Category Archives: data saving lives

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Crossing the creepy line – big data in health

Hospitals and insurers need to be mindful about crossing the “creepiness line” on how much to pry into their patients’ lives with big data.

http://www.bloomberg.com/news/2014-06-26/hospitals-soon-see-donuts-to-cigarette-charges-for-health.html

Your Doctor Knows You’re Killing Yourself. The Data Brokers Told Her

By Shannon Pettypiece and Jordan Robertson  Jun 27, 2014 2:35 AM ET

Photographer: Evan Sung/Bloomberg

Photographer: Pat LaCroix

Photographer: David Paul Morris/Bloomberg

A cupcake eater in San Francisco.

Photographer: Matthew Staver/Bloomberg

A cigarette smoker in Denver.

Photographer: Tim Boyle/Getty Images

A customer at a convenience store in Des Plaines, Illinois.

You may soon get a call from your doctor if you’ve let your gym membership lapse, made a habit of picking up candy bars at the check-out counter or begin shopping at plus-sized stores.

That’s because some hospitals are starting to use detailed consumer data to create profiles on current and potential patients to identify those most likely to get sick, so the hospitals can intervene before they do.

Information compiled by data brokers from public records and credit card transactions can reveal where a person shops, the food they buy, and whether they smoke. The largest hospital chain in the Carolinas is plugging data for 2 million people into algorithms designed to identify high-risk patients, while Pennsylvania’s biggest system uses household and demographic data. Patients and their advocates, meanwhile, say they’re concerned that big data’s expansion into medical care will hurt the doctor-patient relationship and threaten privacy.

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“It is one thing to have a number I can call if I have a problem or question, it is another thing to get unsolicited phone calls. I don’t like that,” said Jorjanne Murry, an accountant in Charlotte, North Carolina, who has Type 1 diabetes. “I think it is intrusive.”

Acxiom Corp. (ACXM) and LexisNexis are two of the largest data brokers who collect such information on individuals. Acxiom says their data is supposed to be used only for marketing, not for medical purposes or to be included in medical records. LexisNexis said it doesn’t sell consumer information to health insurers for the purposes of identifying patients at risk.

Bigger Picture

Much of the information on consumer spending may seem irrelevant for a hospital or doctor, but it can provide a bigger picture beyond the brief glimpse that doctors get during an office visit or through lab results, said Michael Dulin, chief clinical officer for analytics and outcomes at Carolinas HealthCare System.

Carolinas HealthCare System operates the largest group of medical centers in North Carolina andSouth Carolina, with more than 900 care centers, including hospitals, nursing homes, doctors’ offices and surgical centers. The health system is placing its data, which include purchases a patient has made using a credit card or store loyalty card, into predictive models that give a risk score to patients.

Special Report: Putting Patient Privacy at Risk

Within the next two years, Dulin plans for that score to be regularly passed to doctors and nurses who can reach out to high-risk patients to suggest interventions before patients fall ill.

Buying Cigarettes

For a patient with asthma, the hospital would be able to score how likely they are to arrive at the emergency room by looking at whether they’ve refilled their asthma medication at the pharmacy, been buying cigarettes at the grocery store and live in an area with a high pollen count, Dulin said.

The system may also score the probability of someone having a heart attack by considering factors such as the type of foods they buy and if they have a gym membership, he said.

“What we are looking to find are people before they end up in trouble,” said Dulin, who is also a practicing physician. “The idea is to use big data and predictive models to think about population health and drill down to the individual levels to find someone running into trouble that we can reach out to and try to help out.”

While the hospital can share a patient’s risk assessment with their doctor, they aren’t allowed to disclose details of the data, such as specific transactions by an individual, under the hospital’s contract with its data provider. Dulin declined to name the data provider.

Greater Detail

If the early steps are successful, though, Dulin said he would like to renegotiate to get the data provider to share more specific details on patient spending with doctors.

“The data is already used to market to people to get them to do things that might not always be in the best interest of the consumer, we are looking to apply this for something good,” Dulin said.

While all information would be bound by doctor-patient confidentiality, he said he’s aware some people may be uncomfortable with data going to doctors and hospitals. For these people, the system is considering an opt-out mechanism that will keep their data private, Dulin said.

‘Feels Creepy’

“You have to have a relationship, it just can’t be a phone call from someone saying ‘do this’ or it just feels creepy,” he said. “The data itself doesn’t tell you the story of the person, you have to use it to find a way to connect with that person.”

Murry, the diabetes patient from Charlotte, said she already gets calls from her health insurer to try to discuss her daily habits. She usually ignores them, she said. She doesn’t see what her doctors can learn from her spending practices that they can’t find out from her quarterly visits.

“Most of these things you can find out just by looking at the patient and seeing if they are overweight or asking them if they exercise and discussing that with them,” Murry said. “I think it is a waste of time.”

While the patients may gain from the strategy, hospitals also have a growing financial stake in knowing more about the people they care for.

Under the Patient Protection and Affordable Care Act, known as Obamacare, hospital pay is becoming increasingly linked to quality metrics rather than the traditional fee-for-service model where hospitals were paid based on their numbers of tests or procedures.

Hospital Fines

As a result, the U.S. has begun levying fines against hospitals that have too many patients readmitted within a month, and rewarding hospitals that do well on a benchmark of clinical outcomes and patient surveys.

University of Pittsburgh Medical Center, which operates more than 20 hospitals in Pennsylvania and a health insurance plan, is using demographic and household information to try to improve patients’ health. It says it doesn’t have spending details or information from credit card transactions on individuals.

The UPMC Insurance Services Division, the health system’s insurance provider, has acquired demographic and household data, such as whether someone owns a car and how many people live in their home, on more than 2 million of its members to make predictions about which individuals are most likely to use the emergency room or an urgent care center, said Pamela Peele, the system’s chief analytics officer.

Emergency Rooms

Studies show that people with no children in the home who make less than $50,000 a year are more likely to use the emergency room, rather than a private doctor, Peele said.

UPMC wants to make sure those patients have access to a primary care physician or nurse practitioner they can contact before heading to the ER, Peele said. UPMC may also be interested in patients who don’t own a car, which could indicate they’ll have trouble getting routine, preventable care, she said.

