November 24th, 2009

What open source can teach medical practice

Posted by Dana Blankenhorn @ 7:34 am

Categories: Consumer Information, Ethics, General, IT Management, Internet, Medical Office IT, Medical Records, Networking, Open Source, Research

Tags: Gender And Diversity, E-health, Open Source, Human Resources, Healthcare, Dana Blankenhorn

It is frustrating whenever personal medical questions become political questions.

This happens all the time. Example A, ripped from the headlines, is the kerfluffle over mammograms.

Women, doctors and politicians who hate having to go through the procedure are now screaming bloody murder over the non-existent “threat” to halt access to it.

Let’s go back to where this started. It was a population study, done on behalf of the U.S. Preventive Services Task Force,  which concluded that the risk of unnecessary treatment exceeds the risk of death from annual screenings for the disease.

It was a science paper, and it was complicated, couched in the words scientists use to describe their work with precision.

Every profession has its version of this language. Engineers do, lawyers do, even software developers do. Learning the language gives a journalist entree into these professional worlds, but it’s not an exercise most of us will, or should, go through.

Thus this study, like so many, was filtered through the lens of journalism. A flood of words failed to answer the questions women wanted answered

• What are the chances I will die from a late diagnosis?
• What are the chances I will suffer from over-diagnosis and over-treatment?

Calculate the threat to me so I can make a rational choice.

This is where technology comes into play. An Electronic Health Record (EHRs) can show you your own history, we can take your family history, we can analyze your genetic history, and we can estimate based on that.

If, that is, we have access to the larger pool of data. That’s our baseline. It’s what we need to compare your own data to before we can give you the answer you seek.

In scientific studies like this one we don’t have access. The data is locked away somewhere. Mass adoption of EHRs is going to unleash a firehose of data, and the question should occur, very soon, what to do with it.

I’m not talking here about your record. I’m talking about the gross data, this warehouse of numbers describing everyone’s condition, what is being done for us, and what the results are.

An open source attitude toward that data, within the realm of science and throughout the medical community, can help patients gain access to the benefits of that data and answer the question they ask — what should I do?

Unfortunately medicine, health IT, and medical data all suffer from a proprietary attitude born of paranoia, the fear that you may be identified in this data mountain, that your needle will appear in this haystack, and that giving everyone access to data means giving them access to you.

A database, stripped of personal information, consisting of millions of records, is safe for use by software code. The data, and the code, are what we need to provide real answers.

We are collecting the data. We need to unlock it. We are writing the code. We need to share it.

This is what open source can teach the practice of medicine.

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 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 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 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 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?

November 3rd, 2009

Kidneys do not like those chip and diet soda lunches

Posted by Dana Blankenhorn @ 7:11 am

Categories: Consumer Information, General, Research, Wellness

Tags: Correlation, Soda, Chip, Games, Corporate Communications, Semiconductors, Network Technology, Personal Technology, Marketing, Hardware

It’s hard to eat at your desk.

Chained to your computer by a job that must be done, the traditional snack of the programmer is some chips and a diet soda. It gets you through the day.

It may not get you through the night, however, and may hasten that long, long night to come.

Yes, we’re talking about your kidneys.

Julie Lin (right) of Brigham and Women’s in Boston looked at data in the famous Nurses Health Study, going through 3,000 records, collected over time, for evidence on kidney health, matching that data to the consumption of sodas and sodium.

Linn and Gary Curhan published two separate studies, one of which found a correlation between high sodium intake and kidney function decline (that’s the chips), the other of which found a correlation between artificial sweetener intake and kidney function loss (that’s the diet soda.)

There was no such correlation between regular sugar and kidney function (although there was a separate study from Colorado linking fructose and hypertension — modern American sodas are sweetened with high fructose corn syrup).

All this was offered at the annual Renal Week event in San Diego, run by the American Society of Nephrology.

There is a difference between the correlation found here and the headline “diet soda drinkers suffer kidney problems.” A correlation is not a certainty. And all they were studying were aging nurses. They weren’t studying male computer programmers who like Sarah Palin, or young video game players — it’s not a general population study.

But Lin and Curhan did account for extraneous factors within the study, like age, smoking, obesity, and heart disease, before coming to their conclusion.

I’d say take it with a grain of salt, but that might be bad for you.

October 29th, 2009

Diabetes can be kept at bay

Posted by Dana Blankenhorn @ 6:23 am

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

Tags: Diabetes, Dana Blankenhorn

Want to save billions of dollars on America’s health bill?

Cut the rate at which people come down with diabetes.

(The site from which this illustration was taken, at Doctorsecrets.com, has a great page on diabetes, explaining the cause, the symptoms, effects and treatment in plain English.)

Right now 24 million Americans have diabetes and another 57 million are in a “pre-diabetic” stage. The latter group’s risk can be cut in half, over 10 years, with self-discipline on diet and exercise, along with a generic drug called metformin.

The latest study, published in The Lancet’s Online First journal, was a follow-up to the Diabetes Prevention Program, an earlier study which showed diet and exercise reduced onset of the disease 34% over four years, and metformin cut it by 18%, compared with rates using a sugar pill.

In the follow-up people who had been on the placebo or metformin were offered the lifestyle program, since it was proven to have benefits.

While some media reports pushed the lifestyle angle exclusively, the study made clear that those who exercised and ate right but also took the drug maintained their weight loss, while those who made the changes without it gained some weight back.

On average, losing weight alone delayed the onset of diabetes by four years, drug therapy alone reduced it by two years. Those over 60 did even better with lifestyle changes than younger patients.

The American Diabetes Association maintains an online test to assess your risks of Type II diabetes.

While it is fun to say “it’s their fault,” meaning the patients (and it is to an extent), the refusal by society to treat a chronic condition like diabetes runs against medical ethics. It’s not going to happen.

Preventable deaths in the tens of millions to suit your ideology are not in the cards.

Prevention costs a lot less than treatment, and much of the savings expected from health reform is based on studies like this which prove that prevention works.

October 28th, 2009

The fight for medical cost transparency is coming online

Posted by Dana Blankenhorn @ 9:11 am

Categories: Consumer Information, Finance, General, Government, Insurance IT, Internet, state government

Tags: Ingenix Inc., Health Care, Vertical Industries, Benefits, Healthcare, Insurance, Human Resources, Business Operations, Corporate Insurance, Dana Blankenhorn

When conservatives criticize health reform one of the first things they suggest might work is greater transparency in health care costs.

Sites like Healthcarebluebook.com and Changehealthcare.com have been trying to offer this service for some time.

Procedures like MRIs, CT scans, colonoscopies, minor orthopedic surgeries and mammograms can all be shopped with these resources. You can also compare drug prices and learn what to do if a medical claim is denied.

Increased deductibles are giving more families a reason to consult these resources. But they are only a partial answer. Insurers control most costs through their repayment schedules.

This is where government action has proven necessary. But not national government action.

After Ingenix, a unit of UnitedHealthCare, was caught manipulating its repayment rates, New York Attorney General Andrew Cuomo won a settlement that includes a third-party estimate of what insurers should be paying.

That national database, to be called FAIR Health, will debut in about a year under a contract signed recently with Syracuse University and other state universities. The database will calculate “reasonable and customary” charges, based on location, eventually replacing Ingenix.

While Ingenix was used only within the industry, FAIR Health will be available to the public, so you can compare your own doctor’s charges to the market.

Reform and cost controls are a big problem with a lot of moving parts. Most experts agree broadly on what needs to be done. Comparative effectiveness is one tool. Price transparency is another. These are moving ahead regardless of what happens in Washington.