News&Views

November 30, 2008

Do Not Resist…

Engage with grace slide…talking about DNR status with family and friends during the holiday season, according to Engage With Grace: The One Slide Project. The project’s goal is to ignite public interest in this difficult discussion. Their marketing is e-perfect: the project was introduced at last month’s Health 2.0 Conference by software developer Alexandra Drane, who related her inspiring family story. Word-of-mouth publicity is generated through the project’s interactive Web site and a rally of blog postings. To spread the word beyond the Web, they ask every professional lecturer, whatever the topic of their presentation, to close their talk with a final slide (see left), which lists five end-of-life questions designed to engage reflection and thoughtful discussion. The mainstream newspaper The Boston Globe published a front page article on the project last Wednesday, Talking Turkey About Death which is freely available online.



November 19, 2008

Easy Rider 2.0

Filed under: — mlazoff

A fun and interesting 16-minute video clip by David Kibbe, MD MBA, as he visits several self-described Health 2.0 companies that provide technology tools and information to patient consumers, with varying amounts of physician involvement. If “The Great American Health 2.0 Motorcycle Tour” is no longer on the first page of ScribeMedia.org, find the clip under Browse Video List.



January 31, 2008

The healing (multi)touch

Filed under: — mlazoff

Multitouch, the new input technology familiar to iPhone users and fans of the film Minority Report, allows for manipulation of graphic images by user gesturing with one or more fingers, usually on a screen but also a table top or laptop touchpad. An article in today’s Wall Street Journal by columnist Walter Mossberg provides WSJ subscribers with background information and a fun video demonstrating the technology. For non-subscribers, all of Mossberg’s articles are freely available online under the Personal Technology section of All Things Digital, a wonderful blog-type Web site sponsored by WSJ.



November 30, 2007

“Googling my own DNA”

Filed under: — mlazoff

In a recent New York Times report, My Genome, Myself: Seeking Clues in DNA, Amy Harmon continues her series on genetic technology by describing her personal reaction to genetic testing. “For as little as $1,000 and a saliva sample, customers will be able to learn what is known so far about how the billions of bits in their biological code shape who they are.” A side bar on the second page of the article gives a brief description and links to the three companies that currently provide genotyping. The Health and Human Service’s Personalized Health Care Initiative is introduced by Secretary Leavitt in last month’s report, Personalized Health Care: Opportunities, Pathways, Resources. “In the coming years, new gene-based knowledge, combined with the advent of health information technology, can make possible a new kind of medical care for Americans.”



October 9, 2007

Microsecurity on Microsoft’s HealthVault?

Filed under: — mlazoff

Last week, Microsoft unveiled HealthVault, the highly promoted collection of next-generation (Web 2.0) consumer health-related projects. Online now is a personal health records (PHR), which allows for traditional data storage within a consumer-controlled portal through which Microsoft-partnered doctors, clinics and hospitals can, with patient permission, also view the PHR and communicate information and test results back to the patient. According to a New York Times article from October 4th, Microsoft Rolls Out Personal Health Records, “The organizations that have signed up for HealthVault projects with Microsoft include the American Heart Association (AHA), Johnson & Johnson LifeScan, NewYork-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 article provides examples of several corporate collaborations: an online blood pressure management tool created by Microsoft and the AHA where data can be entered by patient or physician; a glucose monitoring tool for diabetics who use Lifescan meters; and how patients within partnered healthcare systems can receive and store test results, such as their EKGs. 

A second site feature provides access and storage facilities to selected consumer health information using their clustering HealthVault search engine, now in beta testing. Microsoft states that all searches are anonymous. The results page includes Sponsored Results. For more information, see Microsoft Debuts HealthVault, an article posted the same day on Digital Healthcare and Productivity Web site.

Privacy issues on PHRs and associated features are addressed. According to the article, ”Microsoft’s privacy principles have impressed Dr. Deborah Peel, chairwoman of the Patient Privacy Rights Foundation, a nonprofit group. In terms of patient control, and agreeing to outside audits, ‘Microsoft is setting an industry standard for privacy,’ said Dr. Peel.”

A news release on the Foundation’s Web site announces that Microsoft “sought advice” from the Foundation in preparing HealthVault and that Dr. Peel appeared with Microsoft at the press conference announcing its launch. ThePrivacyPlace.org, a multi-institution academic research technical privacy center without known relationship to Microsoft, today posted an article on their Web site questioning Is The Vault Really Protecting Your Privacy? ”When the Health Insurance Portability and Accountability Act (HIPAA) was enacted, we did not envision that private software firms would eventually want to create databases for our health records. As a result, HealthVault and other PHR systems are not subject to the same privacy and security laws to which traditional medical records are subject to in the United States because they are not ‘covered entities’ as specified in the HIPAA…Microsoft appears to have sought the counsel of physicians [Dr. Peel] who believe that patient consent is the best indicator of privacy protections. Unfortunately, most physicians do not understand the subtleties buried within healthcare privacy statements within the context of the software that implements those statements…The hype surrounding HealthVault’s privacy protections among those in the medical community must be balanced with the reality of the information security and privacy practice expressed in its public privacy statements.”



September 28, 2007

Public-Private Disconnect?