Being able to predict which patients are likely to get sick or end up at the emergency room has become particularly valuable for hospitals that also insure their patients, a new phenomenon that’s growing in popularity. UPMC, which offers this option, would be able to save money by keeping patients out of the emergency room.

Obamacare prevents insurers from denying coverage because of pre-existing conditions or charging patients more based on their health status, meaning the data can’t be used to raise rates or drop policies.

New Model

“The traditional rating and underwriting has gone away with health-care reform,” said Robert Booz, an analyst at the technology research and consulting firm Gartner Inc. (IT) “What they are trying to do is proactive care management where we know you are a patient at risk for diabetes so even before the symptoms show up we are going to try to intervene.”

Hospitals and insurers need to be mindful about crossing the “creepiness line” on how much to pry into their patients’ lives with big data, he said. It could also interfere with the doctor-patient relationship.

The strategy “is very paternalistic toward individuals, inclined to see human beings as simply the sum of data points about them,” Irina Raicu, director of the Internet ethics program at the Markkula Center for Applied Ethics at Santa Clara University, said in a telephone interview.

To contact the reporters on this story: Shannon Pettypiece in New York atspettypiece@bloomberg.net; Jordan Robertson in San Francisco atjrobertson40@bloomberg.net

To contact the editors responsible for this story: Reg Gale at rgale5@bloomberg.net Andrew Pollack

data saving lives, health market quality, healthcare, policy, politics, rapid learning health systems

New Yorker: Good medicine, it seems, does not always feel good.

This is weird… it’s like doctors are calling themselves out as hucksters? Unable to manage conflicts of interest? Human?? In which case, they can stop carrying on as if they’re something superior.

http://www.newyorker.com/online/blogs/elements/2013/07/when-doctors-tell-patients-what-they-dont-want-to-hear.html

JULY 23, 2013

WHEN DOCTORS TELL PATIENTS WHAT THEY DON’T WANT TO HEAR

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Mindy-580.jpeg

There’s an episode of “The Mindy Project,” Mindy Kaling’s comedy about the life of an obstetrician, that begins in the office of an attractive ob-gyn, Dr. Reed. He sits, beaming, in front of his pregnant patient and her husband. He wears a crown of jewels they have given him, and they exchange pleasantries until the inevitable moment arrives: they need to address the patient’s health. She is obese, and her weight poses many risks to the fetus.

Unwilling to jeopardize the affection of his “favorite patient,” Dr. Reed instead summons the brazen and socially inept Dr. Mindy to do his dirty work. True to form, by the end of the scene, Mindy has offended the patient, which escalates into a shouting match until the patient tells Mindy that she’s the one who needs to lose some weight. Reed emerges, halo intact.

Though the scene marks a bad day for Mindy, I think it also heralds what could turn out to be a bad era for American medicine. Beyond the comedic exaggerations lies an age-old tension: Will our patients still like us if we tell them things they don’t want to hear? The challenge of communicating unpleasant, possibly profoundly upsetting information to patients is timeless. What has changed, however, is that physicians are now being judged, and compensated, based upon their ability to do it.

In October, 2012, Medicare débuted a new hospital-payment system, known as Value-Based Purchasing, which ties a portion of hospital reimbursement to scores on a host of quality measures; thirty per cent of the hospital’s score is based on patient satisfaction. New York City’s public hospitals recently decided to follow suit, taking the incentive scheme one step further: physicians’ salaries will be directly linked to patients’ outcomes, including their satisfaction. Other outpatient practices across the country have also started to base physician pay partly on satisfaction scores, a trend that is expected to grow.

But in a country that spends more per capita on health than any other, with results that remain mediocre in comparison, can we really expect that a nation of more satisfied patients will be a healthier nation over all?

Many insist that we can. One of the leading arguments for pay based on satisfaction, as described in a recent Wall Street Journal article titled “The Talking Cure for Health Care,” is that these incentives will improve patient-doctor communication, which will in turn lead to better health. As the article notes, “Doctors are rude. Doctors don’t listen. Doctors have no time. Doctors don’t explain things in terms patients understand.”

Few object to these generalizations. We’ve all had insensitive doctors who have left us confused and scared. I’m a physician, and I often find myself rushing, interrupting, and overwhelming patients with information. But if the path from good communication to better health is through a better understanding of risk factors and disease, then medicine poses a paradox: how much we understand tends to be inversely related to how well we think physicians have communicated.

Consider, for example, a recent study among patients with chronic kidney disease: the more knowledge patients had about their illness, the less satisfied they were with their doctors’ communication. Another study’s title asks, “How does feeling informed relate to being informed?” The answer: it doesn’t. The investigators surveyed over twenty-five hundred patients about decisions they had made in the previous two years, and found no over-all relationship between how informed patients felt and what they actually knew.

The disconnect between patients’ understanding of disease and their satisfaction with physicians is particularly pronounced for care at the end of life. In a recent study published in the New England Journal of Medicine, oncologists studied patients’ expectations of chemotherapy options. For these patients, with either end-stage colon or lung cancer, chemotherapy may provide some help, but it can also be toxic, and definitely doesn’t provide a cure. Doctors know this, but do patients?

In the study, sixty-nine per cent of patients with lung cancer, and eighty-one per cent of patients with colon cancer, did not understand that chemotherapy was not curative. This finding reminds that we have much to learn about how to communicate medical information to our patients. But it is the second finding that suggests why paying based on patient satisfaction isn’t the way to get us there: the more people understood about the grim nature of their prognosis, the less they liked their physicians.

Understanding that there is no cure for your disease is entirely different from understanding why you need to take a blood-pressure medication. Since I suspect that a bit of denial is precisely what allows the dying to live—see the response of a young, pregnant woman to the news that she has incurable lung cancer in Atul Gawande’s “Letting Go” for a beautiful example—I tend to be more concerned with how to keep people from getting sick in the first place.

And this gets us back to the Mindy problem. Sure, there are nice ways of saying, “You need to lose weight, stop smoking, and take this medication that certainly won’t make you feel better but might very well leave you tired and depressed.” But sometimes there aren’t, and it can be tough to separate how we feel about the message from how we feel about the messenger.

I used to be an avid runner, but have had a slew of running injuries—the most enduring of which is a chronic hamstring problem that has made sitting uncomfortable, and running impossible. But for a long time, my approach to any given injury was simple: run through it.

