Telemedicine

 

Sadly, the United States lags behind many other nations in applying telemedicine, however with concerns about increasing cost of conventional office visits it is now becoming  more common.

In Europe SAMU or (SAMU - System of Emergency Medical  Assistance)  in France- has been in operation for many years. A similar system operates in Brazil.

Telemedicine  incorporates the use of broadband and/or satellite communication between provider-provider provider-patient and provider-provider depending upon the need.

Telemedicine is defined the use of telecommunication and information technologies in order to provide clinical health care at a distance. The term includes a wide array of functionality

Most patients and providers picture a physician at one end of a link sitting in front of a video monitor talking to a patient in a different location.  However telemedicine is much more inclusive, including the following.

Telemedicine can be broken into three main categories: store-and-forward, remote monitoring and (real-time) interactive services

Contents

• 1 Disambiguation  Telehealth, eHealth (Health 2.0) can define the use of internet.
• 2 Early precursors
• 3 Types of telemedicine
  • 3.1 Categories
  • 3.2 Emergency telemedicine
• 4 General health care delivery
  • 4.1 Benefits and uses
  • 4.2 Telenursing
  • 4.3 Telepharmacy
  • 4.4 Telerehabilitation
  • 4.5 Teletrauma
• 5 Specialist care delivery
  • 5.1 Telecardiology
  • 5.2 Telepsychiatry
  • 5.3 Teleradiology
  • 5.4 Telepathology
  • 5.5 Teledermatology
  • 5.6 Teledentistry
  • 5.7 Tele-audiology
• 6 Licensure
• 7 U.S. licensing and regulatory issues
• 8 Advanced and experimental services
  • 8.1 Telesurgery
• 9 Enabling technologies
  • 9.1 Videotelephony
  • 9.2 Health information technology

Real Telemedicine in Action, Ready for the big time

Thousands of heart patients can take advantage of new technology at two Piedmont hospitals that makes their lives much easier.

Cone Health and Forsyth Medical Center are part of a pilot program testing Carelink Express by Medtronic. Carelink allows doctors to collect information from defibrillators and pacemakers in five minutes, much faster than before.

Steven Klein, cardiac electrophysiologist at Cone Health, said hospitals used to call in technicians at all hours of the day to get information from the implant.

“Once they made the decision to do it, it would probably take 30 minutes to an hour before someone could get there to look at the information,” Klein said.

And if there’s nothing, patients can be released more quickly, saving them money, Klein said.

“The patient care is improved because they don’t have to spend so much time in the emergency room,” Klein said.

Carelink device also allows doctors to get information while the patient is at home.

The pilot program will last for another six months. If things continue to go well like they have been so far, the technology will expand to other parts of the country, Klein said.

Surveys indicate the increasing use of telemedicine in daily operations. It will undoubtedly become main-stream as reimbursement standards address the cost of this functionality. Even with the expected increase in capital investment the savings will more than offset the  expense and a documented ROI.

 

Technorati Tags: samu,telemedicine,telehealth,teleradiology,broadband,health20,monitoring,eHealth

Summary of HIT Meetings and Offerings in May and June

 

HIT offers multiple events in May and June 2012

Here are the first 14 events scheduled on/after May 11, 2012

MAY 14

DOD, VA Meeting on Data Sharing, Integrated EHRs

May 14-15, Alexandria, Va.

MAY 14

Health 2.0 Spring Summit on Health IT, Innovation

May 14-15, Boston

MAY14

Harvard Summit on Leadership in Health IT Sector

May 14-18, Boston

MAY 15

Meeting of ONC's Meaningful Use Panel, Subgroup 2

May 15, Online, Teleconference

MAY 16

Meeting on Taking Small Steps in Mobile Health

May 16-17, Palo Alto, Calif.

MAY

22

Brookings Event on Mobile Technology, Health Innovation

May 22, Washington, D.C.

