ZDNet Healthcare

November 20th, 2009

Paying for what does not work remains popular

Posted by Dana Blankenhorn @ 9:36 am

Categories: Consumer Information, Ethics, General, Home Health Care, Internet, Research, Wellness, genetics

Tags: Women, Cancer, Pap, Gender And Diversity, Human Resources, Dana Blankenhorn

Another Day, Another Recommendation to Relax Screening for Women.

That’s the ABC headline on today’s story that young women can avoid cervical cancer just as easily getting pap smears once every two years as every year.

This is good news. Pap smears are a hassle. If you’re a woman, or know any, you know this.

So why the pushback? Why the accusation that the Administration wants to ration necessary tests?

One reason is that women continue to die from cancer, including famous women like Stephanie Spielman (right), wife of former football star Chris Spielman. She first discovered her cancer in a self-exam 12 years ago. It took her life on its fifth recurrence.

But not all cancers kill. If you are diagnosed with prostate cancer and told it has a low Gleason score, you may be told to do nothing — watchful waiting, it’s called. Similarly not all breast cancers are invasively aggressive. Research is ongoing to find better ways to distinguish breast tumors.

Meanwhile, thousands of women are losing their breasts each year to unnecessary surgery or risking death from chemotherapy. And millions of women (as well as men) aren’t doing the first thing to prevent this disaster — losing weight.

We imagine a simple formula. Get tested and if there is cancer get treated. But what scientists are trying to tell us is there is a different formula. Get healthy and seek appropriate treatment based on how dangerous your particular cancer is.

This is just what men have been told about prostate cancer for years. It’s the refusal of some people to accept this fact that’s dangerous.

Many also refuse to accept the fact that you can do everything right and, like Stephanie Spielman, die anyway. It’s tragic, but it’s true. There is still much more to learn about cancer before it is beaten.

The bottom line is this. We know a lot about how to cut health care costs. Stay healthy. Eat right, exercise, don’t get obese. Don’t smoke. But too many think this advice is an infringement on their freedom, that magic tests and magic treatments will save us from ourselves.

They won’t. Do what works, meaning take care of yourself, and you will be less likely to rely on what does not work, frequent testing and over-treatment.

Of course, this advice can be refined if we know your genetic background, what you are most susceptible to, what is most dangerous to you. But in the end predictive medicine is just a refinement, and the advice you will get from it is similar to what doctors are saying now.

You have the best chance of staying healthy if you take care of yourself, and rely on yourself, rather than the magic of medicine, to keep you well. That is what works.

Sorry if you think this violates your freedom. You remain free to eat that brownie, to smoke that cigarette, to have that fifth beer, to overwork and to ignore your doctor.

But at some point your neighbors, who are paying for your excess, whether in the form of insurance or in the form of taxes, are going to start asking these hard questions, like why do you feel free to drink deeply from the well of cures if you’re not doing what it takes to stay well?

November 19th, 2009

Reid promises 60 on Saturday

Posted by Dana Blankenhorn @ 7:18 am

Categories: General, Government, U.S.

Tags: Democrat, Vote, Reid, Taxes, Free Trade, Homeland Security, Personal Finance, Leadership, Financial Planning, Finance

Senate Democrats released their final leadership bill on health reform yesterday, believing there will be 60 votes to start debate on Saturday.

The measure, now known as S. 3590, runs to 2,074 pages, includes a public option, and carries a “CBO Score” claiming a $130 billion reduction in the federal deficit over 10 years.

Democrats who trooped to MSNBC microphones last night expressed confidence the 60 votes needed to beat a Republican filibuster will be there, not only to start debate but to close it and move toward final passage.

Sen. Tom Harkin told Rachel Maddow that a cloture vote to stop a filibuster has to be won, because a bill under the “reconciliation” process would have to come through the Budget Committee, and would thus lose all the money-saving and wellness provisions in the final bill.

Thus while President Bush could push though his tax cuts on a simple majority, Democrats will need unanimity in their 60-member caucus to push this bill through.

