Saturday, June 30, 2012

St. Paul Regional Labor Federation Endorses HR 676

From Unions for Single Payer Health Care –

The St. Paul Regional Labor Federation, AFL-CIO, is the latest labor federation to endorse HR 676, Congressman John Conyers� single payer healthcare bill.

Robert �Bobby� Kasper, President of the St Paul Federation, reports that delegates unanimously endorsed the Conyers bill at their regularly scheduled meeting on Wednesday May 9th. The resolution to support HR 676 was brought to the Federation by Mike Madden, Chair of the Chisago Labor Assembly, AFL-CIO, and a representative of IAMAW Local Lodge 112.

The Federation represents 117 local unions with over 50,000 members in Chisago, Southern Dakota, Ramsey, and Washington counties of Minnesota.

The St. Paul Federation is the 141st Central Labor Council/Area Labor Federation and the 592nd union organization to endorse Conyers’ “Expanded and Improved Medicare for All” legislation.

See the full text of the resolution here.

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]

Dementia Complicates Romance In Nursing Homes


Holding hands is the easy part.

Holding hands is the easy part.

Relationships are never easy.

If the partners in love happen to be living in a nursing home, there are even more challenges. And if they're showing signs of dementia, then things get really tricky.

Although no law forbids intimate relationships between people with dementia in nursing homes, staff and family members often discourage residents from expressing their sexuality, says a recent report in the Journal of Medical Ethics.

Sexuality might be an uncomfortable topic for some families to discuss, but sex is a matter of dignity for many older people, says Dr. Laura Tarzia, lead author of the report and a researcher at the Australian Centre for Evidence Based Aged Care.


Older people who live on their own continue to enjoy romantic relationships, even if they are in the early stages of dementia; the trouble begins when they move into a facility for care.

"You get couples who have been living together for 50 years and then they move into a residential care facility. Suddenly they have to have separate beds, and that can be quite distressing for them," Tarzia tells Shots. "But I think it's even more difficult for people who form new relationships in a residential care facility, because then staff don't really always know how to deal with it and sometimes families have objections."

Many residents who have been diagnosed with dementia rely on family members with power of attorney to make important decisions. Tarzia says that decisions about intimacy shouldn't rise to that level.

"Sexuality shouldn't be categorized as a high-stakes decision, like, say, a will or a major financial decision where you really need the capacity to consent to things," says Tarzia, "We're saying that sexuality is different and the way to establish consent should be different."

These decisions don't come without risks, and Tarzia says it's important that staff in care facilities be willing to discuss the use of condoms for the prevention of sexually transmitted diseases.

Tarzia and her colleagues are currently working to create a self-assessment tool for residential care facilities to audit their sensitivity to these important issues. "[Facilities] can go through a checklist, and it covers a lot of areas like policies, education for staff, families, and residents, and facilities can kind of monitor how they're going, in terms of addressing sexuality," Tarzia says.

Issues with privacy and sexual freedom exist in American nursing homes too, gerontologist William H. Thomas tells Shots. "There are laws about consent for sexual activity, by state, but there's no top age on those laws," Thomas says.

Thomas said that we need to see a shift in our society's understanding of aging. "We need to normalize the idea that older people are human beings," he says. "They have the same needs and same desires they had before. Age changes those needs and desires, but they are still there."

He recommends that adult children talk about the issue of sexuality with their aging parents in nursing homes. "They never thought that Mom would have a boyfriend at the nursing home, but it's true," he says. "As we become an older society, this is something that we need to learn to better address."

Friday, June 29, 2012

6 points with regard to regulatory threats and mobile health IT

Not long ago, the American Enterprise Institute (AEI) hosted an event titled, "There's a medical app for that – or not: Regulatory threats to mobile health information technologies." It was an extension of a recent Wall Street Journal article, focusing on the FDA, medical apps and the future of mobile health IT.

"All eyes are on the Supreme Court – everyone's starting at the Supreme Court, but that's not the only healthcare news in town," said J.D. Kleinke, resident fellow at AEI and healthcare business strategist. "An attempt has been made by the FDA to expand its mission to one of the more dynamic and important issues happening in healthcare and that's health IT generally, but more specifically, mobile applications."

"For the most part, health IT is a politically neutral zone," he continued. "People from the right and the left agree a computerized healthcare system makes more sense. It's a bipartisan idea, whose time has not just come but is long overdue."

Kleinke and Joel White, executive director of the Health IT Now Coalition, outline five points to consider with regard to regulatory threats to mobile health IT.

1. The FDA has taken an interest in mobile apps. In July of last year, the FDA issued its Draft Guidance on mobile medical applications. "So increasingly, we're seeing that in the market place, as more consumers become comfortable with IT and doctors use apps to treat patients, the FDA is looking at these technologies and have been for some time," said White. "IT is rapidly advancing, and they had to think about the advancements and how that'd fit into a regulatory framework." Essentially, he said, the Draft Guidance for mobile apps does a couple things. For instance, it makes it so apps fall under FDA regulatory authority as medical devices and would be classifies as Class One, Class Two, and so forth, based on what the app does in conjunction with diagnosing the patient. "It would have to go through the regulatory structure for approval," said White. "And if [the app] isn't considered a mobile device, it wouldn't have to go through this process."

