Category Archives: rapid learning health systems

health market quality, healthy habits, nutrition, policy, rapid learning health systems

Croakey: Impact of big food health washing

 

http://blogs.crikey.com.au/croakey/2014/12/01/as-nutritionists-enable-health-washing-by-coca-cola-a-call-to-end-unhealthy-sponsorship/

As nutritionists enable health-washing by Coca-Cola, a call to end unhealthy sponsorship

MELISSA SWEET | DEC 01, 2014 10:00AM | | PRINT

When Big Food companies engage in health-washing tactics, what are the consequences for the reputations of the health organisations and health professionals involved?

It’s a question the Nutrition Society of Australia and its members might be pondering, after having Coca-Cola as a gold sponsor of their recent annual scientific meeting.

As the World Cancer Congress in Melbourne this week puts the spotlight on the implications of rising obesity rates for cancer, health advocate Todd Harper highlights the contribution of soft drinks to obesity, and argues that health organisations need to look for healthier funding sources.

***

Todd Harper, CEO of Cancer Council Victoria, writes:

No sporting club or health event would accept sponsorship from a tobacco company in Australia today, even if it was allowed.

We know that smoking kills, and so do everything possible to reduce its visibility to ensure younger people aren’t encouraged to take up the habit.

Obesity is also a known risk factor for many cancers, as well as other chronic diseases, yet organisations and events continue to accept sponsorship from the very companies peddling products that contribute to this significant health issue.

Despite this, some organisations focused on health, and particularly healthy kids, see little problem in holding their hands out for money from soft drink companies.

Our recent Cancer in Victoria: Statistics and Trends 2013 report revealed uterine cancer rates are steadily rising; a cancer for which obesity is a principal risk factor. Obesity is also a risk factor for breast, bowel, oesophageal, pancreas, uterine, kidney, gallbladder and thyroid cancers.

In fact, we recently learned from the World Health Organization (WHO) that nearly half a million new cancer cases around the world can be attributed to high Body Mass Index each year – including more than 7000 in Australia. (A new study by the International Agency for Research on Cancer found that nearly half a million new cancer cases per year can be attributed to high body mass index (BMI). The study was published on November 26 in The Lancet Oncology. Using its methodology, more than 7000 new cancer cases in Australia per year can be attributed to high BMI.)

The number of Victorians diagnosed with cancer is projected to double by 2024-2028 to more than 41,000 cases a year, with obesity considered a significant contributor to this. It’s a problem that we can’t ignore.

Many people are aware of the dangers of smoking, and the link between smoking and cancer – which is why we’ve seen such a rapid decline in smoking rates. At the same time we are seeing an equally rapid rise in the number of people who are overweight or obese. We need the same awareness about this as a risk factor if we are to stop more cancers before they start.

Drinking soft drinks contributes to higher kilojoule intake, weight gain and obesity. With one can of Coke containing 10 teaspoons of sugar, each can consumed increases the risk of being overweight.

The WHO recommends the consumption of sugary drinks should be restricted, as do Australia’s recently reviewed dietary guidelines, while the World Cancer Research Fund recommends consumption should be avoided entirely. Leaders in cancer control are meeting in Melbourne this week for the World Cancer Congress, and the challenges related to rising global obesity will be firmly on the agenda.

In the meantime, Coca-Cola continues to sugar-coat its image; fooling the community into believing it is part of the solution to the obesity epidemic.

Rather than being part of the solution like it claims, this multi-billion dollar company is trying to veil the impact of its products by positioning itself as a promoter of physical activity. This is merely a distraction from the fact that it continues to promote its sugary drinks as being part of a healthy diet.

Disturbingly, the company has aligned itself with organisations that encourage healthy active lifestyles, such as the Bicycle Network.

The decision by Bicycle Network to enter into a partnership with Coca-Cola attracted strong criticism from public health experts after a piece in Croakey a year ago, yet the partnership continues. This is especially problematic considering the ‘Happiness’ program is targeting teenagers, a group particularly susceptible to marketing and the highest consumers of these drinks.

Similarly, the Nutrition Society of Australia, the peak scientific nutrition group in the country, has Coca-Cola as a gold sponsor for its Annual Scientific Meeting underway in Tasmania.

This is disappointing on a number of levels, not least of all the fact that one of the themes for the conference is ‘Diet and cancer: what does the evidence show?’

Coca-Cola’s attempts to link itself with these organisations won’t reduce the consumption of sugary beverages and won’t make a gram of difference in reducing overweight and obesity.

Wouldn’t it be better to create alternative sponsorship sources for health-promoting organisations?

As was done with the banning of tobacco sponsorship and the creation of alternative funding sources through VicHealth, it’s time for some similarly creative thinking.

Creative thinking that will kick Coca-Cola out of sponsoring health-promoting activities, and create healthier options for organisations like the Nutrition Society and Bicycle Network.

My fear is that unless we take such action, we run the risk of limiting the impact of important health programs such as the Rethink Sugary Drinkcampaign, encouraging a switch to water and reduced-fat milk; and theLiveLighter campaign, which aims to help people make simple lifestyle choices to improve their overall health and cut their cancer risk.

These programs are vital yet are minnows in the campaign to win the healthy hearts and minds of the public when faced with the corporate might of the highly processed food and drink companies, but with some creative thinking and political will, the scales can be tipped in favour of a healthier way.

