ZDNet Healthcare

May 8th, 2008

Health care debate is a neverending story

Posted by Dana Blankenhorn @ 11:49 am

Categories: General, Payment Processing, Government, U.S., state government, Aging, Ethics, Finance

Tags: Health Care, Vertical Industries, Benefits, Healthcare, Enterprise Software, Software, Human Resources, Dana Blankenhorn

The longer I cover the health care beat, the more I realize it’s the one market where no one is happy.

This should not surprise. Supply is naturally limited, demand virtually unlimited.

There seems no way to balance the two.

Julie Salamon’s new book Hospital certainly paints a damning portrait of life on the front lines of American medicine. Yet here we have a delegation of 50 Chinese doctors and administrators coming to study us, as though we’re doing something right.

Fewer than half of India’s children get the health care they need, writes the BBC. Some six million die needlessly every year, most of them girls.

It doesn’t matter whether health care is seen as a right. The balance still seems impossible to get right.

In England a killing is blamed for a shortage of mental health care. In Canada some businesses demand some care be put back in private hands, which others see as a code word for letting people die.

Fact is costs rise with lifespans everywhere. They rise exponentially as technology improves. There is no way to make everyone happy in such an economic environment, no way to save everyone.

Debates over health care always involve who will live and who will die, when. Are the rich being made to live beyond their time? Are the poor not being permitted a life at all? Can the rest of us balance costs and income?

It’s a debate that will never end, and we shouldn’t pretend — any of us — that we have all the answers. All we can do is seek equity, seek it knowing we’ll never get the balance quite right.

When you argue about health care, all I ask is that you do so humbly.

May 8th, 2008

Delaying a PC revolution in cell diagnosis

Posted by Dana Blankenhorn @ 6:52 am

Categories: General, Hospital IT, Medical Equipment, Hospital Equipment, Research

Tags: FDA, PC, Test, Clearance, Party Solution, Federal Government, Government, Dana Blankenhorn

What if we could revolutionize medical testing, a platform as basic as a PC? Then what if every application, and every input, had to be separately inspected and approved by the FDA?

That’s life.

Iknoisys of New Haven says it has just such a platform, which it calls CellOptics. At its heart is a robotic microscope, the Ikoniscope, to fully automate cell analysis, running through up to 175 tests in succession, tripling technician productivity.

The list price is about $200,000, not bad for a sophisticated piece of lab equipment. President Paul White expects to hold that price steady for years, using technology advances to add software and capability.

So what’s the hold up?

“We need FDA clearance on each of our tests,” White explains. “Each of our software applications and reagent applications requires an FDA clearance.

“To date we have two clearances, both on existing manual tests. We are in the process of collecting data for FDA submittals for two tests this year, and there’s a very rich product pipeline.”

White is not complaining about the slow process. “The solution the customer needs is a test,” so you get approvals for each test and its components, never the core capabilities of the whole system.

“The other piece you require is the software application specific to the test as well as the reagent used to process the cell. Each is specific. To a patient each application does something different so you want that clearance.”

Thus Ikonysis’ sales force is concentrating on one small piece of the diagnostic market, a new opportunity called rare cell detection.

Right now samples must be meticulously examined, through a microscope, by a technician looking for cancer or other cellular disease. With the Ikoniscope, samples can be loaded, the technician can go out for coffee, and all they have to review are the freshly-identified cells themselves through a computer display.

Such tests are now impossible in most cases because they are so time-consuming, says Chairman Petros Tsipouras.

“There are currently 500 labs which need this automation now, in this country alone.” The opportunity here is much larger than mere automation of existing tests, he insists.

“If you take some of the tests for breast cancer and bladder cancer, the reagents are rare, and the automation is offered by two or three other companies,” not nearly on the level afforded by the Ikoniscope.

Yet Tsipouras, like White, defends the slow FDA process.

“This is clinical testing. There’s a certain inflexibility. The FDA is getting very vigilant in how it oversees tests based on a convergence from different sources.

“Most products are required to have a continous audit trail. Third party solutions are becoming more and more difficult to create in terms of diagnostic testing.”

Ikonisys can’t ask this question, apparently, but I’m just a dumb journalist so I’ll ask it.