2. Issues arise with mobile apps and the 510(k) process. Devices are now classified under the same risk structure as the 510(k) process, which "isn't known as a rapid process," said White. "If you think about the life cycle of apps and software, generally, it is very rapid. So that change in the actual app may trigger some change in the regulatory structure if they go through the 510(k) process." He added that although the FDA does have an "appropriate role to play" in ensuring the safety and effectiveness of these apps, according to the IOM, the 510(k) process has significant issues, most notably, the length of time to get approval. "Most poignantly, the IOM said last year in a report, that the process wasn't working well for the industry or for patients," he said. "So clearly, the process has some challenges."

3. Risk factors do exist when it comes to mobile apps. An IOM report, which was released last November, did confirm three serious issues that exist with regard to mobile apps. "A panel of experts looked at issues of health IT and patient safety, and they concluded serious risk factors," said White. "Errors with how IT operates, errors with how physicians use IT, and information asymmetry issues, or information about a patient or care treatment protocol that wasn't available when using the technology in ways it was intended." What IOM concluded, he said, was there wasn't coordination across agencies, where these issues touch base in jurisdictions. "None of the agencies have resources at their disposal in terms of expertise to address some of the follow-ups in regard to patient safety."

Continued on the next page.

Wednesday, June 27, 2012

Healthcare startups aim to gauge emotion with mobile tech

BOSTON – Oftentimes a proper diagnosis relies not so much on what a patient says as on what he or she shows.

That’s the premise behind a new wave of startups and entrepreneurs looking to make an impact in healthcare. They’re developing mobile technology designed to analyze emotions, studying vocal and visual clues as well as physiological factors.

[See also: Telehealth puts patients at center]

The idea is to pick up signs that a patient might not recognize or be willing to express.

“It’s the dawn of time for that particular technology,” says Joseph Kvedar, MD, founder and director of the Center for Connected Health, part of Partners HealthCare. “There’s so much sensitivity to the role that mental health plays in our healthcare.”

“It’s absolutely brand-new, very much experimental,” adds Meghan Searl, PhD, a psychologist with Brigham & Women’s Hospital in Boston, who sees a future for the technology in detecting depression and mood swings. "It's a very nuanced and complex field, so a lot of validation work has to be done."

[See also: Diabetes texting program gets a boost]

Kvedar says the technology looks to address "the psychology of connected health," which might try to measure moods much as a nurse would take one's vital signs. Mobile and wireless technology would certainly help, he says, if the argument could be made that a psychological sensor is as reliable as a blood-pressure cuff or blood-glucose monitor.

Mental health disorders rank among the top health problems worldwide in terms of cost to society. Depression affects 16 percent of adults, or 32 million people, and is significantly higher in people diagnosed with a chronic condition – between 40 percent and 60 percent of those diagnosed with a chronic condition also suffer from depression, according to recent studies.

Those same studies indicate that as much as 85 percent of people diagnosed with a chronic condition aren't correctly diagnosed with depression, and that less than one-fourth of individuals experiencing depression receive appropriate treatment.

One of the companies trying to solve that dilemma is Cogito, based in Charlestown, Mass., which has been working since 2008 to develop “Honest Signals” technology that measures patient engagement, either through phone conversations or face-to-face encounters. Company CEO Joshua Feast says the idea was first launched in advertising circles to measure how people react to sales pitches or commercials, and is now making its way into population health management.

“We’re co-developing systems that basically will analyze relevant interactions between an organization and its patients,” he says. “What we’re really trying to do here is have more successful interactions.”

Feast is quick to point out that the technology can't read people's minds and isn't meant to be used as a lie detector. "What this technology can do is replicate the observations of an observer," he says. "You're focusing on how people speak and interact, not what people say."

Technology like that being developed by Cogito focuses on vocal clues in phone conversations or visual signals in face-to-face meetings. Other systems are being designed as mobile sensors, worn by patients, to monitor physiological responses to situations.

Feast sees this technology being used in many different scenarios, from diagnosing mental health disorders and PTSD to helping healthcare providers spot stress in employees and preventing burnout.

Another company on the horizon is Waltham, Mass.-based Affectiva, whose technology includes Q, a wearable biosensor, and Affdex, which uses a webcam to read facial expressions.

Like Cogito, Affectiva got its start at the Massachusetts Institute of Technology, having been co-founded by MIT professor Rosalind W. Picard. A group led by Picard, who is also director of the Affective Computing Research Group at MIT's Media Lab, had developed sensors to measure the electrical conductance of the skin, which can determine the state of the wearer's sympathetic nervous system. The company raised $5.7 million in Series B funding in 2011 to commercialize those sensors, and is now exploring how they can be used on epilepsy patients – possibly to detect seizures before they occur.