• Todd Harper is CEO of Cancer Council Victoria.

policy, politics, rapid learning health systems

DoH command and control

 

What’s wrong with Health? Lessons from capability review

What’s wrong with Health? Lessons from capability review

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15.12.2014

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The Department of Health has nowhere near the strategic policy capability it needs. While it has a strong track record of delivery, overworked and unappreciated staff need a break.

The Department of Health is a long way from where it needs to be, according to its recent capability review, which found it in dire need of the capacity to produce an overall strategic policy for Australia’s federated health system. That doesn’t come as a surprise to people who understand how the department works.

The process of developing a white paper on reform of the federation, the likelihood of the current fiscally restrained environment continuing and the High Court’s decision on the legitimacy of federally funded school chaplains — which could have implications for hospitals — are all listed as factors that presage a need for a transformation of the department and its role. The reviewers say the federation reform process, which progressed on Friday with the release of an issues paper on roles and responsibilities in health, is “a significant opportunity for the department to exercise strategic influence on future health system thinking and strategy”.

The department has been highly dependable when it comes to delivering on complex reforms and projects it has been tasked with, but the Australian Public Service Commission’s review team says its “strong focus on tactical, transactional and reactive delivery distracts from the development of a proactive, long-term and system-wide strategy”.

Of the 10 capabilities assessed, two are in urgent need of attention: there is almost nothing in place to motivate Health’s overworked and unappreciated staff, and it lacks an overarching “outcome-focused strategy”. UNSW associate professor of medicine and health policy expert Dr Tom Keating, who has considerable experience working with the department, says the review is “a pretty substantial indictment of the organisation”, but also a valuable tool for its leaders.

“I certainly think there is an issue there with overall strategic capacity.”

“I think it’s a very, very useful review, which I hope the department takes on board and responds to,” he told The Mandarin. “I certainly think there is an issue there with overall strategic capacity. They need that, and they also need leadership from government. Government needs to be interested in and be prepared to develop an overall strategic perspective on where they want to take health, and they’re not there now. To be fair, the last government, after their first year, wouldn’t have been anywhere near it either and they put in place processes to get there.”

It was the National Health and Hospitals Reform Commission, in which the Health Department was just one contributor, that ushered in the more “well-integrated overall policy framework”. “For instance,” said Keating, “the primary care policy of the last government was very well articulated, put together on the basis of really substantial consultation with the sector, and was highly supported.” He suggests the Coalition’s current lack of a coherent federal health policy might make the task of reforming the department even trickier.

“I suspect these things are quite deep-seated and they’re endemic to the organisation in a way, but some of it may be related to the current situation as far as government is concerned, because the current government doesn’t have a coherent, overall health policy — it deliberately went to the last election without one — and now its initiatives are piecemeal, unrelated and pretty incoherent,” said Keating. “So in a way, it’s not surprising that the department might be the same, but I think the review, while it’s been done within the last 12 months, probably reflects some deeper things within the department; that it’s not well-geared to develop a coherent, overall policy framework.”

The review found a need to “better connect sources of evidence across the organisation to support the development of a high-level whole-of-health-system view … in an increasingly contested policy environment” and that despite the establishment of a Strategic Policy Unit, “policy discussions are largely constrained within work silos”. The reviewers comment:

“There is broad acknowledgement that the growing prevalence of chronic disease, continued disparity in health outcomes, increasing citizen expectations and unsustainable long-term rate of growth of government health expenditure are some of the many challenges facing the health system. However, notwithstanding the existence of a Corporate Plan 2014–17, the department has not engaged with its authorising environment to help develop a high-level strategy to seek to address these and other systemic issues.”

Until the review, Health was apparently unaware that government and stakeholders expected it to come up with such an overarching strategic policy:

“The department maintains the belief that policy strategy is not sought by stakeholders or the Government. This view is not supported by evidence gathered as part of this review.”

The Department of Health is highlighted. According to the review: "Evidence demonstrates that high demand–low control workplaces face an elevated risk of ill health among employees."

Delivering services at all costs

On motivation, the review found employees “intrinsically” motivated by their own interest in working at Health, but little else. A very strong track record of delivery has come at a cost. Employees described a “results over people” culture and there is a widespread belief among the various staff and stakeholders interviewed for the review that it can’t go on this way:

“Going forward, many employees and stakeholders commented that the requirement to deliver at all costs on all commitments is increasingly unsustainable in an environment of declining resources. Employees report that they work long hours and under immense pressure to deliver. This is a workplace health and safety risk.”

The immense respect commanded by former secretary Jane Halton came through in the process, but there was criticism of the “command and control” leadership style in the department she led for 12 years. Interviewees variously described senior leaders as “risk averse, outwardly defensive and internally siloed”. Keating says “you can see that reflected from the outside”. The review cautions:

“While this approach may be appropriate in responding to a crisis or national emergency … its application in day-to-day management has resulted in the disempowerment and poor use of its workforce, reinforced vertical silos, limited corporate ownership and potentially hampered innovation.”

The reviewers heard that SES staff work extremely long hours, duplicating each other’s work due to inefficient systems and processes. As a consequence, executive level staff are in no hurry to join them in the upper echelon. As well, the report states that “employees at all levels have overwhelmingly reported that the Executive Leadership Team had zero tolerance for bad news or failure”:

“Employees reported they are fearful of making a mistake or failing to deliver. They report that that this has encouraged a departmental culture of compliance and self-censorship, influencing avoidance behaviours such as the escalation of decisions and a reluctance to report ‘red lights’.”

