Healthy High Tech

Universal coverage is the phrase on everyone's lips (pro or con) when the subject of health care comes up. As Alan Katz points out in his most recent post on The Alan Katz Health Care Reform Blog, the cost of coverage is a highly important and and often overlooked aspect of this discussion.

Mr. Katz points out Carleen Hawn's article in Financial Week from September 2007 which is pertinent to this ongoing debate. In it Andrew Mekelburg, vice president of federal government relations at Verizon Communications, stresses the need for digital infrastructure:

“The key is that we start addressing the cost problems,” he said. “Our No. 1 priority at Verizon is pushing the government to pass health IT legislation. The health-care sector has not undergone all the business process changes that exist elsewhere in the economy. You can go anywhere in the world and get money from an ATM, but you can't go across town and get a document or an X-ray from your medical records.”

Indeed, there is a pressing need for health data to be digital and portable. It is the third of George Halvorson's Eight Developments that Make Health Care Reform Possible, many of which stress innovative use of information technology to reduce workload and increase efficiency while driving down costs.

The [insurance] industry set itself a major new and almost revolutionary goal in 2006 to achieve a functional ability on the part of all insurers and payers to electronically move data between payers in ways that closely resemble comparable data flows in the banking industry.

That is a data bonanza for health care. We are going from all data being held exclusively in inert and inaccessible separate paper medical records or in a myriad of fragmented electronic claims payment files that have different data standards and unusable provider ID codes to a new world of interchangeable electronic data and consistent, national provider ID codes. From a data perspective, that is revolutionary. It's a huge change.

A huge change that also works with market forces as well as reducing administrative costs.

"An IT solution is one way of putting more tools in the hands of consumers to make us better consumers of health care," said Mr. Mekelburg. "If we’re smarter about health care we’ll all save on costs."

SOURCE: "Cost of Health Care System Bugs Employers" 09/24/07
SOURCE: "Health Care Reform Now!: Excerpt"
photo courtesy of Gary J. Woods, used under this Creative Commons license

Microsoft Acquires Global Care Systems from Thailand

Microsoft has just purchased Global Care Solutions (GCS) of Thailand, a company known for its hospital administration software. GCS has been operating for years as a privately held company and works directly with the Bumrungrad International Hospital, a facility that is famed for the volume of multinational tourists it cares for.

Of the various articles about the acquisition I have found, only PC World magazine touches on the aspect most important for those interested in Electronic Medical Records (EMRs):

What makes GCS software special is the amount of specialized record keeping required by Bumrungrad. Doctors at the hospital see over 1.2 million patients each year, including 400,000 foreign patients from 190 countries, meaning varying language, insurance and billing data. Half of the 3,200 patients seen at Bumrungrad each day walk in without an appointment, yet GCS's scheduling software ensures patients wait an average of 17 minutes to see a doctor.

While the software is not in use outside of seven hospitals in the Asia-Pacific region, it is an interesting development and one that could well have ramifications stateside as the debate about Electronic Medical Records continues.

In the meantime the business relationship with Bumrungrad Hospital will continue as will attempts to further develop and refine the existing software solutions. Peter Neupert, vice president for the Health Solutions Group at Microsoft, seemed quite ready to embrace the research and development opportunities the merger represents.

"We now have a partner that's willing to experiment with us," said Neupert. He said future work will include software development as well as experimenting on how RFID (radio frequency identification) can improve hospital care.

Microsoft will focus GCS software sales on hospitals in emerging countries, said Neupert. The software fits well with emerging market hospital needs, requiring just a small investment in computer hardware, he said.

While the stated territory is the Asian Pacific, one must wonder what might evolve from this deal that would be useful here in the States? Any application robust enough to handle a plethora of languages, billing standards, and wide variety of insurance procedures bears watching. A seventeen minute wait for walk-ins to see a doctor? To most people in the U.S., that is quite simply unheard of.

SOURCE: "Microsoft Buys Thai Health Software Vendor" 10/29/07
photo courtesy of TerraPrints used under this Creative Commons license

Veto II: The Sequel?

On Thursday the U.S. House of Representatives passed a revised version of the SCHIP legislation that President Bush vetoed the last time it came through Congress. The final tally was 256-142, enough to pass but shy of the two thirds majority needed to override another veto. (Ten members of the California delegation did not vote due to the wildfires in their home districts.)

While the Democrats refuse to alter the scope of the proposed plan (covering 10 million children at a cost of $35 billion over five years), there are a number of alterations when compared to the previously vetoed attempt. Matt Canham at the Salt Lake Tribune enumerates some of the changes:

The latest bill would:

• Cap income eligibility at three times the poverty level or about $60,000 a year for a family of four. The old bill would allow the president to agree to waivers to cover those making more than that.


• Phase out the adults covered by CHIP in one year instead of two.


• Require the Social Security Administration to verify that all participants are citizens, bolstering provisions barring undocumented immigrants.


• Require the Government Accountability Office to create a report detailing the best ways to avoid "crowd out," where those with private insurance drop it in favor of this government program.

The White House and House Republicans were not impressed by the concessions, calling them "cosmetic."

Depending on how long it takes for this revised bill to negotiate the Senate it could be on the President's desk as early as next week. Several media sources report administration officials as saying President Bush is solidly opposed to the stiff increases in tobacco taxes which would fund the program. Most of these sources agree that a second veto is highly likely once this reaches the executive branch. If that occurs an override vote is likely to occur near November 16, the date on which temporary funding for the program expires.

Stay tuned.


