Two events: Using communications technology to improve health care

Find a full week of events here.

Tuesday Night:

Mobile & Healthcare Seminar: Connected Health – The Future of Managing Health and Wellness?

British Consulate/Uk Trade & Investment – One Broadway Cambridge, MA

Panelists:

• Jonathon Dreyer, Director of Mobile Solutions Marketing, Nuance’s Healthcare Division
• John Moore, New Media Medicine Group, MIT Media Lab
• Anne Pelz, Manager Product Management, PHT Corporation

 Total U.S. health care expenditures were estimated to be $2.8 trillion in 2012, and is expected to grow steadily unless significant reforms take place.   Connected health, or remote care delivery, is viewed as a critical component to the changes that are eminent in our healthcare system to help lower costs for providers, payers and patients, as well as to improve overall care.

If we can empower patients and arm them and the extended care team with mobile technology such as mobile devices, applications, sensors and monitoring devices, we can help the patient manage their own care and work collaboratively with their care team to obtain quality care and improve their own health.  Yet there are still many barriers to adoption and success including; patient engagement, cumbersome visualization that is difficult for the average person to read and understand, integrity of data being shared across platforms and interfaces, and access and knowledge of technology.

Our panel will provide insights using real case examples and talk about the future of MHealth. Come prepared to be part of this dialogue.

Wednesday, 5pm :

Conversations on Complexity
Please join the MIT community for a seminar series highlighting a systems approach to critical contemporary issues.
Massachusetts Institute of Technology — Suffolk building, 292 Main Street. Cambridge, MA

Every year the U.S. Department of Veterans Affairs provides services to more than 6 million veterans and their families at 1,400 sites and 153 medical centers.

Julie Andren and Shahed Al-Haque will examine two service delivery challenges within the Veterans Health Administration (VHA). They will discuss how the VHA is leveraging telehealth capabilities across the enterprise to increase quality health care access. They will also outline recomendations for improving health care delivery to veterans seeking care outside of their home network.

The Globe on alarm fatigue, HIT and a hit to the hospital association

From The Globe:

• Wide heart monitor use tied to missed alarms/ State reports detail 11 patient deaths linked to alarm fatigue in Massachusetts
• Steward Health Care chain quits Mass. hospital group: For-profit chain says it can better advocate for its unique interests
• Report suggests HIT, incubators as part of economic development plan.

Fair pay or bone scam?

Tons of great health reporting in today’s Globe, not all of it on the health page. See stories on brain cells, osteoporosis testing, skanky diet pills and vitamin D.

BHN takes particular note of the bone scan story and wonders — Will politics and science ever find common ground? At this point, it is becoming more and more clear that more scans — be they mammograms, MRIs or test for bone density — do not equal better health.  The message, it seems, is not getting through to heavily lobbied lawmakers

“You have to view these things through common sense. And it doesn’t take a genius to figure out that providing bone density tests for elderly Americans will save this country billions of dollars,’’ said Berkley. “In addition to saving taxpayers money, it will prevent suffering that people with osteoporosis have.’’

Berkley and the key Senate sponsor, Blanche Lincoln, an Arkansas Democrat, who was a pivotal vote in the Senate in favor of health reform, have received hundreds of thousands of dollars in campaign contributions from medical industry sources, including physicians, as have many other lawmakers.

Among the lobbyists working on behalf of several corporations on the effort was a former top staffer to Lincoln, Drew Goesl, who was listed on public disclosure records as being among the people at Washington lobbying firm Capitol Counsel who worked on the issue.

Goesl did not respond to a request for comment. A spokeswoman for Lincoln said neither campaign contributions nor Goesl’s involvement played any role in her position.

For more on bone scans, see my piece on an alternative test, which ran in the Globe in ’08.

Some doctors believe the Fracture Risk Assessment Tool, or FRAX, will improve their ability to identify patients likely to suffer the worst consequence of osteoporosis – broken bones.

For another perspective, see the National Women’s Health Network’s page  on osteoporosis.  NWHN is one of the few patient advocacy groups that does not take industry money.