Filed under: — mlazoff

Yesterday’s Slate article, Where’s My Free Wi-Fi? Why municipal wireless networks have been such a flop, describes the failure of many free citywide Wi-Fi systems, particularly those based on private/public partnerships in cities like Philadelphia and San Francisco. “The result, as this summer has made clear, has been telecom’s Bay of Pigs—a project the government wanted to happen but left to underqualified private parties to deliver…The deeper problem is economics… Private municipal wireless networks have to compete against competitors with better infrastructure who paid off their capital investments years ago…Today, the limited success stories come from towns that have actually treated Wi-Fi as a public calling. St. Cloud, Fla., a town of 28,000, has an entirely free wireless network. The network has its problems, such as dead spots, but also claims a 77 percent use rate among its citizens. Cities like St. Cloud understand the concept of a public service: something that’s free, or near-free, like the local swimming pool.” Ignacio Valdes, MD, creator of the wonderful open access software news blog LinuxMedNews, noted in today’s entry that the failure of several citywide Wi-Fi projects “may shed some light on the failings of RHIOs.”  (For example, see Requiem for an HIE Dream in last month’s News&Views.)



September 11, 2007

In memoriam

Filed under: — mlazoff

The Wall Street Journal’s Health Blog offers an off-topic but reflective page on the World Trade Center: Past and Planned.



The Eyes Have It

Filed under: — mlazoff

An interesting opinion piece by medical resident Michael Hochman, MD, posted today on Boston.com, Eyes Shift From Patient to Keyboard reviews some of the benefits and limitations to physicians in using computers in patient encounters. Benefits include: speed of chart review, increased access to key medical history information, and at least one study that found ”after the introduction of a computer in the office, patients were more likely to feel that their doctors were familiar with their history.” On the other hand, two studies found that a sizeable minority of patients experienced computers as interfering with their time with, and attention from, the doctor. In particular, lack of eye contact between physician and patient is discussed, along with possible remedies, such as acknowledging the distraction to the patient beforehand, and closing each session with a face-to-face review of the visit. Another option not discussed: arranging the monitor so that both patient and physician can see what’s on the screen, as when the patient sits alongside rather than across from the physician’s desk. 



September 6, 2007

P4P’s peek into the future of medical charting

The Leapfrog Group, a powerful group of major company and other large private and public healthcare purchasers known for supporting quality and cost-control incentives, promotes the results of this year’s Pay for Performance (P4P) and Consumer Incentive Survey of 75 “purchasers, government agencies, and health plans”. Conducted biannually since 2003, this year Leapfrog partnered for the first time with the P4P specialty software company Med-Vantage. The actual results are not online, only the press release, which describes several statistics: a nearly four-fold increase in the number of P4P programs to a current 148; a cost savings noted by about a third of respondants; and that provider performance was made publicly available by over 30% of respondants. 

An article posted earlier this week on the Web site of magazine Modern Healthcare Online commented on this press release: “Even as payers issue glowing news releases about the expansion of their programs’ scope and the millions of dollars in physician rewards they’re dispersing, government officials, research organizations and physicians are questioning the motivation and methodology of current pay-for-performance programs.” The above Leapfrog/Med-Vantage survey is contrasted with a report on P4P among commercial insurers released several weeks ago by PriceWaterhouse, which describes significant differences among these programs’ structures, performance metrics and rewards structures. 

The Modern Healthcare article quotes a surgeon/attorney who describes P4P as, “an attempt to control prices—but not for the benefit of the patient or the benefit of the doctor.” From elsewhere in the article: “Meanwhile, the physician-ranking programs [used by over 30% of respondants to the Leapfrog/Med-Vantage survey] under consideration for use by insurers Aetna, Cigna HealthCare and UnitedHealth Group have come under scrutiny by New York State Attorney General Andrew Cuomo, who expressed concern that the rankings may be used to steer patients toward less-expensive rather than higher quality providers.”

HIT is the elephant in the P4P room. According to the Modern Healthcare article, “In the end, the one industry segment that may truly be happy with pay-for-performance programs are health IT vendors who can persuade providers that their electronic systems are absolutely necessary for the data management that require such programs.” The article closes with a comment by a Pricewaterhouse director who believes that wider IT adoption would “‘pave the way for standardized measures,’ mak[ing] it easier to validate physician data and reduce the administrative costs of the programs.” The Leapfrog/Med-Vantage press release agrees: ”Advanced P4P programs are now developing tools to measure improvements in outcomes and eligibility for rewards directly from medical charts.”



August 30, 2007

Chart Review

Filed under: — mlazoff

Patient Records Needs Review is the cryptic title from a Wall Street Journal article that advises everyone to review their own medical records for errors, miscodings, outdated diagnoses, and other inaccuracies. ”Savvy consumers know to check their credit score before applying for a loan. What is less well known is that consumers can improve their chances of getting insured — and of paying lower premiums — by checking that medical information held by doctors, hospitals and pharmacies is accurate…the U.S. health-care system relies mainly on paper records, which make it harder to coordinate care and spot errors.” The article closes with a big nod to EHRs: ”…until the U.S. develops a comprehensive, consolidated [electronic health records] system, the burden falls to individuals to keep tabs on their health histories.”

The article quotes Joy Pritts, research associate professor at Georgetown University’s Health Policy Institute and founding director of their Center of Medical Record Rights and Privacy.  



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