Earlier this month, the company secured a $500,000 National Science Foundation grant to further develop Affdex, its cloud-based emotion measurement platform using facial expression recognition. While much of the company's work with Affdex has been in advertising (including crowdsourcing projects at the 2011 Cannes Lions International Festival of Creativity and the 2012 Super Bowl), officials see the technology eventually being used to help people with autism spectrum disorders and those who have difficulty reading faces in real-time conversation.

Most experts agree the technology has to be validated through studies before it can be applied to healthcare.

Among the questions to be answered, Searl points out: Can emotion-sensing technology be deployed without a patient's approval? "It's sort of like taking a person's blood without their consent," she says.

This past April, Cogito was awarded a contract from the University of Southern California’s Institute for Creative Technologies (ICT) to contribute to the Defense Advanced Research Projects Agency’s (DARPA’s) Detection and Computational Analysis of Psychological Signals Program. The company’s Social Signal Processing (SSP) platform is being integrated into telehealth interactions to allow clinicians to assess psychological stress, depression and engagement among U.S. military personnel, veterans and their families.

“Incorporating Cogito’s technology into the telehealth dashboard will give remote care providers an objective, secure tool to supplement their skills and intuition in assessing patients’ behavioral health status, engagement and rapport during each interaction,” Feast said in a press release announcing the contract. “We are honored to be working with ICT to support our U.S. Service members experiencing depression, post-traumatic stress disorder, or other psychological health concerns.”


Tuesday, June 26, 2012

3.1 million young people covered after health care law

WASHINGTON�More than 3.1 million Americans ages 19 through 25 are covered by their parents' medical insurance policies because of a provision in the 2010 health care law, the Department of Health and Human Services is expected to announce today.

That's up from 2.5 million in December. About 75% of people in that age group now have insurance, up from 64% in 2010, records show.

"This policy doesn't just give young adults and their families peace of mind, it also gives them freedom," said HHS Secretary Kathleen Sebelius, hitting upon a note often struck by Democrats making the case that the law allows young people to pursue entrepreneurial careers that may not give them health benefits. "They will be free to make choices based on what they want to do, not on where they can get health insurance."

The provision has become so popular � both for security reasons for consumers and financial reasons for insurers � that several health companies and employers say they intend to keep it even if the Supreme Court were to strike down the law, or portions of it, this month.

It also adds healthy people to the insurance pool should the court strike down just the part of the law that requires people to buy health insurance, said Ron Pollack, founding executive director of Families USA, which supports the law.

Three large insurers � Humana, Aetna and UnitedHealth Group� have said they intend to leave the provision in place because the policy provides "peace of mind" and stability.

"It's good for consumers," said Robert Zirkelbach, spokesman for America's Health Insurance Plans, adding that there has been no data yet on whether the provision brings down health costs. "The goal is to try to get as many people covered as possible."

Adding young people, who tend not to use health services as much as older people, should bring down everyone's costs, said Sandy Praeger, Kansas insurance commissioner and former president of the National Association of Insurance Commissioners.

"I think it's a good business decision," she said. "If it was causing premiums to go up, companies would think long and hard about going back to the old ways."


Gains in coverage were highest for young men � from 58% to 72%, the new data show. Men ages 19 through 25 are the least likely of any group to have insurance, which probably played into the large increase, according to HHS. The total percentage of young adults who were uninsured fell from 34% in 2010 to 28% in 2011.

"It is striking and very heartening to know that 3 million young adults have gained financial and health security," said Richard Kronick, deputy assistant secretary for health policy for the U.S. Department of Health and Human Services. "I'm not sure I've ever seen a result quite so striking in such a short period of time."

Though he has called for the law to be "repealed and replaced," Republican presidential candidate Mitt Romney has not said whether he would try to keep this portion of the law.

Monday, June 25, 2012

Tele-ICU initiative improves care, increases employee satisfaction

HIGH POINT, NC – High Point Regional Health System has seen big benefits from a three-year tele-ICU pilot with St. Louis-based Advanced ICU Care, officials say – improving care while alleviating clinicians' workload.

High Point's intensivist-led team is based in the Advanced ICU Care Monitoring Center and receives constant information on the patient’s condition through sophisticated software that notifies them of any change in the patient’s health that might require immediate intervention, officials say.

Two-way video in the patient’s room can be activated to conduct a conference between the bedside care team and the Advanced ICU Care team at any time of the day or night. This constant surveillance improves patient safety and health outcomes by avoiding complications and adverse situations with prompt, proactive interventions.

Key to the High Point collaboration is the strong alliance between its staff and the Advanced ICU Care team, officials say. During the three-year partnership, this team has successfully implemented quality care initiatives for better patient management and safety measures to avoid potential complications that can occur in an ICU, such as blood clots, deep vein thrombosis, gastric ulcers and sepsis. A significant achievement is the implementation of an innovative “patient cooling” process for people with cardiac arrest. Patients who have received this treatment have awakened after the arrest with no cognitive impairment.

