Halloween and Health

In deference to the holiday, today's post will be of a slightly different nature than the usual fare -- a slightly different tone before we return to election mania.

Preventative medicine is vitally important. That is something that I believe few will quibble with. Emergency rooms are expensive; that has also been well established. Chronic conditions such as obesity and type 2 diabetes absorb a huge amount of the funds in the health care system, an amount that proper prior behavior can reduce drastically. And Halloween? Halloween is just fun, right?

Like all good things there is dark side to Halloween, and I am not just talking hordes of kids on a massive sugar buzz. The Center for Disease Control has a page up on their web site that details a wide array of health and safety tips ranging from "be careful with toy swords," to advice on substituting health snacks for candy. It's comparatively short and presented as a bullet list, but a good starting point.

The one I really got the most out of this season was a piece by Samara Felesky-Hunt, for The Calgary Herald. Since massive snowdrifts of candy are about to blow through homes across the country her tips for reducing the impact are well timed.

[...] for now, you're dealing with the candy. Here are a few tricks to have up your sleeve before your kids are out of the door on the Halloween neighbourhood prowl.

Have a healthy dinner first. Having a well-balanced dinner with lots of veggies sets the tone for the whole evening. If you send them out with their tummies full, they're less likely to eat candy along the whole way. A healthy dinner -- or even a quick peanut butter sandwich with carrot sticks -- will help to prevent sugar highs and nasty tummy aches later.

The list goes on and is worth a look. You can strike a blow against diabetes, obesity, and sugar fueled hyperactivity all at once. (Hint: look under Sources below.)

SOURCE: "CDC- Halloween Health and Safety Tips" 10/08
SOURCE: "Halloween doesn't have to be unhealthy" 10/30/08
photo courtesy of C.J. Sorg, used under its Creative Commons license

Will Health Care IT Get a Leg Up Under the New President?

One thing that both of our current contenders for the Oval Office have in common is the fact that they both support the use of information technology to help fix our broken system. Since every poll I have seen for the past year agrees that reform is vital, and this approach is one that is central to George C. Halvorson's views on the subject, I would say this is a very good thing.

For analysis, I would like to avoid the usual round of health care publications and instead take a look at Information Week where Marianne Kolbasuk McGee is at it again -- writing intelligent and insightful commentary about IT and health care, that is.

Regardless of the outcome of the presidential election, there's potential for a lot of change in the health care industry in the next four years. Barack Obama and John McCain have very different visions when it comes to health care reform, but there is one thing they both have in common, and that's an emphasis on using technology to digitize patient records and eliminate paper-based processes that are inefficient, redundant, costly, and potentially deadly.

Now we all know that implementation of these sort of systems is a costly scenario, one that many providers balk at. As we watch the bizarre and disturbing ups and downs that Wall Street and the economy have been undergoing, one could easily assume that costly measures like EMRs would be back-burnered while other more seemingly pressing issues get funded.

At least one Senator disagrees:

"We need to make money available for direct grants" and via other avenues to promote the deployment of IT in health care, said Massachusetts Sen. John Kerry (and Democratic presidential nominee in 2004) during a keynote speech in Boston yesterday at a technology symposium put on by the Center for Connected-Health, a division of Partners HealthCare, which operates several Boston area hospitals, including Mass General and Brigham & Women's.

Health care reform can't be deferred by the weak economy because health care is such a big part of the economy -- or $1 out of every $6 dollars spent in the United States, says Kerry. Addressing the health care system's big cost issues will "help the economy move," he says.

One-sixth of the economy. A perversely incented system, to use Mr. Halvorson's words, that is rife with redundancies and top heavy with bureaucracy is one sixth of the American economy. This fact alone should help put things into perspective. For an excellent summation of the situation and the options before us, go take a quick moment and read Ms. McGee's latest. As always, it is a highly informative gem of a column!

SOURCE: "Could Health Care IT Get A Boost Next Year?" 10/28/08
photo courtesy of Violator3, used under its Creative Commons license

The Obama Plan: Economists Speak Out on Forbes

Forbes brings us an interesting piece by a pair of research associates at the National Bureau of Economic Research. The topic, unsurprisingly, is health care and the approach taken on the subject by the Democratic nominee for U.S. president.

The first of the pair, David M. Cutler, is the Otto Eckstein professor of applied economics at Harvard's Department of Economics and Kennedy School of Government, and is also an adviser on health care to Barack Obama. I think we can guess what side of the issues he comes down on. The second one, J. Bradford DeLong, is a professor of economics at U.C. Berkeley.

Between the two, they have crafted a exploration of why their chosen candidate is the one who can save the current health care system. I'm just going to point out two ways in which Sen. Obama's plans agree with our own George C. Halvorson's analysis of the current health care crisis.

First, let's take a glance at one of my favorite topics, Electronic Medical Records. Via the Forbes article:

One element of reform is information: Doctors, patients and administrators simply do not know enough about which treatments work and which are ineffective or harmful. An estimated one-third of medical costs go toward care with no value. Obama proposes to jump-start the long-overdue information revolution in health care with $50 billion to computerize the medical system and spread the word about best practice.