MAY 24

HealthTech's Annual Exhibition, Conference

May 24-25, San Francisco

MAY

30

Meeting of ONC's Meaningful Use Panel, Subgroup 2

May 30, Online, Teleconference

JUN 5

Meeting of ONC's Meaningful Use Work Group

June 5, Online, Teleconference

JUN 5

Third Annual HDI Forum & Health Datapalooza

June 5-6, Washington, D.C.

JUN 6

Summit on Issues Related to Health Data Privacy

June 6-7, Washington, D.C.

JUN 12

Conference on Health-Related Video Games

June 12-14, Boston

JUN 14

Summer Summit on Successful Use of Digital Health

June 14-15, San Diego

SEP 9

Mayo Clinic's 2012 Symposium on Health Innovation

Sept. 9-11, Rochester, Minn.

Read more: http://www.ihealthbeat.org/events.aspx#ixzz1ub6IrgcB

CHCF releases results of Medi-Cal Survey

 

According to a new survey by the California HealthCare Foundation, most Medi-Cal enrollees have a favorable view of this essential health coverage program. However, barriers to access and enrollment exist.

If upheld by the Supreme Court, the Affordable Care Act could add two to three million people to the Medi-Cal program, potentially exacerbating the issues raised by enrollees.

CHCF announces a Sacramento briefing that explores the results of this survey of more than 1,000 Medi-Cal enrollees — the largest of its kind. Presenters will explore the experiences and attitudes of enrollees to illuminate where the program excels and where improvement is needed.

They will also consider implications of the findings for state lawmakers and program officials who are considering ways to slow the growth of Medi-Cal spending as they prepare to integrate millions of new enrollees. A series of short videos will offer individuals' reflections on their experiences with the Medi-Cal program.

Presenters and panelists include:

• Len Finocchio, associate director, California Department of Health Care Services
• Elizabeth Landsberg, director of legislative advocacy, Western Center for Law and Poverty
• Chris Perrone, deputy director, Health Reform and Public Programs Initiative, CHCF
• Tresa Undem, partner, Lake Research Partners

The conference will be broadcast via Webinar or you  can attend in person.

 

Technorati Tags: medi-cal survey,chcf

Health Information, Social Media and Broadcasting

 

              

At this point in my writing most of you now realize I have become indoctrinated in all aspects of social media, from Twitter and Facebook to the new G on the block. No not Guy…but G+.  Google plus offers some unusual features, the best of which in my opinion is the  Google Plus Hangout.  A new feature which just ‘rolled out’ is the ‘Hangout Live On Air”.  

A normal hangout allows for a total of 10 participants, nine others besides you. Google now owns You Tube and has integrated many features from YouTube into Google and vice-versa.  The integration of this feature allows for an unlimited audience as the broadcast occurs beyond the limited 10 in the hangout. In addition the HOA is recorded, archived and can be viewed at anytime.

What does all this cost…you ask ? Zilch, if you discount the need for a broadband internet connection and a computer capable of supporting a web camera.

I hope that some of you will join the G+MD hangouts to be held regularly to organize this as a regular “Hangout Event”  It will be titled  “Medical Minutes”.

The initial hangouts will consist of some ‘housekeeping tasks” and organizational information. If you use twitter set a hash tag for #glevin1. Announcements schedules will be sent via twitter and Google plus. The Stream is at +Digital Health Center.

 

Technorati Tags: Google +,Google Hangout,G+MD,hangout on air,digital health space,twitter,facebook

Report: Some Good News California Health Care Spending Grows, Rate Slows

 

Despite my gloomy report yesterday on the failures of many medical and group practices, todays statistics offer some encouragement.

Total spending on health care in California grew by almost 300% from 1991 to 2009, but the state's spending growth rate has slowed in recent years, according to a new report from the California HealthCare Foundation, the Los Angeles Times' "Money & Co." reports.

According to the CPI as published by the U.S. Dept. of Labor the overall rate of inflation for the CPI is 2.7% for the last 12 mos. (03/12) and 0.3 for 03/12.