In my quest for quick fixes, I have seen more orthopedists than I can count. But there was one doctor, Dr. D., who tried to teach me the error of my ways. He told me that the problem was not with my body but with my behavior. He said I didn’t need MRIs or steroid injections but rather to stop running and give myself time to heal. And I, in turn, found much that was wrong with him: he started late, didn’t return phone calls, had bad breath, typed with one finger, and, above all, didn’t seem to listen to me. I decided he was the worst doctor in the world and went searching for a new one.

Many months and doctors later, last year, I found “my person.” Most important, she told me I would run again. That she was so nice, so pretty, and so put together (and she injected my aching gluteal region with steroid every time I asked) only reinforced my sense that I was in the most expert of hands. I loved her as much as I wanted to be her.

If you had mailed me a satisfaction survey, you can imagine which doctor would have gotten a bonus. But in the end, it’s Dr. D who was right. I still can’t run, but had I heeded his advice, I’d likely be back to doing marathons.

The problem with the patient-satisfaction surveys is that they assume we can evaluate specific characteristics of doctors, or hospitals, as distinct from their general likability. But that’s not easy. The halo effect is a well known cognitive bias that describes our tendency to quickly judge people and then assume the person possesses other good or bad qualities consistent with that general impression. The effect is perhaps best described in the many positive attributes we ascribe to someone we find attractive. As the Nobel laureate Daniel Kahneman noted, for example, “If we think a baseball pitcher is handsome and athletic … we are likely to rate him better at throwing the ball, too.”

This tendency has been well demonstrated in our judgments of the competence of political candidates, or our willingness to assume innocence for someone accused of a crime. (See Paul Bloom’s post on the unwarranted empathic response to the attractive face of the Boston Marathon bomber Dzokhar Tzarnaev.) Though there are several factors informing the general likability of physicians beyond how we feel about what they tell us, there is no reason to assume we would be somehow immune to this cognitive bias when it comes time to rate them.

Although we tend to be totally unaware of the effects of these haloes on our own judgments, hospitals and outpatient practices are not. That’s why they are investing millions of dollars in renovated rooms, new foyers, gourmet chefs, and valet parking. These are nice perks, and undoubtedly lead to higher scores across all domains of the satisfaction survey.

But do higher scores on a satisfaction survey translate into better health? So far, the answer seems to be no. A recent study examined patient satisfaction among more than fifty thousand patients over a seven-year period, and two findings were notable. The first was that the most satisfied patients incurred the highest costs. The second was that the most satisfied patients had the highest rates of mortality. While with studies like this one it is always critical to remember that correlation does not equal causation, the data should give us pause. Good medicine, it seems, does not always feel good.

Lisa Rosenbaum is a cardiologist, a Fellow at the Philadelphia V.A. Medical Center, and a Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania.

Photograph: Fox

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

Blumenthal: On the need for the leaders to be IT savy

 

http://www.commonwealthfund.org/publications/blog/2014/jun/of-leaders-and-geeks

Of Leaders and Geeks

 Tuesday, June 24, 2014

David Blumenthal
By David Blumenthal, M.D.
Consider these seemingly unrelated developments:
  1. An IT failure (healthcare.gov) nearly destroys a president’s legacy, while a seeming IT triumph (the National Security Agency’s electronic snooping skills) throws his foreign policy into turmoil.
  2. According to Michael Lewis’ fascinating and scary book, Flash Boys, Wall Street geeks make billions through high-frequency trading, running circles around clueless masters of the universe in charge of America’s biggest banks and hedge funds.
  3. For the second year in a row, the American Medical Association elects a health IT expert as its president.

This could be nothing. But then again, could it be something really big? Could we be witnessing a fundamental change in the requirements for leadership in health and every other sector of society?

We all live with stereotypes and here is one of the most powerful: We have leaders and we have geeks. Leaders change history. They sit atop governments and corporations. They craft strategy, cut deals, rally the troops, and guide humanity into the future. They don’t need to understand technology, because they have geeks.

Geeks sit in cubicles off-site somewhere. They spend their days coding, wiring, and rushing to help impatient leaders whose systems are down. Geeks show up when they’re needed, and go away when they’re not. The technology they manage is like plumbing or electricity. If you don’t like your plumber or electrician, there’s always another in the wings.

Leaders don’t have to manage geeks. They have people who have people who manage geeks.

Like all stereotypes, this one is exaggerated and not wholly accurate, but it makes a point. In health and other areas, leaders sometimes take a kind of perverse pride in their ignorance of information technology and how it works. It’s as though familiarity with IT would damage the aura that qualifies them for the huge responsibilities they seek and enjoy. Of course, they may have content expertise acquired during their rise through the ranks. In health care, it may be training and experience as a health professional and/or academician; in business, it may be marketing or finance; in government, it may be elected office or policy expertise. But almost never is an understanding of information technology considered a vital ingredient in preparing leaders to assume their great responsibilities.

There are exceptions. The leaders of some of the world’s most successful new companies—Microsoft, Google, Apple, Facebook—are or have been technologists.  But they run technology companies. It makes sense that for this industrial sector, real geeks should sit in the CEO’s office.  But for most of the rest of our public and private enterprises, the gap between technology experts and leaders persists.

This may be changing. Recent history suggests that at least for health care leaders—whether in government or the private sector—a deep appreciation for, and even understanding of, information technology may be a vital asset.  How could it be otherwise? In health care, as elsewhere, information is power: not only the power to heal, but also the power to improve quality, efficiency, reliability, safety, and value.  And information technology, acting as a health care organization’s circulatory system, collects, manages, and circulates that information.

Today’s and tomorrow’s successful leaders do not need to be technologists, but they do have to own technology policy and problems in a way few do right now. And they have to incorporate into their inner circles of advisers individuals capable of bridging the historical divide between technology experts and leaders. The alternative could be a future full of healthcare.gov launches, or worse, a continuing failure to take full advantage of the power of information to optimize health system performance.