If you have any questions on why this is important, I suggest using this blog's internal search function and looking for "electronic medical records." I have written extensively over the past year on the subject from a variety of angles. Let it suffice to say that administrative costs -- the dreaded paperwork that elicits groans from almost everyone -- is one of the areas where spending can most easily be curtailed. To make it a true win-win scenario, doing so will increase efficiency of treatment across the board.

A second element is to fix perverse incentives in medical care. Doctors and hospitals today are paid for performing procedures, not for helping patients. Insurers make money by dumping sick patients, not by keeping people healthy. Obama proposes to base Medicare and Medicaid reimbursements on patient outcomes in a coordinated effort to drive the entire payment system toward paying for improved health rather than just more care.

Perverse incentives is exactly the way Mr. Halvorson puts in in his book, Health Care Reform Now!. There is a vital need to switch from the pay by treatment attitude to results-oriented incentives. With over 9,000 billing codes, there is not one for a cure. That speaks volumes.

The article goes on to cover other health care issues that we return to consistently here: the massive importance of prevention, accessibility of care, affordability of coverage, and more. A very nicely presented piece, and since it is penned by economists, it is of additional interest as we watch the DOW bounce up and down like a rubber ball.

Good reading!

SOURCE: "Obama Can Cure Health Care's Ills" 10/28/08
photo courtesy of bobster1985, used under its Creative Commons license

Oval Office: One Week Away

It is one week until Americans everywhere cast their vote for the future of our nation and the future of its health care system. This is an historic year and one in which the choices we make are of incredible importance.

With that in mind, I'd like to point you towards a piece from USA Today that is great for an overview of the candidates' plans. Composed by the publication's editors, it endorses a strongly bipartisan approach similar to the one that Sen. Ron Wyden has proposed.

Nonetheless, it does help dispel some of the fog of rhetoric that has surrounded the claims on both sides since the election cycle began. Citing highly pertinent, impartial sources like The Annenberg FactCheck and the Kaiser Family Foundation, and deconstructing the media/advertising spin, it does a pretty concise job of laying everything out for the thoughtful voter.

Ultimately, the best health care plan might combine elements of both McCain's market-based reforms with mandates to make sure that everyone has access to coverage. Given how contentious the campaign has been, that might seem far-fetched. But Sen. Ron Wyden, D-Ore., has a plan to do just that.

Even if Democrats pad their congressional majorities on Nov. 4, many of the tough issues that this nation faces won't be solved without bipartisanship. Health care reform is no exception.

Certainly well worth examining. Follow the Fact Check link when you read it.

SOURCE: "Health care Rx: Mix up McCain's and Obama's plans" 10/27/08
photo courtesy of Jeff Milner, used under its Creative Commons license

Reaching Across The Aisle on Health Care

There has been a stealth campaign running in the background during the sturm und drang of the U.S. presidential race. It has been a campaign for health care orchestrated by the terminally ill Sen. Edward M. Kennedy involving a tremendous bipartisan effort to craft a universal health care bill for presentation to the new President in the beginning of 2009.

Jeffrey H. Birnbaum of The Washington Times reports of the stupendous selection of people involved in what Kennedy is calling the "cause of his life":

The discussions, which started in June, included 14 roundtable meetings in the Dirksen Senate Office Building. These were attended not only by Kennedy aides but also by staffers, both Republicans and Democrats, from the Senate committees with jurisdiction over health care. Those include the Budget Committee, the Finance Committee and the committee that Mr. Kennedy leads, the Committee on Health, Education, Labor and Pensions.

Also attending was the entire panoply of interest groups with stakes in the cost and availability of health coverage. These included the AFL-CIO, the Business Roundtable, the U.S. Chamber of Commerce, the National Federation of Independent Business, the National Retail Federation, the Federation of American Hospitals, the American Medical Association, America's Health Insurance Plans, Families USA, AARP and the Consumers Union.

Mr. Kennedy's staff has started to meet regularly with a small group of people representing each facet of industry as well as consumers. Kennedy aides said they have not drafted legislation but probably will do so soon.

Kennedy has remained in touch with the closed door proceedings via regular telephone updates from his staff. In addition, he is spending several hours a day on the phone with other Senators as he pushes to bring this bipartisan effort to fruition. Much like the efforts of Sen. Max Baucus which I have written about in earlier postings, this is an effort to bring all sides together. It would seem from the reports that I am starting to get that Sen. Kennedy's efforts are involving a much broader group of participants than any thus far.

Sidelined for weeks due the diagnosis of brain cancer and the subsequent treatment, Kennedy is nowhere near out of the running. As best as can be determined by the Washington Times article above, his audacity in having universal health care as a goal has drawn together lobbyists and consumers, providers and insurance companies, conservatives and liberals. I have a feeling that the next president will be presented with something truly unique and American when this bill is finalized and hits his desk.