Read the rest of this entry »

May 7th, 2008

Always-on boosted by British government study

Posted by Dana Blankenhorn @ 9:51 am

Categories: General, Always On, Aging, Home Health Care, Curioisities, Medical Records, Finance, Research, genetics, Wellness

Tags: Government, Sensor, Health Care, Vertical Industries, Benefits, Healthcare, Enterprise Software, Software, Human Resources, Dana Blankenhorn

Five years ago, on a Corante blog, I began touting something I called the World of Always-On. (Picture from Ofcom.)

Sometimes I was made to feel crazy, but I remained convinced that sensors and motes, linked to WiFi networks, could create applications living in the air for medicine, security, and personal inventory.

It was the medical applications which most intrigued me. The death of a favorite teacher from a sudden heart attack helped keep me going. I joked that these were “killer apps.”

So each time a new report comes out supporting my thesis, I get a little thrill of validation. And this latest is the best yet.

It’s from Ofcom, the British telecom regulator. It describes systems to make transport more efficient and retailing more transparent. Cars could notify authorities of accidents, for instance — the EU is already considering a mandate for that.

But its focus is on healthcare technologies, specifically implanted sensors that can detect incipient health events and alert doctors without patient intervention.

Yes, its aim is to cut government costs:

“The use of [wireless] technology could empower the individual to take more responsibility in maintaining their health, freeing up resources within the NHS for other, higher priority uses.

Now I’m certain someone is going to write in now and call this “big brother” technology. Please note it’s all opt-in. And the cost-effectiveness of such sensors is not a function of who pays the bills — always-on can save money for insurers too.

This is where a lot of the excitement over Personal Health Records is pointing toward. Once we know what you’re likely to suffer from, what conditions we should be monitoring, real-time data is the next logical step.

Given our continuing aging, and the increasing shortage of health care workers to monitor us one-on-one, technology like this is essential.

Unless you want to drop dead.

May 7th, 2008

Statin era over?

Posted by Dana Blankenhorn @ 6:20 am

Categories: General, Government, U.S., Medical Equipment, Aging, Finance, Research, Drugs

Tags: Gram, Blood Pressure, Merck & Co. Inc., Lipitor, Healthcare, Federal Government, Government, Dana Blankenhorn

The era of statins, drugs like Zocor and Lipitor which lower cholesterol levels, may be ending.

The FDA’s decisions over the last week to reject Merck’s Cordaptive and Isis’ Mipomersen, coupled with a demand that the makers prove the drugs improve heart outcomes, looks like a turning point.

Past approvals of statins were based mainly on the drugs’ lowering LDL cholesterol levels. Lipitor’s market success was based on studying high dosages to get big drops in the number.

But now, with Zocor a generic called simvastatin, Lipitor going generic in the next few years, and the failure of the ENHANCE study to prove a direct link between the number and longer life everything is being re-thought.

No one will admit this publicly, but cost may also be an issue. Doctors continue to prescribe Vytorin despite the ENHANCE study results, and if statins are really having minimal impact on outcomes, why give them more patent protection?

Personally I just came from my daily half-hour workout. I take simvastatin along with time-released niacin which is supposed to raise good cholesterol, and a baby aspirin. Each morning I add a blood pressure pill.

My father’s first heart attacks came when he was years younger than I am, and I feel fine. But is that due to the statin, the blood pressure medicine, or the exercise? (The picture shows my local YMCA from the air.)

Ironically Cordaptive from Merck was not a statin at all, but a combination of niacin and laropiprant designed to  enable people to take higher doses of niacin. I take just half a gram of niacin per day. Cordaptive was being studied to enable doses of up to 2 grams per day.

Mipomersen was initially studied as a way to treat a rare genetic condition which causes astronomical cholesterol levels. The rejection was for its use to treat “routine” high cholesterol.

Still, all these drugs seem to do is manipulate numbers, for LDL and HDL cholesterol. Do they help people live longer?

Until that question is answered the FDA’s approval window will likely remain closed. But you’ll still see me each morning at the Y.

May 6th, 2008

Nanny state resentment is universal

Posted by Dana Blankenhorn @ 8:55 am

Categories: General, Consumer Information, Aging, Home Health Care, Ethics, Wellness

Tags: Health Care, Bachchan, Pushback, Vertical Industries, Benefits, Healthcare, Enterprise Software, Software, Human Resources, Dana Blankenhorn

As much as health professions seek to warn people away from smoking, drinking, over-eating, and sedentary lifestyles, pushback against such “nanny state” antics seems to be universal.