 

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

Me in the AFR

And so the slow, arduous public conversation task begins…

PDF: AFR_Healthcare20_BigDataRoundtable_140625

Story & Video: http://www.afr.com/p/business/healthcare2-0/leadership_vacuum_cripples_health_VrDsiSCDYOWXyuvg54QfJN

Leadership vacuum cripples e-health

PUBLISHED: 19 JUN 2014 05:36:14 | UPDATED: 20 JUN 2014 05:18:23

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MARK EGGLETON

Australia continues to struggle with the concept of e-health, with numerous health sector stakeholders equally to blame. This was one of the key messages to come out of the recent Big Data in Healthcare roundtable held by The Australian Financial Review in partnership with GE in Sydney.

Capital Markets CRC principal adviser Dr Paul Nicolarakis suggested part of the problem was Australia lacks a vision for healthcare. He suggested we don’t have someone or a collection of individuals working towards one goal. There are numerous stakeholders across the sector all vying to be the loudest voice, yet not pursuing a common goal.

Chief scientist at The George Institute for Global Health, Professor Anushka Patel said there was no one out there explaining and selling the potential value of big data and e-health or really engaging the government in a productive manner.

“There’s potential to reduce waste and reduce healthcare expenditure without sacrificing quality of care and health outcomes,” Professor Patel said.

“I also think big data could improve our ability to ensure equity, better health outcomes and health access. Those are the two of the big policy messages that need to be conveyed.”

Professor Enrico Coiera, who is the director of the Centre for Health Informatics, said data is already on the move – it just needs to be better linked. He said there is already plenty of data that’s slowly improving quality out there.

“The job is to get that moving around the system. Cheap fees and hospitals sharing information is what we want. Importantly, let’s drop the e from e-health and just improve health services,” Professor Coiera said.

Paul Nicolarakis reiterated that part of the problem was we lack strong, informed, insightful leaders of our health system.

“With all respect to the Australian Medical Association, they are not appointed to be the leaders of the health system. Our health ministers are not health people, they aren’t clinicians or experts in health, and I think, because of these sort of structural limitations, it’s very hard to develop the idea of e-health.

THE TIME IS RIPE FOR CHANGE

 

For the head of the Australian Healthcare and Hospitals Association, Alison Verhoeven, the time is ripe for change right now. She suggested that, with the federal Health Minister Peter Dutton talking about structural reform in the health system, the time is right to really address the big data question as it can help drive efficiency.

Verhoeven said a more streamlined system would see better consumer as well as clinician engagement.

“It’s about better system leadership as well.

“I’d really like to see a more integrated healthcare system generally come out of the structural reforms being discussed at the moment but whether that happens or not is another matter,” she said.

GE Healthcare Solutions managing director Dr David Dembo shares Verhoeven’s cautious view that we’re not going to see any real change in Australia.

“Unfortunately change happens very slowly in health and it happens slowly because free market principles don’t apply and because we don’t have strong leadership.

“We need to have people step up to the plate who are prepared to make brave and considered decisions, particularly around selling a vision and building a culture that gets buy-in from everybody – doctors, consumers and politicians.

“This journey we’re going on to take the ‘e’ out of e-health is the opportunity to de-fragment our health system and you only do that when everybody agrees this is a data science and this is our opportunity for health to behave as a system.”

 

 

The Australian Financial Review

Story: http://www.afr.com/p/business/healthcare2-0/privacy_fears_curb_health_growth_kxxq9sVuxrKDFz6enebgWP

Privacy fears curb e-health’s growth

PUBLISHED: 15 HOURS 46 MINUTES AGO | UPDATE: 14 HOURS 8 MINUTES AGO

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Privacy fears curb e-health’s growth

“We have to be able to sell people a vision about why e-health is important to them,”, says Australian Healthcare and Hospitals Association CEO Alison Verhoeven. Photo: Reuters

MARK EGGLETON

In a twist on the old highwayman demand of “Your money or your life” we finally have an answer when it comes to e-health. Our personal finances win while our health takes a back seat.

Right now most Australians when they want to get a snapshot of their financial situation can go online and find up-to-the-minute information on their bank balance and outstanding debts. We’re pretty comfortable with the level of security afforded our financial details and even happy to give out further details if we’re keen on purchasing goods or services. Unfortunately, we’re a little leery about having our health records available online beyond what’s stored in a computer on our GPs desk.

Security of data was one of the major focuses of the recent Big Data in Healthcare roundtable held byThe Australian Financial Review in partnership with GE in Sydney with most participants agreeing it was an issue.

According to Australian Healthcare and Hospitals Association CEO, Alison Verhoeven, the best way to address people’s privacy concerns is better communication.

“We have to be able to sell people a vision about why e-health is important to them,” she says.

Furthermore, Verhoeven worries that while we continue to argue around the fringes of the debate we’re falling behind as technology moves on.

“The focus of discussion around e-health is on the desktop versions of e-health. We haven’t actually really begun to talk about the mobile versions of e-health so we’re really constructing a system that works on old technology,” Verhoeven says.

Part of the problem with Australia’s roll-out of some form of e-health framework was the personally controlled electronic health record (PCEHR) set up by the last federal government was it was poorly conceived and advertised, with very few Australians opting to ­participate.

OPT OUT, NOT OPT IN

 

Chief scientist at The George Institute for Global Health, Professor Anushka Patel says the best option would have been to give Australians the opportunity to opt out of the PCEHR rather than opt in.

In her experience in health services research it’s often very difficult to get opt-in consent, logistically, and opt-out consent is frequently used.

“Very few people opt out. Even in situations where opt-out can occur later in the course of the investigations very few people opt out. That’s a real test of whether people have real concerns such as privacy. I certainly think opt-out is the way to go,” Professor Patel said.

Director of the Centre for Health Informatics Professor Enrico Coiera says people do have a right to be a little apprehensive about data security and part of the problem is health services, especially government departments, don’t really “have their heads around the issue yet”.

For Paul Nicolarakis, the principal adviser from Capital Markets CMC and former senior adviser to Tanya Plibersek (the previous government’s health minister), the privacy question is an obvious concern. Yet he believes we have communicated the benefits of e-health in the wrong way.

“If e-health is valuable then it’s the same conversation as immunisation. It’s like everyone feels a bit of pain, you’ve got to go get your injections, but there’s value, which is you don’t get sick.

“If we can start framing an e-health record, as immunisation has been so brilliantly framed over the years, then I think people will get it. The analogy runs right through to there even being a kind of herd immunity granted to the population when everyone or most people are on board. The upside for the community is massive, and I don’t think that’s been articulated that well,” ­Nicolarakis says.

