House subcommittee approves bill defunding AHRQ

WASHINGTON – A House Appropriations subcommittee voted Wednesday to go ahead with a controversial bill that would cut $1.3 billion from the Department of Health and Human Services (HHS) while also eliminating all funding for the Agency for Healthcare Research and Quality (AHRQ). 

Cleared by an 8 to 6 vote, the Labor, Health and Human Services (LHHS) bill would effectively prohibit any federal funding of patient-centered outcomes research, which is conducted by AHRQ. Other provisions of the bill include withdrawing funding from the prevention fund incorporated in the Patient Protection and Affordable Care Act. 

Discretionary funding in the amount of $150 billion is included within the cleared bill, $6.4 billion below last year’s amount. 

Proponents of the drafted bill say the included cuts target unnecessary, ineffective or lower-priority programs. 

“This legislation reflects our strong commitment to reduce over-regulation and unnecessary, ineffective spending that feeds the nation’s deficits and hampers economic growth,” said House Appropriations Chairman Hal Rogers (R-KY) in a Tuesday press release. “A careful look was given to all programs and agencies in the bill, with the budget knife aimed at excess spending and underperforming programs, but also with the goal of making wise investments in programs that help the American people the most,” Rogers continued. 

Subcomittee Chairman Denny Rehberg (R-MT) told POLITICO the decision to cut AHRQ funding all came down to the budget. “It’s not a reflection on anything other than that we’re just trying to bring our fiscal house back in order.”

Other groups say that the bill may appear penny-wise but would prove to be pound-foolish.

“Terminating the Agency for Healthcare Research and Quality, as House appropriators propose, would badly undermine important research on health care quality, disparities in care and patient safety - research that benefits our nation's most vulnerable people,” said Bruce Siegel, MD, chair of AHRQ’s National Advisory Council, speaking on behalf of the National Association of Public Hospitals and Health Systems (NAPH), of which he's president and CEO.

“AHRQ’s budget is a rounding error in the federal budget,” Siegel continued. 

One of the most invaluable of AHRQ’s initiatives, according to Siegel, is Project RED (Re-Engineered Hospital Discharge), a randomized control trial developed at Boston Medical Center that re-engineered workflows and reduced preventable patient readmissions. “Hospital readmissions are a big issue for all American healthcare,” said Siegel. “Project RED could save American taxpayers billions of dollars in years. That’s the kind of work AHRQ does, and that’s the kind of work we need today.” 

One of 12 agencies within HHS, AHRQ was founded in 1989. Originally created as the Agency for Health Care Policy and Research, it was renamed AHRQ in 1999. The agency funds and conducts research related to patient safety, health information technology, the effectiveness of specific medical treatments, prevention and care management and healthcare value.

AHRQ had no official comment.

GOP To Make 31st Attempt To Repeal Obamacare Act

The House Rules Committee takes up a bill Monday called the "Repeal of Obamacare Act." And just like it says, the bill would wipe away the president's Affordable Care Act. A vote of the full House is planned for Wednesday.

It's the first legislative response from House Republicans after the Supreme Court upheld the law. But it is far from the first time the GOP has voted for repeal.

Over the past 18 months, the House has taken 30 floor votes to try to repeal, defund or dismantle the health care law. The first attempt came on Jan. 19, 2011 just two weeks after the GOP took control of the House.

On that day, Rep. Mike Pence,R-Ind., had this to say, "And today, House Republicans are going to stand with the American people and vote to repeal their government takeover of health care lock stock and barrel."

And that's exactly what House Republicans did, all 242 of them. They were joined by just three Democrats. But the measure languished in the Democratic-controlled Senate.

"Even in some bizarre universe where the Senate passed it, President Obama wouldn't sign it into law," says Sara Binder, a senior fellow at the Brookings Institution and an expert in legislative gridlock.

But the House's efforts haven't been necessarily pointless. Binder says votes like the one planned for later this week are all about scoring political points.

"Much of what we see during split party control of Congress, is this message politics, which is the parties taking their chamber and using it to pursue a policy agenda that appeals to their party base," Binder says.

"I think we can agree that this is a vote that the American public has called for and a vote that we owe the American public," said Rep. Rodney Alexander, R-La., speaking in favor of his effort back in April of 2011 to pull funding from the health care law.

It passed the House on an almost purely partisan vote with criticism from Democrats like Connecticut Rep. Rosa DeLauro, "Mr. Speaker instead of working to create jobs, reduce the deficit and do the business of the American people, this majority has been consumed for months now with trying to repeal health care reform."

The measure failed in the Senate. Defunding and repeal efforts large and small have been tucked into everything from defense appropriations to student loans. A handful of smaller items have made it all the way through to a presidential signature. But most have failed or stalled in the Senate.

So, why try again? Why a 31st vote for repeal?

"We want to show people we are resolved to get rid of this," said House Speaker John Boehner, who appeared on CBS's Face the Nation on July 1.

Boehner said the law needs to be ripped out by its roots, and then replaced.

"And while the court upheld it as constitutional," Boehner added, "they certainly didn't say it was a good law."

The only real chance for Boehner and his Republican colleagues to get their way lies with the November election, and possibly an arcane budget procedure known as reconciliation.

For that to work, Mitt Romney would have to win the presidency, Republicans would have to maintain control of the House and win the Senate. When it comes to the Senate, it's virtually impossible for Republicans to get the 60 vote majority needed to overcome a filibuster. And that's where reconciliation comes in. Certain budget bills can go around the filibuster and only need 51 votes to pass.

But Sarah Binder at Brookings says the process would be procedurally challenging.

"It's complicated for Republicans to achieve this, but there is a vehicle if they can carefully calibrate their bill," she says.

That's a whole lot of ifs. And there are questions about if even that could repeal the whole law.

One thing that's not in question, though, is the outcome of Wednesday's expected vote on the Repeal Obamacare Act. Like so many similar efforts in the past, it will pass the House, with overwhelming Republican support.

A Warning on SCOTUS Healthcare Decision: Needs Still Unmet

The U.S. Supreme Court�s recent decision that the president�s health care law is constitutional caused a flurry of celebration on the part of proponents of reform and a vow on the part of Republicans and other on the right to deep six the plan, along with the president.

Proponents of reform see the decision as a step in the right direction and those who oppose taking control of U.S. health care out of the hands of the insurance companies and the pharmaceutical companies have vowed to work tirelessly to defeat the idea of universal health care.

Then, there is the other viewpoint, not necessarily in the middle, but a more objective view of the state of America�s health and the �system� that is, indeed, controlled by nameless, faceless bureaucrats out of Corporate America. Top Republicans in Congress, like Sen. Mitch McConnell and House Speaker John Boehner, are doing their best to see that corporate bureaucrats will continue to stand between patients and their doctors (or other health care practitioners). They have a lot of help.

That other viewpoint is from Physicians for a National Health Program (PNHP), a group formed 25 years ago for a single purpose, to help develop and pass a single-payer universal health plan for America.

When the Supreme Court released its decision, PNHP stated that so-called Obamacare �is not a remedy to our health care crisis.�

In short, the reasons: �(1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because of high co-pays and gaps in coverage that leave patients vulnerable to financial ruin in the event of serious illness, and (3) it will not control costs.�

The legislation, which President Obama spent the first half of his first term attempting to get passed with bi-partisan support, the Affordable Care Act (ACA), is full of shortcomings that will become obvious immediately and some that will take some time to recognize. But the main problem with the ACA, according to PNHP and many others, is that the act �perpetuates a dominant role for the private insurance industry. Each year, that industry siphons off hundreds of billions of health care dollars for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers� bottom line; and it obstructs any serious effort to control costs.�

PNHP and its 18,000 members across the country have a remedy that is clear and simple. They have been advocating a piece of legislation that was introduced in the House of Representatives by Rep. John Conyers, D-Mich., years ago, HR 676. It also is called �Expanded and Improved Medicare for All.�

HR 676 would, literally, take the current Medicare program that provides health care for those who are 65 or older (with some exceptions like prescription drugs and dental, unless you have supplemental coverage) and provide that same care for all. That was not what was envisioned by Obama and the Democratic leadership at the beginning of the fight over a new health care law. When Nancy Pelosi took the speaker�s gavel in the House of Representatives, one of the first things she pronounced was, �Single payer health care is off the table.� Things went downhill from there.

On the stump in the early days of the Obama Administration, Democratic legislators held what were called town hall meetings with constituents. Nearly every meeting was disrupted by self-described Tea Party members, who plunged the meetings into chaos. Little was learned about the reform proposal. Possibly, not much more is known today, but one thing is certain. Those same Tea Party members, or people with the same inclinations, remain unalterably opposed to universal health care of any kind.

Right-wingers seem to believe that Mitt Romney, who is awaiting coronation as the 2012 Republican presidential candidate, is just as opposed as they are to the Supreme Court-blessed (by a 5-4 decision) ACA. Few of them seem to know that Romney�s legacy, as governor to the people of Massachusetts, is virtually the same health care program that Obama signed and the court has upheld.

This puts Romney foursquare at war with himself, but that�s not an unusual position for him to be in. He now has to say that he is opposed to the federal health care reform law, thus denouncing his own legacy in the Bay State. And, he doesn�t seem to be getting any better at keeping his foot out of his mouth.

For example, during the GOP presidential primaries, he responded to a member of the audience with this gem: �Corporations are people, too, my friend.� Although he seemed completely unaware of the lives of working men and women, he should have known that millions of Americans know that corporations are not people, that they have powerful control over their daily lives, and that the U.S. Supreme Court gave Corporate America the right of free speech that was intended to protect citizens, not corporations, in its Citizens United decision. That decision has loosed the power of unlimited money into the political system, polluting it beyond all reason. Romney does not know this.