SOURCE: "Kennedy secretly crafts health care plan- Turns 'cause of his life' into '09 bipartisan bill" 10/24/08
photo courtesy of diggersf, used under its Creative Commons license

Report: Community Based Prevention = Health Cost Savings

Prevention is generally acknowledged as a key factor in fighting chronic health issues. I don't think there is anyone who would dispute the fact that quitting smoking, while incredibly hard to do, vastly reduces your chances of lung cancer among other nasty illnesses. (I pick smoking as my example here because I am on day 22 without nicotine right now.)

Since these chronic issues consume so much of the expenditures made on health care, it is only natural that prevention should come to the fore as we attempt to craft a new system. As obesity and diabetes statistics skyrocket this becomes more and more obvious. What is interesting is a new report that has just been released which addresses a species of prevention not often spoken of in debates: Community-Based Disease Prevention.

Via MarketWatch:

In its report - commissioned by The California Endowment -- entitled Prevention for a Healthier California: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, the Trust for America's Health (TFAH) and Prevention Institute and the Urban Institute find that an investment of just $10 per person per year in proven community-based disease prevention programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use could save California's health care system more than $1.7 billion within five years. This represents a return of $4.80 for every dollar spent.

Furthermore, in 10-20 years the savings could grow to more than $1.9 billion annually, which would be a return of $5.40 for every $1 invested.

Wow. Encouraging numbers. Granted, like most things, implementation is a whole different ball game, but it still provides a goal to shoot for. One thing is confusing though. What exactly is "Community-Based" disease prevention?

Community-based disease prevention programs are things that impact health outside of the doctor's office, such as planning communities to have sidewalks to encourage walking; keeping school athletic facilities open after normal school hours so that youth have a safe haven to engage in physical activity; making fresh fruits and vegetables easily available in communities where there are few or no supermarkets; and implementing local ordinances that prohibit smokers from lighting up in public areas, among many others.

I have no trouble seeing the positive effect such measures could have on both individual health care and on the collective financial bottom line. Of course, much like herding cats, it will be an adventure getting the majority of people to actually utilize or participate in these programs, options and efforts once they are in place.

As always the variable is human behavior, although with so much to gain if may well be possible. I guess we will have to wait and see.

SOURCE: "Report Finds Community-Based Disease Prevention Saves California Money and Improves Californians' Health" 10/23/08
photo courtesy of kcjc009, used under its Creative Commons license

An Injection of Interaction

Health 2.0 is not just a concept, it is also an LLC. A quick glance at the links I've just provided should illustrate the difference handily.

The LLC is currently hosting their Second Annual Health 2.0 Conference , examining the plans offered by our candidates as well as the effects of the chaotic economy on health care and how social technology fits into the overall picture. Evidently, there is quite a bit of interest since as of last Friday night they have had to add another room to the conference where the proceedings may be watched on a large screen due to attendee demand. It is a sign of how vital this conversation is when we see people shelling out money to sit in an adjoining room watching a video feed.

One of the biggest themes at the event is the way in which the methodology is shifting. Social media-driven approaches need to engage with the patient base in ways entirely unprecedented within the medical industry.

Lidija Davis of The New York Times reports:

The rules of engagement however, as Clay Shirky pointed out in his keynote on Wednesday, are changing.

According to a study released today by Edelman [PDF], trust and confidence are inversely proportionate to demand for health care. With an aging population, behavior-related chronic conditions, and expensive innovations, companies must help people address their specific personal health concerns with thorough, transparent and specific information.

Additionally, the financial meltdown is aggravating an already weak health system as people forgo or postpone essential health care due to loss of insurance or inability to pay.

The answer, according to the survey, is engagement: "Effective health engagement can build trust, and conversely, trust is the key to deeper engagement," said Nancy Turett (Edelman).

Interactivity in the name of the game is the modern day. Online access is becoming less and less optional as time goes by, and companies are starting to realize this. The consumer of 2008 has high expectations learned from their use of services like online banking and websites such as eBay and Amazon. As belts tighten during the economic downturn, more and more people will be taking a closer look at their health expenditures trying to find ways to reduce their capital outlay.

A good example on the corporate end is Aetna. The company is working on a system to allow their customers to transfer their existing health records to Microsoft's Health Vault, an online EMR option. Other big players in this aspect of the industry are WebMD, Google, Yahoo and Microsoft all of whom have programs worth watching. (Ms. Davis' article linked below has more detail and quotes from each them.)

Transparency note: The Health 2.0 Conference has Kaiser Permanente as its Flagship Sponsor. This blog's affiliation with Kaiser Permanente can be viewed on our About page.

SOURCE: "Health 2.0: Rules of Engagement " 10/23/08
photo courtesy of zaldylmg, used under its Creative Commons license

Is More Comprehensive Health Care Reform Actually Cheaper?

Ezekiel Emanuel thinks it is, and he says he has got a plan. Starting from the premise that incremental changes involve more fees which mount up to an overall higher cost, sweeping changes and fundamental reforms can be made for substantially less.

In his piece on The Huffington Post last Tuesday, Emanuel goes into detail, reviewing the proposals and expected costs of each presidential candidate's health care platform in detail. That alone makes it a good read; however, that is not where it ends. He then goes on to make the case for the affordability of universal coverage.