Medical care commodities             

                        09/11  10/11 11/11 12/11 01/12 02/12   03/12     
                            2    .3    .2    .2    .6    .8    .4         0.8           0.4     end 03/12 3.3

CHCF publishes California Healthline.

Report Findings

According to the report, "Since reaching its peak of 9.7% in 2003, the pace of growth in health spending has been decelerating. By 2009, towards the end of the recession, spending grew [by] 4.5%, similar to the U.S. rate of 4.6%, and the slowest pace since 1999." Although medical inflation continues to exceed the general increase in the CPI the rate of increase is declining,  with the general CPI at 2.7%  and the Medical CPI at 3.3%

The report also found that:

• Health care spending in California per capita in 2009 was $6,238, the ninth-lowest in the U.S.;
  
• Spending on health care accounted for 12.2% of California's economy, a smaller portion than most states;
  
• Hospital and physician services accounted for the majority of health care spending, at 63%; and
  
• Medicare and Medi-Cal, California's Medicaid program, accounted for nearly 40% of the state's health care spending, compared with 27% in 1991 (McMahon, "Money & Co.," Los Angeles Times, 5/9).

 

Technorati Tags: cpi,consumer price index,medical cpi,inflation

Shocking Medical Financial News

During the initial period of my medical practice in California (1970-1980) the finances of running a medical practice seemed straight  forward. In 1980 things began to change and by 1986 most physicians were bracing themselves for what seemed to be an Armageddon.

Looking at physical facilities for medical clinics and hospitals and the  development of marketing techniques and continuing profitability of insurance companies and their stockholders it  became apparent who was suffering the most…providers and patients.

I had the opportunity to review financial reports from the California Health Care Foundation.  I knew things were bad, but had no idea how bad it has become.

 

Beginning in 1999 until  May 1,  2012  there were 260 medical groups that were closed due to financial failure and/or absorbed by another entity. 5,695,685 lives were effected by these group closures.  NUMBER/PERCENT OF CLOSURES DUE TO FINANCIAL PROBLEMS 97/ 37.3%.

The CHCF report is 46 pages long and can be found amongst these other reports:

PDF File 1

PDF File 2

PDF File 3

ZIP File 4

PDF File 5

PDF File 6

PDF File 7

PDF File 8

PDF File 9

 

Approximately one in five Californians lost continuity of coverage, or moved to another group. The not so hidden legal costs are obvious and added to the legal tort fiasco.  Other financial impacts are not accounted for by the inefficiency involved in transferring care to  a new doctor or medical group.

In Summary":

Highlights for 2009 include:

• Health spending in California reached $230 billion, triple 1991 levels.
• California's per-capita spending of $6,238, was the ninth lowest in the nation. By comparison, the US spending per capita was $6,815.
• Health spending accounted for 12.2% of California's economy — a smaller share of the economy than most states or the nation.
• Hospital and physician services continued to account for the majority of spending, totaling 63%.
• Medicare and Medicaid accounted for nearly 40% of California health spending, up from 27% in 1991.

Read more: http://www.chcf.org/publications/2012/05/health-care-costs-101#ixzz1uLUqbwej

What will health information technology, health information exchanges, electronic health records, accountable care organizations, outcome studies, new ICD codes, elimination of procedural based reimbursement accomplish.

How will our system increase the number of primary care physicians.

All these issues face the current and next generation of health experts and physicians.

 

Technorati Tags: health reform,medicare,medicaid,medical group closures,bankruptcy

My Struggles with Social Media

 

Breaking Blogs (from Summify)

Doctor’s Love-Hate  Relationship with Electronic Health Records…It goes something like this  LOVE/HATE

Creative Destruction, What it Means for Healthcare, Clinical Practice and Consumers?

It goes a bit like this, Creative Destruction

Insurers Embrace 'Virtual' Doctor Visits’ (does this mean they will pay for them?)

 

Strategic Investment in Health Resources (Financial)  Editor’s note: Dave Chase is the CEO of Avado.com, a patient portal & relationship management company that was a TechCrunch Disrupt finalist.

