Category Archives: policy

data saving lives, healthcare, musings, policy, politics

Urologists… WTF?

If the urologists behaved any more egregiously, they’d be drifting into crimes against humanity. It’s good to see the Cancer Council calling this out for what it is: “A disservice to men”. It’s also time for these ghouls to cease veiling their self-interest as their patients’.

http://www.medicalobserver.com.au/news/cancer-council-urges-men-to-think-carefully-before-prostate-testing

Cancer Council urges men to think carefully before prostate testing

Catherine Hanrahan   all articles by this author

A DRAMATIC increase in prostate cancer cases has prompted Cancer Council NSW to call for men to think carefully before being tested, but urologists refute the suggestion men are being treated unnecessarily.

A new study shows the number of prostate cancer diagnoses in Australia jumped 276% over the 20 years from 1987 to 2007.

This is a result of increased testing, lead author Associate Professor Freddy Sitas of Cancer Council NSW, said.

He said that even if a positive result is correct, unless they operate, doctors have no foolproof way of knowing if the cancer is aggressive or relatively harmless.

“Saving lives is our priority, but we urgently need a better test,” Professor Sitas said.

“The tests have saved men with aggressive forms of the disease, but at a high cost.”

A 27% drop in the death rate was observed over the study period, he said.

However, the increase in new cases is much greater than this.

“This indicates that many men were diagnosed with cancers that would not have harmed them.”

However, the Urological Society of Australia and New Zealand has strongly refuted claims by the Cancer Council NSW that men have been done a “great disservice” by the growth in prostate cancer diagnoses, and have been subjected to unnecessary treatment.

“Twenty years ago we didn’t have a test to diagnose prostate cancer, which meant most men presented with advanced, incurable disease,” Professor Mark Frydenberg, the Urological Society’s Vice-President, said.

Many low risk cancers were more typically observed, not treated, he said, with active surveillance, now considered a mainstream pathway.

The University of NSW’s Professor Mark Harris says: “Until we have a better method of screening, men need to be fully informed about the pros and cons of testing.”

Cancer Epidemiol 2013; online 1 November

complex adaptive systems, data saving lives, entrepreneurship, healthcare, healthy habits, meaning, musings, nutrition, policy, quotes & aphorisms, rapid learning health systems, research methodology

The behaviour change arms race…

Behavior change is difficult, but to date it has dominated by industries, such as the processed food industry, who have mastered the art of mass market behaviour change through a withering combination of product research, development and engineering, marketing, advertising and promotion, all founded on an unstoppable and lucrative business model. At this moment in history, industry is the unopposed, global behaviour change super power. Serious capital investment with serious returns but with the unfortunate side-effect of producing a global epidemic of non-communicable disease.

The institutions charged with protecting the public’s health have been caught flat footed. Rather than trying to neutralise industry’s behaviour change efforts, medically-dominated health systems have instead chosen to layer their own lucrative pharmaceutical and surgical business model on top.

Doctors quite legitimately pay lip service to the “diet and exercise” mantra because they know it doesn’t work. And why doesn’t it work? Because anyone can say eat healthier food and exercise, thus making it difficult to justify their years of training and high fees. It’s much better for doctors to note “diet and exercise”, but then pump the drug and surgery options.

So what needs to happen?

A countervailing super power must be established. Not one founded around a powerful business model, but rather a movement of interested citizens, concerned by the grotesque monentization of the population’s health. In effect, a competing super power in the behaviour change arms race.

Key characteristics:

  • protect the children
  • use evidence, but don’t wait for conclusive results
  • empower with data
  • apply political dark arts

Funding sources:

  • social impact bonds
  • crowd sourcing
  • private health insurers
  • government (not a good time for this)

Inspirations

  • Purpose.com
  • GetUp.org.au

 

healthcare, healthy habits, policy, rapid learning health systems, research methodology, technology

Cth Fund on health management apps

  • 40,000 to 60,000 health and wellness apps
  • health app market estimated to be work $700M in 2012, doubling by end of 2013
  • 52% of smartphone owners have used their device to gather health information
  • 19% have at least one health app on their phone
  • safety-net populations have better-than-expected access to mobile devices and are more likely to use their phones to access health information
  • chronic disease (diabetes and asthma) management apps are often extensions of proven interventions that yield clinical benefits and/or financial savings
  • User’s (particularly older users) most popular features: diagnoses, monitoring BP, BSLs
  • User’s least popular features: medication and exercise reminders
  • Providing feedback on progress supports sustained use
  • 30 – 60% of melanomas screened via a teledermatology app were diagnosed as benign!!!!
  • Asthmapolis is an asthma app that is fully integrated with the rescue inhaler to indicate where and when the inhaler is used, correlate that with weather etc.
  • FDA differentiates between lifestyle apps and apps which send data to clinicians – the latter are considered medical devices and will be regulated.