For proof consider Gonzo’s great line from the original Muppet Movie. “I’m going to Bombay, India to become a movie star.” (”But Gonzo,” says Kermit, “we’re going to Hollywood.” “Sure, anyone can do it the easy way!”)

Bollywood is now in an uproar over the nanny state antics of Health Minister Ambumani Ramadoss, who wants film to set a good example for kids by cutting out the drinking and smoking.

Already the country has banned smoking in films and mandated warning labels on old films which show it. (In the U.S., cartoons have been recut to eliminate the cigarettes.)

But the move against drinking has gotten major pushback with stars like Amitabh Bachchan speaking out. Bachchan has even blogged about it.

The actors say they’re depicting reality, and that Ramadoss should first stop the drinking in his own ministry before he goes after them.

The pushback has caused Ramadoss to retreat, saying he was only asking films to set a better example.

All this mirrors disputes in the U.S., not only today but in the past, when the Hays Code was in effect. Both the concerns, and the pushback, are universal.

So how should health authorities make their point without getting preachy?

May 6th, 2008

Can health care make voice interfaces viable?

Posted by Dana Blankenhorn @ 8:05 am

Categories: General, Hospital IT, Medical Office IT, Government, U.S., Assistive Technology, Medical IT, Medical Records

Tags: Medicine, Voice, Health Care, Clinician, Professional Development, Vertical Industries, Career, Enterprise Software, Software, Dana Blankenhorn

One of the big surprises in my career, watching technology develop, has been the failure of voice interfaces. (Image from Paramount.)

Chalk it up to accents and the complexity of English. Listen to a Southerner or a Scotsman and the problem becomes obvious. Better yet try listening to your kids.

The only way to make it work is to make it work. And thanks to the immense growth in military medicine, you have a platform on which this forcing can happen.

Nuance Communications says its Dragon NaturallySpeaking is now being used by over 6,000 clinicians, because it was mandated by the military as the preferred way to document care with its AHLTA system.

Whatever you think of AHLTA or the military, the bottom line is you now have a complete voice-to-text interface for medical diagnosis, with 6,000 users and growing.

AHLTA consultants say the system is saving clinicians time, and enabling the creation of more complete medical records.

Nuance has now begun the process of transferring this experience into civilian medicine, which I hope means that interfaces for McKesson, Cerner and Microsoft are coming soon.

Once we have a beachhead for spoken interfaces in medicine, perhaps we can expand it into other areas, and speech will finally take its rightful space as the right way to talk to a computer.  

May 5th, 2008

How dangerous is computing to your health?

Posted by Dana Blankenhorn @ 8:38 am

Categories: Internet, Consumer Information, Aging, Home Health Care, Research, Wellness

Tags: Health Care, Computing, Keyboards, Hardware, Peripherals, Dana Blankenhorn

Recently I have seen a spate of articles suggesting the computing lifestyle is hazardous to your health:

• Laser toner consists of tiny particles which can be inhaled. In fact indoor air is often worse than outdoor air. As buildings are tightened-up to save energy the need for filters should grow.
• New Zealand researchers have documented something they call ethrombosis, blood clots which form in your legs if you sit at the keyboard too long. Get up once in a while people.
• Remember carpal tunnel syndrome? Back in the 1990s everyone and their dot-millionaire brother had it. Better keyboards have cut cases in half.
• Speaking of keyboards, did you know there are more germs on your keyboard than on your toilet? It’s more washable than you think, and Seal Shield says their keyboards are dishwasher safe.

Don’t get me started on how the sedentary computer lifestyle can leave you fat and even diabetic.

Fact is every lifestyle has its risks. Ignoring those risks is what’s bad for us.

So get up every once in a while, shake out your wrists, get an air filter, and wash your keyboard once in a while.

A little exercise wouldn’t hurt either.

May 5th, 2008

How elastic is health care demand?

Posted by Dana Blankenhorn @ 8:09 am

Categories: General, Government, Home Health Care, Finance, Wellness

Tags: Health Care, Emergency Medicine, Vertical Industries, Benefits, Healthcare, Enterprise Software, Software, Human Resources, Dana Blankenhorn

A New York Times feature on the difficulty insured patients are having with health care costs begs an obvious question.