 

Following in a long shadow cast by eminent blogger and social media expeert, Dr. Mike Sevilla (formerly known as Dr Anonymous) Health Train Express will partner with Digital Health Space for a series of interviews on Google Plus Hangouts, Live on Air

I am developing a list of interested social media experts in health care for an interview. Social media in healthcare is a  rapidly developing function for patient involvement in a niche unrelated to HIPAA regulations.  Our goal is to educate providers and hospitals how to use the new platforms safely without violating the law.

Check back here or at Digital Health Space for upcoming events.

 

Technorati Tags: google plus,google plus hangouts,live on air,summify,electronic health records,twitter,facebook,hipaa,creative destruction,virtual doctor visits

Social Media and Meaningful Use…will be Symbiotic for Digital Patient & Provider Empowerment

 

Now that is a mouthful, one that came to me while reading an article from Healthcare  IT News.

Jennifer Dennard, Billian's HealthDATA, Porter Research, HITR.com talks about “Blowing the Social Whistle on Patient Acquisition” Jennifer Dennard is Social Marketing Director for Atlanta-based Billian's HealthDATA, Porter Research and HITR.com. Connect with her on Twitter @SmyrnaGirl.

***********************************************************************

Social Media seems a total disconnect from criteria for meaningful use of electronic medical records and the ability to qualify for incentive funding by Medicare.  Well, guess again. One of the Meaningful Use, stage II requirement is digital inclusion of patient involvement in access to electronic portals, and medical data.

Not only does Stage II of Meaningful Use call for patient portals and the like it will require enticing patients to use them

This is where Social Media becomes almost essential to a medical practice. “The ‘empowered patient’ responds to this type of marketing – they don’t even pay attention to traditional media. They are the influencers. As Stage 2 of Meaningful Use comes out and providers are required to activate patients online, they’ll need to grab the empowered patients they already have and turn those folks into evangelists.”

It’s a marketing concept not unlike that used in traditional consumer areas. Connect with consumers online, establish trust and credibility with those fans/followers, and then make them an evangelist for your product. Eventually, their fans, followers and family members will also become your customers. That’s the simplified version, anyway.

Sengbusch and his team realize that providers will often jump out of their comfort zone to engage with patients in these more social areas. He stresses that it’s important docs realize “they don’t personally need to be on social media, but they need to be open to their brand being on social media so the can capture positive reviews and become aware of patient advocates.”

And now the added attributes required for Stage II meaningful us.

 

Technorati Tags: medicare,meaningful use,social media,emr,patient portals,web,health it tutorials,#hcsm

Another Conundrum of Chaos Theory or What is the color of your Butterfly ?

 

Click on the Picture

There's a snag in the proposed meaningful use Stage 2 rule, and it concerns whether or not doctors need to be good at typing. Depending on how the final requirements for Stage 2 play out, they might have to be.

The HIT Policy Committee on Wednesday was divided over a measure in the Stage 2 rule that would allow licensed professionals or scribes to enter data into a patient’s electronic health record on behalf of a doctor.

The difficulty is this: If a doctor doesn’t enter the order, he or she will not be able to see the decision support built into the EHR system that appears at that time. Decision support is supposed to help with the prevention of medical errors and is, according to federal officials, one of the reasons for the EHR incentive program in the first place.

Most electronic health record systems only show decision support once, as the computerized physician order entry, or CPOE, is typed into a system, according to Paul Tang, MD, chief innovation and technology officer at the Palo Alto Medical Foundation and vice chair of the HIT Policy Committee. The problem is, most doctors do not type in their own orders. Nurses often enter medication orders or clerical persons type in hand written physicians’ orders, later to be “signed off on” – or approved on the computer – by the physician, often in groups of multiple orders at the end of the day.