“Three years ago, we partnered with Advanced ICU Care to bring around-the-clock intensivist care to ICU patients in our community,” said Greg Taylor, MD, High Point's COO. “From a seamless implementation to the quality enhancements we continue to achieve, the collaboration between our hospital staff and Advanced ICU Care has been a success. We are able to offer our patients the highest level of care available in the ICU today and to continue to improve on that level of care every day.”

Research has shown that patients in intensive care do better when they are monitored around-the-clock by intensivists, physicians specially trained in critical care medicine. Constant surveillance by these specialists is now the recommended standard of care for hospital ICUs.

But a severe shortage of intensivists means it’s simply not possible for most hospitals to meet this standard and have intensivists on staff at the hospital at all times. Advanced ICU Care, the nation’s largest independent provider of tele-ICU programs, helps hospitals overcome this barrier and achieve optimal care in the ICU through a tele-ICU program combining sophisticated telemedicine technology, 24-hour-monitoring by Board-certified intensivist physicians and continuous quality improvement initiatives.

In addition to quality patient care initiatives and protocols, staff satisfaction and working conditions have improved since the implementation of the tele-ICU program, and High Point has seen a reduction in nursing turnover, officials say.

“Our nurses have really embraced this program," said Cindy Stewart, RN, director of critical care and cardiovascular services at High Point Regional. "Being able to speak with Advanced ICU Care in the middle of the night has improved employee satisfaction among our nursing staff. We find that when we recruit, many nurses have heard of remote monitoring, and they’re excited to learn something new.”

Physicians at the hospital say they're comforted that their ICU patients have an intensivist-led team available when they are not in the hospital, making sure their care plans are followed and available should any situation arise that needs immediate attention.

“The Advanced ICU Care program relieves the pressure of having to perform around-the-clock ICU coverage by existing staff and avoids burnout,” said intensivist Peter Brath, MD, medical director of High Point’s Intensive Care Unit and Respiratory Therapy. “There are more doctors available to provide weekend and night backup coverage. From a quality of life standpoint, it’s wonderful.”

“High Point has been a great partner and we are very excited by the strong results that we have been able to achieve together,” said Mary Jo Gorman, MD, CEO of Advanced ICU Care. “We feel very confident the hospital will continue to see additional benefits stemming from our collaboration, from improved patient care to staff satisfaction.”

Woman with flesh-eating disease refusing pain medications

ATLANTA(AP)�A Georgia woman fighting a flesh-eating disease is refusing to take pain medications during some procedures, partly because of her personal convictions, her father said.

Aimee Copeland despises the use of morphine in her treatment, despite its effectiveness at blocking her pain, her father said in a Friday online update on his daughter's condition. Her graduate-school study of holistic pain management techniques leads her to feel she's a "traitor to her convictions" when she uses drugs to manage her pain, Andy Copeland said.

He also said the morphine has been making his daughter groggy, confused and has given her unpleasant hallucinatory episodes.

Aimee Copeland, 24, developed necrotizing fasciitis after cutting her leg in a fall May 1 from a homemade zip line over a west Georgia river. Her left leg, other foot and both hands have been amputated.

On Tuesday, Copeland's condition was upgraded from critical to serious, "a major victory that cannot and should not be diminished," Andy Copeland wrote Friday on his blog, where he has been providing regular updates on her progress. The development came shortly after Aimee Copeland had her first successful skin graft.

"The area of her wound, which I saw for the first time on Sunday during a dressing change, is massive," her father wrote in Friday's update.

"The nurse who completed Aimee's dressing change was astonished at Aimee's insistence to avoid morphine during the procedure, as was her mother and I," he wrote. "I know the pain was significant, but Aimee's courage is greater."

The bacteria that attacked Aimee Copeland's wound releases a toxin that destroys skin, muscle and a layer of tissue below the skin known as fascia, her father says.

Despite the painful skin grafts, Aimee Copeland has crossed several milestones in recent weeks. She can breathe on her own, she no longer needs dialysis and she's now able to eat on her own, her father wrote. Although her major organs are all functioning well, Aimee Copeland still needs supplemental nutrition through a stomach tube.

This weekend, thousands of people are expected at a long-planned fund-raising event outside Atlanta to help the family with medical expenses. The two-day benefit concert in Aimee Copeland's hometown of Snellville begins at 5 p.m. Friday and continues through Saturday night.

Sunday, June 24, 2012

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.

New platform aims to make video easy for healthcare

SEATTLE, WA – Another cloud-based product made itself known to the healthcare industry on Wednesday. Experts say the platform will allow for efficient and affordable uploading, storing and distributing of videos on virtually any device. 

