News&Views

August 29, 2006

iTreo

Filed under: — mlazoff

The Palmdoc Chronicles, a longstanding blog that updates physicians on new PDA hardware and software, gives instructions on how to receive medical podcasts on a Treo. PalmDoc is a self-described, “40 something year old Physician who specialises in Hemonc & Stem cell Transplantation.”



Diagnostic FreeCell

Filed under: — mlazoff

According to a Medical News Today article first published last month, OHSU Scientists Say FreeCell Can Be Adapted To Spot Early Signs of Dementia. As many PC users are aware, FreeCell was one of the first solitare games freely bundled to Windows operating systems. “‘It requires significant planning to play well, and planning is one measure that neuropsychologists attempt to test in clinical situations,’” [OHSU Oregon Center for Aging & Technology investigator Holly] Jimison [PhD] said. ‘We’re trying to replicate that, and we’ve been able to show that we can, at least in early studies with small numbers of people, show distinctions between cognitively healthy elders and those with even mild cognitive impairment.’” Jimison and study co-author Misha Pavel, PhD, professor of biomedical engineering and computer science and electrical engineering at OHSU’s OGI School of Science & Engineering, studied nine people with an average age of 80. All were regular computer users who played the FreeCell game frequently over a six-month period. Each participant was given a cognition score based on a brief battery of tests, and three were found to have mild cognitive impairment.” The article noted that several researchers, including Drs. Jimison and Ravel, also are employees of Spry Learning, a company that may have a commercial interest in the results of this research, though the conflict was reviewed and approved by the OHSU Conflict of Interest in Research Committee. According to their Web site, “Spry Learning is part the Executive Board of a consortium of organizations (including OHSU, Intel, HP and GE) to win an NIA Roybal Center grant for applied research to keep older persons independent, active, and productive in later life.”



August 21, 2006

The electronic era of per$onalized medicine

Filed under: — mlazoff

The Business/Your Money section in this past Sunday’s The New York Times includes Smart Care via a Mouse, But What Will it Cost? (available to free registrants), a futuristic look into how data collection and analysis associated with a widespread use of electronic medical records might affect healthcare quality and cost. “An information revolution in health promises to be powerfully disruptive for some lucrative businesses in the industry, according to medical experts and economists, and could lead to more spending on health care instead of less. ‘Information is a dual-edged sword, especially in health care,’ said David M. Cutler [PhD], a health economist at Harvard. ‘Better information might blow apart some of the blockbuster markets in the pharmaceutical industry, for example. But it might also increase demand for other drugs in smaller, more focused markets. And if better information really helps us understand what is happening in health care,’ Mr. [sic] Cutler added, ‘it could well lead to more care for more people and higher costs for the system as a whole.’” (For more on Dr. Culter and his beliefs, see The Quality Cure? from the March 13, 2005 edition of The New York Times).

The article goes on to describe the potential benefits of outcome measures using anonymous data collected from electronic records in the proposed Nationwide Health Information Network. Today, smaller integrated health systems such as the Veterans Health Administration and the health maintenance organization Kaiser Permanente are described as “leaders in adopting electronic records,” where each organization’s electronic data collection and analysis makes possible “market-disrupting cost savings.” For example, by educating physicians using outcome measures, VA and Kaiser physicians now prescribe more generic lovastatin than other, more expensive “blockbuster” statins. “Ideally, electronic patient records and a national health information network would someday give doctors everywhere the information to make similar prescribing decisions and to track their patients closely, if they chose…Whether more data threatens blockbuster drugs or not, there are likely to be cases in which more information is likely to generate more prescriptions, more care and more health care spending.” For example, future genetic testing might identify an individual patient’s ideal dose of the currently difficult-to-regulate blood thinner, warfarin—and so likely increase its use among physicians and benefit to patients, though at an increased cost. The article closes: “The electronic medical record, for all its promise, is no silver bullet for the nation’s health system. Placing too much faith in technology, skeptics warn, could be counterproductive. Dr. David Himmelstein, a physician and associate professor at the Harvard Medical School, said: ‘It encourages the belief that we don’t need real reform, all we need is computers.’”