On the other hand, the National Osteoporosis Foundation courts industry sponsors including:   

The Alliance for Better Bone Health  which “was formed by Procter & Gamble and Aventis in May 1997 to develop and market Actonel collaboratively in Europe, the United States and Canada.”

Medtronic

Hologic, Inc.

GE Healthcare Lunar

Now you may return to the story on Vitamin D, which also offers news on bone health.

Finally, note that Newton’s Heywoods - the family that developed its own ALS research incubator in response to a brother’s struggle with the illness – makes the news once again. A story in the NYTimes about online patient communities features “PatientsLikeMe” a patient support site that also collects data for research.

HIT safety and Boston-based “dream team”

Healthcare IT News reports:

WASHINGTON – If Donald Berwick, MD, is confirmed as administrator of the Centers for Medicare and Medicaid Services, he and David Blumenthal, MD, the national coordinator for health IT, would be a “dream team” in pursuing a coherent national healthcare and health IT strategy.

At least that’s the assessment of Kerry Weems, who spent 25 years in senior roles at the Health and Human Services Department and was acting administrator of CMS from Sept. 2007 until the Obama administration took over.

At the same time, reporters at The Huffington Post continue to raise questions about HIT and patient  safety that the above team will have to address.

Despite mounting concern over safety risks posed by digital medical records systems, government officials are years away from starting to track hazards stemming from use of the devices.

A federal advisory panel wants to create the first national database of medical software malfunctions and problems as a part of the Obama administration’s drive to spend billions of dollars in economic stimulus money helping doctors and hospitals adopt the technology. 

But the proposed system wouldn’t be up and running before 2013—even though a growing chorus of technology experts is warning that rapidly converting paper records into digital formats can unleash new types of medical errors.

Does the Feds strategic plan address safety?  Read their latest update. It mentions the issue, but not with the same urgency.

…(T)here are several key areas that will need continued discussion. Among the topics discussed during the development of this Framework were the following:

 

 Transparency and Access – ensuring that patients have access to information and knowledge to make informed decisions about their care;

 Personal Choice – finding the right balance between patient privacy and patient choice i.e., some patients do not want their data shared whereas some patients do not mind sharing or want to share their information for research, improved care, and/or for the betterment of society;

 Public Engagement – allowing for continued public discussion and debate on current and emerging health care issues that cannot be resolved easily or through easy technology solutions;

 Technology Innovation – learning from the impact that the internet and social networking has had on our daily lives, and leaving flexibility for how technical innovations may change the delivery of health care; capitalizing on the promise of emerging new technologies while preserving the rights of individuals;

 Support for Research – putting in place appropriate policies and technical infrastructure to allow researchers to access data to support new discoveries and treatments while protecting individual privacy; and

 Unintended Consequences – allowing for processes to capture and learn from unanticipated adverse consequences of HIT use, and developing actions to mitigate and prevent untoward effects.

 

UCSF v. Beth Israel on FDA on heart device safety

Docs from BI, working with the Food and Drug Administration, released a study this week suggesting that medical device makers are providing weak evidence to support the efficacy and safety of products, in particular cardiovascular devices like stents and implanted defibrillators.

The study was release earlier to counter a similar study in the Journal of the American Medical Association that faulted the agency for approving devices based on limited and potentially biased data.

Just prior to the release of the new study, FDA officials announced that they would strengthen the device review process.

The New York Times reported that the BIDMC “study found that more than 40 percent of the studies used to approve cardiovascular devices had lacked high-quality data about either the treatment or safety goals of the study.”Researchers also concluded that 25 percent of trials had failed to adequately follow patients enrolled in studies.”

Dr. William H. Maisel, a cardiologist at the Beth Israel Deaconess Medical Center who was involved in the study, said the review did not find a correlation between lower-quality data and problems related to the devices. However, he said he thought the potential for such links existed.

But, the JAMA study out of the University of California faulted the FDA review process and “concluded that the F.D.A. had approved cardiovascular devices based on data that ‘lacked adequate strength.’”