The trouble with both his Massachusetts universal health care law and the one just upheld by the court is that both leave the power and the profit in the hands of Corporate America, more particularly, its constituent corporations of the insurance, pharmaceutical, and related �industries.� Their power is not curbed in very many ways under either law, one of the problems being that there is no control over premiums, which translate into obscene profits, obscene CEO salaries and benefits, and similar treatment for all of top management in a host of corporations connected to the medical care industry (for many, even the use of the term is distasteful).

Contrary to what politicians and their benefactors in Corporate America say about a single-payer system of health care, PNHP noted recently: �Research shows the savings in administrative costs alone under a single-payer plan would amount to $400 billion annually, enough to provide quality coverage to everyone with no overall increase in U.S. health spending. The major provisions of the ACA do not go into effect until 2014. Although we will be counseled to �wait and see� how this reform plays out, we�ve seen how comparable plans have worked in Massachusetts and other states. Those �reforms� have invariably failed our patients, foundering on the shoals of skyrocketing costs, even as the private insurers have continued to amass vast fortunes.�

Considering the savings, what does it mean that Mitt Romney, Republicans in general, and the right-wingers of every stripe are frothing at the mouth in their attempt to be the most rabidly against the so-called reform? It means that there is a simple choice in the minds of the GOP and all of those in full support of the status quo. They want nothing to interfere with the massive transfer of wealth to the corporations that are in control of the current health care non-system. If that means leaving tens of millions out of the system, with no access to health care, so be it. After all, these are the politicians� benefactors, those who pay their bills.

�The American people desperately need a universal health system that delivers comprehensive, equitable, compassionate and high-quality care, with free choice of provider and no financial barriers to access,� PNHP stated after the court�s decision was announced. �Polls have repeatedly shown an improved Medicare for all, which meets these criteria, is the remedy preferred by two-thirds of the population. A solid majority of the medical profession now favors such an approach, as well.�

What brought the country to accepting this pathetic �reform?� For starters, Barack Obama, Nancy Pelosi, and other Democratic leaders and operatives took off the table the only proposal (HR 676) that made sense, if there truly were to be reform. They went to the bargaining table with the Republicans, so to speak, giving them their last best offer as an opener. If the president had been a union bargainer and had made such a proposal at the opening session of contract talks, he would have been yanked from the bargaining committee as if by shepherd�s crook.

To those who say that we must move toward universal health care in America incrementally, it must be pointed out that that�s what Harry Truman must have thought, back in the late 1940s, when he mulled national health care. It was only 60 years ago, and we�re still debating whether we should provide health care for all.

If we leave it to Mitt Romney to provide universal health care in America, it may be another 60 years before it happens and, if we approach �reform� the way President Obama and the Democrats have done, it�ll give Romney�s timetable a big boost.

(For a PNHP fact sheet on HR 676, visit www.pnhp.org.)

BlackCommentator.com Columnist, John Funiciello, is a labor organizer and former union organizer. His union work started when he became a local president of The Newspaper Guild in the early 1970s. He was a reporter for 14 years for newspapers in New York State. In addition to labor work, he is organizing family farmers as they struggle to stay on the land under enormous pressure from factory food producers and land developers.

How sharper than a serpent’s tooth it is to have a thankless … red state after health reform

Whose districts stand to gain the most from health reform? Darker colors on this map from Harold Pollack show districts with higher numbers of nonelderly uninsured. The votes of the districts' U.S. House representatives on the original House health reform bill are marked with a Y or N. (Click on map for larger image.)

Supporters of the Affordable Care Act breathed a sigh of relief after Thursday's Supreme Court ruling. Yet many remain worried about the decision's Medicaid section.

Although the court upheld the constitutionality of expanding Medicaid, it also ruled that the federal government may not withhold all of a state's Medicaid funding to induce a state's participation in ACA's Medicaid expansion.

In an op-ed titled "Pyrrhic Victory" in Friday's New York Times, Neal Katyal expressed a common concern:

[U]ntil now, it had been understood that when the federal government gave money to a state in exchange for the state's doing something, the federal government was free to do so as long as a reasonable relationship existed between the federal funds and the act the federal government wanted the state to perform.

In potentially ominous language, the decision says, for the first time, that such a threat is coercive and that the states cannot be penalized for not expanding their Medicaid coverage after receiving funds …

This was the first significant loss for the federal government's spending power in decades. The fancy footwork that the court employed to view the act as coercive could come back in later cases to haunt the federal government.

I understand the worry � particularly since the court's reasoning seems (to me, a non-lawyer) quite unconvincing. By making ACA's Medicaid expansion optional, the Justices open the possibility that millions of people could be left uninsured in purple and red states.

I wonder, though, if this decision might perversely turn out to liberals' advantage. For generations, blue-state liberal Democrats have promoted social policies that provide impressive subsidies to poor red-state residents. For just as long, the major foes of such policies have been conservative red-state politicians who have often bitterly opposed expanded social provision for their own constituents.

The New Deal was aptly described as an arrangement whereby the South was forced against its will to accept billions of dollars every year. The same dynamic pertained during many debates over traditional welfare and for Medicaid. It was certainly the case for the Affordable Care Act.

Red states most need ACA's Medicaid expansion …

When the Affordable Care Act was hanging in the balance, I noted in the New Republic that many wavering politicians represented districts that had much to gain from the new law. My colleague Louis Woynarowski graciously mapped these patterns for every House member considered to be on the fence in firedoglake's fantastic whip count. Each district is shaded to represent the percentage of nonelderly adults who lacked health coverage. In case Edward Tufte reads this blog, I added representatives' votes on the original House bill, too. Individual districts of some wavering politicians included 100,000 people lacking insurance coverage. Many still voted no on the final bill.

NPR's Peter Overby noted that 53 of the 100 congressional districts with the highest uninsurance rates were represented "either by Republican lawmakers who are fighting the overhaul, or by conservative Blue Dog Democrats who have slowed down and diluted the overhaul proposals."

… but will governors refuse to implement it?

Many red-state governors and representatives rail against the evils of Medicaid and other programs. These same politicians then quietly accept billions of dollars in subsidies to their districts and states. Mitt Romney might ascend to the presidency and enact "repeal and replace" when he takes office. If not, conservative politicians will face some genuine "put-up or shut-up" moment before 2014.

Whatever Governors Perry or Bryant might believe about ACA, thousands of Texas and Mississippi hospitals, nursing homes, and physicians need the money to care for literally millions of people. Other local constituents need this money, too, particularly during our current period of economic distress. Between 2014 and 2019, Texas is slated to receive more than $50 billion in additional federal funds for ACA's Medicaid expansion, with the federal government picking up more than 95 percent of total costs.

States can always turn down the money. Some Tea Party constituencies may fight for such a course. Judging by this chart, I'm betting they will lose out to a much larger group of service providers, low-income, elderly, and disabled citizens.

However this works out, there's something healthy for American democracy in asking states to openly confront these choices.

KLAS: More providers forming enterprise imaging strategies

OREM, UT – A new report from KLAS finds most healthcare providers have begun putting into place an enterprise strategy for imaging, with the goal of getting "the right image to the right place at the right time."

The study, "Enterprise Imaging 2012: Provider's Strategies and Insights," reveals that vendor-neutral archives (VNA) and PACS enterprise archive solutions are emerging as the top two preferred approaches for most providers.

GE and Philips were the vendors mentioned most often overall in the study as strategic enterprise imaging partners, according to KLAS, and every GE and Philips customer interviewed considered their vendor to be part of their go-forward imaging strategy – especially those going for a PACS enterprise archive centric strategy. Fuji, while not cited as often as the other two, also seems to have a strong PACS enterprise archive offering.

Agfa and Merge were the most-often cited vendors for a VNA-centric strategy, according to KLAS, which reports that Agfa customers using the IMPAX Data Center (IDC) remain committed, despite early indications that a lukewarm PACS experience will affect the IDC experience. Merge has many of the needed pieces, the study adds, but providers are still waiting for integration; Merge customers are looking forward to what they will be able to do with Merge's iConnect platform.

Acuo and TeraMedica are the primary non-PACS players in the VNA space. In most cases, early trends suggest that TeraMedica customers are pleased with the value of the system and hint toward favorable enterprise DICOM management, according to the report, which found that several providers were also leveraging TeraMedica's ability to store other clinical content in its native format.

Acuo clients say their vendor's core strength is in image distribution and data migration. Their increasing number of vendor partnerships and growing mindshare in the VNA space suggest that Acuo is a viable archive option for those who do not want to rely solely on a PACS archive.

Of the providers interviewed by KLAS, 27 percent indicate that a VNA would be central to their enterprise imaging.

"Image storage is a necessity, no matter what option is chosen," said Ben Brown, imaging research director at KLAS and author of the report. "As providers start to bring in more studies and the studies themselves increase in size, the need for storage will increase. In addition, as a provider explained, images will need to be managed as well as stored."

Carestream, Cerner, Dell, DR Systems, EMC, McKesson, ScImage, Sectra and Siemens are also mentioned in the report.

Memphis AFL-CIO Labor Council Endorses HR 676

From UnionsForSinglePayer.org –

Irvin Calliste, President, Memphis AFL-CIO Labor Council, reports that the council has endorsed HR 676, national single payer health care legislation sponsored by Congressman John Conyers (D-MI).

