Category Archives: policy

data saving lives, healthcare, management and leadership, policy, rapid learning health systems

Saying Goodbye to the Old World of Healthcare

Powerful op ed by Toby Cosgrove on the way things will need to be…

http://www.linkedin.com/today/post/article/20140305130248-205372152-saying-goodbye-to-the-old-world-of-healthcare

Saying Goodbye to the Old World of Healthcare

March 05, 2014

It’s a whole new world. The old way of practicing medicine is just that- an old way of doing things. While it took us a while to get to this point, I can say confidently this new world of healthcare will be better for all of us: doctors, patients and the people who pay for healthcare services.

Many of us got into medicine to be independent, to make our own decisions based on our own best judgments and now we’re being asked to join group practices, follow protocols, and take advice from a computer. We’ve always treated sick people, but now we are trying harder than ever to keep them well. We used to bill for single services, but now we have to look at the whole continuum of care. Things have changed.

For the first time in human history, we have the science and computational power to help physicians quickly sort through vast troves of medical literature to determine what actions are best for each patient at each stage of diagnosis and treatment. It would be virtually unethical not to put these tremendous resources to work to improve care and lower costs.

For doctors, it means extra time at the computer, but with each keystroke we are adding to the informational treasure of our patients, our offices, and medical researchers for generations to come. Information technology is helping us to control and direct the cost revolution that is coming to healthcare as surely as it had already come to manufacturing, retail, airlines and other industries.

What will the future look like? We will have a leaner, more efficient, and more integrated system. Large networks of providers will share comprehensive, evidence-based guidelines and provide personalized healthcare services in patient- and family-friendly settings, under the direction of the highly skilled and compassionate medical professionals. It’s a future we can all look forward to with confidence.

 

Photo: oksana2010 / shutterstock

data saving lives, healthcare, management and leadership, policy, politics, rapid learning health systems

NHS data might save lives

Numbers in medicine are not an abstract academic game: they are made of flesh and blood, and they show us how to prevent unnecessary pain, suffering and death.

Tim Kelsey is the man running the show: an ex-journalist, passionate and engaging, he has drunk more open-data Kool-Aid than anyone I’ve ever met. He has evangelised the commercial benefits of sharing NHS data – perhaps because he made millions from setting up a hospital-ranking website with Dr Foster Intelligence – but he is also admirably evangelical about the power of data and transparency to spot problems and drive up standards. Unfortunately, he gets carried away, stepping up and announcing boldly that no identifiable patient data will leave the Health and Social Care Information Centre. Others supporting the scheme have done the same.

This is false reassurance, and that is poison in medicine, or in any field where you are trying to earn public trust. The data will be “pseudonymised” before release to any applicant company, with postcodes, names, and birthdays removed. But re-identifying you from that data is more than possible. Here’s one example: I had twins last year (it’s great; it’s also partly why I’ve been writing less). There are 12,000 dads with similar luck each year; let’s say 2,000 in London; let’s say 100 of those are aged 39. From my brief online bio you can work out that I moved from Oxford to London in about 1995. Congratulations: you’ve now uniquely identified my health record, without using my name, postcode, or anything “identifiable”. Now you’ve found the rows of data that describe my contacts with health services, you can also find out if I have any medical problems that some might consider embarrassing: incontinence, perhaps, or mental health difficulties. Then you can use that information to try and smear me: a routine occurrence if you do the work I do, whether it’s big drug companies, or dreary little quacks.

http://www.theguardian.com/society/2014/feb/21/nhs-plan-share-medical-data-save-lives

The NHS plan to share our medical data can save lives – but must be done right

Care.data, the grand project to make the medical records of the UK population available for scientific and commercial use, is not inherently evil – far from it – but its execution has been badly bungled. Here’s how the government can regain our trust
The Guardian, doctor looking at medical data
‘If the government gets it right, they can save a vital data project, and allow medical research that saves lives on a biblical scale to ­continue,’ writes Ben Goldacre. Photograph: Hans Neleman/Getty Images

Everything would be much simpler if science really was “just another kind of religion”. But medical knowledge doesn’t appear out of nowhere, and there is no ancient text to guide us. Instead, we learn how to save lives by studying huge datasets on the medical histories of millions of people. This information helps us identify the causes of cancer and heart disease; it helps us to spot side-effects from beneficial treatments, and switch patients to the safest drugs; it helps us spot failing hospitals, or rubbish surgeons; and it helps us spot the areas of greatest need in theNHS. Numbers in medicine are not an abstract academic game: they are made of flesh and blood, and they show us how to prevent unnecessary pain, suffering and death.

Now all this vital work is being put at risk, by the bungled implementationof the care.data project. It was supposed to link all NHS data about all patients together into one giant database, like the one we already have for hospital episodes; instead it has been put on hold for six months, in the face of plummeting public support. It should have been a breeze. But we have seen arrogant paternalism, crass boasts about commercial profits, a lack of clear governance, and a failure to communicate basic science properly. All this has left the field open for wild conspiracy theories. It would take very little to fix this mess, but time is short, and lives are at stake.

The care.data project was promoted in two ways: we will use your data for lifesaving research, and we will give it to the private sector for commercial exploitation, creating billions for the UK economy. This marriage was a clear mistake: by and large, the public support public research, but are nervous about commercial exploitation of their health data.