This gives enormous power to conservative Democrats who could withhold the crucial 60th vote, such as Joe Lieberman of Connecticut, Ben Nelson of Nebraska, Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana.

The big smiles on the faces of Democratic leaders like Charles Schumer of New York seemed to indicate Lieberman doesn’t want to lose the chairmanship of his Homeland Security Committee, that polls showing a majority of Arkansans want a public option may sway Lincoln, and that Landrieu is not up for re-election until 2014.

This leaves Nelson of Nebraska. He’s up for re-election in 2012, but Fivethirtyeight.com says voters there oppose a public option 47-39. (Other polls disagree.)

So why the happy faces?

It might be the lesson Obama adviser David Axelrod draws from the loss by Creigh Deeds in Virginia (above). Failure to secure base Democrats makes you a loser, the thinking goes, and base Democrats are big supporters of a strong public option.

In a polarized nation strategic voting does not work. If people want conservatism there’s an app for that. Anyone in the middle of the road gets run over.

Here is what is most likely. Reid gets his 60 votes to start debate. Amendments are offered and the bill becomes more conservative to assure the 60 votes needed to end debate. Then it’s on to a House-Senate conference and my New Year’s Resolution is no more political posts here in 2010.

November 18th, 2009

Practice Fusion in PHR game

Posted by Dana Blankenhorn @ 11:36 am

Categories: Consumer Information, General, Home Health Care, Internet, Medical IT, Medical Office IT, Wellness

Tags: Game, Electronic Health Record, Personal Health Record, PracticeFusion, E-health, Healthcare, Dana Blankenhorn

Practice Fusion is a well-known SaaS vendor of electronic health record (EHR) software to doctors and hospitals, working inside the Salesforce.com cloud.

(Shown is part of the new product’s medications screen, from PracticeFusion.)

Their base product is ad-supported, so while larger vendors are hustling hospitals for multi-million dollar contracts, Practice Fusion is able to get small practices online for zero dollars. Priceless.

So it is natural Practice Fusion would get into the Personal Health Record (PHR) game.

The difference between an EHR and a PHR is that, while the EHR belongs to the doctor or hospital who creates it, the PHR belongs to you. Also, while disclosure of EHR data is subject to HIPAA rules, you control what is released from your PHR, and to whom.

So PracticeFusion is highlighting Salesforce’s annual Dreamforce conference this week with the announcement of PatientFusion.

It’s a PHR built and delivered on the same platform as the EHR offering. Multiplying the number of doctors using its service by their rough patient counts PracticeFusion says it is offering this service to 1 million people at launch.

Any PracticeFusion practice, which may be paying nothing for its service, can thus offer a PHR to their patients, who also pay nothing.  This is not as large a benefit as what Microsoft HealthVault and Google Health offer, but wait, there’s more.

Since the EHR and PHR are in the same cloud, populating your PHR, and managing the permissions needed to keep the data flowing, is easy. Security is also simplified, since once you order your EHR a bunch of data isn’t flowing between systems, but within a single cloud.

When PracticeFusion’s PR shop pitched this to me, they compared it with Kaiser Permanente’s EPIC-based system, myHealth Manager. One can argue that’s unfair, since Kaiser spent billions to build a scaled EHR-PHR system early in this decade, while PracticeFusion has been growing its smaller SaaS operation organically.

But if the feature sets are nearly identical, and the delivery mechanisms are similar, how different are they? Time will tell. As more people get PHRs we’re going to get into a feature war, with all vendors looking to connect a range of devices and analysis to their offerings.

Should be fun.

November 18th, 2009

Why electronic health records have far to go

Posted by Dana Blankenhorn @ 7:30 am

Categories: Finance, General, Government, Hospital IT, IT Management, Internet, Medical IT, Medical Office IT, Medical Records, Physician Information, U.S.