SOURCE: "CHIP Revision Passes House" 10/26/07
photo courtesy of Superturtle on Flickr, used and remixed under this Creative Commons license. Image Remix by George Williams

Massachusetts Promotes Consumer-Driven Health Care on the Web

Comparison shopping, it's not just for the grocery store anymore! In Massachusetts a new website is being unveiled today (with a barrage of advertising) that provides consumer resources for making informed health care decisions.

The Boston Business Journal takes a look at this new online resource and the non-profit organization that launched it:

The non-profit Partnership for Healthcare Excellence on Thursday began an advertising campaign and is now actively promoting its Web site -- www.partnershipforhealthcare.org -- which links consumers to various sources for care and cost data.

"We want to build an 'on ramp' for consumer engagement in health care,'" Jim Conway, Partnership chairman, said in a statement. He's also the senior vice president of the Institute for Healthcare Improvement, a local think tank and Partnership member.

The Partnership initiative is one of many efforts to promote the "consumer-driven" health care movement, which would give consumers a greater voice in their health care choices in an effort to manage costs more efficiently. Such efforts have increased in recent years because health care costs have continued to rise at double-digit levels.

WBUR 90.9 FM, a Boston based public radio station, had Mr. Conway write a guest column for their website this morning. Here is a small sampling from it:

This is a new non-profit that includes more than 40 organizations - including the Massachusetts Health Care Quality and Cost Council, consumer associations, disease and advocacy organizations, doctors, nurses, hospitals, insurers, business groups, and labor....

By arming consumers with useful information such as how to take medications safely, choose a doctor or hospital, and prepare for doctor and hospital visits -- the Partnership gives them tools to improve the quality of their care. It will also be encouraging consumers to advocate for overall system change -- like supporting the wider use of e-prescribing and the rapid introduction of tools to help consumers manage their medications.

We all know the sad litany of statistics about medical errors. We also know that one of the strongest weapons we have in the fight for quality is the informed, empowered and engaged patient. Today, patients have a new ally in the fight for quality -- The Partnership for Healthcare Excellence.

It will be very interesting watching this develop over time. Informing prospective patients of the variations in health care quality they will face, before having to face them, could well be a good tool for helping market forces drive down health care costs. Only time will tell.

SOURCE: "Mass. Web Site to Promote Consumer-Driven Health Care" 10/25/07
SOURCE: "A New Ally for Patients -- The Partnership for Healthcare Excellence" 10/25/07
photo courtesy of George Williams, created for the "Health Care Reform Now!" Blog

Just The Facts, Please

Health care today is a massive issue. A quick glance at any news-oriented media (including this blog) will show the topic being addressed from every angle as a variety of facts, pseudo facts, and pure polemic fight for that all important mindshare -- yours.

The catchphrases and keywords of the discussion are bandied about everywhere: Hillary Care, socialized medicine, single payer plan, SCHIP, government insurance and many others. How is the average American to make any clear sense of this media barrage?

Thanks to the pioneering efforts of Annenberg Political Fact Check from the Annenberg Public Policy Center (APPC) of the University of Pennsylvania, we have a few options available today. A pioneer in presenting non-partisan fact checking online, the APPC accepts no funding from individuals, political campaigns, businesses, unions or lobbying organizations. It also boasts a large team of researchers and journalists to assist in cutting through the rhetoric.

PolitFact, a project from the St. Petersburg Times and Congressional Quarterly, and its "Truth-O-Meter," is another site which checks the veracity of campaign videos and candidates. Particularly useful when the health care issue comes up. It is always interesting to see the myriad ways in which the same numbers can be presented by different sides.

Then there is the new kid on the block: The Washington Post. In early September the Post launched its new Fact Checker feature, helmed by distinguished staff writer Michael Dobbs and research wizard Alice Crites, the backbone of the Post's investigative department for most of the last ten years. During that decade Crites has worked on three Pulitzer-winning series. Personally I like the fact they use "Pinocchios" to rate the magnitude of factual distortion.

Let's take a look at the Fact Checker this morning, where accusations of socialized medicine levied at Senator Hillary Clinton are dissected:

According to MIT economics professor Jonathan Gruber, who advised Romney on his health care reform law and has also advised Clinton, the Massachusetts law has a lot in common with the Clinton plan. Both plans mandate universal health care coverage and subsidize health care for people on low incomes. The main difference is that Clinton's proposal permits people to switch to a Medicare-type plan and increases taxes at higher income levels.

Contrary to claims by Romney and other Republicans, the Clinton plan does not force Americans to accept "government insurance." It offers people a choice. If they are happy with their present health plan, they can keep it. Otherwise, they can switch to the plans offered to members of Congress, or a government-run plan similar to Medicare.

The column goes into great detail providing quotes and sources, as well as detailing the lack thereof. It concludes with "The Pinocchio Test."

The claim that "Hillary care" is tantamount to "socialized medicine" does not stand up to serious examination. The Clinton health care plan has more in common with the Massachusetts plan signed into law by Governor Mitt Romney than the British National Health system. We award three Pinocchios to Romney.

I wonder if anyone will win the coveted "Geppetto Checkmark," the sign denoting a complete lack of factual distortion?

SOURCE: "'Hillary Care' and 'Socialized Medicine'" 10/24/07
photo courtesy of Marc Nozell, used under its Creative Commons license

Next Step in the Health Care Battle? Retreat!

Health Care and its Reform were the major subjects of a retreat for Republican governors and their staff Sunday in eastern Georgia.

The Republican Party has consistently been seen in the media as lacking innovation or imagination when it comes to health care reform. As reported here in a prior post, Karl Rove has publicly urged the G.O.P. to become bold on this subject, so it should come as no surprise that he was one of the featured speakers, along with former Speaker of the U.S. House of Representatives Newt Gingrich and former Governor of Georgia, Zell Miller.