Their conclusion Premarket approval of cardiovascular devices by the FDA is often based on studies that lack adequate strength and may be prone to bias.

According to AP: The new studies, published in separate medical journals, cap a year of scrutiny and criticism for the FDA’s medical devices division. In August, the head of that division resigned, months after scientists under his leadership alleged they were pressured to approve certain products. The year began with congressional investigators saying the FDA should take immediate steps to make sure the riskiest devices are approved through the most stringent process.

Docs from BI, working with the Food and Drug Administration, released a study this week suggesting that medical device makers are providing weak evidence to support the efficacy and safety of products, in particular cardiovascular devices like stents and implanted defibrillators.

The study was release earlier to counter a similar study in the Journal of the American Medical Association that faulted the agency for approving devices based on limited and potentially biased data.

Just prior to the release of the new study, FDA officials announced that they would strengthen the device review process.

The New York Times reported that the BIDMC “study found that more than 40 percent of the studies used to approve cardiovascular devices had lacked high-quality data about either the treatment or safety goals of the study.”Researchers also concluded that 25 percent of trials had failed to adequately follow patients enrolled in studies.”

Dr. William H. Maisel, a cardiologist at the Beth Israel Deaconess Medical Center who was involved in the study, said the review did not find a correlation between lower-quality data and problems related to the devices. However, he said he thought the potential for such links existed.

But, the JAMA study out of the University of California faulted the FDA review process and “concluded that the F.D.A. had approved cardiovascular devices based on data that ‘lacked adequate strength.’”

Their conclusion Premarket approval of cardiovascular devices by the FDA is often based on studies that lack adequate strength and may be prone to bias.

According to AP: The new studies, published in separate medical journals, cap a year of scrutiny and criticism for the FDA’s medical devices division. In August, the head of that division resigned, months after scientists under his leadership alleged they were pressured to approve certain products. The year began with congressional investigators saying the FDA should take immediate steps to make sure the riskiest devices are approved through the most stringent process.

Health Wonk Review: Bosstown edition

Today, BHN hosts the Health Wonk Review, the floating web digest of health policy blog posts.

Guy Aceto/ Backstreets.com

This is Boston, but we already had a baseball theme. Summer reminds me of growing up on  the Jersey Shore. So, this week — the Boss-town edition. Dedicated to Danny Federici,  Bruce Springsteen’s organ player.  He died of melanoma last year.

 For a round up of recent Boston news,  see my fresh posting on Mass Device.com. I blog weekly for this device industry news site.

The Price You Pay

Healthcare Technology News offers a post on the health industry meeting with President Obama: “What We Call Health Care Costs, They Call Income.” The group’s proposed $2 trillion in reductions in the rate of growth of health care costs. They also pledged to reduce the growth in costs by 1.5% each year for ten years. “It’s not enforceable and there are plenty of reasons to view this cynically,” HTN asks. “But is it a signal that health care reform has a real chance this year?”

Joseph Paduda at Managed Health Matters reports on a health reform meeting sponsored by pharmacy benefits company Medco. Of the dozen meetings and press conferences on health reform each week –“This was one of the better ones I’ve (remotely) attended,” he said.  Why? “Because the conversation was realistic, pointed, and quickly got into the reality of health care reform – it’s about cost.” Special extra: retro anti-health reform graphic featuring Ronald Reagan.

Living Proof?

MedicaidFrontPage takes on reform’s hot topic. In “The Public Plan…Balance is the Key to Life,”  Brady Augustine offers updates, thoughts and links on the debate over the public insurance option. He points out that some some states already have public plans for employees or Medicaid recipients.

At the Health Affairs Blog, Harold Luft  proposes a risk pool as an alternative to the public plan in “Beyond The Public Plan Debate: A Pathway To Transform The Delivery System.”  Luft discusses the “weaknesses of the competing visions for a public plan option.” He outlines his proposed alternative: “a publicly chartered major risk pool that eliminates the need for the problematic behaviors of private health plans while enhancing choices for providers and patients.”