 

Technorati Tags: meaningful use,chaos theory,butterfly principal,cpoe,decision support,hit,ehr adoption

Medicare Fraud/Abuse: Don’t Do It

 

Many of our readers are not health professionals, and they are observers of our (their) wounded health system.  The following stories such as these point out how sociopaths impact the federal budget, and directly reduce the ability of honest citizens to obtain medical care. Unlike non violent criminals there actions amount to an assault and sometimes indirect homicide on all of us.

Bolademi Adetola, owner of healthcare equipment provider Latay Medical Services in Gardena, was charged with billing Medicare for power wheelchairs that were never purchased. Greatcare Home Health in Los Angeles allegedly paid kickbacks to recruiters to find "patients" who were perfectly fine, and then have doctors knowingly write phony prescriptions for them.

Dr. Augustus Ohemeng and Dr. George Tarryk, who treated patients at the Pacific Clinic in Long Beach, were among four individuals who allegedly falsely billed for feeding tubes for patients who did not need them.

Lawrence Duran, the former owner of a mental healthcare company in Miami was sentenced last year to 50 years in prison. Or his two co-owners, each of whom was sentenced to 35 years."

In the Los Angeles area, eight people, including two doctors, were charged with fraudulently billing about $20 million for services never provided.

In addition, officials in the Health and Human Services Department suspended or took other administrative actions against 52 medical providers after analyzing billing requests and finding additional "credible allegations of fraud.

 

Many home health, durable medical suppliers and physicians started yesterday with a full waiting room of federal agents, FBI, IRS and Medicare officials with subpoenas, and seizure warrants for records, computers and information regarding billing of Medicare. 

The Feds and Medicare have increased their power of investigation and enforcement using sting operations, whistle blowers and other clandestine operations. The War on Medicare Fraud and Abuse is underway. It is amazing how inventive Medicare embezzlers can become to siphon money from the U.S. Treasury.

Doctors, nurses and social workers from across the country, 107 in all, were charged in what federal officials in Washington called a "nationwide takedown" of medical professionals accused of fraudulently billing Medicare out of nearly half a billion dollars. Of the 107 defendants in the latest crackdown, 87 were arrested Wednesday. Federal agents were either still looking for the others or expecting them to surrender voluntarily.  In addition, officials in the Health and Human Services Department suspended or took other administrative actions against 52 medical providers after analyzing billing requests and finding additional "credible allegations of fraud."

The amount of bogus Medicare claims, totaling about $452 million, was the highest in a single raid in the history of a federal strike force combating rising fraud in the medical industry, according to the Justice Department. Arrests were made in seven major cities.

The Obama administration said it was toughening its attack on those who filed bills for ambulance rides never taken and medical procedures never provided.

The funding for the increase in  enforcement is from a portion of the Health Reform Act (PPACA). It’s part of the 1200 page bill Congress did not read before passing it. It’s one section of the act that is in force…..now….and it can be retained if part of or all of the PPACA is disallowed by SCOTUS

 

Technorati Tags: scotus,fraud,abuse,medicare,PPACA,Medicare,HHS,FBI,IRS

A New Reason to Not Overturn the Current Health Reform Law

 

Last year, in a lower court filing on the case, Justice Department lawyers said reversing the Medicare payment changes "would impose staggering administrative burdens" on the government and "could cause major delays and errors" in claims payment.

WASHINGTON (AP) - Medicare's payment system, the unseen but vital network that handles 100 million monthly claims, could freeze up if President Barack Obama's health care law is summarily overturned, the administration has quietly informed the courts.

The administration fails to address how much it will cost to continue developing an overly burdensome re-organization of health reform.  The true cost is the difference between continuing the present implementation of Obama care, or rescinding part of or all of Obama care.

Although Obama's overhaul made significant cuts to providers and improved prescription and preventive benefits, Medicare was overlooked in Supreme Court arguments that focused on the law's controversial requirement that individuals carry health insurance.

Yet havoc for Medicare could have repercussions as both parties avidly court seniors in this election year and as hospitals and doctors increasingly complain the program doesn't pay enough.