Shannon McCaffrey, a writer for the Savannah Morning News, shares some of the details:

On the agenda were GOP initiatives to drive down health care costs through plans like health savings accounts, the portability of health care records and other free-market proposals designed to boost competition.

The specter of Democratic presidential candidate Hillary Rodham Clinton loomed large over the policy sessions as some members of the GOP fretted about the possibility of "Hillary care" if the U.S. senator from New York wins the White House in 2009. Clinton became known for her failed health care plan during her husband's administration and her campaign has put forward a plan to provide universal coverage.

"When Americans have no ideas and Democrats have bad ideas Americans will choose bad ideas because Americans will almost always choose something rather than nothing," said Bill McInturff, a Republican pollster.

McInturff allowed that health care is not an issue that "gets the blood pumping" in the Republican base.

The gathering was also used to "create a new face for the G.O.P." We now jump from Savannah to Ms. MacCaffrey's other article for the Associated Press:

The group's executive director, Nick Ayers, said that in the last election cycle Republicans were, by and large, focused on attacking their opponents rather than putting forth real ideas. The result was that the party lost control of Congress, he said.

"This is the beginning of the R[epublican] G[overnors] A[ssociation] pushing a theme that really good policy equals good politics," Ayers said.

Ayers said health care is probably the Republicans' weakest issue but added that innovation in the states is arising under the leadership of GOP governors.

It all points to a significant disconnect between Republicans in Washington and in the states, Ayers said.

"Republican governors are popular, but most people are basing their assumptions about the party on what's going in Washington," he said.

Dozens of association contributors from the health care and pharmaceutical industry showed up for a dinner Sunday night, where they mingled with top state officials over a fried chicken.

Rep. Bobby Jindal, who was elected Saturday as Louisiana's governor, will become the 23rd member of the Republican Governors Association. Staff from 17 states attended the retreat.

Stay tuned for more developments.

SOURCE: "GOP Talks Health Care at Georgia Conference" 10/22/07
SOURCE: "GOP Govs Discuss Health Care on Retreat" 10/22/07
photo courtesy of WhiskeyTangoFoxtrot on Flickr remixed and used under this Creative Commons license

Attempt to Overturn SCHIP Veto Goes Up In Smoke

President Bush's veto stands. After a long and acrimonious war of words the results are now in. Williams Neikirk, a senior correspondent for The Chicago Tribune recounts the closing round of the current congressional battle:

The measure fell 13 votes short of the two-thirds requirement to override the veto. The vote was 273-156, as 54 Republicans voted with Democrats to pass the bill, compared with 53 GOP members who voted for the bill when it first passed. Only two Democrats voted to sustain the veto compared with six who voted against the bill originally....

The bill killed Thursday would have cost an additional $35 billion over the next five years and made children's health-care insurance available to more middle-class families. The expansion would have been financed with a 61-cent-a-pack increase in the federal tobacco tax, raising the levy to $1 a pack.

John Godfrey of Dow Jones Newswire gives us some specifics about the tax on CNNMoney:

Companies that would have been affected include R.J. Reynolds Tobacco Co., a wholly owned operating subsidiary of Reynolds American Inc. (RAI); Philip Morris USA, a subsidiary of Altria Group (MO); and Carolina Group (CG), which is a unit of Loews Corp. (LTR).

The $35 billion raised by the tobacco tax increase over five years would have offset the cost of expanding the State Children's Health Insurance Program. The bill's supporters said that by 2012, the expansion would have allowed the program to cover nearly 10 million children.

House Speaker Nancy Pelosi, D-Calif., already has promised to have the same bill back on Bush's desk within two weeks. Asked whether the bill might include an alternative funding source, Pelosi said simply, "no."

Smoking and health, two subjects often found intertwined. It is interesting to note how little this aspect of the legislation has been touched upon over the last few weeks of constant media coverage. To some it is not only a very relevant concern, but also an emotionally charged issue.

Take the following excerpt from a letter to the Yale Daily News by Jose Abrego, a student in the Ezra Stiles College, as an example:

Consider the ramifications of raising the tax on tobacco by such a ridiculous rate. Nearly all of the tobacco farmers in my province in the Dominican Republic would have their contracts frozen. The same goes for other countries in Latin America.

What worries me about this whole issue is that the tax increase guaranteed that hundreds of thousands of farmers across Latin America would suddenly find themselves unemployed. For Third World nations that are already neck-deep in a sea of poverty, this bill promised to drown them outright. Why didn't any of the major news networks report on the number of jobs that Bush saved in Latin America? Or the number of children that will continue to eat because their parents are employed? Isn't the media's job to present the news to us impartially - or at least pretend to do so?

SOURCE: "House Fails to Foil Health-Care Veto: Defiant Democrats Vow Revised Bill" 10/19/07
SOURCE: "House Failure to Override Veto Good News for Tobacco" 10/18/07
SOURCE: "Letter: Media Ignores Benefits of Health Care Veto" 10/18/07
photo courtesy of SuperFantastic on Flickr, used under this Creative Commons license

System vs. System: Canada and the U.S.A.

In a new Op-Ed for the Healthcare Financial Management Association, George C. Halvorson analyses the differences between the U.S. and Canadian health care systems as well as their attendent costs.

Americans are increasingly asking why the United States is the only western industrialized country that has not managed to achieve universal healthcare coverage for all of its citizens. They also are wondering why we don't learn from our neighbors to the north and move the current Canadian universal coverage approach south. That's an interesting and important question.

[...]

Most people who know that Canada spends less money on health care believe that the cost difference is almost entirely due to the lower administrative costs that result from Canada using a “single-payer” insurance model. Is that true? No.