Memphis Congressman Steve Cohen is one of the 76 co-sponsors of this legislation which is also called “Expanded and Improved Medicare for All.”

The Memphis council is the third one in Tennessee to endorse HR 676. The Knoxville-Oak Ridge Area and the Nashville and Middle Tennessee labor councils, as well as the Tennessee AFL-CIO, did so earlier.

HR 676 would institute a single payer health care system by expanding a greatly improved Medicare to everyone residing in the U.S.

In the current Congress, HR 676 has 76 co-sponsors in addition to Conyers.

HR 676 has been endorsed by 593 union organizations including 142 Central Labor Councils and Area Labor Federations and 40 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV
& MA).

For further information, a list of union endorsers, or a sample endorsement resolution, go to UnionsForSinglePayer.org.

Better Coordinated Care

If you are like millions of Americans, you have seen multiple doctors or specialists for the same medical condition. And you might have noticed that, too often, those doctors don�t communicate with one another. That�s not just inefficient � it has the potential to be hazardous to your health.

Fortunately, the Affordable Care Act is helping create Accountable Care Organizations � new groups where doctors, nurses and specialists will work together to coordinate your care. Participation in these groups is entirely voluntary. Here�s one example of how this works:

When a California Medicare beneficiary called to say she hadn�t been feeling well, her doctor�s office knew she was taking multiple medications for several health conditions.� Because she thought she might be suffering from side effects, she stopped taking some of her pills.��The office asked the ACO nurse case-manager to look in on the patient and the case-manager contacted the ACO�s pharmacist.�The pharmacist then went through each prescription to determine where there might be interactions.�He followed up with the patient�s specialists to make sure the prescriptions were right, and he followed up with the case-manager too.

This is just one example of how Accountable Care Organizations can make health care better for patients. We also know from experience that this kind of care also saves money for the Medicare program by preventing bigger health problems before they start.�

And we�re so confident that the ACO approach will create a better, more affordable Medicare program that this program lets ACOs share in the savings they achieve.

Better-coordinated care is especially important for people with Medicare.� One in five seniors has five or more chronic conditions. On average, they see 14 different doctors and get 50 prescriptions and refills a year. �

While some initially doubted that doctors and hospitals would participate in ACOs, it�s now clear that this initiative offers a viable pathway toward delivering better, more affordable care to patients. Today, we announced the selection of 89 ACOs that will serve 1.2 million people with Medicare. That means that 154 ACOs that are already operating in cities and rural communities across the country are serving 2.4 million people with Medicare. These organizations are working hard to provide coordinated, patient-centered health care to Medicare beneficiaries to help them manage their health and stay out of hospitals and nursing facilities.� And that could save the federal government as much as $940 million over four years.

When we look at ACOs we�re seeing a path to a more effective, less expensive health care of the future�just one of the ways the Affordable Care Act is putting all Americans on the road to better care and better health.

5 ways device integration increases the value of data in an EMR

It's no secret EMRs hold numerous benefits, such as enabling physicians and caregivers to make clinical decisions based on the data in the system. But issues arise and dangers are seen when the data in that EMR is incorrect – something that happens all too frequently thanks to the view/write/transcribe mentality of entering data.

"The old way of entering data into a record is looking at it in a monitor, writing in on a clipboard, and later transcribing it into the record. It's of great concern because it isn't timely and there are chances it can be inaccurate," said Sue Niemeier, chief nursing officer at Capsule, which develops connectivity technology.

"But when you introduce device integration into the picture, that goes away," she continued. "You also increase the direct patient care interaction, and you automate the recording of patient data. Suddenly, the whole world changes for that caregiver, and you're relying on that caregiver to truly be at the point of care, which is the real reason they went into their profession."

Niemeier expands on five ways device integration increases the value of data in your EMR.

1. It's more accurate. According to Niemeier, the accuracy of data increases tremendously with integration. "You now have data that was previously transcribed or taken from a device and keyed into a computer," she said. "So you no longer have the opportunity for error." But, more importantly, she continued, nurses or those keying in data no longer forget to do it. "There's not only accuracy, but there's an omission aspect as well," she said. "You don't forget to add a temperature or blood pressure or a key variable that would create a more comprehensive view of the record."

2. The data is timely. With device integration, data is now in near-real time. "You'll see a lot of data out there that shows once you're on a device, it can take hours to get it into the record," said Neimeier. "I've seen two hours and I've seen 12 hours, which tells me the nurse is waiting until the end of their shift to document." Waiting 12 hours, for example, creates a disadvantage for the patient, and, essentially, leaves them for half a day with an incomplete record. "And other caregivers are relying on that record to make clinical decisions, and then there's this void," she said. Additionally, this impacts the way a patient is transferred from one setting to another. "You're holding out data. Device integration and the value of data allows it to be more timely and more accurate."

3. Your data is more frequent. With integration, data is presented in a more consistent and steady stream, instead of in a "batch" fashion, said Neimeier. "Nurses are trained to document when they have time, and they often don't have time because of the higher acuity of their patients," she said. "And then they have this little thing called a nursing shortage too. But when you actually rely on data flowing naturally and automatically, all the clinician needs to do is open the record and do a check – check, check, check, that data is fine and it can be submitted." This is done instead of transcribing, writing and keying in notes, she added, "so that frequency, again, is changed to more of a steady stream of data."

4. Data is much more succinct. When you rely on the data in nursing notes, it can be hard to discern what's important when it's in paragraph form, Neimeier said. "But when you change that to a grid and flow sheet concept, and they can track and trend it, that's where you get great value." Additionally, this allows for a "new picture" to form, displaying how the patient is truly doing. "Now you can actually see it – it's clear and concise," she said. "And it's not incomplete; it's succinct. It tells me where it is in that flow sheet, and that trend apparatus allows me to see my patient is progressing." Nurses can then communicate that information to the physician, or the next caregiver to be working with the patient.

5. Time is given back to caregivers. "As I mentioned, nurses and caregivers all want that time back that's been lost to them because they've been pulled in a million different directions," said Neimeier. "A lot of technologies or processes may be taking them away from the bedside, and that's unfortunate." With device integration, she said, nurses and caregivers are "pulled back" to the patient. "So that time is reinvested, and we give that back to them because they're out of that administrative function. They can really truly be thinking about 'how can I care for this patient better,' because they're at the bedside more."

Diabetes: Combating a Silent and Costly Killer

By 2050, as many as 1 in 3 adults in the United States could have diabetes if current trends continue, according to the Centers for Disease Control and Prevention (CDC). �Diabetes was the seventh leading cause of death in 2009, and people with diagnosed diabetes have medical costs that are more than twice as high as for people without the disease. The Affordable Care Act, the health care law passed in 2010, includes a number of provisions that directly address gaps in diabetes prevention, screening, care, and treatment.

Last week, CDC released its Diabetes Report Card 2012, which provides a snapshot of the impact of diabetes on our nation. Required by the Affordable Care Act, the Report Card profiles national and state data on diabetes and pre-diabetes, preventive care practices, risk factors, quality of care, and diabetes outcomes. ��It also documents the steps the Department of Health and Human Services (HHS) is taking to make a difference in the lives of millions of Americans living with diabetes and pre-diabetes today and to improve the lives of millions of Americans in the future through prevention.�

HHS is committed to fighting the diabetes epidemic across all of its relevant agencies and programs through a broad range of research, education, and programs that strengthen prevention, detection, and treatment of diabetes.� Thanks to the health care law, potentially life-saving preventive services are now offered in many health plans with no cost-sharing. These include:

Type 2 Diabetes Screenings for people with high blood pressure,Diet Counseling for people with known risk factors for cardiovascular and diet-related chronic disease, andBlood Pressure Screenings.

In addition, the Affordable Care Act expanded� CDC�s National Diabetes Prevention Program, a public-private partnership of community organizations, private insurers, employers, health care organizations, and government agencies working together to combat diabetes.�� The law also provides opportunities to improve treatment for people living with diabetes by supporting the creation of Medicaid health homes for enrollees with chronic conditions, and expands opportunities to address diabetes risk factors through community-based programs such as Community Transformation Grants.

We hope this Report Card will encourage individuals, communities, businesses, and other organizations to work with HHS to address the rising rates of diabetes and its consequences.� And we hope that more and more Americans will take advantage of the benefits of the Affordable Care Act, including the many free preventive services, so we can stop the current diabetes trends and be a healthier nation.

Read the full Diabetes Report Card 2012 (PDF - 1.36 MB).

Study: 96% of restaurant entrees exceed USDA limits

If you plan to chow down tonight at a big chain restaurant, there's a better than nine-in-10 chance that your entree will fail to meet federal nutrition recommendations for both adults and kids, according to a provocative new study.

A whopping 96% of main entrees sold at top U.S. chain eateries exceed daily limits for calories, sodium, fat and saturated fat recommended by the U.S. Department of Agriculture, reports the 18-month study conducted by the Rand Corp. and funded by the Robert Wood Johnson Foundation.

"If you're eating out tonight, your chances of finding an entree that's truly healthy are painfully low," says Helen Wu, assistant policy analyst at Rand who oversaw the study. It examined the nutritional content of 30,923 menu items from 245 restaurant brands across the USA. "The restaurant industry needs to make big changes to be part of the solution," she says.

The restaurant industry is "employing a wide range" of healthier-living strategies, says Joan McGlockton, vice president of food policy at the National Restaurant Association. Among them: putting nutritional information on menus, adding more healthful items and launching a 2011 program at nearly 100 brands in more than 25,000 locations that offers children's meals in line with 2010 dietary guidelines.