Now the teams behind care.data are trying to row back, explaining that access will only be granted for research that benefits NHS patients. That is laudable, but potentially a very broad notion. It’s one we would want to unpack, with clear, worked examples of the kind of things they would permit, and the kind of things they would refuse. But that’s not possible because, bizarrely, the specific principles, guidelines, committees and regulations that will determine all these decisions have not yet been clearly set out. This poses several difficulties. Firstly, the public are being asked to support something that feels intuitively scary, about the privacy of their medical records, without being told the details of how it will work. Secondly, the field has been left open to conspiracy theories, which are hard to refute without concrete guidance on how permissions for access really will work.

That said, many criticisms have been absurd. There has been endless discussion around the idea of health insurers buying health records, for example, and using them to reject high-risk patients. Call an insurer right now and see how you get on: within minutes you will be asked to declare your full medical history, waive confidentiality and grant access to your full medical notes anyway.

Many have complained about drug companies getting access to data, and this is more complex. On the one hand, arrangements like these are longstanding and essential: if medicines regulators get a few unusual side-effect reports from patients, they go to the drug company and force them to do a big study, examining – for example – 10,000 patients’ records, to find out if people on that drug really do have more heart attacks than we’d expect. To do this, the UK health regulator itself sells industry the data, in the past from something called the GP Research Database, which holds millions of people’s records already. This needs to happen, and it’s good. But equally, people know – I’ve certainly shouted about it for long enough – that the pharmaceutical industry also misuses data: they hide the results of clinical trials when it suits them, quite legally; they monitor individual doctors’ prescribing patterns to guide their marketing efforts, and so on. The public don’t trust the pharmaceutical industry unconditionally, and they’re right not to.

Trust, of course, is key here, and that’s currently in short supply. The NSA leaks showed us that governments were casually helping themselves to our private data. They also showed us that leaks are hard to control, because the National Security Agency of the wealthiest country in the world was unable to stop one young contractor stealing thousands of its most highly sensitive and embarrassing documents.

But there is a more specific reason why it is hard to give the team behind care.data our blind faith: they have been caught red-handed giving false reassurance on the very real – albeit modest – privacy threats posed by the system.

Tim Kelsey is the man running the show: an ex-journalist, passionate and engaging, he has drunk more open-data Kool-Aid than anyone I’ve ever met. He has evangelised the commercial benefits of sharing NHS data – perhaps because he made millions from setting up a hospital-ranking website with Dr Foster Intelligence – but he is also admirably evangelical about the power of data and transparency to spot problems and drive up standards. Unfortunately, he gets carried away, stepping up andannouncing boldly that no identifiable patient data will leave the Health and Social Care Information Centre. Others supporting the scheme have done the same.

This is false reassurance, and that is poison in medicine, or in any field where you are trying to earn public trust. The data will be “pseudonymised” before release to any applicant company, with postcodes, names, and birthdays removed. But re-identifying you from that data is more than possible. Here’s one example: I had twins last year (it’s great; it’s also partly why I’ve been writing less). There are 12,000 dads with similar luck each year; let’s say 2,000 in London; let’s say 100 of those are aged 39. From my brief online bio you can work out that I moved from Oxford to London in about 1995. Congratulations: you’ve now uniquely identified my health record, without using my name, postcode, or anything “identifiable”. Now you’ve found the rows of data that describe my contacts with health services, you can also find out if I have any medical problems that some might consider embarrassing: incontinence, perhaps, or mental health difficulties. Then you can use that information to try and smear me: a routine occurrence if you do the work I do, whether it’s big drug companies, or dreary little quacks.

This risk isn’t necessarily big, but to say it doesn’t exist is crass: it’s false reassurance, which ultimately undermines trust, but it’s also unnecessary, and counterproductive, like hiding information on side-effects instead of discussing them proportionately. To the best of my knowledge, we’ve never yet had a serious data leak from a medical research database, and there are plenty around already; but then, we are standing on the verge of a significant increase in the number of people accessing and using medical data. There are steps we can take to minimise the risks: only release a subset of the 60 million UK population to each applicant; only give out the smallest possible amount of information on each patient whose records you are sharing; suggest that people come to your data centre to run their analyses, instead of downloading records, and so on. But, while the care.data project might be planning to do some of those things, the ground rules haven’t been properly written out yet.

In any case, even safeguards such as these can be worked around. There are companies out there operating in the grey areas of the law, aggregating data from every source and leak they can find, generating huge, linked datasets with information from direct marketing lists, online purchases, mobile phone companies and more. Who’s to know if someone will start quietly aggregating all the small chunks of our health data?

This, of course, would be illegal. As Tim Kelsey and others are keen to point out, re-identifying or leaking data in any way would be a “criminal offence”. But as this project lands, we’re all becoming rapidly aware that incompetence, malice and creepiness around confidential data is policed with a worryingly light touch. Private investigators have little trouble obtaining confidential data from staff in the police force, banks and tax offices, for example.

Here’s why: it took a long time for anyone to realise that Steve Tennison, a finance manager in a GP practice, had accessed patients’ records on 2,023 occasions over the course of a year, although this was relevant to his work on only three occasions. The majority of records he snooped on belonged to young women: he repeatedly accessed the record of one woman he had gone to school with, and that of her son. The maximum penalty for this is a fine, with a ceiling of £5,000 in magistrates courts. Tennison was fined £996, in December 2013. This is why the public feel nervous, and this is what we need to fix.