The biggest surprise is that even more comprehensive reform, not only achieves universal -- true 100% -- coverage of all Americans but does so while controlling costs. Prof. Victor R. Fuchs and I have proposed Guaranteed Healthcare Access Plan. It phases out employer-based insurance, Medicaid, and Medicare. Instead each American would receive a voucher to buy a standard benefits package modeled on the federal employee health benefits plan through regional insurance exchanges in which private health plans would compete. Workers would receive a pay increase from their employers who no longer pay for health care; state taxes decline because states no longer have to devote 32% of their budgets to health care. The plan is financed by a value-assed tax.

Emanuel continues in this vein for quite some time, elaborating on their approach and reasoning. All-in-all, a fascinating perspective and one that is well worth looking at as we enter the last two weeks of the election. It bears many similarities to the Wyden-Bennett plan I have written about in earlier posts in that it assures Americans portability, guaranteed enrollment, and precludes exclusions for any pre-existing conditions. Follow the source link below to read his entire article.

SOURCE: "More Reform is Cheaper: The Paradox of Health Care Reform" 10/21/08
photo courtesy of a.drien, used under its Creative Commons license

Max Baucus Steps Up for Health Care Reform

Max Baucus, the Democrat who chairs the U.S. Senate Finance Committee, is coming out in a big way for health care reform. He has assembled a council of over 30 medical professionals with the intent of developing five ways in which to improve the health care system, not just in his home state of Montana but across the nation as a whole.

Via Diane Cochran at The Billings Gazette:

"I think in life we only have two choices on most things - try, or do nothing, and clearly we've got to try to crack this nut," Baucus said at St. Vincent Healthcare during one of 10 health care listening sessions across the state. "Doing nothing is not an option."

Reforming the country's health care "hodge-podge" - it's too fragmented to be called a system, Baucus said - will probably be the biggest problem he tackles in his congressional career, the senator said.

One aspect of the problems faced by Americans is especially prevalent in Montana. That would be the plight of small businesses and those employed by them. According to an interview with St. Vincent Health Care CEO Jim Paquette on Montana'sNewStation.com, out of 160,000 uninsured Montanans, roughly 53% of them work for small businesses that do not employ enough people to to create the large pool needed to drive employer provided health care costs down. This among other factors is giving Baucus' efforts a high profile.

SOURCE: "Baucus hears concerns over health care system" 10/21/08
photo courtesy of KimberlyFaye, used under its Creative Commons license

Economics and Health Care in Utah

In the first of what I feel sure will be many articles examining this topic, The Salt Lake Tribune looks at some of the ramifications the current economic crisis is already having on American health care. This particular piece looks at the increasingly dire situations faced by the residents of Utah.

From the obvious implications such as people skipping routine care to conserve finances to the not so blatant ones like the fact that low income residents who rely on Medicare or Medicaid are also skipping these procedures because they are unable to afford the costs of transportation. If you add in the increase in health problems caused by stress and bouts of economy-induced depression amongst the populace, the picture gets more and more grim.

Heather May and Lisa Rosetta report:

Scrimping Utahns are skipping preventive checkups and forgoing needed dentures and crowns. More are seeking treatment for depression and anxiety. They're lining up for nearly free health care or heading to emergency rooms.

Or they simply suffer until they can afford to care for their out-of-control diabetes or festering wounds.

"It takes a lot on one's body and soul even," said Shawna Zink, of Magna. "I'll be 45 this month and I feel like sometimes I'm 60."

The article in question provides a disturbing view of the trends that seem to be beginning to take hold, showing why the need for immediate reform of American health care is essential. It is an unsettling read, but one that I advise. Let us hope that the incoming administration is able to implement substantive reform in time to avert more stories like this one.

SOURCE: "Cash woes bruise health" 10/13/08
photo courtesy of Kugelfish, used under its Creative Commons license

Candidates Claims Under The Magnifying Glass

Yesterday, we looked at what the American people seem to think of the candidates and their approaches to health care reform. Today, we will be looking at both the things that have been distorted by each side and what the experts have to say about the effectiveness of both proposals.

Unlike prior generations, we are inundated with media at every turn: radio, TV, Internet and, with increasing frequency, mobile devices. This not only allows extensive opportunity to be exposed to each side's position but also allows access to numerous non-partisan groups that exist solely in order to get to the substance beneath the glitz. One of my own personal favorites is the Annenberg Political Fact Check.

On the October 14, the Anenberg crew produced their own analysis of the candidates' plans, the mis-statements used to sell them, and the input of a variety of health care experts concerning the contents of said plans. I highly advise checking out the detailed analysis, but for the general edification I will include their summary statement here:

McCain and Obama have sharply different health care plans, and each has made sharply worded attacks that are either false or misleading. McCain proposes a market-based system that relies on tax incentives, which one Obama ad falsely characterizes as the "largest middle-class tax increase in history." Obama proposes new subsidies to expand private insurance coverage and some expansion of government insurance, which McCain falsely claims "will rob 50 million employees of their health coverage."

Neither candidate has offered enough specifics about his plan to allow experts to assess the cost or impact without making various assumptions. Studies agree generally, however, that Obama’s plan would cover more of the uninsured than McCain’s would.