How much is too much? These USDA recommended limits were used to measure against main entrees:

No more than . . .

667 calories
35% of calories from fat
10% of calories from saturated fat
767 mg sodium

Source: USDA

Even then, the restaurant industry-supported "Healthy Dining" seal of approval is too generous on sodium, Wu says. It allows up to 2,000 milligrams of sodium for one main entree, while the USDA's daily recommended limit for most adults is 2,300 milligrams, she says.

Other highlights of the study, which is posted on Public Health Nutrition:

�Appetizers can be calorie bombs. Appetizers � while often shared � averaged 813 calories, compared with main entrees, which averaged 674 calories per serving, Wu says.

�Family restaurants fared worse than fast-food. Entrees at family-style restaurants on average have more calories, fat and sodium than fast-food restaurants. Entrees at family-style eateries posted 271 more calories, 435 more milligrams of sodium and 16 more grams of fat than fast-food restaurants, Wu says.

�Kid "specialty" drinks often aren't healthy. Many drinks offered on kids' menus have more fat and saturated fat on average than regular drinks. While regular menu drinks had a median of 360 calories, the median number of calories in kid specialty drinks, such as shakes and floats, was 430. The message to parents, Wu says: "It's the little extras you order that add up."

Diagnosis of Alzheimer's isn't always accurate

Martin Rosenfeld's loved ones dreaded what might be next: a diagnosis of Alzheimer's.

He had called too many times, confused and frustrated, from a parking lot outside his synagogue, after driving there in the middle of the night for services that wouldn't begin for hours.

Once a meticulous pattern-maker in the clothing industry, he now nodded off mid-conversation. Spilled things. Mumbled.

"We'd be getting calls all night long. He'd say, 'What time is it? Can I get up now?' " said his daughter, Shelley Rosenberg, whose husband, Don Rosenberg, chairs the Alzheimer's Association� Greater Michigan Chapter.

Rosenfeld's confusion, which turned out to be caused partly by sleep apnea, reflects what the head of Wayne State University's Institute of Gerontology worries is a growing trend in the number of Americans being wrongfully assumed � even medically misdiagnosed � with Alzheimer's, the most common form of dementia and perhaps the most feared disease of old age.

"It's a real problem. If you're older and you get a label of Alzheimer's � even a hint that you have Alzheimer's � there's no more critical thinking about it. You're written off by a lot of people," said Peter Lichtenberg, head of the institute and a clinical psychologist who has testified in several probate cases in which a person's mental capacity was at issue.

Lichtenberg, in a December paper for the journal Clinical Gerontology, highlighted two case studies: in one, a man's bouts of confusion and agitation in his late 70s were caused by illness and painful cellulitis, not Alzheimer's; in the other, an 87-year-old woman, who seemed suddenly confused, was suffering from depression.

Lichtenberg's paper builds on research elsewhere that suggests that the difficulty in pinning down Alzheimer's makes misdiagnosis too easy. The research is based mostly on small studies but also on an ongoing, long-term study supported by the National Institute on Aging, which is part of the National Institutes of Health. In cases reviewed so far, about one-third of Alzheimer's diagnoses were incorrect, according to the lead researcher, Lon White.

"The diagnosis was dead wrong one-third of the time, and it was partially wrong a third of the time, and it was right one-third of the time," White said.

The project, called the Honolulu-Asia Aging Study, has been under way since 1991 and focused on the precise brain changes linked to Alzheimer's disease and other types of dementia. Pathologists examined the brains of 852 men born between 1900 and 1919, about 20% of whom were diagnosed with Alzheimer's.

In the cases carrying an Alzheimer's diagnosis, two-thirds of the brains exhibited the types of lesions closely linked to Alzheimer's. Half of those featured other problems, as well, such as scarring on the hippocampus, the part of the brain responsible for memory, White said.

That didn't mean that those without the Alzheimer's lesions were otherwise healthy, "but what we're calling Alzheimer's is very often a mixture of different disease processes," White said.

Lichtenberg said his concerns about misdiagnosis in no way lessen the enormity of Alzheimer's impact.

"I don't know how vast a problem it is, but I see it too often," Lichtenberg said.

The Alzheimer's Association estimates that 5.4 million Americans are living with Alzheimer's. Lichtenberg's grandmother had the disease. A picture of her, dancing, sits in his office at Wayne State.

But understanding how often Alzheimer's and other dementia are misdiagnosed is hard to quantify. Sometimes, that's because loved ones have not yet noticed a decline; sometimes, they don't want to face the possibility, Lichtenberg said.

Rosenfeld's most pressing problem was severe sleep apnea that had aggravated the more manageable symptoms of undiagnosed Lewy-body dementia. Lewy-body dementia causes a visual processing disorder, disrupts the ability to organize, plan and focus and can causes sleep problems and hallucinations.

A breathing machine at night made a dramatic difference, said Shelley Rosenberg: "I'm thrilled. He is what he used to be. I have my father back."

Some too quick to judge

It's a difficult balance for the Alzheimer's Association: trying to raise awareness and boost early intervention efforts for Alzheimer's and other dementias, while also cautioning families and clinicians not to jump to conclusions.

Diagnosing Alzheimer's is tricky and is done, in part, by ruling out other health problems, such as an undetected stroke or brain tumor.

Even well-meaning doctors can be too quick to judge, especially when confronted by worried loved ones listing Mom's memory lapses, said Jennifer Howard, executive director of the Alzheimer's Association -- Michigan Great Lakes Chapter.

An expert evaluation by an interdisciplinary team that includes a geriatrician and neurologist is crucial, she said.

"The brain is not just a physical structure. It's this incredible computer. It's constantly computing where resources are needed and redirecting, depending on energy is coming from and what task you need to do," said Rhonna Shatz, director of Behavioral Neurology at Henry Ford Hospital in Detroit.

For that reason, a common urinary tract infection, a sudden change in blood pressure or depression are all stresses on an older brain that, combined with other problems, can quickly short-circuit it, Shatz said.

The result is acute confusion or delirium that, to an untrained eye, may look like Alzheimer's disease.

"Pulling these things apart and the need for a real diagnosis -- that's important so people can live the best quality of life as possible for as long as possible," said Howard at the Alzheimer's Association.

Other factors missed

In the case of Al Edelson, a former Wayne State professor and cancer survivor, the confusion was really the result of a regular cocktail of 18 medications prescribed for a variety of health issues.

In his mid-70s, the once sharp-witted, effervescent professor of instructional technology began to withdraw, family members said. For years, he and his wife traveled frequently, but he began to be more comfortable remaining near his family's Huntington Woods home.

In the hours before their 5 a.m. departure for a trip to Britain aboard the Queen Mary 2 several years ago, Edelson was wide awake, anxious.

"He said, 'I think I need to cancel this.' It was 2 a.m. I said, 'I will never forgive you,' " his wife, Joanna Edelson, recalled, chuckling.

But the change had become undeniable: Usually at ease dancing with his wife or leading group conversations, the now-retired professor was awkward and withdrawn on the ship, Edelson said.

Eventually, a doctor gave the diagnosis of Alzheimer's.

"The problem is that when you're older and you have a lot of medical conditions, no doctor speaks to the other doctor, and that's basically what happened," said Edelson, a retired teacher.

After consulting with other doctors, family members scaled back Al Edelson's drugs. They were amazed.

"It was like he came out of a coma," his wife said.

When he died in December, having just turned 80, the cause was pneumonia, Joanna Edelson said: "Dementia did not kill my husband."

Author fears for future of the American breast

The American breast is bigger than ever before.

And breasts are developing in girls earlier than at any time in recorded history.

But do breasts have a future?

The biology of the breast is changing � and not for the better, says journalist Florence Williams, author of the new book Breasts: A Natural and Unnatural History (W.W. Norton & Co., $25.95).

She details a number of alarming trends that may be contributing to the USA's high rate of breast cancer � today and in years to come.

Women's breasts are expanding with their waistlines, Williams says. The average bra size has grown from a 34B to a 36C in just a generation. That's troubling, given that weight gain has been associated with an increased risk of postmenopausal breast cancer.

Girls also are hitting puberty earlier than ever before � another trend that increases their long-term breast cancer risk. About 15% of all American girls begin developing breasts at age 7, according to an influential 2010 study in Pediatrics.

Breasts today also are under assault from pollutants, Williams says. Because chemicals such as PCBs and mercury are stored in fatty tissue, they tend to end up in breasts � and breast milk. "Breast-feeding, it turns out, is a very efficient way to transfer our society's industrial flotsam to the next generation," Williams writes. "Our breasts soak up pollution. � Breasts carry the burden of the mistakes we have made."

While nursing her second child, Williams had a sample of her own milk analyzed. It contained perchlorate, an ingredient in jet fuel, as well as chemical flame retardants, at levels 10 to 100 times higher than in European women. Williams says she believes in breast-feeding, and she spends considerable time in her book noting its benefits for a baby's brain, body and immune system.

But she notes that many industrial toxins will persist in our bodies � and our children's bodies � for years, long enough for today's baby girls to pass them on to their own children.

"What happens in our environment is reflected in our breasts," she says. "If we really care about human health, we need to care about our planet."

Surprisingly, doctors stand to learn a great deal about the environment's effect on the breast by studying men, Williams says.

Marine Pfc. Joe Glowacki was exposed to a wide variety of chemicals when he arrived at Camp Lejeune, N.C., in 1959, at age 17. At the time, the Marine Corps didn't realize the danger of allowing petroleum and other chemicals to pollute the groundwater. The base is now home to dozens of Superfund cleanup sites, and at one point Camp Lejeune had the "most contaminated drinking water supply ever discovered in the United States," Williams writes.