“My experience of working with the department,” said Keating, “mainly on policy and program review related work, is that it’s populated by a large number of young, highly intelligent, well motivated people, who know next to nothing about health and who move around fairly quickly. Down through the body of the organisation, that’s the sort of profile, and then higher in the organisation you’ve got people who tend to have been there a very long period of time, and so can lose that critical perspective on the organisation.

“So I think that there might be some organisational characteristics that contribute to the failure to identify these things as organisational risk.”

While the capability review process only began in 2011, Keating says the methodology is solid and its results can be relied on.

“When you’re in a department, it’s hard to see the broader view,” he added. “And one of the striking things for me is that — I’ve done a lot of work and a lot of my research around the functioning of complex organisations, and the things which are described here, such as an organisational culture which doesn’t sufficiently value people, a lack of overall strategic view, problems in governance, problems around managing risk; these are the hallmarks of large, complex organisations.

“This is not an unfamiliar thing but it’s so common with large, complex organisations, [that] if you were running one you would expect to have to address these issues. And the interesting thing for me is they seem not to have put in place strategies to address these as risks within their organisational framework.”

More at The Mandarin: Agency report cards: Health, A-G’s, Veterans’ Affairs review

data saving lives, EF, health market quality, policy, quantified self, rapid learning health systems

Creepy data

 

http://www.theguardian.com/technology/2014/dec/05/when-data-gets-creepy-secrets-were-giving-away

When data gets creepy: the secrets we don’t realise we’re giving away

We all worry about digital spies stealing our data – but now even the things we thought we were happy to share are being used in ways we don’t like. Why aren’t we making more of a fuss?
ben goldacre illustration data security
We have few sound intuitions into what is safe and what is flimsy when it comes to securing our digital lives – let alone what is ethical and what is creepy. Photograph: Darrel Rees/Heart Agency for the Guardian

Ben Goldacre

But these are straightforward failures of security. At the same time, something much more interesting has been happening. Information we have happily shared in public is increasingly being used in ways that make us queasy, because our intuitions about security and privacy have failed to keep up with technology. Nuggets of personal information that seem trivial, individually, can now be aggregated, indexed and processed. When this happens, simple pieces of computer code can produce insights and intrusions that creep us out, or even do us harm. But most of us haven’t noticed yet: for a lack of nerd skills, we are exposing ourselves.

At the simplest level, even the act of putting lots of data in one place – and making it searchable – can change its accessibility. As a doctor, I have been to the house ofa newspaper hoarder; as a researcher, I have been to the British Library newspaper archive. The difference between the two is not the amount of information, but rather the index. I recently found myself in the quiet coach on a train, near a stranger shouting into her phone. Between London and York she shared her (unusual) name, her plan to move jobs, her plan to steal a client list, and her wish that she’d snogged her boss. Her entire sense of privacy was predicated on an outdated model: none of what she said had any special interest to the people in coach H. One tweet with her name in would have changed that, and been searchable for ever.

An interesting side-effect of public data being indexed and searchable is that you only have to be sloppy once, for your privacy to be compromised. The computer program Creepy makes good fodder for panic. Put in someone’s username from Twitter, or Flickr, and Creepy will churn through every photo hosting service it knows, trying to find every picture they’ve ever posted. Cameras – especially phone cameras – often store the location where the picture was taken in the picture data. Creepy grabs all this geo-location data and puts pins on a map for you. Most of the time, you probably remember to get the privacy settings right. But if you get it wrong just once – maybe the first time you used a new app, maybe before your friend showed you how to change the settings – Creepy will find it, and your home is marked on a map. All because you tweeted a photo of something funny your cat did, in your kitchen.

medical records

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Many people will soon be able to access their full medical records online – but some might get some nasty surprises. Photograph: Sean Justice/Getty

Some of these services are specifically created to scare people about their leakiness, and nudge us back to common sense: PleaseRobMe.com, for example,checks to see if you’re sharing your location publicly on Twitter and FourSquare (with sadistic section headings such as “recent empty homes” and “new opportunities”).

Some are less benevolent. The Girls Around Me app took freely shared social data – intended to help friends get together – and repurposed it for ruthless, data-driven sleaziness. Using FourSquare and Facebook data, it drew neat maps with the faces of nearby women pasted on. With your Facebook profile linked, I could research your interests before approaching you. Are all the women visible on Girls Around Me willingly consenting to having their faces mapped across bars or workplaces or at home – with links to their social media profiles – just by accepting the default privacy settings? Are they foolish to not foresee that someone might process this data and present them like products in a store?

But beyond mere indexing comes an even bigger new horizon. Once aggregated, these individual fragments of information can be processed and combined, and the resulting data can give away more about our character than our intuitions are able to spot.