The original piece includes archives of pertinent campaign advertisements, point by point breakdowns of what the candidates have said on the subject, and the results of numerous fact finding polls and studies. As always there is a full bibliography of sources and all claims are hyper-linked to the supporting documentation.

Happy Reading!

SOURCE: "Health Care Spin - McCain and Obama each make false claims about the other's health care plan. We sort through the misinformation." 10/14/08
photo courtesy of Okko Pyykko, used under its Creative Commons license

Who Do the Voters Prefer on Health Care Reform?

The big question -- when not discussing the economy -- is who will win the U.S. presidential race this year. It is an historic ticket of each side of the aisle combined with a colorful, and at times shocking, stage show before the media. Discussion of which way things will go is far beyond propriety for this blog to address.

What we can address and investigate is the positions of these two fine men on health care's future course. Today, thanks to a poll recently released, we can take a quick pulse on the American public and see how they feel about the proposals put forth by the White House hopefuls via News-Medical.net:

According to a report released today by the University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health, the majority of likely voters polled selected Obama as their top presidential pick to handle the country's biggest health care issues, including the high cost of health insurance, and the millions of U.S. adults and children without insurance.

One deviation from that was found amongst voters over the age of 65 who felt McCain has a better grasp of the prescription drug cost issue. Other than that, those polled generally show a marked leaning towards Obama's proposed handling of the health care crisis. Here are some of the numbers from the report broken out by health care issue:

• Health insurance is too expensive for families. The vote: McCain (38 percent) / Obama (62 percent)
• Many people can't afford prescription drugs. The vote: McCain (43 percent) / Obama (57 percent)
• Millions of children are uninsured. The vote: McCain (35 percent) / Obama (65 percent)
• Millions of adults are uninsured. The vote: McCain (35 percent) / Obama (65 percent)
• Some people get lower quality of health care than others. The vote: McCain (38 percent) / Obama (62 percent)

On this subject, it would seem that the Democratic Party is much more in line with the will of the (polled) people. Only time will tell how much influence that will have on the final election outcome. I would suspect that a lot of it will ride on the news about the economy. After all, it was the meltdown on Wall Street that bumped health care down the priority list of the American public. Extreme good or bad news on the economy will profoundly affect how much impact this data ends up having.

For the complete report and a podcast about its results, go visit C.S. Mott Children's Hospital National Poll on Children's Health.

SOURCE: "Voters pick Obama to tackle nation's health care problems" 10/13/08
photo courtesy of Torley, used under its Creative Commons license

Equal Treatment? Not Always For the Uninsured

While many would like to pretend that this is not the case, I think we are all aware of the fact that many times work done for free tends to be of lower quality than work that one pays for. It's hardly a shocking revelation. Incentive counts for a lot, and being paid is the incentive on most American's minds when considering the work they have made their career.

This makes for disturbing contemplation when you apply that little truism to the medical field. Manoj Jain at The Washington Post takes a look at the disturbing differences in care received by uninsured patients as opposed to those with coverage:

It's not uncommon for patients with no insurance or poor insurance to receive different treatment. A 2006 study of 25 primary care private practices in the Washington area showed that in nearly one in four encounters, physicians reported adjusting their clinical management based on a patient's insurance status; nearly 90 percent of physicians admitted to making such adjustments. For patients with no insurance, alterations occurred 43 percent of the time; and for the privately insured, just 19 percent.

This brings to light an aspect of the health care equation that is oft overlooked. It is especially troubling when you consider that one out of every five patients seen by primary care physicians in a hospital setting are uninsured. From a physician's perspective, that is one fifth of their workload that goes completely uncompensated.

As physicians sometimes say, "No other professionals -- lawyers, plumbers, accountants -- provide uncompensated service to one-fifth of their clients."

There are many reasons possible for a lack of coverage, especially in times as tumultuous as these have been recently. From the workplace that does not offer insurance to sudden job loss or complications arising from pre-existing conditions the possible reasons run the gamut. It is not always a matter of husbanding one's resources or living within one's means:

My primary care friend told me about a patient who had left a boil untreated until it needed surgical drainage and intravenous antibiotics. When asked why didn't have insurance, the man said he had lost his job and was recently divorced. Stories like that helped my friend realize what injustices the uninsured face.

SOURCE: "Equal Treatment for the Uninsured? Don't Count on It. Lack of Compensation Can Tempt Doctors to Tailor Their Care to a Patient's Coverage" 10/14/08
photo courtesy of tacomabibelot, used under its Creative Commons license

Open Standards in Health Care Computing

There is a pronounced movement in certain strata of the health care computing field towards open standards. Combine that with the billions of dollars thrown into the mix due to the fact that both Presidential candidates are banking heavily on automated and computerized systems for their respective reform efforts and you have a rich medium for collaborative growth.

Via Dana Blankenhorn at the ZDNet Healthcare Blog:

The latest move is that of Dossia, an alliance of health care technologists mainly on the consumer or medical office side of things, to join Continua, a separate consortium which includes many hospital computing vendors.