Tags: Electronic Health Record, Training, Health Internet, Moore, E-health, Healthcare, Dana Blankenhorn

It’s easy to seize on word that electronic health records (EHR) are not yet saving money and call everything the Obama Administration is doing in health care bogus.

That would be unfair to the technology.

Ashish Jha of the Harvard School of Public Health offered the report this week as a scene-setter for the school’s Public Health and Technology (PHAT) conference, whose speakers’ list is a who’s who of EHR advocates. (Picture from Dr. Ashish Jah’s home page at Harvard.)

Rather than being a hit piece at the current Administration’s aims, the report focuses on the best practices of groups like Kaiser Permanente and the Cleveland Clinic, which have spent years adapting their work to the technology. Do these things and you can make things work, as proven in areas like heart care, he writes.

Rather than focusing on paying for the computers and software, he says, emphasis should be placed on training people, and adapting practices to take advantage of what the data can do. As in any business a failure to adapt means you’re wasting money.

Dr. Jha made this point in the School of Public Health’s in-house publication last month. Speaking at a University-sponsored public forum in September, he said this:

The money in the stimulus bill is going to help a lot in terms of getting systems adopted. You’re going to see this entire field change dramatically in the next several years. You’re going to see new vendors getting into this field who haven’t been there before. I’m hopeful this will mean better products that will require less training. There’s no doubt in my mind that five years from now, we are going to have far more widespread use of electronic health records.

Whether we are going to get to 90% as President Obama has said he wants, I’m not sure. But the bottom line is that this train has left the station. We’re moving towards electronic records. The only question is whether we can do it well. The big challenge for us is to make sure we adopt these systems effectively, that we remember the prize is not electronic records; the prize is higher quality at lower cost. And that’s only going to happen if we really think through how to adopt these systems in a more organized and effective way.

Those are the words of an EHR enthusiast, not a skeptic, and certainly not a cynic.

Fact is the EHR revolution has barely begun. The Health Internet is still being implemented. Barely one hospital in 10 has a functioning EHR system. Moore’s Law of Training (there is no Moore’s Law of Training, we learn as fast as we learn) has barely kicked in.

The health IT revolution will not happen like the turning on of a light switch, as people in every other industry that has been touched by computers, including journalism, will tell you.

It’s a long-term process.

November 17th, 2009

Keep your genes to yourself after this weekend

Posted by Dana Blankenhorn @ 9:03 am

Categories: Curioisities, Ethics, General, Government, IT Management, Medical Records, U.S., genetics

Tags: Insurance Company, Health Care, Genetic Information Nondiscrimination Act, Family History, Insurance, Vertical Industries, Healthcare, Benefits, Business Operations, Corporate Insurance

The Genetic Information Nondiscrimination Act (GINA) goes into force this weekend, and the regulations will impact more than the mere collection of genomes.

The Act was passed last year and signed by then-President Bush.

It makes it illegal to base insurance eligibility or even rates on genetic data, including family histories. Some insurers had been giving discounts to people who completed family history questionnaires. No more.

Employers are already complaining. Some say common health risk assessments will no longer be legitimate. Some complain that wellness programs will be hurt.

Some employer groups and insurers wanted the law’s implementation delayed. Lawyers are already going ka-ching. People who don’t like lawyers are wringing their hands.

The American Medical Association has told its members that physicians should no longer participate with insurers on genetic testing, and even limit disclosures of genetic data to law enforcement.

Basically the new law puts your family history, including your genetic make-up, under requirements similar to those of HIPAA. Just as doctors can’t share your medical data with outsiders, they can’t share your family history either. This may require changes to Electronic Health Record (EHR) software, especially on the server side.

The New York Times says the law will have some unintended consequences. If a CEO’s father and grandfather died of heart attacks at age 50, and the board refuses to promote him to the top chair at age 49, he could have a tort.

Some data can still be collected. There’s a “water cooler” exception, so if you tell the boss about your mom’s breast cancer they can hear that. Or if they later read her obituary in the paper. Or if they ask why you took family leave and you say it’s because your dad has pancreatic cancer.