It’s painful for me to write critically about a project like care.data, because I love medical data, and I know the good it can do. We have a golden opportunity in the UK, with 60 million people cared for in one glorious NHS. Opt-outs would destroy the data, and the growing calls for an opt-in system would be worse: opt-in killed people by holding back organ donation, and more than that, it would exacerbate social inequality around data, because the poorest patients, those most likely to be unwell, are also the least engaged with services, the least likely to opt in. They would become invisible.

So here’s my advice: if you’re thinking of opting out – wait. If you run care.data – listen. There are three things the government can do to rescue this project.

Firstly, make a proper announcement about what you will do in the six-month delay. You cannot rely on blind trust when it comes to sharing private medical records, so explain that you’ll be coming back soon with a clear story. Sort out the governance framework, present unambiguous rules and principles explaining how data will be shared, list the specific clinical codes you’re proposing to upload, then give real-world examples of the kind of access applications that would be approved, and the kind that would be rejected. This is fair, and sensible.

Secondly, show the public how lives are saved by medical research. This needs examples, from the vast archives of medical research on cancer, heart disease and more. Alongside that, give a clear nod to the small risks, and an explanation of how they will be mitigated. Never be seen to give false reassurance on these risks; if you do, you will lose patients’ trust for ever.

Lastly, we need stiff penalties for infringing medical privacy, on a grand and sadistic scale. Fines are useless, like parking tickets, for individuals and companies: anyone leaking or misusing personal medical data needs a prison sentence, as does their CEO. Their company – and all subsidiaries – should be banned from accessing medical data for a decade. Rush some test cases through, and hang the bodies in the town square.

If the government do all this, they have a good chance of saving a vital data project, and permitting medical research that saves lives on a biblical scale to continue. If the government try to fudge – with half measures, superficial PR and false reassurance – then care.data will fail, and it might well bring down other sensible public health research with it. Lives are at stake. This cannot be left to the last minute in the six-month pause, and time is precious. It’s February. If you’re thinking of opting out, please don’t. But mark your diary for May.

complex adaptive systems, cool, healthcare, meaning, policy, politics, quotes & aphorisms, rapid learning health systems, research methodology

A clear head shot from Jeffrey…

Not one stakeholder group left untrashed…

Great Einstein quote – the original definition of insanity presumably:

‘The significant problems we face cannot be solved at the same level of thinking we were at when we created them’

PDF: Braithwaite Delusions of health care JRSM 2014

The medical miracles delusion

Army ants subscribe to a simple rule: follow the ant
in front. If the group gets lost each ant tracks
another, eventually forming a circle. According to
crowd theorist James Surowiecki, one circle 400m
in circumference marched for two days until they
all died.1
Humans are not ants, but we often trudge together
along the same trail, neglecting to look around for
alternatives. Mass delusions involve large groups
holding false or exaggerated beliefs for sustained periods.
Humanity has a long, sorry list of these shadowthe-
leader epidemics of collective consciousness which
appear obviously wrong only in hindsight. Some last
for centuries: early alchemists intent on transmuting
base metals into gold and the Christian Crusades of
Europe’s middle ages, for example. Others have correlates
which resurface decades or centuries later:
McCarthy’s persecution of alleged communists in
the 1950s harked back to the Salem Witch hunts of
16th century America just as the 2008 Global
Financial Crisis had much in common with the
‘South Sea Bubble’ which slashed 17th century
Britain’s GDP.
In the educated 21st century, too, we blithely trust
in economic and political systems which are stripping
the earth’s resources, altering the climate and facilitating
wars. Are we then similarly mistaken, en masse,
about the capabilities of the health system?
Most of us believe in the miracles of modern medicine.
We like to think that the health system is
increasingly effective, that we are implementing
better treatments and cures with rapid diffusion of
new practices and pharmaceuticals and that there is
always another scientific or technological breakthrough
just around the corner promising to save
even more lives; all at an affordable price.
We maintain the faith despite multiple contraindications.
Modern health systems consistently deliver
at least 10% iatrogenic harm.2 Despite very large
investments and intermittent but important interventional
successes, such as checklists in theatres3 and
clinical bundles in ICU,4 there is no study showing
a step-change reduction in this rate, systems-wide.

Only half of care delivered is in line with guidelines,5
one-third is thought to be waste,6 and much is not
evidence-based,7 notwithstanding concerted efforts to
optimise that evidence and incorporate it into routine
practice.8
The reality is that progress is slowing, and medicine
seems to be reaching the limits of its capacities.
The potentially disastrous problems of antibiotic
resistance, for example, are yet to play out. This is
only one point among many. New technologies such
as the enormously expensive human genome project
have provided only marginal benefits to date. We still
do not have the answers to fundamental questions
about the causes of common diseases and how to
cure them. Many doctors are dissatisfied and increasingly
pessimistic.9,10 It must also be remembered that
although death is no longer seen as natural in the
modern era, everyone must die. Yet, we inflict most
of our medical ‘miracles’ on people during their last
six months of life. Le Fanu describes this levelling off
and now falling away of health care progress in The
Rise and Fall of Modern Medicine.11
Every major group of stakeholders has its own
specific delusion which acts to augment the metalevel
medical miracles delusion. Thus, the overarching
delusion is buttressed by a set of related ‘viruses
of the mind’, to borrow Richard Dawkins’ evocative
phrase.12
Although politicians think and act as if they are
running things, modern health systems are so complex
and encompass so many competing interests that no
one is actually in charge. Then, bureaucrats – acting
under their own brand of ‘groupthink’ – assume their
rules and pronouncements provide top-down stimulus
for medical progress and improved clinical performance
on the ground. Yet coalface clinicians are relatively
autonomous agents, so there can only ever be
modest policy trickle down.13,14
Researchers, too, support the medical miracles
industrial complex. The electronic database
PubMed holds some 23 million articles and is growing
rapidly. Every author hopes it will be his or her
results that will make a difference, yet there is far less