Last month the Samaritans launched a suicide app. The idea was simple: they monitor the tweets of people you follow, analyse them, and alert you if your friends seem to be making comments suggestive of very low mood, or worse. A brief psychodrama ensued. One camp were up in arms: this is intrusive, they said. You’re monitoring mood, you need to ask permission before you send alerts about me to strangers. Worse, they said, it will be misused. People with bad intentions will monitor vulnerable people, and attack when their enemies are at their lowest ebb. And anyway, it’s just creepy. On the other side, plenty of people couldn’t even conceive of any misuse. This is clearly a beneficent idea, they said. And anyway, your tweets are public property, so any analysis of your mood is fair game. The Samaritans sided with the second team and said, to those worried about the intrusion: tough. Two weeks later they listened, and pulled the app, but the squabble illustrates how much we can disagree on the rights and wrongs around this kind of processing.

The Samaritans app, to be fair, was crude, as many of these sites currently are:analyzewords.com, for example, claims to spot personality characteristics by analysing your tweets, but the results are unimpressive. This may not last. Many people are guarded about their sexuality: but a paper from 2013 [pdf donwload] looked at the Facebook likes of 58,000 volunteers and found that, after generating algorithms by looking at the patterns in this dataset, they were able to correctly discriminate between homosexual and heterosexual men 88% of the time. Liking “Colbert” and “Science” were, incidentally, among the best predictors of high IQ.

Sometimes, even when people have good intentions and clear permission, data analysis can throw up odd ethical quandaries. Recently, for example, the government has asked family GPs to produce a list of people they think are likely to die in the next year. In itself, this is a good idea: a flag appears on the system reminding the doctor to have a conversation, at the next consultation, about planning “end of life care”. In my day job, I spend a lot of time working on interesting uses of health data. My boss suggested that we could look at automatically analysing medical records in order to instantly identify people who are soon to die. This is also a good idea.

But add in one final ingredient and the conclusion isn’t so clear. We are entering an age – which we should welcome with open arms – when patients will finally have access to their own full medical records online. So suddenly we have a new problem. One day, you log in to your medical records, and there’s a new entry on your file: “Likely to die in the next year.” We spend a lot of time teaching medical students to be skilful around breaking bad news. A box ticked on your medical records is not empathic communication. Would we hide the box? Is that ethical? Or are “derived variables” such as these, on a medical record, something doctors should share like anything else? Here, again, different people have different intuitions.

shopping centre

Pinterest
Many shopping centres can now use your mobile data to track you as you walk from shop to shop. Photograph: Christian Sinibaldi/Guardian

Then there’s the information you didn’t know you were leaking. Every device with Wi-Fi has a unique “MAC address”, which is broadcast constantly as long as wireless networking is switched on. It’s a boring technical aspect of the way Wi-Fi works, and you wouldn’t really care if anyone saw your MAC address on the airwaves as you walk past their router. But again, the issue is not the leakiness of one piece of information, but rather the ability to connect together a thread. Many shops and shopping centres, for example, now use multiple Wi-Fi sensors, monitoring the strength of connections, to triangulate your position, and track how you walk around the shop. By matching the signal to the security video, they get to know what you look like. If you give an email address in order to use the free in-store Wi-Fi, they have that too.

In some respects, this is no different to an online retailer such as Amazon tracking your movement around their website. The difference, perhaps, is that it feels creepier to be tracked when you walk around in physical space. Maybe you don’t care. Or maybe you didn’t know. But crucially: I doubt that everyone you know agrees about what is right or wrong here, let alone what is obvious or surprising, creepy or friendly.

It’s also interesting to see how peoples’ limits shift. I felt OK about in-store tracking, for example, but my intuitions shifted when I realised that I’m traced over much wider spaces. Turnstyle, for example, stretches right across Toronto – a city I love – tracing individuals as they move from one part of town to another. For businesses, this is great intelligence: if your lunchtime coffeeshop customers also visit a Whole Foods store near home after work, you should offer more salads. For the individual, I’m suddenly starting to think: can you stop following me, please? Half of Turnstyle’s infrastructure is outside Canada. They know what country I’m in. This crosses my own, personal creepiness threshold. Maybe you think I’m being precious.

There is an extraordinary textbook written by Ross Anderson, professor of computer security at University of Cambridge. It’s called Security Engineering, and despite being more than 1,000 pages long, it’s one of the most readable pop-science slogs of the decade. Firstly, Anderson sets out the basic truisms of security. You could, after all, make your house incredibly secure by fitting reinforced metal shutters over every window, and 10 locks on a single reinforced front door; but it would take a very long time to get in and out, or see the sunshine in the morning.

Digital security is the same: we all make a trade-off between security and convenience, but there is a crucial difference between security in the old-fashioned physical domain, and security today. You can kick a door and feel the weight. You can wiggle a lock, and marvel at the detail on the key. But as you wade through the examples in Anderson’s book – learning about the mechanics of passwords, simple electronic garage door keys, and then banks, encryption, medical records and more – the reality gradually dawns on you that for almost everything we do today that requires security, that security is done digitally. And yet to most of us, this entire world is opaque, like a series of black boxes into which we entrust our money, our privacy and everything else we might hope to have under lock and key. We have no clear sight into this world, and we have few sound intuitions into what is safe and what is flimsy – let alone what is ethical and what is creepy. We are left operating on blind, ignorant, misplaced trust; meanwhile, all around us, without our even noticing, choices are being made.

• Ben Goldacre’s new book, I Think You’ll Find It’s a Bit More Complicated Than That, is published by Fourth Estate. Buy it for £11.99 at bookshop.theguardian.com

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data saving lives, EF, entrepreneurship, health market quality, healthcare, rapid learning health systems

Health Analytics Intrapreneurial JV

Teams building analytics technology for healthcare organizations find themselves jointly holding intellectual property and equity in new arrangements not seen before in healthcare.