Three years ago, Glowacki found a lump on the right side of his chest. "The next thing you know, I'm one of the girls," says Glowacki, now 70, of Medford, N.J. Glowacki was diagnosed with breast cancer and had a mastectomy and chemotherapy. About 2,190 of the 229,060 breast cancers diagnosed in the USA each year are in men, according to the American Cancer Society. More than 70 have been diagnosed in men who have lived at Camp Lejeune, Williams writes.

"In 1957, who knew all of this?" Glowacki writes. "We disposed of our excesses by pouring them down the drain."

ONC looks to grow the power of health gaming

BOSTON – At Games for Health 2012 on Thursday – amid talk of virtual worlds, avatars, Kinect sensors, biomechanics, social media crowdsourcing and exergaming – a policymaker from the Office of the National Coordinator for Health IT said that gaming is "on the radar of the federal government."

Games for Health, currently in its eighth year, is a different kind of health IT conference. Many speakers kicked off their talks with a slide showing "what I'm playing" – games that ranged from old-school Nintendo titles to mobile apps such as Words with Friends to multiplayer online games to Xbox dancing and kickboxing simulations. 

"I play a new game every day – like, as a policy," said Peter Smith, who researches immersive learning technologies at Joint ADL Co-Lab in Orlando.

Erin Poetter, from the ONC's department of Consumer e-Health/Innovations, also spends a lot of time thinking about policy.

In her presentation, "Adding Play to Our Toolbox: HHS & Games," she explained how, at ONC, "we see games a part of a larger initiative."

With their "miraculous ability to take complex data and make it actionable and meaningful," games are the perfect tool to help ONC expand its focus to engage consumers, said Poetter.

With just 10 to 20 percent of health outcomes determined by what happens in the healthcare system, it's important to do whatever's possible to improve wellness outside of the doc office walls. "Better engagement in health can make a real difference," she said. "More activated patients achieve better results."

Any tools or technology that could spur that engagement can help. Like games. "It's time that healthcare catch up with the way we live the rest of our lives," said Poetter.

Gaming is big business, after all. Really big: a projected $79 billion in revenues in 2012.

With applications affecting everything from health and wellness to rehab and physical therapy, PTSD, stroke rehabilitation, autism and more, there's no reason games shouldn't have a big role to play in health.

That's why experts from heavy hitters such as Microsoft and United Health, Yale and UPenn – designers, developers, care providers and more, from as far afield as Glasgow, Vienna and Kyushu – convened in Boston this week.

Games offer a whole lot more value beyond mere entertainment, Poetter pointed out. They can motivate people to overcome challenges; enable them to visualize change and progress; improve self-efficacy through knowledge and goal sharing and facilitate patient/provider communication and interaction.

And they can do even more than that. At Games for Health, one session explored how Xbox's Kinect could be be used not just burn calories with its virtual tennis, but be applied to gauging biomechanics and assisting with telesurgery and helping with catatonic schizophrenia. There were talks titled "Prescribing Video Games (Not Medication) for ADHD" and "Evaluating the Ergogenic Impact of Music During Exergaming When Players Are Co-Located."

It all points to an exciting future. But FDA regulations are a wild card.

As attorney James M. Flaherty of Foley Hoag LLP, said in his talk, "Games, Medical Devices and the FDA: Now, Near and Next," all video games are potentially subject to regulation by the Food and Drug Administration. "Once you start making therapeutic claims" about a product, he said, you "turn it into a medical device, just like that."

And on the FDA front, there are "a lot of unknowns" when it comes to gaming. So far, there have been no approved or cleared games with medical claims, said Flaherty. "They're not dealing with it right now," he said, but it seems likely that when they do get around to thinking of it, they will be seen through the lens of mobile medical devices.

Games are terra incognita for the FDA, Flaherty warned. And when "FDA doesn't know a particular industry or product line, they will overregulate – that's their nature."

The best way for game developers to make sure their products have the best and fastest chance to positively affect health is to "have your voice heard now, early on," he said.

In the meantime, Poetter said ONC was looking for opportunities to help, and that it wanted to hear how best to do that. Facilitate connections between gaming and research communities? Set standards for health data interoperability with technologies such as EHRs? Develop agency expertise to evaluate health games? Coordinate gaming activities across government agencies?

"Gaming is certainly on the radar of the federal government," she said. "We're looking to socialize it more broadly."

What Obama’s Next Steps Should Be on Health Care

The following article is from AlterNet. AlterNet asked dozens of writers, experts and activists on key issues to write about where the country needs to go, and the priorities for Barack Obama’s early days in office.

By Sara Robinson, fellow, Campaign for America’s Future

The most important thing for incoming Obama policy makers to remember right now is that, while Obamacare is a fine step in the right direction, they shouldn’t be shy about using the words “single payer.” (Or, put it another way: Medicare for all.) The K Street lobbyists for the insurance and pharmaceutical companies may scream bloody murder whenever the idea is floated, but the polls over the past several years have shown irrefutably that the American public — including a majority of Republicans — is behind this idea at least 2 to 1. That’s a lot of political cover, and they should take full advantage of it to do the right thing.

It’s also an absolutely necessary thing. American workers are competing with European and Canadian workers who have the choice to go back to school, start a small business, take time off and travel, stay home with their kids for a few years, fully recuperate from a disabling condition, or tell their boss where they can stick it without the threat of losing their insurance. Having guaranteed health care not only makes these workers physically healthier and extends their productive years; it also increases these countries’ social and economic capital by enabling them to become better skilled, better traveled, more entrepreneurial and more personally fulfilled. American workers simply can’t compete on an equal footing in a tight global labor market until they have equal access to care.

It’s also the right thing to do economically. A new Harvard Law School study found that more than half of the mortgage defaults underlying the subprime meltdown were triggered by overwhelming medical bills or job loss due to disability. It’s probably not an overstatement to say that much of America’s current financial distress is the direct product of our health care crisis. (It’s ironic that the same financial wizards who so boldly proclaimed that we were all on our own — or should be — are now losing everything because they simply didn’t notice how interconnected these issues are. If they’d shared just enough of their loot to ensure that Americans had decent health care, they’d still be Masters of the Universe. They didn’t. So we don’t. So they aren’t. Who says there’s no such thing as karma?)

Most importantly: It’s the best thing an incoming Obama administration can do to usher in a new and enduring progressive era. Giving every American access to health care will do more to undercut the entire conservative worldview and replace it with a new progressive political philosophy than anything else you can name. Once people realize that government can do this much good for this many people, it will restore our faith in the power of democracy — and when that happens, all manner of now-impossible things will suddenly become possible.

Health Wonk Review

This week, Maggie Mahar edits the Health Wonk Review, a biweekly compendium of the best of the health policy blogs.

Voices from the Blogosphere, May 21-June 6

I've decided to let the "Voices" of healthcare bloggers become the theme of this edition of Health Wonk Review. Some are passionate; others are dispassionate; some are disarmingly candid; others are angry.

I'm not going to try to "rate" the posts, or tell you which ones I like. Instead, I want to let you hear those voices, as directly as possible, and decide for yourself.� To that end, I'm quoting liberally from the posts submitted to HWR.

A right to health care?

One of the most provocative entries that I received comes from the Center for Objective Health Policy (COHP), a group that reaches out to medical students while arguing that health care reform violates individual rights.

Nathan Fatal explains: "The problem with [the] assumption" that everyone has a "right to health care … is that a right to a good or service would require that somebody provide it, i.e., that somebody be forced to provide it."

He objects to the individual mandate: "Just as one cannot kick down a neighbor's door and hold a family hostage until all members pay a small fee toward his healthcare costs, a large number of citizens cannot properly hand the role of hostage-taker to the … government in order to exact indirect but forced payments from all fellow citizens … all such actions are the same since they violate freedom of action by initiating force against innocent people in order to provide ‘basic security' to those who ‘need' it."

Fatal also defends the rights of insurers and doctors:

"As Richard Salsman explains in Forbes, health insurance is�'a valuable service provided by intelligent, hard-working professionals . . . people who, like other Americans, … have a right to their own life, liberty, property and the pursuit of their own happiness. Doctors, nurses, hospitals, drug-makers, and health insurers are no more servants of the masses, or even of those in need of health care, than are businessmen, bankers, teachers, journalists, or truck drivers …'"

Supreme Court's ruling on health reform law

Here, on healthinsurance.org, Linda Bergthold also considers the mandate, and suggests that it's "worth reviewing again what's at stake" if the Supremes strike down the entire ACA. She writes:

"We could lose things that have already been implemented" including "free preventive services; children's access to coverage regardless of pre-existing conditions; tax credits for small businesses; and the provision that lets "children under 26 stay on their parents' plan." Meanwhile, "lifetime limits on your insurance plan would probably be reinstated."

If just the individual mandate is overturned, "Most economists and business analysts predict that health care costs would increase, because the uninsured would continue to use the system as a last resort, shifting the costs to those of us who are covered."�But, she notes, "There are a number of ways to get around the overturning of the individual mandate."

Over at the Health Affairs Blog, Alan Weil and Sonya Schwartz each review the impact the Court's decision could have on the states:

Weil writes that "the States' responses" to the ACA "have unfolded in three acts." When the Court issues its decision, "we will see the opening of Act IV. "He offers a "visual representation" of those four acts.