take up than imagined and comparatively little
investment in the science of implementation8 – translating
evidence into real life enhancements.
Nor are clinicians or the patients they serve
immune. While frontline clinicians strive to provide
good care, many myopically assume their practice is
above average; the so-called Dunning-Kruger
effect.15,16 Of course, statistically, half of all care clinicians
provide is below average. And notwithstanding
decades of public awareness, patients believe modern
medicine can repair them after decades of alcohol,
drugs, sedentary lives and dietary-excesses, despite
evidence to the contrary.
Meanwhile, the media’s unremitting propensity to
lend credibility to controversial views and to hone in
on ‘gee whiz’ breakthroughs – while ignoring the
incremental and the routine – fuels unrealistic expectations
of what modern medicine can deliver.
Throughout history, mass delusions have been
aligned with mass desires for favourable outcomes.
In the pursuit of medical miracles all of our interests
line up in a perfect circle. We seem more like army
ants than we think.
Just as the Global Financial Crisis was a wake-up
call for the serious consequences of blind fiscal faith
we must begin to manage our expectations of the
health system. Progress is always in jeopardy when
the real problems are obscured.
The challenge is to harness the tough-minded
scepticism needed to tackle this widely held ‘received
wisdom’. One realistic way forward is to encourage
stakeholders – politicians, policymakers, journalists,
researchers, clinicians, patients – to first consider
that their own and others’ perspectives are simply not
logically sustainable. This may be achieved through
genuine inter-group discourse about the health
system, where it is at, and its limitations.
As is so often the case, Albert Einstein said it best,
in a typically neat aphorism: ‘The significant problems
we face cannot be solved at the same level of
thinking we were at when we created them’.17 If we
can humbly accept that we need new perspectives
for healthcare – and radically different ways of
thinking – we will be better placed to free ourselves
from the hold of these peculiar viruses of the mind.

entrepreneurship, healthcare, policy, quantified self, startup

Rock Health visits Australia – preview

 

 

 

FUELLING CHANGE IN AUSTRALIA’S HEALTHCARE THROUGH TECHNOLOGY; LESSONS FROM ROCK HEALTH

By Melia Rayner | February 27th, 2014 in Intelligent Thinking First, Technology Second

Cellscope oto

Above: Rock Health funded startup CellScope are reinventing the otoscope (image courtesy of Yahoo)

Social change through technology is all around us, in the way we shop, communicate, pay bills and arrange services. So why has the incredibly important area of health been so slow to move in line with the digital economy? Australia has led medical breakthroughs in the past; from the implementation of the first bionic ear in 1982 to the cervical cancer (HPV) vaccine in 2007, but the past few years have seen our healthcare landscape struggling to get further than the ‘middle of the pack’.

Elsewhere, the digital health movement is growing rapidly. In Washington, a startup called KitCheck helps hospital pharmacies process medication kits faster and without error, whilst in San Francisco CellScopehas built a smartphone-enabled diagnostic toolkit, including a digital otoscope. Even global magnates have put resources and teams into developing health innovation, such as General Electric’s Logiq; which is an ultrasound for the whole body, and Walgreens’ Pill Reminder app and Find Your Pharmacist web tool.

All the companies above have capitalised on the need for social change in healthcare through the vehicle of technology. Utilsing innovations in technology to solve human problems is behind everything we do at Portable. The point at which culture and technology meet is where social change can really happen. It’s in this mission that our maxim ‘Intelligent thinking first, technology second’ hits home; in the utilisation of technology to support social change rather than commandeer it.

This is why we’re bringing out a digital health innovator like Dr. Nate Gross as part of our Portable Talksseries. Nate’s company Rock Health provides startups (such as KitCheck and CellScope) with funding and full service support to advance the healthcare industry through technology. Their partnerships across the industry – from medical institutions to venture capital firms and corporates – give them unparalleled knowledge of how to innovate change in a highly regulated industry. In addition, Nate’s successful development of healthcare game changers such as Rock Health and Doximity makes him uniquely qualified to present to Australian audiences on lessons in innovation from Silicon valley and how to break down barriers to entrepreneurship and communication in this sector.

We spoke to Nate about the importance of change in healthcare and some of his other key maxims in advance of his recently announced tour for Portable Talks in May.

https://www.youtube.com/watch?v=V7Q9y1zRdXQ

Above: Nate speaks briefly about the story of Rock Health.

 

Why did you decide to come all the way to Australia for Portable Talks?

Well, that’s easy: Australia and Portable Talks. It seems to be a very exciting time in Australia, where the next engine of growth could be technology, healthcare, or both — and the [Australian] people are consistently applauded for living healthy lives. And of course, Portable’s reputation preceded itself as I had watched several previous [Portable Talks] series online, thus knowing there were amazing and in-depth conversations to be had.

 

How can the USA learn from Australia’s approach to health innovation, and vice versa?

I think we can learn from the approaches and we can learn from the businesses themselves. The startup community in Australia is smaller but accelerating, and most importantly the quality is high, a recipe for wins that will attract more entrepreneurial ideas and capital.