As IBM noted recently, such moves can be excuses for inaction. There is, potentially, an enormous amount of value destruction involved in a move to open standards. Proprietary systems can demand top dollar.

But customers of all sorts — from hospitals to consumers to government — are now demanding substantive, real change.

It would seem that more and more evidence is mounting to support George C. Halvorson's theory that we are at the point of a "Perfect Storm" as far as health care reform goes. I would say that a trend of this nature is a very pointed piece of support for that position. Is it just me or does this indicate a realization that the need for our system to work supersedes the need to maintain a short term profit? Besides, once standards are set, competition can help the continuing evolution of the system built upon them.

We do, after all, already have the baseline tools for this sort of development already in use.

The devil here is in the details, but we do have the ingredients of an agreement, in the form of Internet standards, XML technologies, and such industry-specific things as HL7.

Publication of and adherence to those standards would naturally encourage more open source projects and consortia. Having a firm standard to write to means such groups need not hit a moving target.

And that really is one of the best aspects of this approach. The need for standards -- objectives that can actually be met -- will do an amazing amount for the speed of development.

SOURCE: "Growing open standards pressure on healthcare" 10/13/08
photo courtesy of cmdrfletcher, used under its Creative Commons license

EMRs on the iPhone: The Canadian Lesson

Let's take a good look at what can be achieved when a practical approach to technology is applied. I keep hammering on the subject of Electronic Medical Records (EMR) because it is an aspect of George C. Halvorson's strategy that really resonates with me on a personal level.

In the wake of Hurricane Gustav, we saw one major advantage that the ongoing discussion rarely touched on: having backups of paper records destroyed in a natural disaster. Now it is time to take a look at portability and accessibility in the age of the iPod and iPhone.

Via Briony Smith at ITWorld Canada:

The paramedics can now use an iPhone to access the patient’s history, courtesy of Raven, a program from Calgary health-care integration and collaboration software vendor Coalese that was rolled out earlier this year. Next January will see the region’s health-care providers take the application bi-directional, and update information in the patient’s file that could benefit the person’s primary care. “That way, if the paramedic sees that Granny hasn’t been taking her meds or needs to note procedures done in the ambulance, the primary care physician can see that in their record right away,” said Coalese president Andrzej Taramina.

To get everyone on the right footing, paramedics and doctors from local clinics and hospitals gathered together to determine what information they needed to access on the go. “Confidentiality was one issue, but, with the iPhone, nothing is stored there. It’s the (Web-based) program that accesses the records,” she said.

The iPhone is ubiquitous; every day you see more and more people carry them or their near cousin the iPod Touch. Both devices have been gaining ground along with a whole new generation of wireless devices. Using these portable devices to access medical records "on the fly" is a logical extension of EMRs that is not often discussed.

In an increasingly mobile and digitally connected society, this makes perfect sense. Health care pros could access full patient records almost instantly from the scene of an accident. Allergies could be determined before administration of medication. Current treatments added to the record while en route to hospital treatment could allow a doctor to be up to the minute on what has been done to the patient on the way.

As we get more and more people on board for EMRs, we really need to look at the potential for wireless devices. I think the Canadians are dead on the money with this one!

SOURCE: "The iPhones Could Save Your Life" 10/10/08
photo courtesy of William Hook, used under its Creative Commons license

Dateline Nashville: Frist Moderates Panel on Health Care Reform

Nashville has been hopping lately -- as far as health care goes, that is. The Nashville Health Care Council hosted a high powered panel discussion about the state of American health care and the potential reform platforms of the Presidential candidates. Bill Frist, former U.S. Senator and Cressey Co. partner, acted as the moderator for the four-person panel which included the following luminaries:

• Chris Jennings, former senior health care adviser to then President Bill Clinton
• Chip Kahn, President of the Federation of American Hospitals
• Dick Morris, former Clinton adviser and current Fox News contributor
• John Podesta, Chief of Staff for Bill Clinton from 1998 to 2001

Walker Duncan of The Nashville City Paper reports on the proceedings:

Dick Morris got the discussion underway with a particularly sunny outlook, opining that the next president will “have a job much like a trustee in a bankruptcy.” He continued saying that while the political will may be there, that the “money for health care reform went out the door last week,” referring to the recently passed bailout solution.

Others disagreed with that take, saying some change could be effected even in light of the current financial crisis. Jennings made a handful of points addressing the issue, pointing to the strong demand from the business community, to the awareness that despite our huge health care spending we’re not getting an equal amount of value, and to the fact that any sort of economic reform is going to have to include health care as a factor.

Essentially, according to his argument, the need for change is both too great and too apparent for no progress to be made.

Duncan does a great job of providing a synopsis of the entire panel, covering issues such as time frame to reform in the face of the economic crisis, current and revised potential for universal coverage, and predictions for the next two years facing us.

All in all, it is a very interesting insight into the situation from a new group of voices. Experts abound, and I am sure we will be hearing from all of them over the next few short weeks before election day.