The product, dubbed mpx Essentials, was created by thePlatform, a video publishing company and independent subsidiary of Comcast. Previously focused on the entertainment industry, thePlatform is now extending its cloud-based product to the healthcare industry in hopes of procuring new success.

Tim Sale, director of technical sales and program leader of mpx Essentials, said he expects the product will take off, partly due to the increasingly ubiquitous nature of health information technology these days. 

“What we’re seeing is that healthcare providers are using video for a variety things, from virtual facility tours to patient education programs,” Sale said. “We think it will continue to expand,” because the product allows healthcare facilities to “provide a really high-end experience to their customers on any device – without requiring IT and without requiring a developer."

The product was created in response to the growing demand for cloud-based platforms, a technology catching like wildfire in the healthcare industry.

“More and more organizations are using video to communicate with their customers, employees and stakeholders, and their needs are rapidly evolving,” said Ian Blaine, CEO of thePlatform. 

Sale said he sees this product as a “business tool” for the healthcare industry without the need for web developers or IT professionals. “It’s not generally the focus of a healthcare service or provider to be in the business of managing video content or developing video players, so we think this product frees up resources to do other things and really simplifies how much time you spend on the service.”

Key features of mpx Essentials include: 

Ease of use: A Web-based console, with consistent blade-based navigation and customizable shortcuts; Increased video views: Mix and match play-lists with generated video lineups; Improve search and discoverability with metadata toolset and other features; Search-optimized feeds for Google and Bing, as well as a Connector for auto-publishing to a YouTube account;Custom video player designs: Choose dimensions, skins, colors, layers, social media integration (such as Facebook and Twitter), closed captioning support, and other third-party plugins; Playback across devices: Smart video players provide video playback on PCs, Macs, smartphones, tablets and other internet-connected devices;   Support: 24X7 customer support and content delivery network (CDN) services for storage and multi-bitrate streaming.

Saturday, June 23, 2012

The Reward for Donating a Kidney: No Insurance

From the New York Times –

When Erika Royer�s lupus led to kidney failure four years ago, her father, Radburn, was able to give her an extraordinary gift: a kidney.

Ms. Royer, now 31, regained her kidney function, no longer needs dialysis and has been able to return to work. But because of his donation, her father, a physically active 53-year-old, has been unable to obtain private health insurance.

Like most other kidney donors, Mr. Royer, a retired teacher in Eveleth, Minn., was carefully screened and is in good health. But Blue Cross and Blue Shield of Minnesota rejected his application for coverage last year, as well as his appeals, on the grounds that he has chronic kidney disease, even though many people live with one kidney and his nephrologist testified that his kidney is healthy. Mr. Royer was also unable to purchase life insurance.

Officials with Blue Cross and Blue Shield of Minnesota refused to discuss Mr. Royer�s case because of privacy laws, but said in a statement that Minnesota residents who are rejected by private insurers can buy coverage through the Minnesota Comprehensive Health Association high-risk pool, which is what Mr. Royer said he did, though he is paying more for less comprehensive insurance.

The officials refused several requests for an interview, saying in an e-mailed statement that �healthy individuals who happen to have one kidney can and do receive coverage� through Blue Cross and Blue Shield as long as their test results are within medically accepted normal ranges.

Mr. Royer said he is baffled by the denial. �From my perspective, I�d be a good risk,� he said. �I�d just be putting in premiums and helping balance the system out.�

There is little data on how often kidney donors have trouble obtaining insurance, but advocates say the fear of being uninsurable may be a powerful deterrent to donation. A 2006 study done by an advocacy organization for transplant professionals found that 39 percent of transplant centers reported that they had had eligible donors who declined to donate because they feared having future insurance problems.

The health of living donors is seldom at issue: Though some research suggests that kidney donors may be slightly more prone to develop high blood pressure as they age, long-term studies have found donors live as long as other healthy people. One study reported that donors live even longer.

Most insurers maintain that prior kidney donation does not affect coverage decisions or premiums, but while transplant cases like Mr. Royer�s are rare, advocates and social workers who work closely with donors say the problem may be more common than is recognized. A review study published in 2007 by Canadian researchers found that as many as 11 percent of them have encountered problems with life and health insurance coverage.

It�s a problem with implications for thousands of people. In 2008, the last year for which figures were available from the National Institute of Diabetes and Digestive and Kidney Diseases, 17,413 kidney transplants were performed, most of them (11,382) from cadavers. But there were 87,820 people awaiting a kidney transplant as of February 2011, and another 2,249 waiting for both a kidney and a pancreas.

Continue reading…

Report: N.Y. school with sick teens not toxic

ROCHESTER, N.Y.�Additional environmental testing at a Le Roy, N.Y., high school where a cluster of students had unusual neurological symptoms earlier this year has found no evidence of contaminants that could be linked to the facial tics and verbal outbursts.

In a community letter released Wednesday afternoon, Le Roy Central Schools Superintendent Kim Cox said, "I have excellent news. There are no adverse health impacts from contaminants in the air, soil or water in or around our high school campus."