GINA may be impacting you right now, because many companies are engaged in “open enrollment programs” for next year’s health insurance. There are no longer discounts for giving the insurer data. Some analysts think the new law is America’s definitive statement that they don’t want insurers playing their present expansive role in the health care system.

As with everything, there are unintended consequences. Some baseball teams have used genetic tests to identify (and set the age for) players from Latin America. One basketball team refused to re-sign a player without a genetic test. Perhaps, as Roberto Duran once said, no mas.

One more thing. The blog Queerty notes that if they ever find the the “gay gene” employers can’t test for it, nor discriminate against you based on it. They’ll have to rely on finding your two tickets to “Gypsy”, or meeting your companion at the company picnic. (Hey, I love “Gypsy.”)

November 17th, 2009

The emergency room myth busted

Posted by Dana Blankenhorn @ 6:11 am

Categories: Curioisities, Ethics, General, Government, U.S.

Tags: Tort, Emergency Room, Insurance, Financial Planning, Business Operations, Corporate Insurance, Finance, Dana Blankenhorn

One of the more interesting aspects of watching the health reform debate evolve is looking closely at the arguments of reform opponents.

1. Tort reform, they shout. OK, want to federalize insurance torts? No way. Then how do you put tort reform into this bill?
2. Buy across states, they shout. OK, want to federalize insurance regulation? No way. Then how can you overrule state regulations?
3. Let the poor die. OK, but what about our being a Christian nation? Let charities take care of it. And when they’re inadequate, as they are?
4. The poor can go to emergency rooms.

It’s this last one that got the attention of Harvard Medical School researchers. So they combed through data from The National Trauma Data Bank, which has 2.7 million cases from over 900 trauma centers.

Guess what they found? As reported in the Archives of Surgery, uninsured people had higher risks of death, even adjusted for age, sex, type of injury, etc. In some cases, like operating rooms, they were nearly twice as likely to die as insured patients, from the same injuries.

Brent Eastman, newly-elected chair of the American College of Surgeons, which runs the journal in question, added a tut-tutting commentary, calling the findings disturbing.

Opponents of reform can hang their hats on this. One of the authors of the new study, Dr. Atul Gawande (above), is known to be very much in favor of health reform.

He authored the piece in The New Yorker describing why costs in McAllen, Texas are much, much higher than elsewhere in the state, pointing to conflicts of interests among doctors who own hospitals.

In Gawande’s latest article, for The New York Times, he got together “positive outliers,” people from cities whose results and costs are better than average. Just by copying their best practices, he writes, we could save $1,500 per Medicare patient, slow inflation to 3% per year, yet improve quality.

We now return you to your regularly scheduled trolling.

November 16th, 2009

Niacin best for raising good cholesterol

Posted by Dana Blankenhorn @ 5:42 am

Categories: Aging, Consumer Information, Drugs, Finance, General, Home Health Care, Medical Equipment, Research, Wellness

Tags: Cholesterol, Dana Blankenhorn

Want more of that good HDL cholesterol?

(Picture from Costco.com.)

Try a timed-release niacin, and be skeptical if your doctor gives the sales pitch for Zetia or Vytorin.

The authority for this is a study dubbed ARBITER-6, which was stopped suddenly this summer, with the study’s authors insisting safety had nothing to do with it.

It was a question of efficacy.

The results, described in the New England Journal of Medicine, make clear that niacin does better at the main job, keeping arteries open.

“The use of extended-release niacin causes a significant regression of carotid intima–media thickness when combined with a statin and that niacin is superior to ezetimibe.”

Ezetimibe is the generic name for the active ingredient in Zetia, while Vytorin combines the same drug with a generic statin, simvastatin.

This does not mean ezetimibe is worthless. It works. It just doesn’t work as well as niacin.

This has important implications for anyone who, like me, has a family history of hypertension and high cholesterol. But if you want to save some serious money, look further.