Interestingly, the US, which a few years ago was in last place in terms of implementing an e-health strategy, is now considered a leader in terms of ­policy sharpness and ensuring e-health has a positive impact.

US EXAMPLE

 

The US has built the idea of “meaningful use” into the core of their electronic health record technology.

“It’s not talking about whether you have your boxes ticked in terms of what software you’ve got or what computers you have. It asks the question of whether the e-health record has a meaningful impact on patient care,” Nicolarakis says.

Dr Terry Hannan from the University of Tasmania and Launceston Hospital has seen the meaningful impact more connected health and better use of data can have on a number of projects around the world. He was the co-founder of the largest e-health system in the world for managing the AIDS epidemic of 40 million people in Africa.

“We’re now in over 200 countries in the world and we have a massive amount of standardised data for clinical day-to-day care, resource utilisation, research and outcomes. It’s now linked to the mobile health phenomenon and patients are using their own data via a mobile phone as a tool for improving their care.”

Hannan says similar programs have been rolled out in a number of communities in developing countries.

“In Pakistan, we track the multi-drug treatment for tuberculosis right down to the individual house and patient.

We can monitor the food that’s supplied to these impoverished people so they comply with their medication, all recorded on a mobile phone in a country with interrupted connectivity to the internet,” Hannan says.

PREVENTATIVE OPPORTUNITY

 

The roundtable panel agreed the great potential of e-health lies in the preventative health sphere where the use of non-health data such as our nutrition habits could help revolutionise our future health outcomes.

Professor Patel says we could potentially link the quite extensive databases that already exist.

“We already have one for everything that’s available in any supermarket in Australia and a lot of that information was crowd-sourced – people with their mobiles.

“Link that to frequent user, loyalty programs that some of the big supermarkets have and we can look at what people spend at the check-out counter, and you can very accurately predict how levels of obesity are going to change due to the composition of ­people’s diet, their salt intake and more,” she says

“It allows you to target health outcomes at the policy level.”

Unfortunately, this hardly gets mentioned in the more emotive debates around privacy and the supposed infallibility of clinicians.

“Most of the unexplained variation in health research is from people who believe their own clinical insights and experience is of greater value than what might be data driven or might be ­evidence-based,” Patel says.

Verhoeven agrees and says moving our thinking away from anecdote-driven decision-making to data-driven decision-making is a real challenge for clinicians.

Professor Patel says the future starts now, but it requires a change of thinking across the profession.

“It is important this data driven approach to medicine is integral to the training of this current generation of doctors and healthcare professionals otherwise we’re not going to get the ­cultural change down the track.”

 

 

The Australian Financial Review

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The Vitality Institute: Investing In Prevention – A National Imperetive

Vitality absolutely smash it across the board…

  • Investment
  • Leadership
  • Market Creation
  • Developing Health Metrics
  • Everything…!

Must get on to these guys…..

PDF: Vitality_Recommendations2014_Report

PDF: InvestingInPrevention_Slides

Presentation: https://goto.webcasts.com/viewer/event.jsp?ei=1034543 (email: blackfriar@gmail.com)

 

From Forbes: http://www.forbes.com/sites/brucejapsen/2014/06/18/how-corporate-america-could-save-300-billion-by-measuring-health-like-financial-performance/

Bruce Japsen, Contributor

I write about health care and policies from the president’s hometown

How Corporate America Could Save $300 Billion By Measuring Health Like Financial Performance

The U.S. could save more than $300 billion annually if employers adopted strategies that promoted health, prevention of chronic disease and measured progress of “working-age” individuals like they did their financial performance, according to a new report.

The analysis, developed by some well-known public health advocates brought together and funded by The Vitality Institute, said employers could save $217 billion to $303 billion annually, or 5 to 7 percent of total U.S. annual health spending by 2023, by adopting strategies to help Americans head off “non-communicable” diseases like cancer, diabetes, cardiovascular and respiratory issues as well as mental health.

To improve, the report’s authors say companies should be reporting health metrics like BMI and other employee health statuses just like they regularly report earnings and how an increasing number of companies report sustainability. Corporations should be required to integrate health metrics into their annual reporting by 2025, the Vitality Institute said. A link to the entire report and its recommendations is here. 

“Companies should consider the health of their employees as one of their greatest assets,” said Derek Yach, executive director of the Vitality Institute, a New York-based organization funded by South Africa’s largest health insurance company, Discovery Limited.

Those involved in the report say its recommendations come at a time the Affordable Care Act and employers emphasize wellness as a way to improve quality and reduce costs.

“Healthy workers are more productive, resulting in improved financial performance,” Yach said. “We’re calling on corporations to take accountability and start reporting health metrics in their financial and sustainability reports.  We believe this will positively impact the health of both employees and the corporate bottom line.”

The Institute brought together a commission linked here that includes some executives from the health care industry and others who work in academia and business. Commissioners came from Microsoft (MSFT);  the Robert Wood Johnson Foundation; drug and medical device giant Johnson & Johnson (JNJ); health insurer Humana (HUM); and the U.S. Department of Health and Humana Services.

The Vitality Institute said up to 80 percent of non-communicable diseases can be prevented through existing “evidence-based methods” and its report encourages the nation’s policymakers and legislative leaders to increase federal spending on prevention science at least 10 percent by 2017.

“Preventable chronic diseases such as lung cancer, diabetes and heart disease are forcing large numbers of people to exit the workforce prematurely due to their own poor health or to care for sick relatives,” said William Rosenzweig, chair of the Vitality Institute Commission and an executive at Physic Ventures, which invests in health and sustainability projects. “Yet private employers spend less than two percent of their total health budgets on prevention.  This trend will stifle America’s economic growth for decades to come unless health is embraced as a core value in society.”

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Google Ventures – moving medicine out of the dark ages

Duke story about direct monkey brain implants that allow the control of more than two arms.

Great take on dealing with lagging regulation:

“You shouldn’t ignore the laws. But if you worry as an investor about, “Oh, you shouldn’t invest in any personal genomics companies because there’s a lot of regulations that need to be updated.” Well, you won’t do anything innovative.”