The additional tests were done after an outcry over the appearance of unusual neurological symptoms among as many as 18 students in the Genesee County, N.Y., district's junior and senior high schools, which share a building.

A number of medical experts eventually said the most likely explanation for the cluster was conversion disorder, a stress-related, possibly neurological condition in which patients display symptoms of psychological origin. The condition often eases over time; as of a few months ago, some students were said to be showing improvement.

On that point, Cox's letter said only "the best news of all is that our students are doing well."

Concern about the cause of the health problems prompted one round of tests last fall that found no contaminants in the structure.

But when the cluster of illnesses drew national attention in January and the furor mounted in Le Roy, Cox said more comprehensive testing would be done to allay parents' and students' fears that an environmental contaminant might have triggered the symptoms.

The resulting study by Leader Professional Services of Perinton, N.Y., made public Wednesday, said nothing unexpected was found and nothing was present at levels that could cause harm.

There was no detection of the industrial solvent trichloroethylene, or TCE, which some -- including environmental activist Erin Brockovich -- had worried might have migrated from a 1970 spill site three miles away. There also was no evidence of other contaminants such as mercury or formaldehyde and no unusual level of fungi in the schools' air.

Carbon monoxide levels were acceptable, although elevated carbon dioxide was noted. The latter is not a health concern, the report said.

Arsenic was found in soil near a school-owned natural gas well in a concentration slightly above New York state cleanup guidelines. The gas well, which is behind a chain-link fence, is one where a tank that holds brine from the well had previously overflowed. The study suggested the arsenic was naturally occurring.

Friday, June 22, 2012

Mizzou researchers use sensors for remote monitoring of seniors

COLUMBIA, MO – The University of Missouri announced its development of new technologies that could help aging adults stay in their own homes longer while still being monitored by healthcare providers.

Marjorie Skubic, a professor of electrical and computer engineering in the MU College of Engineering, and Marilyn Rantz, a curator’s professor of Nursing in the MU Sinclair School of Nursing, have used motion-sensing technology to monitor changes in residents’ health for several years at TigerPlace, an eldercare facility in Columbia. 

Now they've received a grant from the National Science Foundation to expand their work to a facility in Cedar Falls, Iowa.

Fiber networking in Columbia and Cedar Falls will provide the infrastructure necessary for health care providers in Missouri to remotely monitor the health of elderly residents in Iowa. High-speed video conferencing capabilities will allow communication between staff and residents at the two locations.

“Using what we’re already doing at TigerPlace and deploying it at the facility in Cedar Falls will allow us to further test the concept of remote healthcare,” said Rantz. “Monitoring individuals with in-home sensors allows us to unobtrusively monitor their health changes based on their individual activity patterns and baseline health conditions.”

Rantz says the in-home monitoring systems use proactive, rather than reactive, ways of monitoring seniors’ health. The systems provide automated data that alert health providers when patients need assistance or medical interventions. The sensors will include video gaming technology for measuring residents’ movements in the home, and the researchers will integrate new hydraulic bed sensors that will monitor an individual’s pulse, respiration and restlessness.

“We’re using high-speed networks to solve real-world problems,” Skubic said. “Implementing the health alert system in Cedar Falls will tell us how the approach we use at TigerPlace compares to other settings. It will be an important step toward facilitating independent housing, which is where most seniors want to be.”

Skubic and Rantz said in-home sensors, such as the ones in their study, can help identify early changes in health. Identifying issues early is the key to maintaining health, independence and function for older adults, the researchers said.

“The sensors help identify the small problems – before they become big problems,” Rantz said. “Based on the data collected by the sensors, health providers can offer timely interventions designed to change the trajectory in individuals’ functional decline.”

The research is funded by US Ignite, an endeavor financed by the National Science Foundation and the White House Office of Science and Technology Policy that supports health care technology development.


Thursday, June 21, 2012

Fewer antibiotics prescribed for children

The number of antibiotic prescriptions for kids declined 14% from 2002 to 2010, but antibiotics remain the most frequently prescribed drugs for pediatric patients, a federal analysis finds.

Antibiotics accounted for about a quarter of all pediatric prescriptions; amoxicillin leads the list.

Overall, 263.6 million prescriptions were written for patients 17 and under in 2010, down 7% from 2002, finds the analysis of prescription claims databases by Food and Drug Administration researchers, published today in the journal Pediatrics. By comparison, 3.3 billion were dispensed for ages 18 and up, 22% more than in 2002.

The medical community has made "an enormous effort to decrease antibiotic use" for kids in the past decade "by educating parents about the futility of treating viral infections with antibiotics" and about antibiotic resistance, the FDA study says.

Those efforts "are succeeding to some extent," but this study and others show antibiotic overuse "is still a big problem," says Adam Hersh, assistant professor of pediatric infectious diseases at the University of Utah. He says overuse of azithromycin and other broad-spectrum antibiotics "is contributing to the epidemic of antibiotic-resistant infections."

