ZDNet Healthcare

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.

November 11th, 2009

Why not pay for what works?

Posted by Dana Blankenhorn @ 11:44 am

Categories: Drugs, Gadgets, General, Government, Home Health Care Equipment, Hospital Equipment, Insurance IT, Medical Equipment, Medical IT, Medical Office Equipment, Rehabilitation, U.S., state government

Tags: Patient, Health Care, McCaughey, Insurance, Financial Planning, Vertical Industries, Benefits, Healthcare, Business Operations, Corporate Insurance

In all the hullabaloo over health reform, Charles Silver and David Hyman write at The Health Care Blog, a key point of cost control has been lost.

Paying only for what works.

Silver and Hyman are law professors, not doctors. They point to a RAND Corp. study saying that “one-third or more of all procedures performed in the United States are of questionable benefit.” (The illustration is from the study.)

What happened to this simple idea?

The way to enforce it is through comparative effectiveness. Analyze data from millions of patients, develop best practices, and move physicians toward the most cost-effective solution.

This is what every other country does, regardless of how they pay for care. Formularies drive care, based on cost effectiveness. Anyone who wants to go outside what works had better have a good explanation. Often, going outside what works is simply forbidden, or patients are told to buy it with their own money.

Isn’t that how you set priorities? Why should governments or insurance companies act differently?

Unfortunately this was one of the first dominoes to fall in the debate. Reform opponents like Betsy McCaughey called this “getting between a patient and their doctor.”

This happened in conjunction with the debate over the Obama stimulus, and the subject was health IT. The purpose of the HITECH Act’s $19.2 billion in stimulus was to collect the data that would drive decisions on what to pay for.

McCaughey’s scare worked. Explicit promises were made not to use comparative effectiveness in any way to deny care, not to use evidence to decide what we should pay for.

The alternative to evidence is politics. Silver and Hyman note that millions of insurance dollars are spent annually on entirely non-medical treatments like Christian Science, but there’s more:

Lobbying from providers and supportive patients explains why many states already mandate coverage of elective services like in-vitro fertilization, massage therapy, and visits to athletic trainers. Concerns about the efficacy and cost-effectiveness of treatments are washed away by a stream of campaign contributions, and sad stories about patients who can only obtain the “necessary” services if the insurer will pay for them.

This is what is wrong with the present system. State regulation of insurance is based on politics, so your coverage includes any procedure that becomes politically powerful in your state. That’s why insurance costs are rising through the roof.

There is nothing wrong with paying for prayer but it’s not medicine, they write. There’s nothing wrong with in-vitro fertilization but it’s optional, not something everyone should have to cover.

Thus, by tossing away evidence as a way to rule-out certain coverages, you pay for a lot of stuff you don’t need.

Silver and Hyman wrote to argue against a politically-motivated individual mandate. Any mandate should be based on science, not politics, and by giving up on comparative effectiveness early in the process, it became impossible to set that standard, either through the federal government or through the states.

If this was Betsy McCaughey’s intent, she is fiendishly clever. Health care will remain a growth industry, because Americans will keep having to pay for stuff that doesn’t work, regardless of whether reform passes or fails.

November 11th, 2009

CCHIT going on almost as if nothing happened

Posted by Dana Blankenhorn @ 8:53 am

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

Tags: U.S. Department Of Health And Human Services, Electronic Health Record, Health Care, Standards, CCHIT, Blumenthal, E-health, Quality, Healthcare, Vertical Industries

One of the big controversies early this year was over the role CCHIT was playing, certifying vendors to sell Electronic Health Record (EHR) software.

CCHIT (Certification Commission for Health Information Technology) was formed in 2004 out of HIMSS (Healthcare Information and Management Systems Society), an industry group, and began certifying EHR systems in 2006. Until this year you entered the EHR market by first undergoing CCHIT certification.

Was their approach right, or was it too rigid? Was it really helping buyers, or just pointing them toward expensive solutions from members of the HIMSS industry group?

When we last left the story the good guys seemed to have won. The standards under which software will be approved for stimulus cash are functional, requiring meaningful use. They’re not programmatic. It’s not what the software does, but whether it’s used, and for what, that counts.

So what happened to CCHIT? They’re going along pretty much as before.

In an extended interview with Healthcare Informatics, CCHIT head Mark Leavitt (above) said the group has added a new Preliminary ARRA 2011 Certification to its suite of products.