SOURCE: " Panelists, Frist attempt to tackle health care reform" 10/08/08
photo courtesy of Exothermic Photography, used under its Creative Commons license

Economy vs. Health Care

Everything that happens lately does so to a back beat of economic fear. As the DOW plummets and venerable banking institutions fall to pieces, there is little that is not infected in some way or other by the watchful unease (and yes, outright fear) of American eyes watching the economy as it seems to spiral down the drain.

The question before us in this blog is how does this fear of coming recession -- or if some are correct depression -- affect health care spending by the citizens of America? Simple application of logic dictates that as belts get tightened, essential routine health care expenditures would fall by the wayside. How closely does this train of logic resemble fact?

Via CIGNA press release on MarketWatch:

According to recent CIGNA surveys, about one-third of Americans say yes, the economy has changed the way they take care of themselves. Of those, 55 percent report taking better care of their health by exercising, eating healthier or getting regular check-ups and screenings, while 41 percent say they are taking worse care.

Among those who are taking worse care of themselves, more than one-third (35 percent) say they're not going to the doctor regularly or at all, while 17 percent say they're taking their medications less often or not at all. Ten percent say they can't afford to eat properly or are eating less healthy foods.

The survey goes on to point out long term cost savers built into many policies, things like regular checkups and preventative screenings. I would consider it advised reading, especially if the new austerity ends up lasting awhile.

SOURCE: "The Shaky Economy: Is it Changing the Way People Take Care of Their Health?" 10/08/08
photo courtesy of Epicharmus, used under its Creative Commons license

The Doctor Shortage in Massachusetts

We keep checking back on Massachusetts to see how their experiment in expanding health care is going. Since the state's Health-Care Reform Act, an additional 440,000 people have become insured. The path being tread has been a balancing act from the start. A myriad of factors assert their influences upon the day-to-day mechanics of trying to bring health care to the state's entire population.

Each time we bring our gaze back to Massachusetts, we find more practical lessons to learn from their path-finding exploration in the realm of health care and coverage. This time, we discover a growing shortage of doctors to provide for the health care needs of the thousands of newly insured.

Via Christine McConville at The Boston Herald:

The data comes from the medical society’s annual work-force survey.

For starters, it shows a shortage of physicians who practice internal medicine, family medicine, oncology, neurology, dermatology, emergency medicine, general surgery, neurosurgery, orthopedics, psychiatry, urology and vascular surgery.

[Medical Society President Bruce] Auerbach said some of the shortages are due to the gap between the cost of living in Massachusetts, and what insurance companies and the government will pay for certain medical procedures.

There are also widespread fears of being sued.

As we explore the web of factors that influence the path to universal health care, it seems we shall need to keep in mind that providers are an important piece of the puzzle. Access is essential if coverage is to mean anything substantive.

SOURCE: "Study Sees Doctor Shortage" 10/06/08
photo courtesy of Subconsci Productions used under its Creative Commons license

Coin: Democrats Press Health Care In Ads

Well, well, well. While I was writing yesterday's post, the Obama camp was delivering the second part of a one-two punch comprised of advertisements focused on health care. We saw the first one in my last post; now the Dems have aired another ad entitled "Coin."

Martina Stewart, an associate producer for CNN's Political Ticker blog, has a great resource addressing the divergent positions taken by the candidates. Her Political Ticker post made on October 5 not only give a synopsis of the commercial along with a video link, but also includes some great responses and rebuttals from each camp.

On Sunday, the [Obama] campaign also held a conference call about health care reform policy that featured Kansas Gov. Kathleen Sebelius, who was the Kansas Insurance Commissioner prior to becoming governor, and the Pennsylvania and Ohio insurance commissioners. The call focused on criticizing Sen. McCain’s health care reform proposal.

The day before, the McCain campaign held a conference call of its own where it sought to refute the Obama campaign’s assertions about the McCain health care reform plan and, at a campaign event in Virginia, Obama called McCain’s plan “radical.”

The audiocasts of these two conference calls add a much needed additional dimension to the issues presented in the advertisement. Links to them are near the bottom of the Political Ticker post cited at the bottom of this entry.

The chaos of these recent months has included its own health care aspects in each of the major issues. In the wake of Hurricanes Gustav and Ike, we saw firsthand, palpable proof of the importance of electronic medical records. As Wall Street melts down and the Dow plummets, the impact of health care costs on our economy is massive. During the Presidential race, it is once more rising to the surface.

We may see health care moving back towards its proper position as a centerpiece issue for the next President.

SOURCE: "Obama camp releases another health care ad" 10/05/08
photo courtesy of KevinDooley, used under its Creative Commons license

Health Care Returning to the Presidential Race?

As the pundits rail about the race for the Oval Office and the newscasts are filled with baleful economic predictions, the American public continues to find health care reform of utmost importance. Unfortunately, the topic seems to have drifted out of the media coverage zone, eclipsed by political spots and visions of a failing Wall Street. This is especially a shame considering many have tied the ills of the health care industry directly to the economic hardships we are now facing. (See last Thursday's blog post for Elizabeth Edwards' take on the subject.)

Now that the first two debates -- Presidential and Vice Presidential -- are passed, it would seem that this vitally important topic may be returning to the spotlight it so richly deserves. Sen. Obama has brought out a new ad which brings the subject to center stage, evidently sensing a weakness on the subject in his competitors. Foon Rhee, deputy national political editor at Boston.com, has posted the video...