The ARBITER-6 study compared ezetimibe with Niaspan, a drug form of timed-release niacin. But you can get similar dosages, for a lot less, with a supplement containing the same stuff. I use something called Slo-Niacin.

On most insurance plans you’ll pay $10/month for a generic statin and $30/month for Niaspan, or $30 for Zetia, “saving” $10 by using Vytorin (which contains the statin).

But Costco offers 150 Slo-Niacins for about $10, so even if you double your dosage to 1 gram (as many doctors recommend, taking one in the morning and one at night to prevent flushing), that’s $14/month for simvastatin and niacin, or $30/month for Vytorin.

Last time I got checked out, my combination of simvastatin and 1 gram of SloNiacin per day was working like a champ. Total cholesterol under 150 and a ratio of bad to good that had my doctor putting exclamation marks on my chart.

The paragraphs above, combined with the results of ARBITER-6, represent the heart of comparative effectiveness, and the way we old-timers can interpret those results to stay healthy for less.

As health IT begins collecting hundreds of millions of health records over the next several years studies like this will become easier to do, and they will be more accurate, given the larger number of records being studied.

But this is bad news for drug-makers. You not only have to prove safety, not only prove that your drug does what it claims, not only prove you’re better than a placebo, but you now have to prove you’re better than alternatives before you’re going to get the big money.

Bad for drug companies, good for patients. That’s what comparative effectiveness studies are all about.

November 13th, 2009

I'm in a nanny state state of mind

Posted by Dana Blankenhorn @ 8:45 am

Categories: Consumer Information, Curioisities, General, Government, Home Health Care, Internet, U.S., Wellness, state government

Tags: State, Tobacco Company, Rates, Taxes, Free Trade, Financial Planning, Finance, Dana Blankenhorn

The headline is that the U.S. smoking rate has stalled at over 20%, but the news is those places that have the strongest “nanny state” policies against smoking and smokers are still making progress, while those that don’t are not.

In other words, the nanny state works.

The government broke out its numbers by age, race and education, as well as by state.

Rates are highest among native Americans (more than one-third), among those with limited education (nearly half of those with a Graduate Equivalency Diploma (GED) smoke), and in coal country (rates are highest in Kentucky and West Virginia).

Rates are lowest where elements of social control are strong (Utah leads at 11%), and where policies aggressively fight smoking (California is second at 14%). The rate in New York, where the state tax for each pack of cigarettes is now $2.75, dropped from 18.3% in 2007 to 16.8% in 2008.

Smoking is the leading cause of preventable death in the U.S., killing over 1,000 people each day, the CDC said, with 1 in 10 of those deaths being caused by second-hand smoke.

The real scandal, shown in the chart above, is that only 3% of the excise taxes and settlement dollars collected by states go to smoking cessation programs. While $24.9 billion is available, the states spend just $75 million. Tobacco companies spent $13 billion in advertising in 2006.

In other words, we’re being outgunned better than 13-1 even though we’re putting out twice as much money to fight smoking as the tobacco companies are laying out to keep it around. That’s Halliburton-like efficiency.

If you want to save money on health care, in other words, maybe you too need to get into a nanny state state of mind. Or just become a little more personally intolerant of having smokers around you, so you don’t wind up among the 100 non-smokers killed by cigarettes each day.

November 12th, 2009

Watch BPA get taken seriously now

Posted by Dana Blankenhorn @ 7:15 am

Categories: Curioisities, General, Research, Wellness

Tags: China, Exposure, Study, Industry, Worker, BPA, Strategy, Management, Dana Blankenhorn

The warnings about Bisphenol-A (BPA), which we began covering here some time ago, have mainly gone unheeded. (Picture from China’s Peoples Daily of a chemical explosion in Jilin, China.)

It’s hard to take the flexibility out of plastic. It’s hard to create something new in quantity. It might be expensive to spray something other than BPA into metal food cans. And then what about liability?

And what’s it hurting anyway? Mood and memory? Is it making you fat? Is it making girls mean?

Big deal.