The truth is that Medicare already operates in a climate of havoc now.

 

Each year there are an assortment of systemic changes foisted upon congress, providers, patients,hospitals and in order to continue operating these institutions face considerable costs annually to meet governmental and insurance regulations.

Annually Congress refuses to make a definitive change to the SGR (sustainable growth rate) for provider reimbursement. Beginning over ten years ago the SGR has been delayed…..each year it called for adjustments between 3% and 5%. until today when the accumulated SGR is 30% or more. This,s is not a well known issue among the public sector.  Each year it is not addressed until the final 11th hour and then attached to another bill for last minute approval.

The devil in Medicare’s details are hidden, buried in the Federal Register, attached to another bill (usually not health related)

In papers filed with the Supreme Court, administration lawyers have warned  of "extraordinary disruption" if Medicare is forced to unwind transactions that are based on payment changes required by more than 20 separate sections of the Affordable Care Act.

This predicament can be squarely placed upon members of congress and Nancy Pelosi. Most of congress did not read the bill, and had they it most likely would have faced considerable amendments.

Nancy Pelosi made the pronouncement  “we would know what was in it when it is passed.”

Passage was accomplished  for political expediency. It was immediately obviously because of it’s partisan support and the reaction of the American public.  It was not greeted with enthusiasm, except for a sigh of relief by Democrats.

Opponents say the whole law must go. The administration counters that even if it strikes down the insurance mandate, the court should preserve most of the rest of the legislation. That would leave in place its changes to Medicare as well as a major expansion of Medicaid coverage.

Former program administrators disagree on the potential for major disruptions, while some private industry executives predict an avalanche of litigation unless Congress intervenes.

Tom Scully, who ran Medicare during former President George W. Bush's first term, does not foresee major problems, although he acknowledges it would be a "nightmare" for agency bureaucrats.

"It is highly unlikely in the short term that any health plan or provider would suffer," said former CMS head  Scully. "They're probably likely to get paid more going forward. If you look at the way the law was (financed), it was a combination of higher taxes and lower (Medicare) payments. That's what you would be rolling back."

Another former CMS head  Don Berwick, Obama's first Medicare chief. "I would not be surprised if there are delays and problems with payment flow. Medicare has dealt with sudden changes in payment before, but it is not easy." (they have done it every year in the past) No one in administration or congress complained this loudly then.

It's not just reimbursement levels that would get scrambled, Berwick said. The law's new philosophy of paying hospitals and doctors for quality results, rather than for sheer volume of tests and procedures, has been incorporated in some payment policies.

In truth no one really knows what the  effect would be since the whole process is arcane and byzantine.

The White House declined to comment

 

Technorati Tags: scotus,obamacare,sgr,health reform,cms,don berwick,tom scully,pelosi

The Ethics of Waste Avoidance

And the majority of waste is not fraud and abuse, but our current system of procedural reimbursement, redundant, unnecessary testing, and unproven treatments.

When I was a medical student, intern and then a resident we were taught to go the distance in order to find the correct diagnosis or render optimal treatment. Ethically there were no other options.

Weighing in heavily was the fact I trained at what would now be designated a tertiary medical center.  Patients were referred to our center when their family physician or general internist was stumped in making a diagnosis or referred for an expert treatment or to receive specialized treatment from a specialist who had multiple experiences with a particular disease or surgeries.

Physician outcomes differ radically between community hospitals, amongst themselves and tertiary centers.  In some cases outcomes are ‘better’ at a higher level of care for elective surgery And in other cases, such as infectious disease or critical illness, less common acute or chronic diseases they will be worse. Many times incurable illness or those with lower survival rates are referred to a tertiary center.

In this week’s New England Journal of Medicine an article by Howard Brody, M.D.,  PhD explains the”transition from the ethics of rationing to that of the ethics of waste avoidance”.

(From the Institute for the Medical Humanities, University of Texas Medical Branch, Galveston)

Admirably Dr. Brody does an exemplary, articulate and admirable job of desensitizing  an issue that is an emotional conundrum which is rightly anathema to physicians, patients and families.