Extrapreneurial energy turns intrapreneurial analytics initiatives into companies in which healthcare enterprises retain some equity, remain customers, and benefit other healthcare enterprises who wish to purchase analytics technology and services.

Involves a definitive ten-year agreement valued at more than $100 million, to combine technologies, some of which Allina developed since becoming the first customer of Health Catalyst technology in 2008.

“We have a lot of confidence in our partner in Health Catalyst. Eighty percent of that [$100 million] is standard, but 20% of it is at risk, based on how we perform on key indicators, like how well the tools perform, for example, on reducing readmissions or unnecessary admissions for people who can spend nights in their own bed.

Wheeler says use of Health Catalyst technology has permitted Allina clinicians to significantly reduce readmissions, elective inductions of labor, time required to diagnose breast concerns, and sepsis rates.

http://www.healthleadersmedia.com/print/TEC-312328/Allina-Health-and-Health-Catalysts-Unusual-Deal

Allina Health and Health Catalyst’s Unusual Deal

Scott Mace, for HealthLeaders Media , January 20, 2015

Teams building analytics technology for healthcare organizations find themselves jointly holding intellectual property and equity in new arrangements not seen before in healthcare.

Follow the money, they say. It’s not always easy. “Terms of the transaction were not disclosed” is the common coin of many a deal. But despite this, some deals are harbingers of bigger things.

To make my point, I will appropriate a word: extrapreneur. It’s a word that you won’t find in most dictionaries. In 1992, the American Heritage Dictionary defined intrapreneur as “a person within a large corporation who takes direct responsibility for turning an idea into a profitable finished product through assertive risk-taking and innovation.”

So what’s an extrapreneur? One suggestion from England: Someone who shares information among organizations that they wouldn’t share among themselves.

That’s a good place to start when trying to understand what is occurring at Cleveland Clinic, Geisinger Health System, and, most recently, Allina Health, where teams building analytics technology for healthcare organizations find themselves jointly holding intellectual property and equity in new arrangements not seen before in healthcare.

Extrapreneurial energy turns intrapreneurial analytics initiatives into companies in which healthcare enterprises retain some equity, remain customers, and benefit other healthcare enterprises who wish to purchase analytics technology and services.

The term extrapreneurial also reminds me of extranets, the early e-commerce concept that extended intranets (internal TCP/IP-based corporate networks) to business partners as supply chains started being built when the World Wide Web was young.

In 2009, Cleveland Clinic’s extrapreneurial initiative spawned Explorys, an analytics platform which now counts numerous large healthcare systems among its clients. Yet, for quite some time, Explorys remained located on the Cleveland Clinic campus. And Cleveland Clinic remains an investor.

Geisinger created xG Health “to bring Geisinger’s expertise in healthcare delivery transformation to organizations nationwide,” according to xG’s Web site. xG describes itself as the primary provider of Geisinger’s health performance improvement intellectual property.

Launched in 2013 with $40 million of financing from venture capital partner Oak Investment Partners, and located in Columbia, Maryland, xG is not far from Geisinger’s Pennsylvania base of operations.

Allina and Health Catalyst
Then, on January 6, Allina Health joined the extrapreneurial ranks. A few terms of the agreement are intriguing the entire analytics industry. Allina took an undisclosed stake in analytics firm Health Catalyst.

Health Catalyst had just come off an impressive year, having raised $41 million in funding in January 2014, and convening a conference of its own rapidly-growing healthcare system analysts last fall in Salt Lake City, where the company is located.

But back to those interesting terms between Allina and Health Catalyst. It’s a definitive ten-year agreement valued at more than $100 million, to combine technologies, some of which Allina developed since becoming the first customer of Health Catalyst technology in 2008.

Once a year, a governing committee of the Allina / Health Catalyst partnership will identify a prioritized list of improvement projects, each designed to provide measurable care improvement and financial value to Allina. As the partnership achieves each goal, both partners will share in the benefits of that success.

The deal also means that Allina is outsourcing its data warehousing, analytics, performance improvement technology, content, and personnel to Health Catalyst to accelerate advances. Beginning this month, in phases, Allina employees working in these areas—some 60 in all—will become onsite Health Catalyst team members.

When you have a partnership of this magnitude, extrapreneurial forces also allow each partner to remain agile rather than locked into an arrangement that has the possibility of souring due to the changing vicissitudes of technology and healthcare.

The $100 million represents the cost of what the staff and tools were costing Allina, says Penny Wheeler, MD, president and CEO of Allina Health, a $3.7 billion not-for-profit organization whose more than 90 clinics, 12 hospitals, and related healthcare services provide care for nearly 1 million people across Minnesota and western Wisconsin.

Use the Best Tool
“We weren’t falling back on hope as a strategy,” Wheeler says. “We have a lot of confidence in our partner in Health Catalyst. Eighty percent of that [$100 million] is standard, but 20% of it is at risk, based on how we perform on key indicators, like how well the tools perform, for example, on reducing readmissions or unnecessary admissions for people who can spend nights in their own bed.

Wheeler says use of Health Catalyst technology has permitted Allina clinicians to significantly reduce readmissions, elective inductions of labor, time required to diagnose breast concerns, and sepsis rates.