We can also learn from the businesses themselves — many successful concepts may be translated or shared due to some similarities between the mixed private and public components of our healthcare systems. That’s not to call our systems too similar, of course, as there is much to learn from Australia about accessibility and affordability.

 

In your opinion, what are the three biggest hurdles facing digital health innovation internationally?

Differences in incentives is often at the top of the list, which can make cost a barrier to different parties in different healthcare systems.

The funding environment is another. I think many cities and countries are ready to scale up their innovation efforts, but it can be a chicken-and-egg problem where some local wins are first required to attract capital to the area.

Language itself is a barrier, which Australia is perhaps more cognizant of than Silicon Valley, as it’s a leader in the Asia Pacific region. And there are many other hurdles that may become more relevant depending on the venture: market size, privacy, interoperability, the US regulatory process, infrastructure, consumer readiness.

 

Health is often perceived to be a topic that individuals outside the industry don’t actively engage with. Why should individuals from outside health and medical fields engage with in this industry?

Two reasons: First, because you don’t want to wait until you get sick to start solving these problems. And second, healthcare is an entrenched industry, which means there’s a lot of entrenched thinking. Outside perspective can lead to fantastic innovation, and many of the startups that have come through Rock Health have been founded by “outsiders”.

What is the key message you’d like to bring to your talks in Australia?

It’s the right time to get involved in digital health. There has never been a better time to be a health entrepreneur, and there are many ways you can get involved to transform the healthcare sector.

Nate will be discussing topics such as trends in digital health, innovation in heavily regulated industries and breaking down barriers to entrepreneurship and communication in healthcare throughout his Portable Talkstour in early May. This event is a must-see for those working in digital innovation, healthcare, technology, startups, or high-tech funding. The tour will cover Melbourne and Sydney with tickets available here – be quick to secure an earlybird discount. Nate will also spend a day as Portable’s ‘Entrepreneur in Residence’, delivering a new agenda with the team to help encourage innovation and creative thinking in cross disciplinary fields.

To find out more about the Rock Health Portable Talks tour or to enquire after a private company consultation with Dr. Nate Gross, please contact Kate at kate(at)portablestudios.com.au

For all other tour enquiries please contact Mikala Tai at mikala(at)portablestudios.com.au

data saving lives, healthcare, policy, quantified self

Physicians coy on apps…

Physicians won’t prescribe apps because there’s no regulatory oversight…

 

http://www.fiercemobilehealthcare.com/story/physicians-split-use-mhealth-apps/2014-02-24#ixzz2uTHTX4hO%20

Physicians split on use of mHealth apps

February 24, 2014 | By 
A poll of 1,500 physicians across the country finds that 37 percent have prescribed a mobile medical application to their patients, according to QuantiaMD, a social learning network for physicians.

An additional poll of 250 physicians found:

  • Forty-two percent won’t prescribe apps because there is no regulatory oversight of them
  • Thirty-seven percent have no idea what apps are out there
  • Twenty-one percent never recommend apps to patients
  • Twenty-one percent won’t prescribe apps because there’s no longitudinal data on apps’ effectiveness
  • Another 21 percent won’t prescribe apps because it would generate an overwhelming amount of patient data

Mike Paskavitz of Quantia, Inc. compared the effectiveness of medical apps to prescription drugs, which have roughly seven years of data about their effectiveness and safety giving physicians assurance when prescribing them to patients. Medical apps have no history of this sort, he pointed out, which is important to keep in mind this week at the Healthcare Information and Management Systems Society (HIMSS) Conference in Orlando, Fla.

“So as hundreds of medical app developers gather in Orlando for HIMSS, it’s important to note that physicians are still split in opinion on whether they should ‘prescribe’ medical apps to their patients–the main reason being the lack of regulation, especially as the movement to enable self-care is advanced through tools such as medical apps,” Paskavitz said in the announcement.

The regulation of mHealth apps has been contentious for a while now–asFierceMobileHealthcare reported last week, the PROTECT Act, a bill introduced in the Senate, removes Food and Drug Administration regulation from some high-risk clinical decision support (CDS) software, mobile medical apps and other medical device functionality.

FierceMobileHealthcare Editor Greg Slabodkin argued that the PROTECT Act was too dangerous in an editorial last week.

“Patient safety must always come first,” Slabodkin wrote. “In the end, the so-called PROTECT Act would only serve to protect app developers in their zeal to make a quick buck free of government regulation.”

Nonetheless, while regulation is debated in Washington, mobile medical apps continue to emerge daily. Just last week, the American College of Cardiology and the American Heart Association announced a mobile and web-based app for healthcare professionals to use with their patients in determining risk for developing atherosclerotic cardiovascular disease (ASCVD), a major cause of heart attack and ischemic stroke.

To learn more:
– read the announcement

cool, data saving lives, file note, healthcare, policy, politics, rapid learning health systems

NPR on health care price transparency

  • Very cool, very powerful
  • I+PLUS can do it already (excluding PHIs that aren’t on board)
  • Think we should go for it
  • Could potentially take it to the US

Audio: 

http://www.npr.org/blogs/health/2014/02/12/276001379/elusive-goal-a-transparent-price-list-for-health-care

Elusive Goal: A Transparent Price List For Health Care

by ERIC WHITNEY  3:36 AM

Some states are trying to make health care prices available to the public by collecting receipts from those who pay the bills: Medicare, Medicaid and private insurers. Some states’ efforts to make these prices available are in jeopardy.