Rationing is a dirty word….especially in medicine.  It conjures up the idea that some patients are worth saving while others are not, and it also conjures up thoughts about “death panels”.  This was clearly an anxious moment for Health Reform to remove the idea of a committee of physicians and ethicists making life and death decisions for patients and their families.  Clearly, politicians quickly dismissed any idea of ‘death committees’.  Any further mention would have doomed “health care revolution”.

To quote Dr. Brody,

A case study for the shift in ethical focus is the treatment of advanced, metastatic breast cancer with high-dose chemotherapy followed by autologous bone marrow transplantation. This treatment was initially thought to offer perhaps a 10% chance of a significant extension of life for patients who would otherwise be fated to die very soon. Insurers' refusal to pay the high costs of this last-chance treatment did much to torpedo public trust in managed care during the 1990s. Data now suggest that the actual chance of meaningful benefit from this treatment is zero and that the only effect of the treatment was to make patients' remaining months of life miserable. In this case, the ethical debate over rationing was misplaced.

We have for too long ignored how much money is spent in the United States on diagnostic tests and treatments that offer no measureable benefit.3 Redirecting even a fraction of that wasted money could expand coverage for useful therapy to all Americans, while reducing the rate of overall cost increases.

The ethical question therefore shifts to waste avoidance. Even though the concept of medical futility has had a vexed history, this new ethical question is a subcategory of the futility debate. We now realize that futile interventions may be administered not solely because of patients' demands but also by physicians acting out of habit or financial self-interest or on the basis of flawed evidence. The ethics of waste avoidance is thus in part a component of the ethics of professionalism.5

The two principal ethical arguments for waste avoidance are first, that we should not deprive any patient of useful medical services, even if they're expensive, so long as money is being wasted on useless interventions, and second, that useless tests and treatments cause harm. Treatments that won't help patients can cause complications. Diagnostic tests that won't help patients produce false positive results that in turn lead to more tests and complications. Primum non nocere becomes the strongest argument for eliminating nonbeneficial medicine.3

Physicians, as loyal patient advocates, must invoke the process when (according to their best clinical judgment) a particular patient would benefit from an intervention even if the average patient won't. Few tests and treatments are futile across the board; most help a few patients and become wasteful when applied beyond that population. But the boundary between wise and wasteful application will often be fuzzy.

The Ethics of Eliminating Waste

Berwick and Hackbarth note a relatively minor ethical point, but a serious policy concern2: a substantial reduction in health care spending would seriously disrupt a $2.5 trillion industry, and thus the U.S. economy as a whole, and would require careful planning and gradual implementation. A stepwise strategy also makes good ethical sense in the face of the current limitations of evidence-based medicine. Given our patient-advocacy duties, it is better first to eliminate interventions for which we have the most solid and indisputable evidence of a lack of benefit. We can then extend the policy gradually as comparative-effectiveness research identifies other sources of waste with reasonable confidence.

An ethical mandate to prioritize waste avoidance doesn't address the political hurdles, of course. Given that one person's health care expense is another person's income, we can anticipate pitched battles, accompanied by demagoguery such as talk of “death panels.” Medicine's role in this campaign will pose a serious challenge to physician professionalism. Will U.S. physicians rise to the occasion, committing ourselves to protecting our patients from harm while ensuring affordable care for the near future?

This fresh approach gives hope to those who are suspicious of what will happen in health reform.

It is critical that patients and physician have voice in ethical decision making, and not become powerless or ‘victims’ of a changing system

 

Technorati Tags: Berwick,Hackbarth,Ethics,Waste,rationing,medicine,medicare,outcomes,tertiary care,community hospital

More on Big Data

 

fig.1

A data visualization created by IBM shows that big data such as Wikipedia edits by bot Pearle are more meaningful when enhanced with colors and position.

