegal or disruptive postings. Comments are also invited. In the last year, almost 700 stories have been posted and the site has logged more than 500,000 page views. The stories range from glowing reports about a favorite gastroenterologist to complaints about getting a “runaround” from administrative staff at a particular institution.
HealthcareScoop.com is just one of a slew of intriguing projects aimed at getting more input from consumers on health care. I’ve also written here about PatientsLikeMe.com and Microsoft’s ambitious HealthVault personal health record project. It’s all part of a new paradigm shift that has many in the health care field scrambling to catch up.
For example, soon after the site launched, Stump says, “Someone wrote to us saying ‘People are complaining about the long wait time at our institution, what are we supposed to do?’” Stump then asked if the institution’s wait time was, indeed, a problem. “The answer was yes, and the logical step after that of course is to fix it,” she says.
A lot of concerns were voiced before the site was launched, but given the pace that social networking is advancing, the company felt confident that this was necessary now. For one thing, the site helps to differentiate BCBS from its competitors. It also helps BCBS’s relationship with local providers. “It helps us connect the providers to their patients in a new way,” she says.
Starting out, there were also concerns from providers that BCBS would use information gathered from the site when contracting with physicians. “It’s not our intent to do that,” Stump says. But she was pleased to hear that providers are starting to monitor the site. “It’s definitely a chance to learn what is not working from the consumer’s point of view.”
“This is new territory,” she emphasizes, “And this is how the younger generation communicates. It will not be for everyone, but it was never designed with that in mind.” Another concern was that people just wouldn’t post stories about health issues. The company tested the site internally to see if they would, and they did.
Asked what tangible benefits BCBS does expect Stump says “You either start with a business model, or you start with an unmet need and connect to a business model.” HealthcareScoop.com is an example of the latter. Down the road, however, BCBS would like to see if the site can be tied into disease management, for example. “We’re thinking about things like effective diabetes management measures and aggregating certain types of stories,” Stump says.
Stump’s point of view is that it’s unwise not to try and make such connections with consumers. “The cat was out of the bag once we launched consumer-directed models,” she says “Now we have to provide the tools for patients to make choices as customers, rather than as passive recipients of care.”
by Malorye Allison
October 6, 2008 at 12:23 pm · Filed under Policy Makers
McCain would pay for his planned healthcare tax credits – the cornerstone of his reform plan — with savings from Medicare and Medicaid, said Douglas Holtz-Eakin, McCain’s senior policy advisor, according to a report today in The Wall Street Journal. Holtz-Eakin said McCain would reform payment policies and eliminate Medicare fraud to reduce costs. “It’s about giving them the benefit package that has been promised to them by law at lower cost,” the paper quoted him as saying.
Over the weekend Obama brought health care reform back into the spotlight focusing on McCain’s plan to offer a new healthcare tax credit of $2,500 per person and $5,000 per family. McCain would also have the government tax the health insurance benefits people receive though work. The idea is for people to shop for the best coverage deals.
Until now, McCain’s campaign has repeatedly said his health care plan was budget neutral, and aides have suggested he would apply both an income and payroll tax to health benefits. But according to the WSJ report “Holtz-Eakin said the campaign never intended to apply the payroll tax to health benefits.” This new detail means that McCain’s plan would lower taxes for most people, but that he’ll have to find new revenue sources to make it budget neutral, hence the new focus on reducing Medicare and Medicaid costs.
Obama launched four television ads in key states criticizing McCain’s health care plan. He also spent the weekend attacking McCain’s plan in speeches, calling it “a shell game” that would still leave many people without insurance.