The truth is that Canada now spends about $2,600 per resident per year less than we spend on healthcare costs in the United States because-very simply-Canadians spend less money on the actual purchase of care.

What follows is a lucid and detailed analysis of the various contributing factors including, but not limited to:

• The Canadian Pricing Model


• Prescription Drug Coverage


• Adminstrative Costs

There is much talk of the Canadian health care system in the media as more and more Americans are drawn to the health care reform debate. This article is a wonderful source of hard numbers for anyone who is interested in the Canadian aspect of the discussion.

SOURCE: "Understanding the Trade-Offs of the Canadian Health System" 10/17/07
photo courtesy of striatic on Flickr under its Creative Commons license

When Johnny Comes Marching Home

After the Walter Reed Hospital scandal earlier this year President Bush created a bipartisan commission which determined that the treatment of our wounded veterans needed "fundamental change."

Tuesday President Bush sent legislation to Capitol Hill and began pushing Congress to help update the current system.

Deb Reiechmann reports for the Associated Press:

"Medical advances have enabled battlefield medics and hospitals to provide our wounded warriors with care that would have been unimaginable just a decade ago," Bush said, standing in the Rose Garden with wounded troops, including two that rode in on Segways.

"Yet our system for managing this care has fallen behind. It's an old system. It's an antiquated system. It's an outdated system that needs to be changed."

According to the President his legislation is focused on streamlining both the evaluation and compensation processes. There are many elements to the plan, some of which will be directly implemented by the administration, some of which require congressional approval.

James Gerstenzang, a staff writer for the Los Angeles Times describes some of the fine print in the President's appraoch:

The White House also said that the Veterans Affairs department would establish "recovery coordinator" positions -- patient advocates assigned to oversee the management of individual veterans' care, help them handle paperwork and other requirements of the federal bureaucracy, and ease their transition to civilian life. Creation of such a position was a key recommendation of the commission.

In legislation being sent to Congress, the administration would replace Pentagon disability payments with pensions, beginning with Iraq and Afghanistan war veterans. Additional payments would be awarded to cover the losses of potential earnings and quality of life as a result of service-related injuries.

Veterans would be reassessed every three years, and the rating system would be adjusted to reflect "modern concepts of medicine and disability," the White House said, describing the plan.

Bush said the new plan would move away from the current practice of wounded troops often undergoing two examinations -- by the Pentagon and by Veterans Affairs -- and filling out two sets of paperwork.

It will be interesting to see how the U.S. Congress responds.

SOURCE: "Bush Asks Congress to Help Fix VA System" 10/17/07
SOURCE: "Bush Unveils Plan For Wounded Troops" 10/17/07
photo courtesy of The Army's Soldiers Media Center on Flickr under this Creative Commons license

SCHIP, The Frosts and Catholics United

October 18 is fast approaching. On that day, once the Senate votes are counted, we will know whether or not the President's veto of SCHIP will stand. As is hardly shocking, the rhetoric and campaigning will continue to escalate between now and then.

A quick sampling unearths the following news items related to this piece of legislation.

As noted in one of my recent posts, the conservative blogosphere has been in attack mode ever since the airing of Graeme Frost's pro-SCHIP radio address. As The Wall Street Journal notes, this approach seems to have backfired:

That narrative was bolstered this week by some conservative bloggers. After the Schip veto, Democrats chose a 12-year-old boy named Graeme Frost to deliver a two-minute rebuttal. While that was a political stunt, the Washington habit of employing "poster children" is hardly new. But the Internet mob leapt to some dubious conclusions and claimed the Frost kids shouldn't have been on Schip in the first place.

As it turns out, they belonged to just the sort of family that a modest Schip is supposed to help. One lesson from this meltdown is the limit of argument by anecdote. The larger point concerns policy assumptions. Everyone concedes it is hard for some lower-income families like the Frosts to find affordable private health coverage. The debate is over what the government should do about it.

Sheila Suess Kennnedy, associate professor of law and public policy at the Indiana University School of Public and Environmental Affairs in Indianapolis, corrects the President's facts in the Indianapolis Star:

We can discount the inartful and downright inaccurate descriptions of the bill coming from the White House. In a press conference, Bush complained that the bill wasn't really focused on the poor -- that it would cover children whose families earned up to $83,000 a year. Several senators, including Charles Grassley, a Republican sponsor of the legislation, were quick to correct him.

The bill maintains current law, and limits the program to children whose families earn up to twice the federal poverty level. That would be $41,300 for a family of four.

Daily Kos also notes an unexpected twist to the debate as a segment of the pro-life movement gets involved in supporting the progressive stance:

Catholics United will launch a radio advertising campaign targeting ten members of Congress whose opposition to the State Children's Health Insurance Program (SCHIP) have compromised their pro-life voting records.

The ads, which feature a mother urging her Congressional Representative to support SCHIP, will primarily air on Christian and talk radio stations from Monday Oct. 15 to Wednesday, Oct. 17 as Congress approaches a critical Oct. 18 vote to override President Bush's veto of bipartisan SCHIP legislation.

[...]

The script for the radio commercial reads: "I'm the mother of three children, and I'm pro-life. I believe that protecting the lives our children must be our nation's number one moral priority. That's why I'm concerned that Congressman X says he's pro-life but votes against health care for poor children. That's not pro-life. That's not pro-family. Tell Congressman X to vote for health care for children. Call him today at XXXX, that's XXXXX."

We will try to keep you informed on the latest news on this subject between now and the October 18 vote.