“Our agreement with Health Catalyst says that if we find a better tool out there, we can use it,” she says. “So, for example, if [Epic analytics software] Cogito excels at the capabilities that we work with, then we use that,” she says.

“So it’s more about what can you use the best to improve care than any exclusivity. That just speaks to the confidence level we both have in our ability to partner and make things better, despite what else is out in the market.

“I’m pretty confident that we’re going to have a ten-year agreement and beyond,” Wheeler says.

“The margins in healthcare right now are so razor-thin, and that’s pretty apparent at Allina, given some of their recent financials. But they want to be able to create a little bit of a for-profit business around this core competency they’ve built in terms of managing their clinical performance with IT, which is what’s going on here,” notes Judy Hanover, research director of provider IT transformation at IDC Health Insights.

In the era of extrapreneurs, it’s all part of doing business.

Scott Mace is senior technology editor at HealthLeaders Media.

complex adaptive systems, data saving lives, EF, health market quality, healthcare, healthy habits, rapid learning health systems

Population Health: A riddle wrapped in an enigma

PN: The health sector is very happy to take full responsibility for the health of the population for as long as substantial monies are tied to that claim. The moment the health sector is asked to account for it, they get nervous.

Tying funding to value is a terrifying prospect for the health sector as having to account for the benefit they deliver would inevitably lead to a diminution in income and status.

“Because so many factors lie outside clinicians’ control, we need to understand what factors the healthcare system can reasonably be expected to act on, given professionals’ training, infrastructure and scope of practice,” they said. “We also need to determine the appropriate levels of health system accountability for population health outcomes.”

http://www.modernhealthcare.com/article/20150108/BLOG/301089997/population-health-improvement-still-a-riddle-wrapped-in-an-enigma

Population health improvement still a riddle wrapped in an enigma

By Melanie Evans  | January 8, 2015
Population Health
New England Journal of Medicine
The push to invest more of the healthcare industry’s time and money into promoting good health is, so far, uneven and uncertain in terms of effectiveness. Perhaps nowhere is that more apparent than in federal initiatives to broadly improve health by extending care beyond clinics and pharmacies into neighborhoods and homes.Federal funding for population-health efforts—the management of health and medical care for an entire group of patients or a community—has expanded under the Affordable Care Act. It’s included financing for states and providers to experiment with ways to better coordinate healthcare and other needs that affect health, such as housing and transportation. But the initiatives are not without risk or challenges, a point three federal officials underscored in the latest issue of the New England Journal of Medicine.

Efforts are still underway to identify what works and how to make widespread use of the most effective strategies, write Dr. William Kassler, Naomi Tomoyasu and Dr. Patrick Conway of the agency that oversees Medicare and Medicaid. The CMS Innovation Center, in a report to Congress last month, also said results were largely not yet available for nearly two dozen initiatives to bolster population health, improve quality and increase efficiency in healthcare, financed with $2.6 billion through last year.

Calculating a dividend from those investments presents another challenge, the trio wrote. Kassler is one of the CMS’ chief medical officers; Tomoyasu is deputy director of the prevention and population health care models group within the CMS Innovation Center; and Conway is the CMS’ deputy administrator for innovation and quality.

The return on any investment in prevention will necessarily take time, raising the risk that “current actuarial methods used to evaluate return on investment may underestimate potential savings,” they warned.

Investment at the federal level is not small. Medicare and Medicaid—which combined account for $1 of every $3 the nation spends on healthcare—have increasingly poured money into strategies for disease prevention and health promotion.

Those strategies extend the reach of healthcare beyond hospitals, clinics and pharmacies into neighborhoods, homes and schools. Such extended investment can include help with housing, transportation, literacy, day care and groceries, the officials wrote.

But with that expanded reach comes a debate “regarding the specific population-based activities that fall within healthcare providers’ scope of practice,” wrote the CMS officials. “Because so many factors lie outside clinicians’ control, we need to understand what factors the healthcare system can reasonably be expected to act on, given professionals’ training, infrastructure and scope of practice,” they said. “We also need to determine the appropriate levels of health system accountability for population health outcomes.”

Follow Melanie Evans on Twitter: @MHmevans

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WSJ: Can a Smartphone Tell if You’re Depressed?

 

http://www.wsj.com/articles/can-a-smartphone-tell-if-youre-depressed-1420499238

TECHNOLOGY

Can a Smartphone Tell if You’re Depressed?

Apps, Other Tools Help Doctors, Insurers Measure Psychological Well-Being

By

JOSEPH WALKER

HUNTERSVILLE, N.C.—Toward the end of Janisse Flowers’s pregnancy, a nurse at her gynecologist’s office asked her to download an iPhone app that would track how often she text messaged with friends, how long she talked on the phone and how far she traveled each day.