"It is unclear how long Act IV will run," Weil adds. "If significant aspects of the law are struck down, states may have to wait a very long time before it is clear how Congress and the President will respond. States in search of a stable, unambiguous federal statutory and legal environment will almost certainly be frustrated."

Meanwhile, Schwartz grades the possible Supreme Court rulings on a "Richter Scale" of disruption, as she looks at "what each possible ruling would mean for the states that have been most active in implementing the ACA."

"If the Supreme Court invalidates components of the Affordable Care Act, active states will try to adapt to the shifting ground by designing new policies to mitigate adverse selection and cover the uninsured," she concludes. "However, their success in doing so will depend in part on how much the ground shifts."

On Colorado Health Insurance Insider,� Louise explains why Governor Hickenlooper Says Reform Can Succeed Without an Individual Mandate. She agrees that "that if you can make health insurance attractive enough and affordable enough, people will buy it without a mandate." She believes that the generous subsidy program" included in the ACA "should be a significant help."

But if the mandate is struck down, and the provision holds that insurers cannot turn down applicants because of a pre-existing condition, "this could quickly lead to out-of-reach premiums" because healthy people would wait until they were sick before joining the pool. If that happens, she says "the states will have to be creative, and get to work hammering out some sort of carrot and stick program to incentivize people to purchase insurance."

The business of medicine

Over at the Prepared Patient Forum, Jessie Gruman turns from the politics of healthcare to the business of medicine.

Her post begins:

"On Monday morning at 8:30 a.m. the pianist was playing Chopin in the beautiful but deserted four-story lobby of the new hospital where my father was being cared for … the contrast between that lovely lobby and the minimal attention my dad received over the weekend, combined with a report about the architectural ‘whimsy' of a new hospital at Johns Hopkins ("a football-field-size front entrance" with ‘manicured gardens and a rectangular water feature') make me cranky."

Why do hospitals indulge in "conspicuous spending" on amenities that the truly sick cannot possibly appreciate, while accepting "staff shortages" (nurses checked her father just once each shift) and "dangerous medical errors"? Gruman:

"We should probably just grow up and recognize that our na�ve notions of the beneficence of health care generally and hospital care specifically are outdated … Health care is big business" and "these new fabulous facilities and all this advertising constitute the cost of … competing for private payers."

Cancer, too, has become a big business. On Health News Review, Gary Schwitzer critiques the media hype surrounding news of an experimental cancer drug.

"When the New York Times reports something, the TV networks are soon to follow," Schwitzer observes. "So when the Times reported ‘A new class of cancer drugs may be less toxic,' featuring a single patient's experience with T-DM1 ��NBC followed closely – featuring the exact same patient in the exact same setting."

"One woman out of 1,000 in the trial. Who chose her?" asks Schwitzer. "The drug company PR people? "

By contrast, Schwitzer calls USA Today's piece "refreshing."�He offers "Excerpts:

2nd sentence: ‘The experimental drug, T-DM1, doesn't cure anyone.'"Later: ‘… statistically, it's possible that those findings could be due to chance, Horning says.'"

Roy Poses, founder of Health Care Renewal� also questions how the quest for earnings affects healthcare, zeroing in on the for-profit hospice industry:

"Remarkable public comments by some for-profit hospice marketers show their focus on increasing patient volumes, even if that means recruiting patients who are not really at the end of life."

Poses explains that this means that some patients suffering from "acute illnesses and injuries may not receive … treatment" they need, while profit-driven hospice care "ends up shortening their lives."

"It's funny that the people who were so alarmed by ‘death panels' do not seem so alarmed by this pathway to denying care for profit," Poses observes.

Rising costs of Medicare and Medicaid

Meanwhile, on Managed Care Matters, Joe Paduda compares how fast the costs of Medicare, Medicaid and commercial insurance have been growing.

"Medicare and Medicaid trends are looking better these days" he writes. "And this trend looks like it will continue. Note this is per-capita growth, which is more accurate when comparing different payer types."�But he reports, "employers' health care costs are up 5.9% this year, and would have increased more if not for a significant increase in cost-shifting to employees (up over 19% from 2011 – 2012)"

Giving physicians a check-up

But money does not drive all of the problems in our health care system � at least not among doctors � writes Brad Flamsbaum in Why We Lie�on the The Hospitalist Leader.)

Doctors sometimes fib, Flamsbaum acknowledges, to insurers, in order "to obtain pre-certification for patient testing perceived as necessary"���and, yes, they lie to patients: "We are humble folk and he says, physicians have the same foibles as the flock we oversee."�Yet, "it's not about the money," he explains, "but a host of other factors ���surprisingly more potent than financial rewards."

Flamsbaum points to research on why humans lie that begins with our "ability to rationalize," followed by "conflicts of interest," "creativity," "previous immoral acts," and "being depleted," all illustrated here.

On�Health Business Blog, David Williams expresses his own�concerns about physicians. �He quotes a doctor advising that�doctors should be candid with families�and "raise the issue of a grim prognosis early on," giving them "an opportunity to deal with it." Otherwise families may fall victim to "optimism bias."

Williams is "wary." The Physician may be "wrong, or unduly certain." He realizes that doctors "must find ways to deal with death" or "they can't practice medicine. But … I don't want a physician to make peace with my relative's death … while he's still alive."

By contrast, Michael Gavin and Mark Pew, executives at Prium, a worker's comp utilization company, worry that�doctors are too quick to give injured workers a heavy dose of pain-killers. �Writing on Evidence-Based, they point to "A new ruling from Texas … that finds payers liable for a range of opioid-related side effects ranging from addiction to death. Prediction: This is just the beginning."

Finally, over at�The New Health Dialogue, Joe Colucci and Shannon Brownlee turn to�how television depicts physicians. "The Fox show House ended last week," they write. "It was entertaining, but as far as health policy is concerned, we're not sorry to see it go … Dr. House exemplified the "cowboy doctor" as "hero" who is in fact a "hazard" … practicing "reckless, unscientific, non-evidence based medicine."

Just "one point in House's favor: he works with a team" and they "actually talk to each other … Unfortunately, that's as unrealistic as the rest of the show."

Thoughts on obesity

In another post,�The New Health Dialogue's�Colucci examines New York Mayor Mike Bloomberg's most recent public health proposal,�banning sugary beverages�"gigantic enough for a small marine mammal to do laps in." Bloomberg would limit sodas served in restaurants to 16 ounces.

"The reaction has included furious opposition from �people claiming this is the nanny state run amok," Colucci reports, but in fact, "There is extensive evidence from psychology and behavioral economics that people respond to larger portions by eating more."

Over at 365 Days of Wellness, Kat Haselkorn focuses on a different profit-driven problem. In Unstoppable Obesity Epidemic, she acknowledges that "obesity is a bigger issue in low-income communities and is more likely to affect minorities." But "marketing and advertising play a significant role in childhood obesity, nudging children towards processed foods and sugar. Government subsidies allow Big Agriculture and top manufacturers to aggressively market products to children … 77% of obese children become obese adults."

Uninsured veterans

The government might better be spending that money on Veterans. On the Healthcare Economist, Jason Shafrin's Memorial Day post�reports that "About 10 percent of U.S. veterans under the age of 65 lack health insurance and are not being taken care of by the VA."�Eligibility for VA services "is based on veteran status, service-related disabilities, income level, and other factors," Shafrin explains. "Proximity to VA facilities and cost-sharing requirements" also affect access.

High anxiety

On Workers' Comp Insider, Julie Ferguson reports on another group at risk. The "boom in cell phones has spawned" a huge demand for radio towers, and "brutal" schedules are leading to more fatalities among tower workers. �(See this video from a prior post.)�"Tower work is carried out by" layer after layer of subcontractors, she explains allowing large companies to "deflect responsibility for on-the-jobwork practices." In an era of sub-contracting, "this layering makes OSHA enforcement almost impossible."

Electronic health records

Jann Sidorov focuses his concern on Electronic Health Records (EHRs)�and "The Need for Legal Framework." Writing on Disease Management Blog�about a piece in the Economist that examines the need for legal reform for military drones and driverless cars, �Sidorov argues that "since robot-like artificial intelligence is involved in electronic health records, the same legal protections may be necessary there."

Age rating

Although I'm a fan of health reform, I too, have my worries. Under the Affordable Care Act, insurers can charge older Baby-boomers (in their 50s and early 60s) premiums three times higher than they would charge a 20-year-old for exactly the same coverage.

I explore the issue here, on HealthInsurance.org, where I've recently begun posting. (Soon, I�ll be re-launching HealthBeat thanks to technical assistance from HealthInsurance.org. In the future, I�ll be writing on both web sites.)

Protesters outside and inside White House health care forum in Iowa

By O.Kay Henderson for Radio Iowa–

There were protesters outside and inside this morning’s White House health care forum in Des Moines.

About 20 protesters stood on the street outside, waving signs and chanting. A psychiatrist from University of Iowa Hospitals in Iowa City stood in the middle of the group, wearing his white lab coat and chanting “Everybody in, nobody out” along with the others. Dr. Jess Fiedorowicz is a member of Physicians for a National Health Program. “‘Everybody in, nobody out’ truly universal health care. Universal health care has become a buzz word in the elections, but if you look at the proposals people are proposing, they truly do not intend to cover everybody,” the doctor said. “�We’re interested in everybody being covered.”

Sixty-one-year-old Vashti Winterburg of Lawrence, Kansas — another protester — opposes any plan that keeps health insurance companies in business. Winterburg said the Kansas nonprofit board she serves on is finding it more and more difficult to pay the premiums of workers who provide in-home care to the elderly. “It costs us a thousand dollars per policy, per employee, per month,” Winterberg said. “That’s horrible.”