Other drug categories down from 2002-2010 were allergy medications (61%); pain (14%); and cough/cold without expectorant (42%). But prescriptions increasing include corticosteroids for asthma (14%); contraceptives (up 93%, possibly because of secondary uses, such as acne) and attention deficit hyperactivity disorder (46%).

"It's good news that cough and cold prescriptions are down, given that they don't work and can have serious side effects," says Danny Benjamin, a professor of pediatric medicine at Duke University. In 2008, the FDA advised against them for the youngest children. But he says the rise in prescriptions for ADHD and off-label use of proton pump inhibitors for certain gastrointestinal disorders is worrisome. Safety of long-term ADHD drugs is unknown, he says. The study cites 358,000 outpatient prescriptions for lansoprazole (Prevacid) for infants, despite labeling that it is not effective in babies under 1 year.

Wednesday, June 20, 2012

Gains from health IT won't show without more reform, researchers say

ARLINGTON, VA – It's going to take more healthcare reform for productivity gains to show up from HIT adoption, according to a new report.

A RAND Corporation report published Thursday in the New England Journal of Medicine finds that existing administrative data used to measure productivity gains may be unable to detect the progress.

 [See also: Mostashari rankled over HIT survey conclusions.]

“As seen previously in manufacturing and other industries, the benefits of computerization in healthcare may only become evident over time as the delivery of healthcare is reengineered,” said Spencer Jones, the paper’s lead author and an information scientist at RAND, a nonprofit research organization.

“Health IT has the power to change the way healthcare is delivered and we need to develop tools that can accurately measure the impact of those changes,” Jones said.

One recent RAND study found that less than 2 percent of ambulatory performance metrics were suitable for measuring the effects of computerization, with other performance measures unable to capture improvements that can be made through health IT, according to researchers.

For example, health providers who use telephone calls or email in lieu of some office visits will appear to be less productive based on existing healthcare productivity measures, even if they deliver care in a more-convenient and effective fashion than other providers, according to the RAND health analysis.

In the analysis, RAND researchers discuss a productivity paradox that became apparent during the computerization of many other U.S. industries during the 1970s and 1980s. Despite a vast increase in computing capacity, the growth of productivity fell dramatically during the period. The relationship became known as the “IT productivity paradox” and economists debated whether the investments in it were worthwhile.

Further study showed that once these industries reengineered their processes to fully harness the benefits of IT, the anticipated productivity gains were realized.  But it took time for this to happen.

For health IT to produce similar gains, the healthcare professions need to do more than just digitize paper-based workflows, according to the RAND analysis. Health IT should lead to new processes that support teamwork, care coordination and innovative approaches such as interactive patient portals.

Monday, June 18, 2012

When a Job Disappears, So Does the Health Care

ASHLAND, Ohio � As jobless numbers reach levels not seen in 25 years, another crisis is unfolding for millions of people who lost their health insurance along with their jobs, joining the ranks of the uninsured.

The crisis is on display here. Starla D. Darling, 27, was pregnant when she learned that her insurance coverage was about to end. She rushed to the hospital, took a medication to induce labor and then had an emergency Caesarean section, in the hope that her Blue Cross and Blue Shield plan would pay for the delivery.

Wendy R. Carter, 41, who recently lost her job and her health benefits, is struggling to pay $12,942 in bills for a partial hysterectomy at a local hospital. Her daughter, Betsy A. Carter, 19, has pain in her lower right jaw, where a wisdom tooth is growing in. But she has not seen a dentist because she has no health insurance.

Ms. Darling and Wendy Carter are among 275 people who worked at an Archway cookie factory here in north central Ohio. The company provided excellent health benefits. But the plant shut down abruptly this fall, leaving workers without coverage, like millions of people battered by the worst economic crisis since the Depression.

About 10.3 million Americans were unemployed in November, according to the Bureau of Labor Statistics. The number of unemployed has increased by 2.8 million, or 36 percent, since January of this year, and by 4.3 million, or 71 percent, since January 2001.

Most people are covered through the workplace, so when they lose their jobs, they lose their health benefits. On average, for each jobless worker who has lost insurance, at least one child or spouse covered under the same policy has also lost protection, public health experts said.

Expanding access to health insurance, with federal subsidies, was a priority for President-elect Barack Obama and the new Democratic Congress. The increase in the ranks of the uninsured, including middle-class families with strong ties to the work force, adds urgency to their efforts.

�This shows why � no matter how bad the condition of the economy � we can�t delay pursuing comprehensive health care,� said Senator Sherrod Brown, Democrat of Ohio. �There are too many victims who are innocent of anything but working at the wrong place at the wrong time.�

Some parts of the federal safety net are more responsive to economic distress. The number of people on food stamps set a record in September, with 31.6 million people receiving benefits, up by two million in one month.