Coffee is important to many of us, but let’s say your coffee maker breaks. Finding a new one is as easy as typing “shop coffee maker” into your browser. Voila — you’ve got models, prices and customer reviews at your fingertips. But say you need something less fun than a coffee maker — like a colonoscopy. Shopping for one of those is a lot harder. Actual prices for the procedure are almost impossible to find, and Bob Kershner says there’s huge variation in cost from one clinic to the next. “You see the range is from $2,800 down to just about $400,” he says, pointing to a computer screen displaying some colonoscopy prices in Denver. Kershner works for a nonprofit called CIVHC, which is starting to make health care prices publicly available in Colorado. His boss, Edie Sonn, says knowing prices can change the whole health care ball game. “Knowledge is power,” she says. “None of us have had much information about how much health care services actually cost, and how much we’re getting for our money.” A database that includes all health claims in a particular state, she says, “gives you that information, so you can become an empowered consumer.” Colorado is one of eleven states that are starting to make public a lot of health care prices. It’s taken years. An “all payer claims database” is the first step in Colorado. It’s basically a giant shoebox that aims to collect a copy of every receipt for a health care service in a given state. Since doctors and hospitals generally don’t tell people how much services cost beforehand, the best way to figure out the price is to get receipts from the parties that pay the bills: insurance companies, Medicaid and Medicare, mostly. The more such information is made public, Sonn says, the more people will “vote with their feet” and migrate away from high-cost providers. However, turning this information about price from eye-crossing rows in a spreadsheet into consumer-friendly formats is hard. Colorado’s effort has taken years. Laws had to be passed to get insurance companies to send in their claims data (the receipts for what they’re paying), and sorting through all the information is a lot tougher than organizing a pile of paper receipts in a shoebox. “Claims data is dirty,” says Sonn. “It’s really dirty. It takes a lot of scrubbing to make sense of it. It’s complicated, time consuming and expensive.” Colorado has had funding to do that from private grants, but those are drying up. In order to keep on making basic price information accessible to the public for free, the state wants to sell more complicated, custom data reports to businesses within the health industry. There is a growing market for those sorts of reports, says Dr. David Ehrenberger, the chief medical officer for Avista Adventist hospital, outside Denver. He would like to see reports that show not just how much his competitors are charging, but also whether their patients have more or fewer complications. That would give him better negotiating power with big insurance companies. “The insurance industry still has a dramatic advantage over, particularly, smaller physician groups and smaller health care organizations. There’s not a level playing field there,” Ehrenberger says. That’s because big insurance companies pay bills at hospitals all over the state, so they have a big picture view of how much everybody charges for procedures, and of details such as complication rates. Individual hospitals only know their own prices. It’s as if only customers could get a list of prices for different coffee makers, but Cuisinart and Mr. Coffee couldn’t, so they wouldn’t know if they were asking too much or too little for their coffee makers. The better view Ehrenberger can get of the entire marketplace for health care services, the better he can set prices. “What we want to do is be able to have the data that shows, unequivocally, that we can provide a better quality product — and [at] a cost they can afford,” he says. But there’s a glitch. In order to get the kinds of reports Ehrenberger and other health care providers want, they have to include price information from all payers, and one of the biggest is Medicare — it pays about a fifth of all health care bills in Colorado. At the moment, Edie Sonn explains, they cannot use that Medicare data in any of the custom reports they want to sell. “Current federal law restricts what we can do with that Medicare data,” she says. “The only thing you can use their data for is public reporting.” Sonn’s organization and others like it have found support on Capitol Hill to let them sell Medicare data. It turns out that Democrats and Republicans agree that price transparency is key to controlling costs. A measure that would make that change is now part of a bigger Medicare bill (find it in section 107) working its way through Congress. If it passes, Colorado will be one step closer to making shopping for health care as easy as shopping for a coffee maker. This story is part of a partnership between NPR and Kaiser Health News.

business, facts & data points, file note, healthy habits, musings, nutrition, policy, politics, quotes & aphorisms

“There is no freedom in addiction”

Michael Bloomberg was laughed at for suggesting that New York City businesses limit soda serving sizes. It was never a perfect plan, but his public shaming shows how closely we equate food with ‘freedom.’ The problem is, there is no freedom in addiction. As the Nature Neurosciencestudy showed above, rats and humans alike will overeat (or eat less healthy food options) even if they know better.

Hence the magic bullet at the center of McDonald’s letter: a precise combination of fat, sugar and salt that keeps us craving more. As NY Timesreporter and author of Salt Sugar Fat: How the Food Giants Hooked UsMichael Moss said in an interview

These are the pillars of processed foods, the three ingredients without which there would be no processed foods. Salt, sugar and fat drive consumption by adding flavor and allure. But surprisingly, they also mask bitter flavors that develop in the manufacturing process. They enable these foods to sit in warehouses or on the grocery shelf for months. And, most critically to the industry’s financial success, they are very inexpensive.

PN: The fallacy in the rump of this discussion is that cigarettes are not that more harmful than a big mac. I’m just as likely to die from smoking a single cigarette in front of you, as I am if I were to eat a big mac in front of you. The problems arise when you smoke/eat these products every day of your life.

http://bigthink.com/21st-century-spirituality/should-big-food-pay-for-our-rising-obesity-costs

Should Big Food Pay For Our Rising Obesity Costs?