SOURCE: "SCHIP Howlers" 10/13/07
SOURCE: "Veto Sends Message About Priorities" 10/15/07
SOURCE: "SCHIP Stories: Republican's Getting Grief From All Angles" 10/11/07
photo courtesy of Tony Wan Kenobi on Flickr under this Creative Commons license

Taking The Pulse: A Political Check Up

It has become an axiom that health care in the United States needs a drastic overhaul, hence this blog (among many others) and its companion, George C. Halvorson's book, Health Care Reform Now!. According to surveys, health care reform is one issue that unites the vast majority of Americans regardless of ideology. How to implement that needed reform remains a major point of contention .

As we end this week on the Health Care Reform Now! blog, it occurs to me that our readers might appreciate some resources for comparing the various politicians and Presidential candidates on the issue of our health care system.

First of all, the New York Times offers up their "Presidential Candidates on Health Care" page where all the candidates are presented with both their proposal to expand coverage and how they intend to pay for it. Very nicely laid out and accessible, the content here is presented in the candidate's own words with links back to the debates and news articles from which they were drawn.

Farhana Hossain, a New York Times blogger, sums up the page nicely in its introduction:

Presidential candidates in both parties are promising to overhaul the nation's health care system and cover more - if not all - of the nation's uninsured. In 2005, 44.8 million people - 15.3 percent of the population - were without health insurance, according to estimates released by the Census Bureau in March. The leading Democrats are competing among themselves over who has the better plan to control costs and approach universal coverage. The Republicans, for the most part, are promising to expand coverage without increasing the role of the federal government, and reduce cost through tax incentives. Most of the candidates have not presented a detailed outline of their health care plans, but here is what they have said so far.

Another useful page for comparing our leaders on the subject is located at On The Issues, a site that attempts to track "every political leader on every issue." Their Health Care page contains a wealth of information delivered in simple bullet pointed lists. What makes this a very different resource from the New York Times page is the fact that it does not solely focus on Presidential hopefuls, instead trying to track the position and records of everyone currently in office.

To give a brief example, let us look at a name that has been far from the spotlight recently, Newt Gingrich. Here is the text of his entry on the Health Care page:

Newt Gingrich on Health Care

Former Republican Representative (GA-6) and Speaker of the House

Click here for 6 full quotes by Newt Gingrich OR click here for Newt Gingrich on other issues.

• Medicare opt-in to private health savings accounts. (Dec 2006)


• Focus 21st Century Intelligent Health System on individuals. (Dec 2006)


• Market competition yields more health choice at lower prices. (Dec 2006)


• Save dollars and save lives--so transform urgently. (Sep 2003)


• Focus on prevention; would save $14B with diabetes. (Jul 1998)


• Ongoing battle against liberals nationalizing healthcare. (Jul 1998)

The modern voter has a plethora of new tools available with which to inform him/herself, aggregate information pages like these being a terrific example. With a subject as important as health care reform, having all the data can be crucial to making a correct decision.

SOURCE: "The Presidential Candidates on Health Care" ONGOING UPDATES
SOURCE: "Health Care" ONGOING UPDATES
photo courtesy of b-may on Flickr, used under its Creative Commons license

Suffer The Children, Even if They Have Insurance

A staggering new report was released this morning that puts a whole new spin on the subject of children's health care. Nine million children across the country lack health insurance. We have seen those numbers repeatedly in recent news, but are the children with coverage truly taken care of? This report's shocking findings say no, and go on to state that less than half of them are.

The Seattle Times spoke with the study's prime mover:

"I was very surprised - and very distressed - about our results," said Dr. Rita Mangione-Smith, the study's lead author and a researcher at Seattle Children's Hospital Research Institute and associate professor of pediatrics at the University of Washington School of Medicine.

"There are a lot of failures there. And on very basic things that people agree we should be doing."

The nonprofit RAND Corp. contributed to the research, which is published in the New England Journal of Medicine. It was funded by the Centers for Medicare & Medicaid Services, the Robert Wood Johnson Foundation and the California HealthCare Foundation.

The records showed that children got the proper care only 46.5 percent of the time. It relied on records collected between 1998 and 2000 of 1,536 children in urban areas who had actually seen doctors, and for whom researchers were able to obtain one or more medical records.

Experts said it is unlikely that care has improved significantly since then, except for some improvements in immunization rates and asthma care. And almost all the children in this study were insured.

While debate continues over the uninsured youth of America, this study shakes some of the perceived axioms of that discussion. It is tacitly assumed that getting all of our country's children coverage is the answer, but what then? If only half of them get proper care once insured then there seems an even longer path ahead than previously thought.

ABC News zeroed in on the demographic slant:

"We had primarily white children with insurance from middle- to upper-middle income families," said Mangione-Smith. "This is probably a best-case scenario; this is as good as it's going to get."

More than half of children studied failed to receive the care they needed. More than half in a study that had few uninsured, minority, or rural children. So basically of those children who have the best health care protection, the batting average is less than 50%. Dr. Paul Wise, a Stanford University pediatrician and health policy researcher who was not directly involved with the study, finds the results disturbing. "The quality indicators are just so awful that even if they're off by a considerable extent, they still hold up," Wise told the San Jose Mercury News. "The findings suggest that the quality of health care for children is pretty pathetic."

BusinessWeek gives us some more statistics from the report:

Some of the more startling discoveries:

• Sixty-nine percent of 3- to 6-year-olds did not have their height and weight measured at annual checkups, and only 15% of adolescents were weighed and measured, even though one-third of American children are overweight or obese.


• Fifty-four percent of children diagnosed with asthma did not get recommended treatment.


• Sixty-two percent of children were not screened for anemia in the first two years of life, although the test is recommended for all babies.


• Only 38% of children received the proper care for acute diarrhea, one of the main causes of hospitalizations in children under age 5.

As additional information is revealed, the dialogue on children's health care and insurance reform gains more and more urgency.