“It doesn’t really matter” what the National Coordinator of Health IT, David Blumenthal, or his policy committee come up with, Leavitt told Anthony Guerra.  CCHIT’s “Get Certified” seminar in October drew an overflow crowd.

Blumenthal’s policy committee called its government standard “HHS certification.” Leavitt called the same set of criteria “Preliminary ARRA Certification” because the Department of Health and Human Services (HHS) may give it yet-another name, and because the rules on all this don’t go out until next month in any case.

Even after that there will be time for CCHIT and others to comment, and for those comments to be digested, before they are final. Then certifying authorities must be appointed, and CCHIT has applied to be one. Meanwhile hospitals and doctors are having to make decisions that may haunt them through their professional lifetimes.

In his interview, Leavitt called the ARRA rules “basic” and his own rules “comprehensive,” but in fact one is the government standard and the other CCHIT’s private one.

What has happened is that CCHIT has been forced to take a step back, from being the gatekeeper of market entry to being one of perhaps several groups looking to be certification authorities under the new rules.

This is not Leavitt’s spin on the matter:

We’ve heard from provider groups, we’ve heard from the specialties that the marketplace was not making adequate progress in making the products they needed with all the features they needed.

There’s more than just federal standards, there are other requirements they have as providers, such as supporting workflows and maintaining a legally adequate record. They really thought CCHIT was a way to have a community conversation and move the entire marketplace forward.

We’re not a gatekeeper. We’re a community conversation. The CCHIT “comprehensive” standards aren’t for the  “sophisticated CIO,” in Leavitt’s words, but for small hospitals, for small practices, the people who need help in making an informed choice.

Maybe, but these same customers also have the most constrained budgets, and fairly basic needs. Do they need something a private industry group has deemed meets “comprehensive” standards or not?

That is a question the market will have to decide. Will hospital administrators and practice managers insist on the comprehensive CCHIT-approved label, or will they accept any solution that brings them that sweet, sweet stimulus cash?

November 10th, 2009

What's up with the rabbit penis, doc?

Posted by Dana Blankenhorn @ 8:57 am

Categories: Consumer Information, Curioisities, General, Rehabilitation, Research

Tags: Technique, Organ, Rabbit, Productivity, Dana Blankenhorn

News that the Wake Forest Institute for Regenerative Medicine (yep, WFIRM) has successfully grown rabbit penises in a lab set off a media feeding frenzy.

These are fully-functioning organs. The rabbit recipients went at it like, well, rabbits.

But there is more to this story than meets the snark.

This is an important proof-of-concept test for Dr. Anthony Atala (right), the center’s director.

The concept is that cells from a reduced organ are sprayed onto a collagen matrix, then bathed with compounds that stimulate cell growth and left in kept in an environment that duplicates the temperature and chemical makeup of living tissue.

The success of the technique means Dr. Atala could also grow new noses, new ears, perhaps even new fingers that are fully compatible with, and in many cases nearly identical to, the originals. This is not a fancy “stem cell” technique but a more straightforward one with wide application.

The news comes just months after Dr. Atala formed an Alliance for Regenerative Medicine that not only includes other colleges like Stanford and Georgia Tech but corporations like Geron and Johnson & Johnson, along with venture capitalists like Kleiner Perkins.

The aim of the group is to maintain political support for research and for the technique itself, said Geron CEO Thomas Okarma in the group’s initial press release.

The apparent success of the technique may be the best advertisement of all.

Although we know what Jay Leno will say about it. “Does this mean Cher can finally become a grandmother?” Rimshot optional.

November 9th, 2009

Health reform now in Senate hands

Posted by Dana Blankenhorn @ 7:54 am

Categories: General, Government, U.S.

Tags: Bill, Democrat, Republican, Health Care, U.S. Senate, Cao, Vertical Industries, Benefits, Healthcare, Leadership

As expected, the House passed a version of health reform on Saturday, 220-215, with Louisiana Republican Anh “Joseph” Cao (right) joining the Democrats.

Cao was elected unexpectedly last year to replace the indicted William Jefferson, who was later convicted of bribery. His majority-black district is heavily Democratic, thus he was torn between loyalty to party and the desires of constituents.

He chose self-preservation while sitting between Republican leaders who were leaning on him to make their opposition unanimous, making his choice known after the 218 majority had been achieved.

Cao’s support was mostly symbolic. This is a Democratic bill, just as the Senate Finance Committee bill endorsed by Sen. Olympia Snowe of Maine is a Democratic bill. But any break in Republican unity is seen by Democrats as a big deal.