Reason to Believe

Kaiser Family Foundation’s head, Drew Altman, sees big differences in opinion between experts and the public on health care.

 Dave Williams at the Health Business Blog doesn’t think Altman has it quite right. He looks at the Kaiser survey point by point and tells us where he thinks the public stands on issues like HIT, quality and unnecessary care. A post on New Health Dialogue by Joanne Kenen  offers more thought on Altman’s ideas. 

Cadillac Ranch

Julie Ferguson gathers up reports on the potential impact of Chrysler and GM’s bankruptcies on state workers’ comp systems over at Workers’ Comp Insider. For example, she notes that Ohio’s Attorney General Richard Cordray has filed a "limited objection" to the pending sale of Chrysler, claiming the new owner won’t be required to meet workman’s comp obligations. WCI gives a nod to Roberto Ceniceros of Business Insurance for his thorough coverage of the issue.  

 Devil’s Arcade

Photo by Dop Deep

The Health Care Renewal blog offers a post entitled From the “Era of Cyber Hospitals to an Unfinished “Pipe Dream”There, Brown University’s Dr. Roy Poses notes that testimony in the ongoing civil lawsuit against corrupt HealthSouth hospital CEO Richard Scrushy cautions against buying into innovation hype. The “digital hospital” idea HealthSouth trumpeted in 2001 is an empty building. At the trial Scrushy testified that the hospital was a “pipe dream.”

 Dr. Poses digs way back and finds a lot of cheerleading for this failed digital hospital project. “We are constantly bombarded with publicity about the latest health care ‘innovations.’ We are warned, however, that any new regulation of health care corporations may dry up the pipeline of ‘innovations,’ imperiling us all.  Yet how many of these “innovations” actually improve health?” he writes   

 

Are you tough enough to play the game they play? 

Maybe this was an excuse to play video games, but David Porter at the Health Disparities blog explains how researchers are using the World of Warcraft and other “virtual worlds”  to study natural experiments. In this case, he talks about a virtual virus – the kind that attacks player in the game, not the computer.

 For the uninitiated, this involves a using a virus-infected virtual pet to attack the enemy. Porter described it as “an excellent example of a natural experiment and how people may act during a pandemic…” He said researchers analyzed data supplied by the game developer and cites two papers one Epidemiology and another in The Lancet Infectious Diseases.

 

Working on a Dream

Anthony Wright presents Getting to universal… posted at Health Access WeBlog.  He agrees with with the CBO that an individual mandate by itself won’t get us to universal coverage, but disagrees with other supposed barriers to that goal.

 BNET Healthcare asks “Thought Leaders Propose Health Reforms, But Will They Work?”  The authors of New England Journal of Medicine article favor "accountable care organizations" that would enable healthcare providers to improve quality and reduce cost growth.  BNET thinks their view of physicians and the health care business is “too idealistic to offer a practical road map to reform.”

 Colorado Health Insurance Insider reports that the governor has signed Colorado Senate Bill 88 granting dental and health insurance benefits to domestic partners of gay and lesbian state employees.

 

Spare Parts  

The Health Care Blog offers a post by Mark Leavitt, head of Certification Commission for Healthcare Information Technology, or CCHIT. "Certifying Health IT: Let’s Set the (Electronic Health) Record Straight." In this post, Leavitt responds to accusations that CCHIT is too close to the HIT industry to act as a certifying agency. The charges emerged in stories from the The Washington Post, including one entitled “Group Seeks Sway Over E-Records System.” The Post also reported on the dispute. 

 Neil Versel at Healthcare IT Blog comments on an “outrageous statement” by the CEO of Epic Systems “Vendors, this is your wake-up call”

 

 The Big Muddy

Sam Solomon of Canadian Medicine describes a medical crisis triggered by a nuclear accident. “When nuclear nonproliferation is the problem” He describes his post as “an article about the potential consequences, both clinical and political, of the recent shutdown of the nuclear power plant in Ontario that produces about half of the world’s supply of a certain critical radioisotope used in diagnostic imaging exams.”