SOURCE: "Health Care For Kids Falling Short" 10/11/07
SOURCE: "'Stunning' Deficiencies in Kids' Health Care" 10/11/07
SOURCE: "Health Care for US Kids Falls Short" 10/11/07
photo courtesy of ninjapoodles on Flickr under the Creative Commons license

Politics Over Productivity

Children's health care is a subject we cannot get away from, especially recently. The SCHIP legislation and President Bush's veto are impossible to escape when one surveys the morning news. Vitriol pours from both sides of the issue as thick and bitter as service station coffee.

As one digs through the multitude of vituperative articles, blog posts, and paid propaganda, it becomes more and more apparent that most of the discussion is politics rather than objective analysis. The Democrats are now experiencing the backlash from their recent radio campaign. In that campaign, Graeme Frost, age 12, made a radio address asking President Bush to sign off on the SCHIP legislation on the grounds that he and his siblings would not have received hospital care after their auto accident without it.

From the Baltimore Sun

But while the Frosts were helping a bipartisan majority in Congress sell a plan to expand the program, they were not prepared for comments such as this one, posted over the weekend on the conservative Web site Redstate:

"If federal funds were required [they] could die for all I care. Let the parents get second jobs, let their state foot the bill or let them seek help from private charities. ... I would hire a team of PIs and find out exactly how much there parents made and where they spent every nickel. Then I'd do everything possible to destroy their lives with that info."

The arguments continue, as chronicled in the Baltimore Sun, over the state of the Frost family's finances and their reliance on SCHIP. Rush Limbaugh discussed the family's assets and financial status on his show last Monday, while conservative blogger Michelle Malkin posted about visiting the family's business and driving by their home.

Quotes such as this one (again from Redstate) seem par for the course:

"Hang 'em. Publicly," the contributor wrote. "Let 'em twist in the wind and be eaten by ravens. Then maybe the bunch of socialist patsies will think twice."

You do not have to be an advocate of public hangings or destroying lives to make your point. The Atlanta Journal-Constitution is a fine example:

Are the Democrats grandstanding? Are they playing politics with a critical issue? Of course, they are. When don't politicians play politics? But at least they're blanketing the airwaves and blitzing the phone lines with an issue that matters — health care for children of working families.

It's a little vexing to listen to ultraconservative Republicans berate Democrats for trying to score political points. For the past several years, the GOP has made a fine art of scoring points over issues both petty and private: for example, the overblown travel office "scandal" during the Clinton years; for another, the intrusion into the difficult decisions faced by the family of Terri Schiavo. They've exploited flag-burning, same-sex marriage and religious faith, all to gain political advantage. It seems a bit churlish for them to complain when the tables are turned.

And so the debate rages on.

SOURCE: "Frost Family Draws Ire of Conservatives" 10/10/07
SOURCE: "Democrats Politicking for Good Reason: Peach Care" 10/10/07
photo courtesy of Graniers on Flickr, used under this Creative Commons license

HealthVault: Holy Grail or Pandora's Box?

How many aspects of your life do you handle online? Do you buy books from Amazon? Do you bid or sell on eBay? Do you check your bank balance in a browser? How about your investments? Do you communicate by email more often than you write physical letters? Most modern Americans do at least one or two of these things on a regular basis. Now consider this, when was the last times you looked at your prescriptions, X-Rays, or health records online?

The advantages and cost savings of EMRs are consistently touted, both on this blog and in many other places. The recent unveiling of Microsoft's HealthVault makes it seem a viable EMR option is looming on the horizon. While at first glance this is a good thing there are many who seem uneasy about it. Robert Langreth, Senior Editor for Forbes, is one of them:

Microsoft, the company whose personal computer software is regularly attacked by hackers, the company reprimanded by governments for its aggressive monopolistic behavior?

While the aknowledged leader in the field of computing, Microsoft's history does lend itself to some unsease when considering privacy concerns (Win XP, Service Pack 2 anyone?). Langreth's interview with Peter Neupert, Microsoft VP in charge of development for their health group, is an interesting one as Langreth tries to counter that perception.

Microsoft argues that HealthVault can avoid the countless security problems that have afflicted its operating systems. "It's an apples and oranges comparison," he [Langreth] asserts. "It's a lot easier for us to manage a service for reliability, security and privacy than it is to manage hundreds of millions of distributed personal computers." Microsoft is working with two hacker organizations to test the security of its system.

Although HealthVault will be free for consumers, this is no philanthropic effort. Microsoft hopes HealthVault will translate into more search revenues through targeted health-related ads. The site includes an improved online search that uses a machine-learning algorithm to help consumers search through articles on health issues by breaking broad topics into concrete subcategories.

"By providing a great health search experience, we will actually improve the search loyalty of Microsoft overall," says Sean Nolan, the Microsoft programmer who designed the site. He admits though that moving into the medical record arena "is a huge crazy challenge." Among other issues, Microsoft will have to tiptoe the line between assuring people their information is private -- and serving up advertisements relevant to the health problems they have.

Walking that line might be easier than suspected. The success of numerous social networking sites, as well as online products such as the Google suite of applications show that while this is a concern it seems a rapidly diminishing one. People everywhere are getting used to seeing keyed text ads in the margins of their Gmail / Hotmail / Yahoo mail, getting reccommendations from eBay and Amazon when shopping, and generally having their data not only stored on the net but also implemented for promotional means.

Is this good? Is this bad? Will the public embrace or revile it? Only time will tell.

It is, after all, "a huge crazy challenge."

SOURCE: "Who Are You Going To Trust?" 10/08/07
Photo courtesy of: Library of Congress via pingnews.