FEBRUARY 25, 2014, 4:29 PM
Bt-big-food

Paul McDonald didn’t expect his letter to go public. The Valorem Law Group partner had queried sixteen states, asking leaders to consider investigating Big Food’s potential role in paying for a percentage of the health system’s skyrocketing obesity costs. The Chamber of Commerce got wind of this letter and made it public, setting off a national debate over food marketing, ingredient manipulation and personal responsibility.

McDonald’s premise is simple enough: if large food companies are purposefully creating addictive foods to ensure consumer loyalty, adding to the rising obesity levels in this country, they should be responsible for covering costs associated with treatment. The backlash was immediate and biting.

Comparisons to the Big Tobacco companies came first to mind. In the 1998 Tobacco Masters Settlement Agreement, major players in the tobacco industry agreed to pay $246 billion to offset health risks and diseases associated with its product. Critics of McDonald’s idea believe there is no link between tobacco and food.

Advertising

On the face of it, this would appear true: you don’t need to smoke, but eating is a necessity. Smoking is a choice, and therefore if you choose to smoke, you pay the consequences. Eating falls into an entirely different category.

Yet the neural mechanisms might be similar. A 2010 study in Nature Neuroscience found that rats consumed well past their limits when offered high-calorie foods such as bacon, sausage and cake, speculating that humans, when faced with an equivalent scenario, also choose to overeat.

Harvard University Professor of Medicine, Emeritus David Blumenthal’s study, Neurobiology of Food Addiction, found a similar link between food and drug abuse. In the summary he writes

Work presented in this review strongly supports the notion that food addiction is a real phenomenon…although food and drugs of abuse act on the same central networks, food consumption is also regulated by peripheral signaling systems, which adds to the complexity of understanding how the body regulates eating, and of treating pathological eating habits.

The argument against food addiction is a tough one, waged by industry insiders who want to keep 60,000 products on American shelves. The real question, however, is: are food companies purposefully producing addictive foods that change our neurobiology? If so, should they be held economically accountable?

American obesity costs are currently $147 billion per year. The CDC estimates that 35.7% of adults and 17% of children ages 2-19 are obese—a number that has risen dramatically over the last two decades. A joint report between Trust for America’s Health and the Robert Wood Johnson Foundation estimates that 44% of American adults will be obese by 2030. The report predicts that will add between $48-66 billion to our costs, some of which is paid for by taxpayers.

Yet food is such an emotional topic. For example, when informing someone that I’m vegan, they immediately let me know why they could never do such a thing (I didn’t ask) or that it’s ‘wrong’ for them, and sometimes by extension, me (last week’s annual blood work shows me in perfect shape).

Michael Bloomberg was laughed at for suggesting that New York City businesses limit soda serving sizes. It was never a perfect plan, but his public shaming shows how closely we equate food with ‘freedom.’ The problem is, there is no freedom in addiction. As the Nature Neurosciencestudy showed above, rats and humans alike will overeat (or eat less healthy food options) even if they know better.

Hence the magic bullet at the center of McDonald’s letter: a precise combination of fat, sugar and salt that keeps us craving more. As NY Timesreporter and author of Salt Sugar Fat: How the Food Giants Hooked UsMichael Moss said in an interview

These are the pillars of processed foods, the three ingredients without which there would be no processed foods. Salt, sugar and fat drive consumption by adding flavor and allure. But surprisingly, they also mask bitter flavors that develop in the manufacturing process. They enable these foods to sit in warehouses or on the grocery shelf for months. And, most critically to the industry’s financial success, they are very inexpensive.

Inexpensive to companies, not to consumers. Paul McDonald is striking an important nerve in how we manufacture, distribute and consume food in our country. There will be a lot of resistance and debate from both industry and citizens. But if we don’t begin this conversation now, our national and mental health is only going to continue to decline.

Image: Aliwak/shutterstock.com

healthy habits, policy

Activity guidelines shun sitting…

Oh yes. Could really have seen the Tele lap these guidelines up… especially the standing agenda item piece. Terrific.

 

http://www.abc.net.au/health/features/stories/2014/02/24/3947295.htm

Why the exercise guidelines take a stand on sitting

by Claudine Ryan

For the first time our physical activity guidelines are not only telling us to get more exercise, they’re also telling us to stand up for our health.

sitting_300x150GIULIO SAGGIN, FILE PHOTO: ABC NEWS

Australia’s exercise guidelines have recently been overhauled, and they’re going to come as a rude shock to many of us. Not only are we being told we need to do a lot more physical activity, but we’re also being urged to get out of our chairs – even if we do the right amount of exercise.

The new guidelines are now officially known as Australia’s Physical Activity and Sedentary Behaviour Guidelines, and they focus not just on the exercise but on the amount of time we spend being sedentary.

Listen

ABC Health & Wellbeing producer Claudine Ryan spoke to Julia Christensen from ABC Local Radio in Darwin about the new guidelines, and why we all need to to ‘sit less’.

11 mins 42 sec | 2.6 mb | Download mp3 audio

Sedentary behaviour is the term used to describe physically inactive tasks that don’t require a lot of energy, basically sitting or lying down. Activities are often measures in METs (Metabolic Equivalent of Task),sedentary activities are in between 1 and 1.5 METs, walking at a moderate pace ranges from 3 to 3.5 and jogging is about 7.

In recent years, a growing body of research has linked sedentary behaviour to obesity, type 2 diabetes, heart disease, some cancers and premature death. It’s considered such a risk that one US expert has gone so far as to suggest sitting for most of the day may be as dangerous to your health as smoking.