 

PDF: 1713_SilowCarroll_clinical_mgmt_apps_ib

Source: http://www.commonwealthfund.org/Publications/Issue-Briefs/2013/Nov/Clinical-Management-Apps.aspx?omnicid=20

data saving lives, healthcare, policy, rapid learning health systems

McKinsey on Big Data in Health Care

 

Key drivers for big data:

  • Fiscal concerns
  • Moves to value-based reimbursement
  • Aggregated, live data sets provide best evidence for decision making

Key barriers to adoption:

  • patient privacy
  • reluctance to take a holistic, patient-centred approach to value

Pathway to a new value framework:

  • right living (prevention)
  • right care – correct Dx, Rx, Mx + coordination/sharing
  • right provider – workforce innovation
  • right value – outcomes-based reimbursement
  • right innovation – R&D to reduce costs, not increase it

Exemplars of Big Data in Health

  • Kaiser Permanente has fully implemented a new computer system, HealthConnect, to ensure data exchange across all medical facilities and promote the use of electronic health records. The integrated system has improved outcomes in cardiovascular disease and achieved an estimated $1 billion in savings from reduced office visits and lab tests.
  • Blue Shield of California, in partnership with NantHealth, is improving health-care delivery and patient outcomes by developing an integrated technology system that will allow doctors, hospitals, and health plans to deliver evidence-based care that is more coordinated and personalized. This will help improve performance in a number of areas, including prevention and care coordination.
  • AstraZeneca established a four-year partnership with WellPoint’s data and analytics subsidiary, HealthCore, to conduct real-world studies to determine the most effective and economical treatments for some chronic illnesses and common diseases. AstraZeneca will use HealthCore data, together with its own clinical-trial data, to guide R&D investment decisions. The company is also in talks with payors about providing coverage for drugs already on the market, again using HealthCore data as evidence.

McKinsey_BigData_Offerings

Ginger.io

Another company, Ginger.io, offers a mobile application in which patients with select conditions agree, in conjunction with their providers, to be tracked through their mobile phones and assisted with behavioral-health therapies. The app records data about calls, texts, geographic location, and even physical movements. Patients also respond to surveys delivered over their smartphones. The Ginger.io application integrates patient data with public research on behavioral health from the National Institutes of Health and other sources. The insights obtained can be revealing—for instance, a lack of movement or other activity could signal that a patient feels physically unwell, and irregular sleep patterns (revealed through late-night calls or texts) may signal that an anxiety attack is imminent.

Key Assumptions

  • Value-based payment reform must continue
  • There will be a willingness to progress, innovate and learn from other sectors
  • Privacy issues prevail

 

Notes from interview with Nicolaus Henke (video)

  • data availability
  • easier and cheaper to link data sets and then compute them
  • understanding population health better – predict who’s going to get sick, especially with regard to chronic disease – better clinical and economic outcomes

Current opportunities for providers:

  • understanding, predicting and preventing diseases in individuals and populations
  • linking up the health system around the patient
  • understanding value (holy grail) – where are funds being directed, how can they be moved around to optimise outcomes and made more efficient

Future opportunities – change the practice of medicine altogether:

  • Medicine is currently an art that involves the application of heuristic judgement by highly trained professionals distributed around the world
  • Imagine a future where half of all diseases are well characterised, and can be automatically detected sensors embedded in our environment

Building capabilities

  • We currently mainly capture clinical and payment transactional data
  • How do we capture and exploit new, less structured data – behavioural, genomic, environmental – allows prediction
  • Managing very large data sets – totally new skill set
  • Analytics
  • Understanding the consumer better (a la other industries)
  • Health economics and value analysis – where can we invest on the margins to save money
  • Clinical leadership is critical – they need to be inspired and engaged in order to create new models of care and improve their own outcomes and systems

 

PDF: The_big_data_revolution_in_healthcare
Source: http://www.mckinsey.com/insights/health_systems_and_services/the_big-data_revolution_in_us_health_care

data saving lives, healthcare, healthy habits, nutrition, policy, rapid learning health systems

futuresupermarkets…

I received this email on Thursday from my local supermarket. Not my local supermarket chain. My local supermarket. It featured personalised in-store specials for what I like to buy.

And so it begins.

Prompted by this development, I just searched for Coles and Health Insurance and came up with this media release from June 2013 announcing a partnership between Medibank Private and Coles whereby you get double flybuy points for buying fruit and vegetables.

And so it has already begun. Sure it is Vitality-lite, but you have to start somewhere. Awesome.

FlybuysCapture

 

content of personalised flybuys email (PDF)

Coles and Medibank Reward Customers for Better Health (PDF)

TripleFlybuys_MedibankGenerationBetter

 

Generation Better Triple Flybuys TVC: http://www.youtube.com/watch?v=Ftq2i9f6PBo