Digital Medicine

While the pros and cons of SCHIP dominate the news and the blogosphere, a quiet little press release snuck onto the web this morning offering news of advances in the field of electronic medical records (EMRs).

CNNMoney reprints the original Siemens press release:

Siemens Medical Solutions is fulfilling the demand for a workflow-oriented, patient-centric approach to healthcare with its Enterprise Document Management (EDM) and Soarian(R) Healthcare Information Management (HIM) solutions, which are helping healthcare institutions enhance patient care, improve patient safety initiatives, and reduce healthcare costs.

Why would this drive the costs of health care down?

Accessible from any location, EDM and Soarian HIM coordinate processes within and between departments, as well as tasks between users. With their Web-based intuitive user interfaces, the solutions host concurrent and multi- user access, helping to eliminate multiple trips by clinicians and patient financial services staff to the HIM department to access patient data. When patient charts are virtual, costs and time associated with chart storage and retrieval are reduced. Many EDM and Soarian HIM customers are seeing positive outcomes as a result of use at their facilities.

So....

Transparent and portable medical information, eh? Good idea, sounds familiar. According to the release the implementation of these digital sstems has driven down costs while improving efficiency and accessibility. Photocopying costs are a good example. The cost of making copies of medical records was reduced by $100,000 annually for CaroMont Health of North Carolina. and $45,000 for the Mountain States Health Alliance after the implementation of HIM solutions.

The release presents some specific examples on a case by case basis:

CaroMont Health has reduced the number of record requests by 30 percent, its record analysis by 50 percent, its medical records delinquency rate by 84 percent, unbilled accounts receivables by 50 percent and photocopying costs by $100,000 annually.

You can rest assured that we will be returning to this story when there is more to report.


SOURCE: "
Siemens Soarian Health Information Management is Widely Adopted by Leading Healthcare Institutions in 2007: Leading Healthcare Institutions Embrace Technology That Enables Free Flow of Patient Documentation Throughout the Enterprise
" 10/08/07
Image by George Williams

Microsoft Trumps Google with Online Health Service

Microsoft has beaten Google to the punch on offering an online health records solution.

Both companies have been developing online systems for Electronic Medical Records (EMRs) for quite some time now. A prototype of Google Health was shown to health professionals and advisors in August of this year, but has yet to launch and may be experiencing difficulties after having recently lost its leader Adam Bosworth.

While Google Health remains in limbo, Microsoft's HealthVault, announced in Washington yesterday, is now online and includes an impressive array of partners, as pointed out by the New York Times:

The organizations that have signed up for HealthVault projects with Microsoft include the American Heart Association, Johnson & Johnson LifeScan, New York-Presbyterian Hospital, the Mayo Clinic and MedStar Health, a network of seven hospitals in the Baltimore-Washington region. The partner strategy is a page from Microsoft's old playbook. Convincing other companies to build upon its technology, and then helping them do it, was a major reason Windows became the dominant personal computer operating system.

The service is free to consumers and revenue will be generated by search driven advertising, something ubiquitous in Google's online applications such as Gmail.

Information Week compares this to other efforts :

Microsoft's consumer-centric model for PHRs differs from the approach others are taking, especially employer-sponsored PHRs, like Dossia, a consortium of employers including Intel and Wal-Mart, which is building a PHR system for its workers.

Although Dossia says its employer members will not have access to workers health data, in the larger picture, trust and privacy questions are issues that hinder consumer confidence in electronic medical records systems overall, including PHRs offered by health plans and insurers.

However, with the consumer being the controller of data in HealthVault, users may be more accepting, said Deborah Peel, founder of privacy advocacy group, the Patient Privacy Right Foundation, who was a speaker at the HealthVault event.

CRN reminds us of prior Microsoft attempts using this consumer driven model:

Whether consumers will trust Microsoft to manage sensitive health information is an open question. Microsoft takes pains in HealthVault's terms of service to specify that it will not use any information stored at the site for commercial purposes or release it to any outside parties without explicit permission. However, customer concerns about giving Microsoft access to a treasure trove of personal data killed off Microsoft's Hailstorm project five years ago, which aimed to aggregate users' financial and other personal details in one Microsoft-owned repository.

SOURCE: "Microsoft Rolls Out Personal Health Records" 10/04/07
SOURCE: "Microsoft Unveils Free Web Health Tools for Consumers" 10/04/07
SOURCE: "Microsoft Beats Google To Consumer Health Market" 10/04/07
photo courtesy of Orangeacid using this Creative Commons license

The Veto Heard Round The World

President George W. Bush on Wednesday issued his expected veto of $35 Billion in children's health care funding. In short order the commentary and criticism of this move have rippled through not only our own national news, but across the the global media as well. Here is a quick World Tour of reactions to this fourth veto of President Bush's career:

The first stop on our world tour is Korea, where we pick up a copy of The Korea Times and read about the SCHIP legislation:

The bill has problems. It is expensive, $35 billion over five years; the use of a cigarette tax to finance it is questionable; and it may indeed cover some families who could afford private insurance.

But it is not, as some overheated opponents charge, socialized medicine or anything like it. Some Republicans charge that SCHIP is the first step toward "HillaryCare," but even if that were in the back of the Democratic candidate's mind, it would be beside the point.

Then we head over to nearby China to see what The Xinhua News Agency has to say:

The veto of Bush was seen by analysts as a high-risk gamble that might impair his party's efforts to compete with democrats for the next presidency and the dominance in Congress.