So yes, absolutely, the regulations need to catch up with reality. I think as the outcomes of the science with Foundation Medicine, 23andMe, etc., start to become important to people and to patients, people will demand that change. And that’s how it happens.

http://recode.net/2014/06/21/google-ventures-bill-maris-on-moving-medicine-out-of-the-dark-ages/

 

Google Ventures’ Bill Maris on Moving Medicine Out of the Dark Ages

June 21, 2014, 7:00 AM PDT

By James Temple

Google Ventures made health startups a sizable part of its portfolio from the earliest days, even as other investors avoided the space in recent years.

Venture capital funding for the life sciences sector dropped by $5 billion from 2008 to 2012 and was basically flat last year, according to market reports. But the search giant’s venture arm, established in 2009, has steadily plugged money into companies throughout the space, including: 23andMe, Adimab, DNANexus, Doctor on Demand, Foundation Medicine,Flatiron Health, iPierian, One Medical Group, Predilytics, Rani Therapeutics, SynapDx and Transcriptic.

Some of the bets have started to pay off. Foundation Medicine raised $100 million in an initial public offering in 2013. Earlier this year, Bristol-Myers Squibb bought portfolio company iPierian in a deal that could be worth up to $725 million.

The focus on the space at least in part reflects the background of Google Ventures’Managing Partner Bill Maris. He studied neuroscience at Middlebury College and neurobiology at Duke University. In his early career, he was the health care portfolio manager at Swedish investment firm Investor AB.

Maris also took a lead role in the creation of Calico late last year, a Google-backed company focused on delaying aging and the diseases that come with it. (Google has declined to discuss the company, which is run by Genentech Chairman Arthur Levinson.)

“Medicine needs to come out of the dark ages now.”

Bill Maris, managing partner, Google Ventures

Google Ventures generally isn’t taking the old biotech route, betting on companies somewhere along the winding path of developing drugs that may — but probably won’t — someday earn Food and Drug Administration approval. Rather, the firm is focused on companies leveraging the increasingly powerful capacities of computer science, including big data, cloud processing and genomic sequencing, to improve diagnostics or treatments.

In the second part of my two-part interview, which has been edited for space and clarity, Maris discusses the promise of these tools for medicine as well as what’s still standing in the way.

Re/code: Looking through your health-care investments, there’s 23andMe, DNA Nexus, Foundation Medicine, Flatiron. To the degree there’s a common theme, it seems these are all big data plays, using a lot of information and smart algorithms to make advancements in medical research or hit upon more effective treatments. Is that part of your investment philosophy?

Maris: I used to be a health-care investor a long time ago in the public markets. One thing I learned that we tried to apply here is that investing in small molecules, trying to invest in the next treatment, there’s an element of gambling to that.

I’m glad that people started those companies and I’m glad that they have people who specialize in investing in them. But that’s not our specialty, because you have to build a portfolio to make a success overall.

What we try to put into our practice is “invest in what we know,” which is where health care meets technology. In some sense, almost all companies these days need to be big data companies.

Bill Maris, managing director, Google Ventures

Especially when you get around genomics or, like Flatiron, looking for insights across vast amounts of oncology data. These are by definition big data companies that couldn’t have existed 10 or 15 years ago.

Take Foundation Medicine. The tools didn’t exist to actually genotype quickly the way that we can today, and in 10 years it will be even more advanced. So by necessity the companies we’re investing in are in that space, because that’s the forefront.

Clinicians treating patients based on “if you present with these symptoms, I’m going to treat you based on the knowledge in my head?” Those days are either disappearing or will soon disappear, I hope. We can get much better outcomes from people if we understand the genetic basis of the exact cancer that they have, what interventions might be most effective against it, what’s worked in the past and what hasn’t. I think that’s where the future of health care is.

So yes, lots of these are big data companies, in that sense. But that’s a catchphrase, they’re more than that. They’re data-informed companies that are trying to build businesses that are commercially important and, in this case, relevant to patients. That means they’ll get better outcomes, you’ll live longer and be healthier.

Medicine needs to come out of the Dark Ages now.

There is a unique challenge when it comes to data and medicine. Either you have a lot of information that is stored away in paper filing cabinets in doctors’ offices, or you’ve got companies that did studies decades ago that might be of use but they’re either not digitized or they’re holding on to them as intellectual property. So while there’s this great potential, it’s actually really hard to get at it. Can you talk a bit about what needs to happen technologically?

Of course it’s difficult. If it were easy it would be done by now, there would be nothing remarkable about what Nat [Turner] and Zach [Weinberg] are doing at Flatiron. The fact that it’s difficult is what makes it something an entrepreneur needs to tackle — and this isn’t unique, right?

All the information in the world has been pretty dispersed, but Google’s mission has been to organize it and make it universally accessible. That’s kind of a crazy mission and they’re doing okay at it. It takes people with a vision to say, “We’re going to try to organize this and make it accessible to people.” When we do those things, good things will result from that.

Maybe it takes a generation, because doctors will start using the system. Or maybe it just takes one big push, where we’re just going to go into clinicians’ offices and help them get all the data organized and put into electronic formats. Once you’ve done it one time you can gain an infinite number of insights to help your patients, so there’s a good motivation to do that.

Organizing healthcare information is a daunting task, but it is not an impossible task. We’ve had people walk on the moon. This is a lot more doable.

I want to ask about 23andMe. We’ve seen a handful of companies in that space that have closed or haven’t gone anywhere, and 23andMe obviously hit a big wall with the FDA last year.

I don’t know what you’re talking about.

Yeah, I read it somewhere. But that was a big part of their business, can you talk about what their ongoing prospects are and what direction they could steer in?

Yeah, as I understand it, the heredity product is still available and we see big businesses being built there, like Ancestry.com and others.

At the same time, their vision is bigger than that. They’re at an impasse with the FDA right now, but no one has thrown up their hands. Communication is ongoing, they’re trying to work that out, we’re dedicated to trying to resolve that roadblock. And we think it’s a product that is of value to people, so they can look at and understand their own genomic information.

I think the company’s prospects are great, I’ve known [co-founder] Anne [Wojcicki] for almost 20 years now, and she’s nothing if not focused, dedicated and motivated. She’s a believer in this. I think the company has been a little bit ahead of its time.

It’s inevitable that everyone will eventually be genetically sequenced because it’s going to be really important to their health care, to understanding their future and what they’re at risk for. If you believe that, then you believe that there’s probably a big business to be built here because someone has to deliver that information.