The bill passed by the House includes a public option, but prohibits any coverage for abortion, even within the proposed health exchange, when a patient is buying with a subsidy. This provision was added to the bill through an amendment by Rep. Bart Stupak of Michigan, who said conservative Democrats would not vote for the bill without it.

Cao, a Catholic and former seminarian, credited the Stupak Amendment with securing his vote.

All this goes to the Senate, which appears to lack the votes to beat a filibuster on a leadership bill containing the public option.

Majority Leader Harry Reid has indicated his body may not pass a bill until next year, after which both Houses will hold a conference to come up with a single bill both must then pass without amendment before the President can sign it.

So the show goes on.

November 6th, 2009

Canadians get a taste of American medical system with IMS Health buy

Posted by Dana Blankenhorn @ 7:28 am

Categories: Finance, General, Government, Medical Office IT, Payment Processing, Research, SaaS

Tags: IMS Health Inc., IBM IMS, CPP, CPP Investment, Sales Strategy, Sales Force Management, Personal Finance, Benefits, Payroll Solutions, Sales

You have likely never heard of IMS Health, but they’re a big deal in the current IT environment of American medicine.

IMS buys prescription records in bulk from big pharmacies, strips out the patient names but identifies the doctors, then tells drug companies of the doctors’ prescribing habits. This lets the drug companies target their sales efforts.

The picture at the right, taken from IMS’ current home page, illustrates the firm’s view of it. The little blue ball represents sales, and the nice lady has IMS knowledge to shoot it accurately.

Critics have their own view. New Hampshire sought successfully to stop IMS data collection in court, and the American Medical Association (AMA) runs a program through which doctors can opt-out.

Regardless of your view, it’s a data processing company that makes money. IMS earned $311 million on sales of $2.3 billion last year. This made it attractive, and a leveraged buy-out of the company was announced yesterday.

Which is where the Canadians come into the story. The main player here is TPG Capital, run by the renowned financier David Bonderman, but his partner in this deal is the CPP Investment Board.

CPP is the investment arm of the Canada Pension Plan, which you might compare with a privately-run Social Security system. CPP Investment seeks a return on the pension contributions of Canadians. The CPP collects the fees and pays the pensions.

Out of the CPP’s $116.6 billion in assets, private investments like this represent “just” $18.4 billion. But that’s enough money, and the law offers CPP Investment enough leeway, for it to get into some very interesting deals.

Like this one.

All of which means that Canadian pensions may be riding on the success of an American company performing computing feats that would be incomprehensible in their own country, which is a single-payer system run through the nation’s provinces.

November 6th, 2009

House due for its health reform vote tomorrow

Posted by Dana Blankenhorn @ 5:54 am

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

Tags: Protest, Democrat, Republican, Health Care, U.S. Senate, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

Defying a Republican Day of Rage on the Capitol steps, House Democrats said they will vote through a health reform bill, with a public option, on Saturday.

For history buffs, the protest came a little over 40 years after the left’s infamous Days of Rage, a series of protests against the Vietnam War that turned violent and tarred all liberals for a generation.

Yesterday’s event featured most of the House Republican leadership and signs comparing reform to Naziism, Maoism, and the Joker as played by the late Heath Ledger.

There was no violence, just a star turn by Minnesota Rep. Michele Bachmann (right, naturally), the tea party’s Janis Joplin, who performed a medley of her greatest rhetorical hits and basked in the love.

Keith Olbermann called the protest “an orgy of veiled threat,” but perhaps getting him riled was part of the point. (Snarks might say Bachmann took another little piece of Keith’s heart now, ba-bee.)

As the vote neared President Obama became more visible, appearing at the White House briefing room to tout endorsements of the House plan by the American Association of Retired Persons (AARP) and the American Medical Association (AMA).

For the bill to become a law, it must be merged with a yet to-be-passed Senate bill, then go through both Houses again. Opponents of reform in the Senate may have to depend on Sen. Joe Lieberman (CFL-Conn.), who as noted last week has said he would support a filibuster aimed at killing any proposal with a public option.

After a decade of Democrats watching Lieberman as Droopy Dog playing Hamlet (will he, won’t he, he din-nit) now Republicans can enjoy that thrill. Starting Monday he will have become their Obi-Wan Kenobi, their only hope.

Here is the smart takeaway on all this (as opposed to the smart-aleck takeaways above). Once whatever passes passes (or doesn’t) employers know the environment into which they’re putting a major portion of their budgets, and can firm decisions on whether to hire, or how much, next year.