Iowa Farmers Union president Chris Peterson of Clear Lake said he’s glad the forum was held in the Midwest, as most Americans don’t understand the challenges rural citizens face. “Rural Iowans struggle with finding affordable insurance. Even solidly middle class farmers are feeling the pinch. Nearly one in eight Iowa farmers battle outstanding health debt,” Peterson said. “I am one of them.”

Peterson, who is 53, was kicked off his private insurance plan about two years ago for what the company said was a preexisting condition. Peterson and his wife, who has no private insurance either, have accumulated $14,000 in medical debts in the past two years. “The health care system in this country is dysfunctional and burdensome,” Peterson said of the private insurance industry. “…Personally, what I’ve been through, it seems at times it’s a ponzi scheme — they’re taking your money — or (it’s) just the robber barons pulling money out of your pockets.”

Once the forum got underway, protester Mona Shaw of Iowa City stood to call the event “shameful” because health insurance companies were participating. As she was escorted out of the event hall, Shaw accused insurance companies of ignoring the needs of their customers. “Governor Culver has taken $20,000 from Blue Cross-Blue Shield, of course he’s not going to let the insurance industry take any of the flack for this,” Shaw shouted toward reporters as she left. “Iowans are dying.”

President Obama’s White House advisor on the health care issue sat on a panel that included Iowa Governor Chet Culver, the governor of South Dakota and Senator Tom Harkin. Seventy-five-year-old Darlene Neff of Iowa City, a retired school teacher, told the group she’s survived breast cancer and a brain tumor. “We who are retired and have insurance as well as Medicare know how good we have it as far as health care goes, but we know, too, that there are millions out there who don’t have good health care,” Neff said. “That basic health care should be available to everyone today.”

Small business people like John Piper of Des Moines were among those who talked of their difficulties in keeping employees because they cannot offer health insurance as a benefit. “I reduced the size of my company because of health insurance,” Piper said. “So now, it is a one-person company.”

Those who provide health care services were part of the discussion, too. Karen Van De Steeg , executive director of a cancer center in Sioux City, urged officials to consider private companies are doing things to control the cost of health care. Van De Steeg manages Siouxland Pace which provides inhome care to the elderly.

“Essentially, the private sector, our company has taken on risk for taking care of these patients,” Van De Steeg said. “We are providing some of the poorest, oldest, most-frail people the absolute best care they could possibly get in their homes. It’s an alternative to nursing home care and the whole reason we’re successful is it’s about prevention. We do everything possible to keep that person well.”

A couple of state legislators and a pharmacist from eastern Iowa were among those who also stepped to the microphone to air their thoughts on health care reform, too.

From Radio Iowa.

Health Law's Downfall Could Put GOP In Odd Spot

The Supreme Court will rule in the coming weeks on the constitutionality of the Affordable Care Act � the health care law that has been a flashpoint of partisan acrimony and debate since its beginning.

Much of that debate has been philosophical. But now that the law is under review by the country's highest court, politicians have to plan for the real implications of the court's decision. That's proving particularly difficult for congressional Republicans.

They've rallied for repeal of the plan since the day it passed in 2010. And they won a majority in the House later that fall.

But now the GOP has a problem. In the two years since the law passed, several of its parts have become very popular with voters � among them, parents' ability to keep kids on their health plans until age 26 and a ban on denying insurance because of pre-existing conditions.

So it wasn't surprising when news leaked to Politico last week that Republicans were making plans to try to preserve those popular parts of the act if the Supreme Court strikes the law down.

But the political blowback for the GOP was immediate and harsh. Staffers described dozens of calls from angry conservatives. Right-wing think tanks blasted the endorsement of what they called "government meddling in business." And just a few short hours after the news was leaked, House Speaker John Boehner, R-Ohio, sent an email blast to the media, saying, "Our plan remains to repeal the law in its entirety. Anything short of that is unacceptable."

This isn't the first time GOP leaders have hinted at their support for those provisions. Right after Republicans first won the majority, House Majority Leader Eric Cantor, R-Va., spoke at a forum at American University in Washington.

Student Alyssa Franke, who has a chronic medical condition, asked Cantor the question that still stands today: "Will you try to preserve these two provisions as they stand or continue to push for a full repeal of the health care bill?"

At the time, Cantor said: "We too don't want to accept any insurance company's denial of someone because he or she may have a pre-existing condition. And likewise, we want to make sure that someone of your age has the ability to access affordable care, whether it's under your parents' plan or elsewhere."

That was more than a year and a half ago, long before last week's firestorm over the same Republican sentiment.

What changed? Well, reality. Back in 2010, the concept of repealing the Affordable Care Act was a long shot. The idea of keeping the popular provisions and dumping the rest was mostly theoretical.

Now, there's a real chance the Supreme Court could strike the whole thing down. And the law is designed so that the ban on pre-existing conditions and the parents' insurance provision are paid for by the thing Republicans hate � the mandate that all Americans buy insurance.

House Democratic Leader Nancy Pelosi of California put the Republicans' quandary this way: "It's all about the guys who brung 'em to the dance. It's about the health insurance industry, and that's the agenda that they will roll out."

Insurance companies, many of which are big Washington political donors, are prepared to fight tooth and claw against any new insurance mandate that doesn't also generate new profits for them.

So Republicans may have to choose who they're going to listen to � the voters or the donors.

E. coli outbreak sickens 14 in six states

An outbreak of a less-common form of E. coli has sickened at least 14 people across six states and killed a 21-month old girl in New Orleans, the Centers for Disease Control and Prevention reports.

As of Friday, state health officials in Alabama, California, Florida, Georgia, Louisiana and Tennessee reported cases of the Shiga toxin-producing E. coli strain called O145. The more commonly known form is E. coli O157:H7. The first illness report came April 15, and the most recent is from June 4, the CDC says.

With E. coli infections, it can take up to two to three weeks from "the beginning of a patient's illness to the confirmation that he or she was part of an outbreak," according to the CDC.

No source of the infection has been identified. State public health officials are interviewing ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness.

Shiga toxin-producing strains of E. coli usually manifest as illness two to eight days after a person has swallowed the bacteria. Most people develop diarrhea, usually watery and often bloody, and abdominal cramps. Most illnesses resolve on their own within seven days, but some can last longer and be more severe.

Most people recover within a week, but in rare cases, some develop a more severe infection. Hemolytic uremic syndrome, a type of kidney failure, can begin as the diarrhea is improving. HUS can occur in people of any age but is most common in children under 5 years old and the elderly.

Because the source isn't known, health officials can't give consumers specific advice on how to avoid the infection, but in general, E. coli can be prevented using these tips from the CDC:

�Wash hands thoroughly after using the bathroom or changing diapers and before preparing or eating food.

�Wash hands after contact with animals or their environments (at farms, petting zoos, fairs, even your own backyard).

�Cook meats thoroughly. Ground beef and meat that has been needle-tenderized should be cooked to a temperature of at least 160 degrees. It's best to use a thermometer, as color is not a very reliable indicator of "doneness."

�Avoid raw milk, unpasteurized dairy products and unpasteurized juices (such as fresh apple cider).

�Avoid swallowing water when swimming or playing in lakes, ponds, streams, swimming pools and backyard "kiddie" pools.

AMA calls for 2-year extension of ICD-10 deadline

WASHINGTON – The American Medical Association (AMA) has asked the federal government to delay the implementation deadline for ICD-10 from Oct. 1, 2013, until Oct. 1, 2015, "at a minimum."

The AMA asked for this two-year compliance deadline in a May 10 comment letter to the Centers for Medicare & Medicaid Services (CMS). "A two-year delay of the compliance deadline for ICD-10 is a necessary first step," AMA officials wrote to CMS Acting Administrator Marilyn B. Tavenner.

During the delay AMA proposes, officials urge CMS to institute a process to engage all relevant, stakeholders including physicians, to assess whether an alternative code set approach is more appropriate than the full implementation of ICD-10.

Earlier this year, CMS nodded to rolling back the deadline from Oct. 1, 2012, to Oct. 1, 2013, delaying compliance by one year.

In November 2011, AMA’s House of Delegates voted to call for a  repeal of the federal requirement to move to ICD-10 so that physicians and other stakeholders could assess an appropriate alternative.

Physicians will be overwhelmed with the financial and administrative burdens of a transition to ICD-10 while they are also facing implementation of “a number of inadequately aligned” federal programs, AMA officials wrote. The burdens are further compounded by a proposed 31 percent Medicare reimbursement cut proposed for Jan. 1, 2013.

 

Stronger Benefits for Seniors, Billions in Savings This Year

Two years ago, President Obama signed the Affordable Care Act and provided important relief to seniors, including a 50% discount on brand-name prescription drugs for those in the coverage gap known as the �donut hole.�

Prior to the passage of the new health care law, people on Medicare also faced paying for preventive benefits like cancer screenings and cholesterol checks out of their own pockets. �Now, these benefits are offered free of charge to beneficiaries.

These new benefits are already making a difference in communities across the nation. �Before 2011, David Lutz, a community pharmacist from Hummelstown, PA, described customers, �splitting pills, taking doses every other day, missing doses, stretching their medications,� noting that not taking their medications as prescribed was not good for their health. �

But, according to David, this has begun to change since the passage of the Affordable Care Act. �People cannot take their medications if they can�t afford them. This [Affordable Care Act] will make them affordable and they�ll take their medications on time, the way they�re supposed to, which will improve their health,� Lutz says. �There�s no question about it.�

In 2010, for example, those who hit the donut hole received a $250 rebate � with almost 4 million seniors and people with disabilities receiving a collective $1 billion. ��In 2011, Medicare beneficiaries received more than $2.1 billion in savings � averaging $604 per person last year � from the 50% discount on brand-name drugs in the donut hole.