The app was part of an effort by Ms. Flowers’s health-care provider to test whether smartphone data could help detect symptoms of postpartum depression, an underdiagnosed condition affecting women after they give birth. The app’s developer, San Francisco-based…

complex adaptive systems, data saving lives, EF, facts & data points, health market quality, healthcare, policy, politics, quantified self, rapid learning health systems

Yach: Changing the Landscape for Prevention and Health Promotion

 

http://www.huffingtonpost.com/dr-derek-yach/changing-the-landscape-fo_1_b_6439328.html

Become a fanExecutive Director of the Vitality Institute

Changing the Landscape for Prevention and Health Promotion

Posted: Updated:

By Bridget B. Kelly and Derek Yach*

Chronic diseases like heart disease, diabetes, and cancer are major contributors to poor health and rising health care costs in the U.S. The cost of treating these conditions is estimated to account for 80 percent of annual health care expenditures. More and more, experts agree on the great potential for preventing or delaying many cases of costly chronic diseases by focusing on environmental, social, and behavioral root influences on health. Yet the U.S. has been slow to complement its considerable spending on biomedical treatments with investments in population-based and non-clinical prevention interventions.

What is getting in the way of strengthening our investments in prevention and health promotion? A few consistent themes emerged across multiple expert consensus studies conducted by the Institute of Medicine (IOM), which were summarized in the report Improving Support for Heath Promotion and Chronic Disease Prevention — developed in support of the recent Vitality Institute Commission on Health Promotion and Prevention of Chronic Disease in Working-Age Americans.

First, prevention is challenging — chronic health problems are complex, and so are the solutions. Second, decision-makers who allocate resources have tough choices to make among many competing pressures and priorities; prevention and promotion can be at a disadvantage because their benefits are delayed. Third, there is a need for better, more usable evidence related to the effectiveness, the implementation at scale, and the economics of prevention interventions. Decision-makers need information that makes it easier to understand, identify, and successfully implement prevention strategies and policies. As noted in a recent opinion piece in the Journal of the American Medical Association (JAMA), limited investment in prevention research has resulted in an inaccurate perception that investing in preventive measures is of limited value. This has profound implications for federal funding allocations.

The mismatch in funding allocations is seen right at the source of our nation’s major investment in new health-related knowledge: the National Institutes of Health (NIH). A new paper in the American Journal of Preventive Medicine found that less than 10 percent of the NIH annual budget for chronic diseases is allocated to improving our knowledge base for effective behavioral interventions to prevent chronic diseases. This means that despite the immense potential for prevention science to reduce the burden of chronic diseases in the U.S., it is woefully underfunded compared to what we invest in researching biomedical treatment interventions for these conditions. NIH investments affect what evidence is ultimately available to those who decide how to allocate resources to improve the health of our nation, and they also affect the kinds of health experts we train as a country. By not investing in prevention science and in a future generation of scientists capable of doing high quality research in prevention, we are perpetually caught in the same vicious cycle where prevention continues to lag behind in our knowledge and therefore our actions.

There is hope that the landscape is slowly changing. Initiatives such as the NIH Office of Disease Prevention‘s Strategic Plan for 2014-2018 and the Affordable Care Act’s mandated Patient-Centered Outcomes Research Institute (PCORI) have the potential to strengthen prevention science and build the evidence-base for effective prevention interventions. Innovations in personalized health technologies and advances in behavioral economics also show great promise in improving health behaviors for chronic disease prevention.

The Vitality Institute Commission’s report emphasized the need for faster and more powerful research and development cycles for prevention interventions through increased federal funding for prevention science as well as the fostering of stronger public-private partnerships. It is essential to generate and communicate evidence in a way that enables decision-makers to understand the value of investing in prevention while taking into account their priorities, interests and constituencies. This will lead us to more balanced investments, make prevention a national priority, and boost the health of the nation.

*The authors are responsible for the content of this article, which does not necessarily represent the views of the Institute of Medicine.

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

The Temporary Tattoo That Tests Blood Sugar

 

http://www.theatlantic.com/health/archive/2015/01/the-temporary-tattoo-that-tests-blood-sugar/384581/

The Temporary Tattoo That Tests Blood Sugar

An electronic sensor may mean the end of finger pricking.

UC San Diego

A painful prick of the fingertip reveals a mountain of medical information for many diabetes patients. But health professionals have long struggled to find a reliable and painless way to gather blood sugar measurements. Just last year, Google announced that it was developing contact lenses that measure glucose levels in its user’s tears. But now, nanoengineers may have found an even easier way for diabetes patients to monitor their vital levels: temporary tattoos.

Amay Bandodkar, a researcher at the University of California, San Diego, has created a flexible sensor that uses a mild electrical current to measure glucose levels in a person’s body. Measuring blood sugar levels multiple times a day is vital for diabetes patients because it shows how well their body is managing their disease as well as the dose of insulin they require, if they need any at all. But because many people find needles unpleasant, they tend to avoid measuring their levels, which puts them at risk of developing serious medical complications. The new device is painless—It contains electrodes printed on a thin tattoo paper that patients can even dispose after use. “Presently the tattoo sensor can easily survive for a day,” Bandodkar said in a statement. “These are extremely inexpensive—a few cents—and hence can be replaced without much financial burden on the patient.”

The tattoo has already provided accurate glucose measures for seven healthy patients, the team reported in a recent issue of the journal Analytical Chemistry.The patients, all non-diabetics between the ages of 20 and 40, wore the tattoos before eating a sandwich and drinking a soda. Following the carb-rich meal, the tattoo recorded the spike in each patient’s glucose levels as accurately as a traditional finger-stick device. The tattoo is a few steps away from providing the numeric value of glucose levels, so scientists have to remove and analyze it in order to retrieve its measurements. Eventually, Bandodkar said the tattoo will have “Bluetooth capabilities to send this information directly to the patient’s doctor in real-time or store data in the cloud.”