The show has been fun, but it needs to close.

UPDATE: Maybe not tomorrow, maybe later. Like some old rock concerts I don’t remember.

November 5th, 2009

PriceDoc bringing price transparency to you

Posted by Dana Blankenhorn @ 11:45 am

Categories: Curioisities, General, Internet, Medical Office IT

Tags: Patient, Health Care, Price, PriceDoc, Patrick Bradley, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

Whenever I write about health care policy at ZDNet Healthcare one demand comes from readers loud-and-clear.

People want price transparency. They want to know what things cost. They want doctors to compete the way everyone else does.

That’s what PriceDoc is starting to offer, and it’s going national.

PriceDoc launched earlier this year, using Seattle as a test market. It’s now soliciting doctors nationwide to list their prices for $49/year$49/month, aiming to sign up 10,000 by the end of the year and then “turning on the spigot” with a little consumer advertising in 30 major markets.

NOTE ON CORRECTION: All doctors are listed free. The $49 fee covers their filing of profiles with credentials, descriptions of specific services, listing prices, and participating in special offers. The company is looking to reduce or eliminate the fee in the future.

Patrick Bradley is the CEO. “We can deliver new cash-paying patients. Physicians love cash-paying patients.”

While the focus in Washington is the health insurance market, expanding it or controlling its costs, Bradley says there is already a $200 billion cash market for health care. It’s not just the uninsured, but patients who may lack specific coverage for their teeth, their eyes, or for alternative treatments like chiropractic.

Buyers in this market want very much to know how much something will cost before they get it done. PriceDoc delivers.

In the PriceDoc model doctors sign up to show their qualifications and specialties, and are encouraged to post prices for common procedures.

Initial reaction from doctors was mixed. “Some are very big believers in transparency. Others are more reluctant to post prices. They want patients to call them. What we’re finding is those who are getting called for a price decide to post prices, knowing they’ll get more hits.” Play the game by the rules and you can win.

The current site is organized with folders, but Bradley has already seen the future and has a patent pending on a bidding system.

“You search out a provider, and if they have a posted price you can make a counter offer. That online negotiation and verification is covered in the patent.”

Even without direct bidding, PriceDoc has had one big impact on price. Bradley calls it the PriceDoc special price.

“We post those at the top of the page. It is a price for a procedure with a special condition. An orthodontist may post a special price for a specific time of day. You come in between 10-2 I’ll give you a better deal.” Airlines call this yield management.

So if you’re uninsured, or just not insured for a specific procedure or discipline you need (you want nice acupuncture, Mister?) you should soon be able to give PriceDoc a whirl.

And we’ll find out if the claim that transparency lowers prices is right.

November 5th, 2009

What the Google Privacy Dashboard can mean for health

Posted by Dana Blankenhorn @ 8:34 am

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

Tags: Google Inc., Privacy, Dashboard, Health Care, Personal Health Record, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

If you have checked out the Google Privacy Dashboard, you may not have noticed that it covers all Google products.

This includes Google Health, the company’s Personal Health Record (PHR).

The media focus here has been on what Google knows about you, and the oh noes that Google will use that data against you.

But with the Dashboard’s access to Google Health, it occurs there might be another use for it.

What if you could find out where all your health data is? What if you could learn just which doctors, which hospitals, which insurers have what types of electronic data on you?

Knowing what’s out there, and knowing the rules for releasing that data, you can have full control of your privacy as we move from paper records to electronic records.

Given the trend within health IT toward more open standards, and more standards generally, it should not be too hard to provide support for this capability within, say, the NHIN-Connect system, which the Administration now calls the Health Internet.

There are lots of ways for this to go down, but the most efficient might be for the Health Internet to support a spidering technology that lets service providers offer a full health dashboard to consumers. Where within the NHIN system are what types of data on you. Not the specific data, but who has stuff, which is information we should all be entitled to.

I’ll bet that would be an incredibly valuable service, because it’s something we don’t have right now. The availability of such a service might even drive consumer acceptance of the Health Internet itself.

Take my case, for instance. In addition to my regular doctor, I have an eye doctor, I’ve seen an orthopedist, I have an insurance company, and a guy who did my colonoscopy. I also have a pharmacist. All that data, in time, is supposed to feed my Personal Health Record, along with data I might create, like my workout data.

Knowing who has what puts me in charge. Computers can tell me that. This encourages me to embrace computers, and powers the movement toward PHRs.

Did I mention Google Health is a PHR?