This is heartening to see since it was not that long ago that I wrote an entry here entitled "Health Care Falls Off the Radar".

SOURCE: "Obama sees opening on healthcare" 10/03/08
photo courtesy of Chesi Photos CC, used under their Creative Commons license

Feds Uphold San Fran Health Care Program

Sacramento, California, has been the center of much contention about health care reform. One aspect in particular has not only come under fire in the press but also has been the subject of litigation spearheaded by restaurants in the area.

Gov. Schwarzenegger's plan requires a level of financial participation from employers heretofore unseen in the state. As is usual when people or groups are asked to pay more, the reaction was far from positive. A court battle rapidly ensued as the restaurant association asserted that the payment structuring and financial participation demanded of their industry was in violation of federal law.

It would seem that the judges do not concur. Marc Lifsher of The LA Times reports:

Ruling on a suit brought by a local restaurant association, a three-judge panel of the U.S. 9th Circuit Court of Appeals found that fees charged to employers under the 10-month-old San Francisco Health Care Security Ordinance do not violate federal laws regulating employee benefit programs.

The San Francisco ordinance, which took effect Jan. 9, requires for-profit employers with 20 or more workers to offer health insurance, set aside funds in health reimbursement accounts or pay a fee to the city's Healthy San Francisco program. Nonprofit employers with 50 or more staffers are also covered.

While this news is not greeted with any joy on the part of restaurant owners, supporters of the plan, Healthy San Francisco, see it as proof that through shared responsibility the current health care crisis can be met and vanquished.

"Today's ruling is a huge victory for the city and for the 46 million Americans who don't have health insurance," [San Francisco Mayor Gavin] Newsom said. "San Francisco is proving that it can be done. By thinking outside the box, every city and state in this country can provide health insurance if they are willing to challenge the conventional wisdom."

In the short ten months the plan has been in place, basic medical care has been extended to 30,000 San Francisco residents that lack insurance. A good beginning, but only time will tell the full impact on not only health care but also the local economy and the businesses that make it up. Another process that I would classify as well worth watching.

SOURCE: "Federal court upholds San Francisco healthcare program" 09/30/08
photo courtesy of paraflyer, used under its Creative Commons license

Elizabeth Edwards Speaks: Health Care and the Economic Downturn

Elizabeth Edwards is back in the news, and once more she is lending her voice to the cause of health care reform. Mrs. Edwards is waging two battles currently: one against incurable cancer and another for universal health care and reform of our current system.

On Wednesday, she participated in a roundtable discussion in North Carolina. It is a state whose electoral votes are up for grabs in the current race for the White House due to both an influx of new residents hailing from the more liberal northeastern area of the country and a highly mobilized African-American population that leans toward the Obama camp.

As Wall Street continues its meltdown and the word "bailout" seems to be at the center of almost every conversation about the economy, Mrs. Edwards draws a link between the ongoing crisis in health care and the economic woes facing the country.

Mike Baker of The Associated Press reports:

Elizabeth Edwards said during a conference call Tuesday that medical bills often lead to foreclosure, a primary factor in the lagging housing market that's led to the demise of several Wall Street firms. Those without health insurance are often less productive, she said, because they miss work after failing to get treatment.

"Reform of our health care system is a very important part of the answers we're going to need to solve our economic woes," she said.

I'll be bringing you more info as soon as details of the roundtable are available.

SOURCE: "Elizabeth Edwards ties health care to economy" 10/01/08
photo courtesy of NCBrianused under its Creative Commons license

Get Health Care Elsewhere, We'll Pay You!

Medical Tourism- traveling out of the country for health care and procedures.

In a story that frankly surprised me a bit, The Wall Street Journal examined the fact that some health insurance now covers medical tourism.

Via M.P McQueen at The Wall Street Journal:

Now, a handful of plans are beginning to cover treatment overseas for heart surgery, hip and knee replacements and other major surgical procedures.

While medical tourism isn't expected to be a solution to the country's soaring health-care costs, the practice is intended to produce savings for insurers, employers and workers. Open-heart surgery, which can cost roughly $100,000 in the U.S., can be done at an internationally accredited hospital in India for just $8,500, for instance. Proponents note that many international hospitals are staffed with American and European-trained physicians. Many facilities also are accredited by an affiliate of the Joint Commission, a nonprofit group that is the main accrediting body for U.S. hospitals.

Some of these plans actually pay a bonus to those who elect to travel for their medicine. This is an astounding and innovative approach.

While issues such as a lack of legal recourse and the lack of follow up care plans are certainly concerns, it would seem that this idea has gained a lot of traction since I last wrote about it. The issue that I find unsettling is the lack of certainty regarding the safety and sterility of tissues and blood used in transplant-oriented procedures and surgeries.

Still, this is an interesting option and one still in its early stages. I would say it bears watching.

SOURCE: "Paying Workers to Go Abroad for Health Care" 09/30/08
photo courtesy of crucially used under its Creative Commons license