Experts say we’re sedentary on average for seven to 10 hours a day (and this doesn’t include our time spent sleeping). Even if you are meeting, or exceeding, the recommended 60 minutes a day of moderate intensity physical activity, you can still be considered sedentary. (This group of people is sometimes referred to as ‘active couch potatoes’.)

While researchers are still trying to understand exactly why sedentary behaviour has such a negative effect on our health, it appears to be related to how our bodies process fats and sugars. There are enzymes involved in this process that are released when certain muscles contract during standing. When you sit for prolonged periods the production and activity of these enzymes appears to slow down.

The guidelines don’t make any specific recommendations about how long you should sit for, instead they say we should “minimise the amount of time spent in prolonged sitting” and to “break up long periods of sitting as often as possible”.

However, some experts recommend breaking up any period of sitting that lasts longer than 20 to 30 minutes. You do this by simply standing up for a couple of minutes or taking a short walk. (It’s also worth noting, that neither the guidelines, nor those working in this field, are suggesting that you need to spend your entire day standing.)

Here are some ways to cut back on the amount of sitting you do:

At work:

  • Try to encourage standing or walking meetings. If this doesn’t work, see if you can get your colleagues to include a standing break, or ‘standing agenda’ item.
  • Stand up when using the phone, or when reading emails, documents or reports.
  • Set up printers, rubbish bins, drawers, and other things you may need during your work day, away from your desk so you need to get out of your chair more often.
  • Try walking to your colleagues to talk to them instead of using email if possible.
  • Set yourself a reminder on your computer to stand up regularly.
  • Make it a habit to drink more water throughout the day. You’ll have to move to get your regular glasses of water and their effect on your bladder will mean you’ll take more regular trips to the toilet.
  • Break for lunch, even if it’s just a ten-minute walk.
  • Walk or ride to work.
  • Get off public transport or park your car a little further from your work and walk some of the way.

At home:

  • Stand up and walk around when using your phone.
  • When watching TV, stand and do household chores, such as folding clothes and ironing.
  • Put your remote control away so you are forced to get up to use manual controls.
  • Embrace household chores.
  • Stand when catching up on news via the newspaper, phone or tablet.
  • Walk or ride when you need to do things that are closer than a certain distance to your home.

Published 24/02/2014

healthy habits, nutrition, policy, rapid learning health systems

Too cool… Tetris is good for you???

  • Of the 119 people that participated, 80 reported craving something: 58 people wanted food or drink of some kind, 10 wanted caffeine, and 12 wanted nicotine.
  • Their mean craving levels were “reasonably high,” the researchers write. Playing Tetris reduced their cravings by about 24 percent.
  • The relationship between playing the game and craving reduction remained statistically significant, even when the researchers accounted for a general lessening of the craving over time, or removed the people who were only slightly craving something.

 

  • Potential confounder: doing nothing for three minutes could have resulted in an increase in cravings!????

http://www.theatlantic.com/health/archive/2014/02/playing-tetris-can-reduce-urges-to-eat-smoke-drink/284056/

Playing Tetris Can Reduce Urges to Eat, Smoke, Drink

Three minutes of the game reduced cravings by 24 percent in a recent study.
Richard Drew/AP

The never-ending falling blocks of Tetris have caused innumerable people untold amounts of frustration. YouTube star Hank Green even has a song memorializing the evil of “The Man Who Throws The Tetris Piece.” But a new study published in Appetite shows that the unwinnable game may be good for something other than wasting hours, days, lives—reducing cravings.

The Plymouth University researchers—graduate student Jessica Skorka-Brown and professors Jackie Andrade and Jon May—tested Elaborated Intrusion Theory, which says that cravings rely heavily on visual imagery. They write that this is the first test of that theory using naturally-occurring cravings. To capture the 119 participants’ natural cravings (rather than artificially inducing them in the lab by having them evaluate chocolates or something),  asked them when they came in for the experiment if they were currently craving something, and to rate their craving from 1 to 100. Participants completed the Craving Experience Questionnaire, which measured the “strength, imagery, vividness, and intrusiveness of their current craving.”

Then participants sat down in front of a computer, which either loaded Tetris for them to play, or looked like it was going to load Tetris but never actually did. They either played Tetris, or didn’t, for three minutes and then answered the same questions about their craving, describing what happened to the craving while they were playing the game (or, you know, sitting there).

(YouTube)

Of the 119 people that participated, 80 reported craving something: 58 people wanted food or drink of some kind, 10 wanted caffeine, and 12 wanted nicotine. Their mean craving levels were “reasonably high,” the researchers write. Playing Tetris reduced their cravings by about 24 percent. The relationship between playing the game and craving reduction remained statistically significant, even when the researchers accounted for a general lessening of the craving over time, or removed the people who were only slightly craving something.

Obviously a 24 percent reduction doesn’t mean the craving is gone, but neither is that nothing. “Tetris reduced the vividness and frequency of craving imagery, as well as craving intensity,” the study reads. Tetris is a very visual task, which the researchers posit may be why it seems to impede the strength of craving imagery.

Strange as it may seem, Tetris could actually be a helpful tool for those trying to quit smoking, or just avoid indulging in an unhealthy snack. Because despite its frustrations, Tetris is one of the most popular video games ever—people like playing it. And if three minutes of arranging colored blocks could help curb a craving, it might be worth logging onto FreeTetris.org the next time you feel one hit.