So we have a lot of faith in the team.

Taking that case — and given that health care and medical research is moving in this digital direction — do you think there are some regulatory shifts that need to take place?

I think the laws need to catch up with science and reality, and the law is never good at that. It’s always slow.

I mean, look at the patent office. I just saw a patent that Smucker’s has for a peanut butter and jelly sandwich. It’s sort of crazy.

Look at Uber and its regulatory challenges, taxi and limousine commissions trying to stop Uber. When you sit with my job — which is a really fun job to do, kind of a judge at a science fair — it’s really important to look at the technology and how it might benefit people, and not worry about the bureaucracies that might try to impede that.

At the end of the day, what always happens is, the right products for society and the people get out there.

You shouldn’t ignore the laws. But if you worry as an investor about, “Oh, you shouldn’t invest in any personal genomics companies because there’s a lot of regulations that need to be updated.” Well, you won’t do anything innovative.

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So yes, absolutely, the regulations need to catch up with reality. I think as the outcomes of the science with Foundation Medicine, 23andMe, etc., start to become important to people and to patients, people will demand that change. And that’s how it happens.

You studied neuroscience and neurobiology. What are some exciting developments you’re seeing in your own area?

I also think we’re just coming out of these Dark Ages in neuroscience. The forefront of neuroscience is (he points to parts of his head), “Well, this is the learning area, this is memory, this is where the right arm is controlled.” That’s not really how the brain works, it’s this cloud-based understanding.

I forget which neuroscientist said this, but you essentially have a Jennifer Aniston neuron. There are certain pathways in your brain that remember who that is. The more you fill up your brain with those things, the more neurons get used up.

So we’re getting closer to a point, and there are some folks at MIT working on this and other places as well, to really understanding the wiring of the brain. What makes it a whole, what causes consciousness. It’s not just that these cloudy regions all talk to each other.

You can’t do anything without a map. Until you can diagnose something you can never cure it, you can’t understand it. It’s hard to get from here to there without a map. So the first thing to do is to build a model.

When you can map an entire human brain, then you can really understand how it all works.

We don’t even know if everything gets recorded in your brain and your brain is just really good at controlling noise, where it’s just filtering out a bunch of things that you don’t need to think about because you’d just be overloaded. So there are these fundamental questions of neuroscience we just now have the tools to understand.

It’s so far behind, it’s so underfunded, in a way. We as a people and a country spend a lot of money on a lot of things. But we all walk around with this thing in our head and we have no understanding of how it actually works.

Machine-brain interfaces are a way to understand that. There’s a guy at Duke named Miguel Nicolelis, who I worked with and who comes out here every once in a while. He does work where he implants electrodes into brains and he’s now got monkeys who can move cursors on a screen [with virtual arms] and they get a reward of orange juice. Then he thought, “Well, why is the monkey just limited to one [virtual arm]? Maybe I could teach them to move three at once, or four.”

What we are learning from that is, well, we have two legs and two arms, but your brain is actually capable of operating four or six of them if you had them. There’s so much potential.

Here’s what the monkey saw in that experiment:

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Duckett: Has health reform failed? Yes

A big issue for the health system in Australia is that no-one’s in charge. Not the Commonwealth, not the states, not the private health insurance funds. Most provision is private: general practitioners are increasingly employed by for-profit chains, and before that, small business people. They respond to incentives designed by the Commonwealth government.

http://theconversation.com/did-the-health-reform-process-fail-now-well-never-know-27921

Did the health reform process fail? Now we’ll never know

Abandoning health reforms will undoubtedly lead to worse performance, including longer waiting times, across the health system. AAP Image/Quentin Jones

Yesterday was a sorry day in the long history of health reform in Australia. The Council of Australian Governments (COAG) Reform Council issued its five year score-keeper’s report on health reform progress. It will be the last such report, since the COAG Reform Council has been sacrificed on the altar of savings in the May budget, and we will no longer know how our governments are performing.

The COAG Reform Council paints some lipstick on the pig but overall reform results are poor in the health system. Compared to last year, Australians are waiting marginally longer for elective surgery, longer for community support in the home, and dramatically longer to get into residential aged care.

On the upside, we’re living slightly longer, having fewer heart attacks and the incidence of some cancers has reduced. The five-year trends for performance paint a similar picture to the year-on-year results.

It’s easy to conclude that the health reform process was a waste of time and money. But this is shortsighted. Many of the structural reforms focused on building the foundations of a health system that was on the verge of being able to deliver real improvements in patient care.

Slow road to reform

Kevin Rudd’s gab-fest of health reform talk in 2009 and early 2010 led to an alphabet soup of new health agencies, some investment in parts of the health system, more data in the public domain than we’ve ever seen but precious little in terms of real on-the-ground improvements.

But there were some important exceptions. The Rudd-appointed National Health and Hospitals Reform Commission identified a gap in availability of rehabilitation beds in the system. Without adequate rehabilitation care people were ending up in nursing homes when they could have been at home. Reform money helped to address that gap, although that funding was abruptly terminated in the 2014 budget.

Funding was also provided for better prevention programs and to reward improvements in waiting times where they occurred. Medicare Locals were created to provide a platform for improvements in primary care such as better after-hours services.

Running a health system is hard, improving it is even harder. But we have to improve every day just to stand still. The new treatments that are introduced every week put pressure on the health dollar. These new treatments, though, mean we’re living longer – so we get something for the extra money.

A big issue for the health system in Australia is that no-one’s in charge. Not the Commonwealth, not the states, not the private health insurance funds. Most provision is private: general practitioners are increasingly employed by for-profit chains, and before that, small business people. They respond to incentives designed by the Commonwealth government.

The pathology and radiology markets are also highly concentrated corporatised businesses. Around one-third of hospital beds are in private hospitals, and most of those are for-profit businesses as well.

Abolishing the foundations

The health reform process mainly concentrated on two aspects of the system: primary care and public hospitals. Primary care reform was mainly effected through the creation of Medicare Locals and GP Super Clinics.

Both were good ideas but flawed in implementation: some Super Clinics are still not open five years after the policy got underway. Medicare Locals were over-hyped by the previous government, wrapped up in red tape by the Commonwealth Health Department and as a result of the budget are being abolished and replaced by new organisations.