How much you want to bet that changes now that China has discovered male workers exposed to BPA had a high incidence of erectile dysfunction.

The Chinese study, in the British journal Human Reproduction, leaves a lot of questions unanswered. Just how high was the exposure of these workers? Are exposures of American chemical industry workers comparable? What level of BPA exposure causes harm, and at what level of exposure do we find what types of harm?

There’s going to be a boom market in medical studies aimed at answering these questions.

BPA has been in common use for over 30 years. It’s probably in you right now, probably more of it than you think.

The chemical industry is going to fight any attempt to limit its use or (later) to take legal responsibility for the consequences. Here is how the American Chemistry Council has responded to the most recent news:

• The Chinese study has limited relevance to consumers.
• Last year’s study by Consumer Reports is inconsistent with what regulators say.
• Other studies have limitations and unclear conclusions.
• Exposure levels in baby bottles are very, very low.

Wash, rinse, repeat. And don’t forget to put out a Web site that claims to be unbiased but is in fact an industry front.

Asbestos makers could be isolated from the rest of the industry and allowed to run down. The makers of BPA are a who’s who of America’s chemical industry. Bayer, Dow, GE, Sunoco. BPA is part of the green energy push.

But if it’s going to make our little soldiers go limp, I’m sure we can find a way to get rid of it.

November 12th, 2009

What Intel wants in health care

Posted by Dana Blankenhorn @ 6:10 am

Categories: Aging, Assistive Technology, Gadgets, General, Home Health Care, Home Health Care Equipment, Medical Equipment, Rehabilitation

Tags: Health Care, Intel Corp., Venturebeat, Vertical Industries, Benefits, Healthcare, Sales Strategy, Human Resources, Sales, Dana Blankenhorn

Our Tom Foremski is shocked, shocked that Intel is launching a camera that reads.

What’s going on, he asks? Intel is terrible at consumer products. (Picture from Intel.)

But the Intel Digital Health Group is as serious as a heart attack, and the Intel Reader is part of it. The device is actually a specialized computer, combining a camera, optical character recognition, and a voice chip.

I have a stake in this, because my daughter is dyslexic and my mother blind. I appreciate the hard work that went into this. The $1,500 price tag is off-putting, but Moore’s Law tells me that in time it should come down.

And therein hangs our tale.

Intel produces what is now a commodity. It is the dominant supplier of chips but margins are thin. It needs higher margins to thrive.

Health care offers those higher margins. Health care and assistive technologies offer humongous margins because production runs are often small and sales channels thin. Venturebeat says the Intel Reader, for instance, will be going to CTL, Don Johnston, GTSI, Howard Technology Solutions and Human Ware.

None are exactly Best Buy. These are specialty resellers. Johnston, for instance, specializes in technology for dyslexic and autistic kids.

Still, these are growing markets. The Intel Health Guide, for instance, is aimed at the business of aging in place. There are 76 million of us baby boomers and we’re not getting any younger — ka-ching.

And let’s look again at the Reader. Products for the blind, for the autistic, and for the dyslexic are traditionally seen as separate markets. Here we have one product that addresses all of them. That means more sales which can drive down costs. In this business that’s an innovation.

So there is potential here for the perfect marketing storm. A company that can drive down costs enters a market with enormous margins. It can get fat on slimmer margins than those it finds in the market. As it drives down prices it expands the market — I might get that Reader for my daughter when it comes in at $400 (and in time it will).

This can truly be a win-win-win. The assistive technology and health care markets want lower prices, which Intel can deliver. Lower prices will expand the reach of things like aging in place technologies and readers for the dyslexic. Intel can build a highly-profitable business that in time delivers top line growth as well as bottom line growth.

Sure, there are specialty channels to figure out. Sure there are new marketing skills here Intel has not yet mastered. But price can cover that up while those skills are learned. This is the lesson Japanese and Chinese producers have been teaching us for decades.

And if they want to offer a review unit, I’ve got some good testers coming in for Christmas.