Lets shift perspective to Western Europe, how are they viewing this? A quick glance at The Economist (UK Edition) unearths the following:

Up with children, down with smokers: it was, in other words, an easy sell. But Mr Bush balked for several reasons. He said that expansion would mean shifting the programme's focus away from poor children. Better off parents might be tempted to drop their private coverage in lieu of the government option, nudging the country down the dangerous road to nationalised care. Mr Bush objected to the tax increase. And although this White House is not known for fiscal restraint, it thought the expansion would cost too much. Mr Bush had previously said that a $5 billion spending increase would be about right.

Getting a bit closer to home we find the Dominican Republic rejoicing at the veto. Why? As Dominican Today reports, it has saved their industry:

Tobacco farmers of the country's north region (Cibao) yesterday heard with joy the news that U.S. president George Bush's vetoed a bill passed by Congress, which threatened to decimate the Dominican and Central American tobacco industries.

The president of the Cibao Tobacco Harvesters Federation, Jorge Mercado, said the U.S. president's decision would reactivate the north zone's tobacco industry, mainly in Santiago province. "The veto of the law represents hope and relief for more than 300 harvesters in this region who have lived off the production of tobacco for centuries."

Agriculture minister Salvador Jiménez, quoted by the newspaper Diario Libre, said if the bill had been signed into law the country would've lost some 54,000 jobs.

Stay tuned.

SOURCE: "Veto of Child Health Bill" 10/04/07
SOURCE: "Bipartisan Tension Tightens as Bush Vetoes Program" 10/04/07
SOURCE: "Why Did George Bush Veto a Popular Health Care Bill?" 10/04/07
SOURCE: "Bush Veto Saves The Dominican Tobacco Industry" 10/04/07
photo courtesy of Bluedharma used under this Creative Commons license

Lilly CEO Calls for Reform and EMRs

While the health care reform community is focused on President George W. Bush’s imminent veto of the children's health insurance bill, a major announcement about Electronic Medical Records (EMRs) has evaded the spotlight.

Sidney Taurel, CEO of pharmaceutical giant Eli Lilly put forth a call for development of a health information technology system. His proposed system would be a collaborative effort of both public and private sectors and would involve the U.S. government, the health care industry and the medical community as active participants.

The aim is tracking both actual effectiveness and side effects of drugs that have been released into the market. This "real world" data will enhance the safety profile of drugs first established through standard drug trials.

CNNMoney reports on Taurel's address at the Cleveland Clinic:

Although traditional drug trials will continue to test new hypotheses about medicines after they have reached the market, Taurel outlined how a well-functioning health IT system could serve not only to frame hypotheses for so-called "Phase IV" clinical research, but also become the practical equivalent of massive, real-world trials. Such a system would collect detailed data from day-to-day medical practices and feed insights quickly, seamlessly and at a lower cost to doctors, regulators, and drug manufacturers. The result would be a more accurate picture of a drug's safety and efficacy than exists today.

Once again we see the importance of developing portable, transparent records as Kaiser-Permanente CEO George Halvorson outlines in his book, Health Care Reform Now!

The CNNMoney article goes on to describe the current collaboration along these lines:

Taurel explained that as EMR systems build out, they provide what amounts to a 'commons' in which organizations can collaborate to share health information.

For example, Lilly, Pfizer, and Johnson & Johnson are collaborating with 'e-Health Initiative' - a not-for-profit health information technology group - as well as with the Indiana Health Information Exchange and the Partners Healthcare System in Boston. The goal is to test how safety signals can be located and understood using existing data, potentially leading to a better understanding of the risk and benefits of medicines.

SOURCE: "Lilly’s CEO Calls For Reform of Nation’s Drug Safety System" 10/02/07
photo courtesy of Uh…Bob

Eight States to Sue Administration Over Child Health Care

As the time approaches for President Bush to veto the current SCHIP legislation, as he has repeatedly promised, the adversarial nature of the debate is turning litigious. Tom Hester at Newsday reports:

New Jersey on Monday joined seven states in filing separate lawsuits against the Bush administration's challenge of proposed federal rules the states say will force poor children to lose health coverage.

The lawsuit for New Jersey was filed Monday morning in federal court in Trenton, state Attorney General Anne Milgram said. New Jersey joins Maryland, Arizona, California, Illinois, New Hampshire, New York and Washington in filing similar litigation.

"The Bush administration has gone beyond its regulatory rights," New Jersey Gov. Jon S. Corzine said as he announced the lawsuit at an East Orange health center.

At the core of the conflict are rules issued by the Center for Medicare and Medicaid Services which the suits claim exceed the statutory authority set forth in Title XXI of the Social Security Act. The SCHIP legislation currently facing veto would remove these new strictures. What new strictures, you ask? Ralph Thomas at the Seattle Times brings us the following clarification:

Under the restrictions, before states can start enrolling kids above 250 percent of the poverty level, they must make sure they are covering at least 95 percent of kids at or below 200 percent of the poverty level.

[Washington State Governor] Gregoire said no state has been able to reach that mark. She said Washington has one of the nation's highest coverage rates, at about 91 percent.

"We just do not believe that is achievable and in fact was put in place to guarantee that we couldn't go above 250 percent of poverty," she said.

The restrictions also require new enrollees above 250 percent of the poverty level to go a year without insurance before they could enroll in SCHIP.

These strictures are being cast as beyond the legal limitations on federal power, and more states continue to bring suit agaisnt them.

"The federal government lacks the authority to do what it is trying to do," [NJ Attorney General] Milgram said, adding that New Jersey's plan has been approved eight times, including five times by the Bush administration.

[New Jersey Gov. Jon S.] Corzine has said the rules could risk health insurance coverage for 10,000 New Jersey poor children.

SOURCE: "8 States Sue Bush Over Children's Health Insurance" 10/01/07
SOURCE: "State to Sue Feds Over Childrens Health Insurance" 10/02/07
photo courtesy of Scott Ableman