Public hospital reform had two elements. In most states it included increased local autonomy through introduction of local boards, and increased services with expanded rehab being the best example. At the national level it included a new alignment of Commonwealth and state interests in controlling hospital costs.

From June 1, 2014, the Commonwealth will meet 45% of the costs of increased hospital activity, but only up to an independently determined “efficient price”. This is a good reform, because could have ended the blame game between Commonwealth and states over money by locking the former into funding increased health state health spending. But these changes will be undone in 2017.

So come 2017, most evidence of health reform will have vanished. There will be some ongoing structures and services, but the big aspirations to address the big problems will have fizzled out.

The problems won’t go away, however. Innovation and system reform will still be required. If anyone is around to issue the next score-keeper’s report it will undoubtedly show worse performance, including longer waiting times, across the health system. There’ll then be more calls for reform and the whole cycle will start again, but with wasted years in the meantime.

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Scruitiny starts to land in healthcare…

“When hospital administrators meet with doctors, we talk in great platitudes, and it’s easy for physicians to say, ‘Well, my patients are sicker.’ Data takes out the emotion. It can be a moment of shock.“

They key to delivering information unemotionally is using a physician leader as the messenger. 

“The important mental transition that has to occur within physicians is, ‘This is about a team concept and approach to care. It’s not just about me and why I think is best for my patient.’ That’s a problem some physicians have.”

http://www.healthleadersmedia.com/print/PHY-305709/Physicians-Feel-Reforms-Tight-Scrutiny

Physicians Feel Reform’s Tight Scrutiny

Jacqueline Fellows, for HealthLeaders Media , June 19, 2014

Thanks to healthcare reform, there are now more eyes on how doctors treat their patients and more opinions on how they should be treating them. But one physician leader says the pressure doesn’t necessarily mean that doctors have to be on the defensive.

All working professionals, from writers to physicians, have a preference for the way their work gets done, but a doctor’s penchant for how he or she cares for a patient is increasingly coming under scrutiny.

First, there are cost and quality pressures from hospitals, health systems, and payers as a result of the value-based healthcare transition that affects how physicians practice, not to mention public pressure on how much physicians get paid with the recent release of Medicare payment data.

Then there are the efforts to standardize patient care among providers in hospitals, group practices, and health systems in an effort to improve quality.

All of it leads to more eyes (and opinions) on how doctors care for patients, which can be uncomfortable.

Kevin Wheelan, MD, chief of staff and co-medical director of cardiology for Baylor Heart and Vascular Hospital, a joint venture hospital within Dallas-based Baylor Scott & White Health, says the pressure doesn’t necessarily mean that doctors have to be on the defensive, or have an adversarial relationship with leaders.

Rather, Wheelan looks at the issue through a different lens. Without uniformity of care, quality can suffer, and patients leave confused. “Ten different sets of discharge instructions sets up [the hospital] for inconsistency,” he says. “If the patient doesn’t leave the hospital with a well-articulated game plan, that could lead to an unscheduled visit to the ER.”

That’s code for readmissions and possible penalties. Reducing both requires better communication with the patient, which Wheelan says has improved at BHVH with better and easier-to-understand discharge instructions.

“The tools have improved in terms of more detailed collateral materials as a resource for patients to refer back to,” says Wheelan.

In addition, Wheelan says BHVH has also enhanced medication reconciliation by having both a nurse and a physician review what medicine a patient is taking at home that could interfere with medication prescribed upon release.

The post-discharge appointment is also a more focused discussion, says Wheelan.

“Instead of telling a patient, ‘See you within 30 days,’ for example, the goal is to have a follow up appointment scheduled, so it’s not a nebulous concept of when they’re returning.”

Follow-up phone calls also help reduce readmissions and anxiety from patients. The phone calls are also a data mining exercise that shows variance among physicians. It’s not intended to be an exercise in checking up on physicians, but it has helped standardize care and reinforce a culture of teamwork.

“We keep track of all of these phone calls,” says Wheelan. “We have a document typed up, blinded to the patients’ names, and those results are provided back to the physician leader and the physician practices for an opportunity for improvement issue.”

Using data to show a variance can take some of the sting out of a difficult conversation with a physician. It helps, says Wheelan, that physicians see exactly what a patient is saying.

“It gives [physicians] a different insight,” he says. “The doctors get to see types of concerns the patients have.”

Wheelan says BHVH’s system isn’t not perfect. There are still difficulties with weekend discharges, but he says setting a specific follow-up appointment time is the biggest change since BHVH opened in 2002. But it didn’t happen easily because of physician preference.

“It’s an issue of compromise,” says Wheelan. “You have a group of physicians who say, ‘I need to see a patient two days post-op,’ and another group who says they need five days. So we have to come to an agreement that we will see the patient within 2–5 days.”

Getting standardization among physicians is difficult, admits Wheelan, but it’s also an opportunity for physician leaders to emerge because “someone has to be a champion,” willing to track down the other physicians and get buy in for clinical protocols.

Using data to accompany a potentially hard conversation about performance is an approach that is also used at Southwest General Health Center, a 354-bed hospital in Middleburg Heights, OH.

“Physicians tend to be logical, numbers-driven people,” says Jill Barber, director of managed care operations and revenue integrity for Southwest General. “When hospital administrators meet with doctors, we talk in great platitudes, and it’s easy for physicians to say, ‘Well, my patients are sicker.’ Data takes out the emotion. It can be a moment of shock.”

Also like BHVH, Southwest General uses verbatim comments from patients to give physicians insight into patient satisfaction. “By sharing with them the actual comments, it brings it home,” says Barber.

They key to delivering information unemotionally is using a physician leader as the messenger. It’s what BHVH and Southwest General rely on because it is peer-to-peer, and more “collegial” rather than punitive, says Barber.

Physicians also have to think differently in a value-based era of healthcare, explains Wheelan.

“The important mental transition that has to occur within physicians is, ‘This is about a team concept and approach to care. It’s not just about me and why I think is best for my patient.’ That’s a problem some physicians have.”

It’s a problem they’ll likely have to grow out of, too, in order to withstand the pressure, opinions, and eyes that are watching.

Jacqueline Fellows is an editor for HealthLeaders Media.