How elastic is health care demand? (Comedian Soupy Sales, born Milton Supman, turned 82 in January.)

The idea of price elasticity is essential to making markets in goods and services. As prices rise, buyers forego purchases and demand goes down. Eventually the market clears.

We are presently undergoing that exercise with gasoline. Despite many folks’ claims they drive as much as ever, I can get around on Atlanta freeways with no trouble on the weekend. That was not true $2/gallon ago.

So how elastic is demand for health services? Maybe it’s more elastic than we think. And maybe that’s not an altogether good thing.

The stereotype about British teeth being bad actually developed in the last century, when hard times made people forego a lot of things, even dental visits. Since the NHS began covering dental care, British teeth have gotten much better.

When dental visits were very expensive, in other words, the British people took poor care of their teeth. Once these visits became cheap, they took better care of their teeth.

You can learn more about health care demand elasticity by visiting a hospital emergency room. Many people wait until they’re deathly ill before going to a doctor, and then die. Emergency medicine is increasingly routine care. Those with real emergencies get left out.

The point here is that the way many of us deal with rising prices may be penny wise and pound foolish. Our reluctance to spend on preventive care causes our acute care bills to skyrocket, and on those bills there is no choice. Someone has to pay even if the patient dies.

The aim of most health reform plans is to reduce out-of-pocket costs for preventive care. Or, as ol’ Soupy told me every day when I was growing up,  Be true to your teeth and they won’t be false to you.

May 2nd, 2008

Will computing save health care?

Posted by Dana Blankenhorn @ 8:33 am

Categories: General, Consumer Information, Aging, Home Health Care, genetics, Wellness

Tags: Dr., Health Care, Computing, Carey James Kriz, Vertical Industries, Benefits, Healthcare, Enterprise Software, Software, Human Resources

Carey James Kriz is nothing if not an optimist.

Dr. Kriz, who heads the American Academy of Urgent Care Medicine in Orlando, is convinced that technology is the answer to the train wreck called the health care financing system.

Predictive Health, knowing what your genes have in store and customizing care accordingly, can transform medicine, lower costs, and let us all live longer, he believes.

He has put this vision into a book called The Patient Will See You Now. (It’s $24.95 from Amazon.)

The book’s marketing people claim this blows holes in the whole idea of universal health care.

In fact it does nothing of the sort, unless you believe a freeze in the Florida orange groves will impact next year’s apple crop in Washington. How we care for people and paying for it are two different things.

But how we care for people is changing, and folks like Dr. Kriz are leading the way.

Even more important is that Dr. Kriz is, as the business reporters say, “eating his own dog food.” He is backing a company called Prospective Health Corp.  aiming at branding this new style of health care.

From the site’s about page:

Prospective Health is an acquisition company with considerable capital resources, seeking physician-owners who want to continue in their businesses, to grow revenues and profits, while meeting the highest standards of patient outcomes and expectations.

Now you’re talking my language, doc! The entrepreneur will see you now.

May 2nd, 2008

Cellular medical imaging for the people

Posted by Dana Blankenhorn @ 8:08 am

Categories: General, Medical Equipment, Medical Office Equipment, Gadgets, Networking, Home Health Care, Research

Tags: Phone, Hospital, Physician, Medical Imaging, Imaging, Image, Wireless Link, Mergers & Acquisitions, Telecom & Utilities, Healthcare

This is not an innovation which will make much sense to Americans.

A UC Berkeley scientist, Boris Rubinsky, who also works for Hebrew University in Jerusalem has developed a system for moving complex medical images over cellular links.

The key to success is placing the processing software in a central computer. The raw data is transmitted by cell phone, processed, then sent back as a finished image. Everything else is just interfacing.

Some three-quarters of the world’s population has no access to such images as ultrasounds, x-rays or MRIs. Self-contained units are just too expensive for most hospitals in the developing world, and these hospitals in turn are too far from patients.

But even the most remote villages have cell phone links now. In some places you can build a thriving business with a phone and a contract, visiting those who need to make a call and up-selling the service.

So most of the infrastructure is already in place. Camera phones are dirt cheap. Wireless links are there. All a physician needs to bring is a simple acquisition device using electrical impedance tomography.

The two universities are jointly marketing the technology to manufacturers, with Rubinsky and his colleagues having the patents.

Their paper is now online at the Public Library of Science.