 In a post entitled Death Form a Thousand Cuts Outside of the Patient Centered Medical Home,  Jaan Sidorov notes “that while health reform may be on the way, there are a surprising number of day to day hassles that are bleeding primary care physicians dry.” From the The Disease Management Care blog

 

Don’t get caught on the wrong side of that line

Mike Feehan at Insureblog contemplates the difference between medical care and health care. “In order to reach meaningful conclusions about the direction of health care reform, we need to understand the relationship of health care to wellness… We can exercise (free). We can get adequate sleep (free). We can steer clear of substance abuse of all kinds (free). We can keep a reasonable diet (free). We can always wash our hands (free). We can hold it down to 85 on the Interstate (free). We can stop smoking or never start (better than free). To a great extent we already have free health care in the U.S.”
  

Better Days

Jason Shafrin at Healthcare Economist notes that Medicare Part D plan was supposed to provide a prescription drug benefit for those who did not have it. The Healthcare Economist reviews a paper that that asked how well the program is working. It found that after the enactment of Medicare Part D,  only 7% of seniors lacked drug coverage, compared to 24% before the launch of Part D.

Glenn Laffel at Pizaazz tell us: “It’s been a long strange trip for Dendreon, the makers of Provenge a new immune therapy for prostate cancer. No one seemed to take the stuff seriously, but now the definitive trial has been completed and lo and behold, it works! No one could be happier than its shareholders.”

Growin’ Up

Philip Zorn presents guest blogger Robert Nelb on Effortless Enrollment Saves Taxpayers $ and Helps Uninsured Children Access Medicaid and CHIP posted at Say Ahhh! A Children’s Health Policy Blog. Nelb talks about a Brookings Institute paper on the need for effortless enrollment in CHIP and Medicaid programs. He makes the case that automatic enrollment would not only save taxpayers money, it could save lives.

 

Spirit in the Night

Find Clearing the Haze – Is Marijuana Addictive?  at Brain Blogger. ”America’s most popular illegal drug has remained largely a scientific mystery. It is a drug that millions of Americans have been using regularly for years, and, from a clinical perspective, it remains the least studied illicit drug of all.”

Fun with Health Information Technology — An “Interoperetta”

The actual title of this bit of wonky fun:  ”HITECH:An Interoperetta in Three Acts.”  Also on You Tube.

Here, Maryland doctor Ross Martin finds true harmonization. He also comes up with rhymes for two Boston heavies — Obama HIT man David Blumenthal and John Halamka, the CIO at Beth Isreal Deaconess Medical Center. 

 Dr. Blumenthal, Won’t you give me a call/

So I can work at the ONC (Office of the National Coordinator of HIT)…

  We’ll work for Jon Halamka / As for lunch we’ll always comp ya.

I found it this on BIDMC CIO Paul Levy’s “Running a Hospital” blog.

MassDevice.com: A new Boston news site on medical devices

I’ve started doing a weekly round-up for a business news site – MassDevice.com. These folks recognize that the medical device industry has a huge role in our lumbering health care system

             It moves markets, creates jobs and is an invaluable economic engine for the region. And it’s not just The Bay State. Thriving medical device clusters have popped up all over New England.

They went live on Monday. The site offers a Q&A with the head of the state Life Sciences Center and profiles of companies and inventors. One story describes the device industry as a “safe harbor” in hard times.

…(T)here are signs of hope for medical device and diagnostics companies, as nervous investors seek quicker returns than pharma or other life science firms can offer.

Experts say the local job market for medical device professionals remains comparatively strong, despite the downturn, and the New England device industry remains an attractive target for government grants and other efforts to stimulate innovative sectors of the economy.

Don’t they hope that holds up.

I stumbled into writing for the trade press years ago when I wanted to move to D.C. One of my newspaper editors raised his eyebrow and said Through the revolving door, ehh? Not at all. Sites like MassDevice.com offer journalism, not PR. It’s not a newsletter from an institution or a cheerleader for the industry.

 So, check it out. My weekly includes a bit from BHN, but mostly new material, including some actual reporting.