Telebiopsy report

Filed under: — mlazoff

A recent press release from Kansas University Medical Center describes how surgeons in the OR are teleconferencing with pathologists in their lab. “The system uses two computers equipped with cameras, an intranet connection and high-quality video conferencing software to create a virtual connection…surgeons can send a tissue sample to the lab and communicate from the OR as the pathologist examines the sample under a microscope. In fact, surgeons can see both the pathologist and the microscope slide on the computer screen, making the process truly interactive.” The press release describes this as an “innovative system,” but is this really not being done elsewhere in 2006? (Thanks to HIStalk, who notes, “That’s one of those ‘why didn’t we think of it earlier’ ideas that’s cool, easy, and cheap.”)



August 18, 2006

InfomORcials

Filed under: — mlazoff

From the August 14th issue of Newsweek, Lights! Camera! Incision! describes a free resource offering live and archived instructional operating room procedures, all professionally filmed with narration. OR-Live.com was created 6 years ago for a physician/surgeon market, but according to the article, “In the last year, Webcast viewership has more than doubled from 62,000 to 131,000 per week—and consumers make up 60 percent of the audience.” There are dozens of upcoming live events and hundreds of archived surgeries available, particularly on the newer procedures in cardiology, orthopedics, OB-GYN and pediatrics. Content is broad but selective. For example, a search for “appendectomy” found no videos; “ASD [atrial septal defect] repair” returned three OR-Live videos on the new transcatheter repair of ASDs from two adult and one pediatric hospital; “knee repair” returns 172 hits, most referencing the same videos of total knee replacement surgeries—both full and minimally invasive, and also several cartilage restoration procedures. The site founder describes its funding as PBS-type corporate sponsorship, but the Newsweek article suggests otherwise: the pharmaceutical and medical device companies, some employed or installed during the operations, use surgeons and patients “chosen to showcase optimal results.” 

When I accessed the site, I was unable to identify the source of funding for individual videocasts prior to actually viewing the videocast. The ones I viewed reminded me of educational promotions of hospital staff/resources and medical devices, basic CME fare (though none is offered, so there are no ACCME accreditation safeguards, such as they are); it seems that most hospital-sponsored programs are patient-oriented while most medical device-sponsored programs are directed at physicians. Features include not only narrated video clips but also automated slide shows and user interactivity. Multimedia quality using RealPlayer (the site links to free download) is excellent. OR-Live.com is owned by Internet broadcasting for healthcare company slp3D, Inc whose Web site states, “All slp3D solutions are designed to generate tangible Return on Investment in the form of increased revenue and brand awareness.” Some patients clearly love this kind of patient education and may appreciate a referral to view a particular operation or discussion, but average patients who stumble upon the site without prior knowledge are not likely to identify the promotional bias (especially without the source of funding clearly noted) or place an individual procedure into therapeutic perspective.  



August 14, 2006

Bullseye

Filed under: — mlazoff

Missing the Target, another thoughtful Health Care Renewal blog by owner Roy M Poses, MD, begins with an extensive requote of a Times (UK) article last Thursday by geriatrician and philosopher Raymond Tallis on how Targets have failed the NHS. Access Dr. Tallis’ article for its persuasive eloquence regarding the effect of “target-mania” on UK’s healthcare—including his description of NHS’s information technology as, “brewed in No 10 [Downing Street], constantly exposed to political interference and rarely reality-checked with professionals expected to use the systems”—and for the breadth of reader comments that follow the article.  Dr Poses’s conclusion:  “Maybe we in the US should look at the British experience before rushing off to implement P4P [pay-for-performance].”  (For another perspective, see the NEJM’s recent, generally favorable “look” into the UK’s experience—links in No Performance Anxiety.)



August 10, 2006

YouTooTube

Filed under: — mlazoff

The potential of YouTube for something more than creative narcissismhomemade music videos, get well video cards and documentary promotions: patient education is showcased by five video clips (on using asthma inhalers and spacer devices, on blood sugar testing, and cervical cancer screening) from Builth & Llanwrtyd Medical Practice, a surgical practice in rural Mid Wales, UK. Spanish-speaking patients, and those who appreciate more artistic ventures, will appreciate Como Usar Su Inhalador and How to Recognize and Treat Fever in Children by amateur filmmaker Nathanial Smith with a team of Penn med and nursing students in Guatemala, a local family, and the local Hosptitalito Atitlan, for the Tzu’tujil people of the area—and now, the whole world.