The researchers hope the tattoo will eventually be used to monitor levels of other compounds in the blood, like metabolites, medications, or alcohol and illegal drugs. Whatever the application, the fewer needles the better.

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A pinch of prevention will prevent a pound of turnstile medicine

 

http://www.afr.com/p/opinion/pinch_of_prevention_will_prevent_cTMfa5vns8VzT46UA8cigJ

JOHN DWYER

A pinch of prevention will prevent a pound of turnstile medicine

PUBLISHED: 12 HOURS 58 MINUTES AGO | UPDATE: 12 HOURS 38 MINUTES AGO

 

A pinch of prevention will prevent a pound of turnstile medicineA lack of infrastructure in Australia to care for more people in a community, rather than a hospital, costs us dearly. Photo: Louie Douvis

JOHN DWYER

Poorly considered and obviously unacceptable policies have forced the government to go back to the drawing board to consider ways to improve the cost effectiveness and sustainability of our health care system. This time let’s move beyond the government’s focus on having us pay more for a visit to our GP to concentrate on the evidence-based structural reforms we should be discussing. This time broad consultations are promised. Hopefully, the following facts and suggestions will influence decisions.

A good start would see the government stop talking about the fiscal sustainability of Medicare. Were it not for the destructive division of health care responsibilities shouldered by State and Federal governments, Canberra would not be looking at Medicare as if were isolated from the rest of the health care system. Hospital expenditure, at nearly $60 billion a year, dwarfs Medicare spending ($19 billion a year) and is increasing more rapidly. The immediate catalyst for changes to Medicare is not a fiscal crisis – our 9.3 per cent of GDP spent on health is about average for the OECD –but rather the unsatisfactory health outcomes delivered that are fuelling the growth in hospital care. A lack of any real infrastructure to provide our community with an improved capacity to prevent illness and care for more people in a community rather than hospital setting is costing us dearly.

More than 600,000 admissions to hospital each year (average cost more than $5000 per episode) could be avoided by a timely community intervention in the three weeks prior to admission. There is no doubt that the future of cost-effective, readily available hospital care is dependent on a reduction in the demand for hospital services. That must be the goal of a restructured Primary Care system. Last year Australians forked out $29 billion to supplement their health care (second only to the US in terms of out of pocket expenses). Much of this was spent on paying for surgery in the private sector. Public hospitals are swamped with complex medical patients seriously reducing their capacity to offer timely surgical services. Reducing medical admissions and restoring timely surgical services is a key to reigning in surgical costs and better educating the next generation of surgeons.

This time could our new health minister and her department open their eyes to international trends in cost effective health care that are producing better health outcomes. There is now an abundance of evidence that a focus on prevention in a personalised health system improves outcomes while slashing costs. Some systems have reduced hospital admissions by 42 per cent over the last decade. The British government has just been presented with a review that concluded that an extra 72 million ($132 million) spent on improving primary care in the community would save the system 1.9 billion ($3.5 billion) by 2020. The data available provides the government with a clear message that it does not want to hear. Only by spending more money on arestructuredMedicare will significant system wide savings be achievable.

A competent government would be looking at a timetable for introducing the highly successful Medical Home model of Primary Care, where teams of health professionals populate a practice and are available to enrolled patients. The infrastructure is available to help people avoid illness, have potential problems recognised earlier, offer co-ordinated in house care for people with chronic problems and care for many in the community currently sent to hospital. International experience tells us that a decade is required for the completion of necessary changes. We need to start on that journey and, fortunately, can do so without any panic about current health expenditure.

There is another related imperative that needs urgent action. Only 13 per cent of young doctors express any interest in becoming a GP. Only 1 per cent are contemplating a career as a rural GP. Primary Care training is rigorous and GPs are true specialists. How does all the rhetoric from Canberra about the pivotal role they play sit with the proposed $31 fee for a standard consultation. The discrepancy in the income potential for GPs when compared to that of other specialists is now huge.

Young doctors looking at the professional life of our GPs are uncomfortable with the current “fee for service” model that encourages turnstile medicine that is so professionally unfulfilling. Many GPs join corporate Primary Care providers preferring a salary. In New Zealand the government has facilitated 85 per cent of the nation’s GPs moving away from fee for service payments. The same is true for 65 per cent of US Primary Care physicians. Throughout the OECD health systems recognising the perverse incentives associated with fee for service remuneration are exploring changes that increase a GP’s remuneration for keeping people well.

There are numerous cost impositions in our health system that should be addressed before we are asked to pay more. Nine departments of health for 23 million people. A $5 billion dollar cost for the private health insurance rebate that could be better spent on achieving the above goals. $20 billion dollars spent on poor value or unnecessary procedures. The government asks: “if you don’t like our ideas then what would you do?” Well, here come the suggestions, please listen.

John Dwyer isEmeritus Professor of Medicine at the University of NSW.

The Australian Financial Review

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Data is just a shadow of human experience. We still need to connect the dots – Roni Zeiger

http://eepurl.com/-rUf9

“Data is just a shadow of human experience. We still need to connect the dots,” Smart Patients founder and Rock Health entrepreneur Roni Zeiger argued last week. Luckily, healthcare may finally be ready for big data—just so long as the algorithms don’t ruin your life.