And today, we have more good news. Even more seniors and people with disabilities on Medicare have benefited from these important measures:

In 2010 and 2011, over 5.1 million people on Medicare saved over $3.2 billion on prescription drugs in the donut hole. �In the first four months of 2012 alone, more than 416,000 people have saved $301.5 million � an average of $724 a person so far this year.In the first four months of 2012, 12.1 million beneficiaries on traditional Medicare received at least one free preventive service. �This includes over 856,000 who have taken advantage of the Annual Wellness Visit � a new benefit that allows patients to meet with their doctors once a year to develop and update a personalized prevention plan. �In 2011, over 26 million beneficiaries in traditional Medicare � received one or more preventive benefit free of charge.

These new benefits will increase over time. �In the coming years, the automatic discount on drugs in the donut hole will expand, and by 2020 the donut hole will be closed completely. And Medicare is growing stronger in other ways as well. Doctors and hospitals are beginning to receive new incentives to provide better care to patients �improving patient safety and lowering costs. �The new law also invests more resources in fighting Medicare fraud, to protect the trust fund, and keep Medicare secure for longer.

Thanks to the Affordable Care Act, seniors and people with disabilities are enjoying a Medicare program that is stronger and working better for David�s community and others all across the country.

Kentucky, Healthbridge partnership 'tip of the iceberg' for health data sharing

The Kentucky Health Information Exchange, St. Elizabeth Healthcare and Healthbridge are successfully sharing patient information. The partnership, says Trudi Matthews, director of policy and public relations for HealthBridge, is just the “tip of the iceberg” in terms of connecting healthcare providers and sharing patient information in Kentucky and healthcare markets in bordering states.

Connecting to St. Elizabeth Healthcare, one of the largest healthcare providers in the Greater Cincinnati-Northern Kentucky region with six facilities and 62 physician practices, represents a significant milestone for KHIE towards achieving connectivity throughout the state. St. Elizabeth Healthcare is also one of the first participants of HealthBridge, which was founded in 1997 and is one of the largest and financially sustainable health information exchanges in the U.S.

[See also: HealthBridge data exchange gives boost to e-prescribing, diabetes registry]

St. Elizabeth Healthcare didn’t want to duplicate its HIE activities with KHIE, so now as data flows to HealthBridge, the HIE sends a copy of the feeds – with appropriate filters in place – to KHIE, Matthews said. Authorized healthcare providers can securely access critical patient information in order to make timely, better-informed decisions.

KHIE uses a query model, enabling emergency department physicians, for example, to search and receive a matched summary of care record with health information from Medicaid and healthcare providers such as St. Elizabeth Healthcare. KHIE now has the capability to receive and send patient information from St. Elizabeth Healthcare to other participants of the statewide HIE.

For HealthBridge, this partnership also represents a significant milestone. HealthBridge serves a healthcare market that spans three states – Ohio, Kentucky and Indiana. It is already connected with the Indiana HIE and four other HIEs, including HealthLINC, based in Bloomington, Ind.

[See also: HealthBridge offers HIE advice]

“This is a perfect microcosm for inter-state exchange,” Matthews said, of the partnership. “This effort is going to grow over time.”

The Office of the National Coordinator for Health IT (ONC) funded connectivity among KHIE, HealthBridge and St. Elizabeth Healthcare through its State Health Information Exchange Program and Beacon Community Program. ONC selected the Greater Cincinnati-Northern Kentucky community as one of the 17 ONC-funded Beacon Communities. St. Elizabeth Healthcare is participating in the Greater Cincinnati Beacon Collaboration.

HealthBridge is also connecting with the Nationwide Health Information Network. It has already installed Direct and Connect, as additional means for connectivity with other exchanges. “There’s still a lot of work to do with standards to make it [connectivity] easy, but we’re showing it can be done,” Matthews said.

[See also: Kentucky health data exchange kicks off e-prescribing initiative]

Single-Payer Debate on NPR

Yesterday, Dr. Steffie Woolhandler, of Physicians for a National Health Program, debated Robert Moffit, of the Heritage Foundation, on single-payer healthcare and healthcare reform on NPR’s Radio Times.

Here’s the NPR description and an MP3 of the hour-long debate.

When Barak Obama outlined his proposal for reforming the health care system, the concept of a single-payer system was once again left out of the equation. But there still is a strong and vocal voice for the concept. What is a single payer system and why is it, or isn’t, the solution to our health care crisis? Our guests are ROBERT MOFFIT of the Heritage Foundation and STEFFIE WOOLHANDLER of Physicians for a National Health Program.

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have Javascript enabled in your browser.

Click the little triangle.

What is 'histrionic personality disorder'?

Few outside the psychiatric community knew about "histrionic personality disorder" until it was reported that attorneys for former Penn State assistant football coach Jerry Sandusky would bring it up in his defense on child sex abuse charges.

Today, the condition took center stage as a psychologist who evaluated Sandusky took the stand. The condition is defined in the American Psychiatric Association's diagnostic manual (called the DSM, short for Diagnostic and Statistical Manual of Mental Disorders) as "a pervasive pattern of excessive emotionality and attention seeking."

Psychiatrists familiar with such disorders aren't convinced such a claim will help Sandusky.

"That doesn't make any sense at all," says psychiatrist Carl Bell of Chicago, who has been in practice for 45 years. "He may have a histrionic personality, but I'm not sure it's going to do him very much good. I would never walk into court for a defense with a personality disorder because the courts don't recognize it. Personality disorders are rarely, if ever, a reason not to find somebody guilty of a crime."

The DSM says histrionic personality disorder is indicated by five or more of eight potential characteristics that include being "uncomfortable in situations in which he or she is not the center of attention." Among others: "interaction with others is often characterized by inappropriate sexually seductive or provocative behavior," "consistently uses physical appearance to draw attention to self," and "considers relationships to be more intimate than they actually are."

Experts who are editing the diagnostic manual, which is being revised for publication next year, propose to delete it as a separate disorder; it probably will be placed in the appendix, which suggests further study is warranted, says Renato Alarcon of Oakland, an emeritus professor of psychiatry and a consultant for the Mayo Clinic in Rochester, Minn.

Bell and Alarcon are among those on the personality disorders panel, which is recommending the revision for all such disorders, not just histrionic personality disorder.

"The whole issue of personality disorders is being reviewed," Alarcon says. "It will be considered mostly a trait or a feature and not a type and may be called something different, such as exhibitionism or grandiosity."

Psychiatric Ryan Shugarman, who teaches at Georgetown University and at Saint Elizabeths Hospital in Washington, D.C., says histrionic personality disorder has been recognized since 1968, and the percentage of people who meet criteria for it is low compared with that for mood or anxiety disorders.

"I see a few patients per year that meet that criteria," he says.

Estimates suggest that almost a quarter of Americans have some sort of psychiatric condition in their lifetime, and histrionic personality disorder affects about 10% to 15% of those who have received psychiatric care, Shugarman says. Some suggest the disorder is more common in women, but he says the research isn't clear on that point.

Hearing loss technology wins global mHealth competition

CAPE TOWN, South Africa – Massachusetts Institute of Technology (MIT), in partnership with Brazil’s Federal University of Rio Grande Do Norte, won the Mobile Health University Challenge with software that screens for hearing impairment.

With an estimated 588 million people worldwide and 5.7 million Brazilians afflicted by some level of hearing loss, the technology – dubbed the Sana AudioPulse – aims to make testing easier for hearing-impaired populations in rural and poverty-stricken areas that may not have access to medical care. Laws in Brazil mandate that newborns be screened for hearing loss; however, the implementation process has been stymied by funding limitations and shortages of staff and proper equipment. This AudioPulse technology could help overcome these obstacles. 

As the winning team, MIT and the Federal University of Rio Grande Do Norte will be offered mentoring towards the future development of their innovation and the opportunity to exhibit at key industry events such as the GSMA's Connected Living Latin America Summit, which is being held in Brazil in June 2012.

The competition, held at the GSMA-mHealth Alliance Mobile Health Summit in Cape Town, asked university students worldwide to develop a mobile health concept that would address a specific healthcare need. From the initial group of entrants, the top 13 teams were invited to attend this week's finals at the GSMA-mHealth Alliance Mobile Health Summit to present their ideas to a judging panel comprised of venture capitalists and major players in the mobile and health industries. From these 13 teams, four were chosen to present to the judging panel in a final round, and from the final four, one overall winner was selected.

Besides MIT and Federal University of Rio Grande Do Norte, the finalists were:

Jordan University of Science and Technology (Jordan) - Snore Detector, a smartphone application used for detecting and monitoring Obstructive Sleep Apnea Syndrome (OSAS). UC Berkeley (US) – LifeCheck, a digital checklist technology for hospitals aimed at reducing redundancy and hospital errors.  University of Oxford (UK) – BabeeMon, a baby monitoring technology, specifically for preterm infants, that detects respiration, blood oxygen saturation and heart rhythm.

"The teams were challenged and encouraged to use their originality and creativity to create a compelling and viable mHealth solution, and we commend the enthusiasm and commitment shown by all those who took part in our inaugural competition," said Jeanine Vos, Executive Director, mHealth at the GSMA. "Our congratulations to the winning team, MIT and the Federal University of Rio Grande Do Norte and our thanks to all those who participated."