August 8, 2006

Take 2 Web sites and email me in the morning

Filed under: — mlazoff

Buried in the TechNews.com section of today’s Washington Post.com is the prophetic The Web Returns to Health. The largely “disappointed” U.S. adults, about 80% of whom have already tried searching the Web for health information, has spurred a second wave of corporate investment: “more than $100 million into building virtual destinations that offer consumers something beyond disease encyclopedias. Some want to make it as easy to choose a doctor as a restaurant. Others eventually hope to offer ‘virtual assisted living’ by monitoring medicines or pacemakers remotely, so the elderly can stay in their homes longer.” According to Wayne Gattinella, chief executive of WebMD (which the article describes as the dominant corporation in the field), “‘The health category is the last frontier where the Internet has not yet transformed that industry, the way it has done for travel, finance, and commerce…The consumer is starting to expect the same information with respect to a health provider as they expect with an airline or investment vehicle. Those are the big forces that will accelerate changes in our industry in the next five years,’” though the article makes clear that not everyone agrees. 

The article goes on to describe three upcoming sites: “EverydayHealth.com…set to launch later this year, will deliver personalized health information, even by phone or personal digital assistant, to more than 11 million people who have created profiles on one of Waterfront’s existing health-related sites”; HealthCentral Network’s HealthCentral.com is a collection of sites “revamped” into, “a network of 25 condition-specific destinations that offer physician-reviewed information and the ability to connect with ordinary people who have experienced the same illness”; Revolutionhealth.com, the Web portal of Revolution Health, is scheduled to launch in the fall. Described as “probably the most ambitious of WebMD’s would-be competitors,” Revolution Health will offer “the usual searchable encyclopedia of disease information” and Web tools for patients to locate physicians, schedule appointments and manage health-related expenses. “What sets Revolution Health apart is its offline investments in walk-in retail clinics at places such as Walgreens and Wal-Mart for minor medical issues, and in insurance providers that offer high-deductible plans directly to consumers…RevolutionHealth.com plans to make money by selling customized services to employers and health plans, selling advertising and charging membership fees for a suite of premium services, which may include access to better-quality doctors.”  I wonder how Revolution Health will determine who is a better quality doctor?



August 3, 2006

Kicking back Anti-Kickbacks

Filed under: — mlazoff

“‘This is a big day for the advancement of health IT,’” Health and Human Services (HHS) Secretary Mike Leavitt is quoted as saying in the August 1st news story, HHS: Doctors May Accept Donated EHR Systems, posted today on the proprietary Web site Government Health IT. The article describes how the federal agency issued an exception to the Stark Law that previously prevented hospitals, health plans and other organizations from paying for EMRs and e-prescribing systems for doctors and other clinicians. In describing the exception, which will take effect in October: “…the doctors can receive as much as 85 percent of the cost of health IT as a donation from hospitals where they refer patients.” Importantly, HHS requires that all donated EHR systems be certified by CCHIT. Although not noted in the article, see HHS press release for similar exceptions outlined for e-prescribing software. There’s not a lot online about this potentially important change, but there’s this on BSTI Consulting Firm’s Healthcare IT blog, HHS Enables Health IT Donations to Doctors: “Some have expressed concerns that large scale donation of healthcare IT will cause physicians to become clients of hospitals, dependent on the hospital to stay in business, resulting in a loss of physician independence.” Is the concern only for large scale donations?



Top Bedside Software?

Filed under: — mlazoff

Fifteen of the usual suspects make up the arguably best listing of The Top PDA Resources For Family Physicians, from the July/August issue of AAFP’s Family Practice Management. See if you agree. We like that the drug program from our former publisher, The Medical Letter, is included.

(While there, take a look at What Family Physicians Need to Know About Pay For Performance for a quick catch-up on the basics, appropriate for all specialties. The closing section, A Look Ahead, paints quite a rosy picture.)



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