During the past 25 years or more Medicare and private insurers have gathered data on diagnosis codes,, reimbursement patterns and demographics for providers and patients. Gradually the amount of data has increased enormously.

Now with the implementation of electronic  medical records and health information exchanges the collection and retrieval of clinical information will explode.

From Google Plus comes this information on BIG DATA. This is a new term which seems to be #trending in Health IT the past month.

The term is not confined to Health IT, and appears now in social media circles, including Google Plus.

Big Data can be defined….Wikipedia:

“In information technology, big data^[1] consists of data sets that grow so large that they become awkward to work with using on-hand database management tools. Difficulties include capture, storage,^[2] search, sharing, analytics,^[3] and visualizing. This trend continues because of the benefits of working with larger and larger data sets allowing analysts to "spot business trends, prevent diseases, combat crime."^[4] Though a moving target, current limits are on the order of petabytes, exabytes and zettabytes of data.^[5] Scientists regularly encounter this problem in meteorology, genomics,^[6] connectomics, complex physics simulations,^[7] biological and environmental research,^[8] Internet search, finance and business informatics.”

While common knowledge in IT circles among health providers it is important to recognize the world’s technological per capita capacity to store information has roughly doubled every 40 months since the 1980s (about every 3 years)^[11] and every day 2.5 quintillion bytes of data are created.^[12]

^{This can also be assumed to have taken place in HIT.}

Big  Data  has been around for a long time…at the IRS, Census results, NASA, NOAA, and others.  The CIA probably has  ‘Mega Data” when it comes to Big Files.I

Health Information Technology now offers a fertile ground for ‘Big Data’.

One current feature of big data is the difficulty working with it using relational databases and desktop statistics/visualization packages, requiring instead "massively parallel software running on tens, hundreds, or even thousands of servers".^[13] The size of "big data" varies depending on the capabilities of the organization managing the set. "For some organizations, facing hundreds of gigabytes of data for the first time may trigger a need to reconsider data management options. For others, it may take tens or hundreds of terabytes before data size becomes a significant consideration."^[14]

^{The standard display of tables with contents and rows of data do not properly  represent results, and it may require A data visualization created by IBM shows that big data such as Wikipedia edits by bot Pearle are more meaningful when enhanced with colors and position. (figure 1)}

^{Providers must be aware of how the information their EMR contributes to the pool of data, how it will be extracted and manipulated to make public health decisions, create treatment paradigms, and develop outcome studies.  Insurers and public entities are very interested in these numbers..  Incentivization by government funding for EMR reinforces the need of government and health planners to have accurate information.}

^{Now for Chapter 2, in addition to Big Data we have:}

Massively Coordinated Care

By Ian Morrison
May 01, 2012

Author, consultant and futurist based in Menlo Park, Calif. He is also a regular contributor to H&HN Daily and a member of Speakers Express.

“Big data and new thinking can transform the care of heavy users. In health care we are throwing off big data as we increasingly digitize the health care system. One analyst estimated that in 2011 alone, health care would generate 150 exabytes of information (by my calculation that is equivalent to 6 million times all the published works in the Library of Congress). “

Big IT Vendors stand to reap significant rewards:

“Global consulting players and industry gurus such as McKinsey and IBM are talking up big data, big time. McKinsey, for example, estimated that big data could create $300 billion in value by reducing health care spending by 8 percent. They argued that big data adds value to industries by:

• making information transparent and usable more quickly;
• enabling better performance measurement through digital capture;
• allowing finer grain segmentation;
• improving business analytics and decision support;
• enabling new products and services.

All of these changes are plausible in health care, and we should welcome them, particularly if they are applied to the challenge of predicting, analyzing, segmenting, treating and coordinating the care of the heavy users of health care.

Big data and the processing power of massive computers like IBM's Watson can help sort through tough analytical problems and provide guidance and support, maybe even replicating at scale and at speed the really tough work of clinical decision-making “

Accountable Care Organizations will catalyze development of new software and data analysis . All of this explained further by "Six Key Technologies to Support Accountable Care

 

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