Nearly 4.4 million people are receiving unemployment insurance benefits, an increase of 60 percent in the past year. But more than half of unemployed workers are not receiving help because they do not qualify or have exhausted their benefits.

About 1.7 million families receive cash under the main federal-state welfare program, little changed from a year earlier. Welfare serves about 4 of 10 eligible families and fewer than one in four poor children.

In a letter dated Oct. 3, Archway told workers that their jobs would be eliminated, and their insurance terminated on Oct. 6, because of �unforeseeable business circumstances.� The company, owned by a private equity firm based in Greenwich, Conn., filed a petition for relief under Chapter 11 of the Bankruptcy Code.

Archway workers typically made $13 to $20 an hour. To save money in a tough economy, they are canceling appointments with doctors and dentists, putting off surgery, and going without prescription medicines for themselves and their children.

Archway cited �the challenging economic environment� as a reason for closing.

�We have been operating at a loss due largely to the significant increases in raw material costs, such as flour, butter, sugar and dairy, and the record high fuel costs across the country,� the company said.

At this time of year, the Archway plant would usually be bustling as employees worked overtime to make Christmas cookies. This year the plant is silent. The aromas of cinnamon and licorice are missing. More than 40 trailers sit in the parking lot with nothing to haul.

In the weeks before it filed for bankruptcy protection, Archway apparently fell behind in paying for its employee health plan. In its bankruptcy filing, Archway said it owed more than $700,000 to Blue Cross and Blue Shield of Illinois, one of its largest creditors.

Richard D. Jackson, 53, was an oven operator at the bakery for 30 years. Mr. Jackson and his two daughters often used the Archway health plan to pay for doctor�s visits, imaging, surgery and medicines. Now that he has no insurance, he takes his Effexor antidepressant pills every other day, rather than daily, as prescribed.

Another former Archway employee, Jeffrey D. Austen, 50, said he had canceled shoulder surgery scheduled for Oct. 13 at the Cleveland Clinic because he had no way to pay for it.

�I had already lined up an orthopedic surgeon and an anesthesiologist,� Mr. Austen said.

In mid-October, Janet M. Esbenshade, 37, who had been a packer at the Archway plant, began to notice that her vision was blurred. �My eyes were burning, itching and watery,� Ms. Esbenshade said. �Pus was oozing out. If I had had insurance, I would have gone to an eye doctor right away.�

She waited two weeks. The infection became worse. She went to the hospital on Oct. 26. Doctors found that she had keratitis, a painful condition that she may have picked up from an old pair of contact lenses. They prescribed antibiotics, which have cleared up the infection.

Ms. Esbenshade has two daughters, ages 6 and 10, with asthma. She has explained to them why �we are not Christmas shopping this year � unless, by some miracle, Mommy goes back to work and gets a paycheck.�

She said she had told the girls, �I would rather you stay out of the hospital and take your medication than buy you a little toy right now because I think your health is more important.�

In some cases, people who are laid off can maintain their group health benefits under a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1986, known as Cobra. But that is not an option for former Archway employees because their group health plan no longer exists. And they generally cannot afford to buy insurance on their own.

Wendy Carter�s case is typical. She receives $956 a month in unemployment benefits. Her monthly expenses include her share of the rent ($300), car payments ($300), auto insurance ($75), utilities ($220) and food ($260). That leaves nothing for health insurance.

Ms. Darling, who was pregnant when her insurance ran out, worked at Archway for eight years, and her father, Franklin J. Phillips, worked there for 24 years.

�When I heard that I was losing my insurance,� she said, �I was scared. I remember that the bill for my son�s delivery in 2005 was about $9,000, and I knew I would never be able to pay that by myself.�

So Ms. Darling asked her midwife to induce labor two days before her health insurance expired.

�I was determined that we were getting this baby out, and it was going to be paid for,� said Ms. Darling, who was interviewed at her home here as she cradled the infant in her arms.

As it turned out, the insurance company denied her claim, leaving Ms. Darling with more than $17,000 in medical bills.

The latest official estimate of the number of uninsured, from the Census Bureau, is for 2007, when the economy was in better condition. In that year, the bureau says, 45.7 million people, accounting for 15.3 percent of the population, were uninsured.

M. Harvey Brenner, a professor of public health at the University of North Texas and Johns Hopkins University, said that three decades of research had shown a correlation between the condition of the economy and human health, including life expectancy.

�In recessions, with declines in national income and increases in unemployment,� Mr. Brenner said, �you often see increases in mortality from heart disease, cancer, psychiatric illnesses and other conditions.�

The recession is also taking a toll on hospitals.

�We have seen a significant increase in patients seeking assistance paying their bills,� said Erin M. Al-Mehairi, a spokeswoman for Samaritan Hospital in Ashland. �We�ve had a 40 percent increase in charity care write-offs this year over the 2007 level of $2.7 million.�

In addition, people are using the hospital less. �We�ve seen a huge decrease in M.R.I.�s, CAT scans, stress tests, cardiac catheterization tests, knee and hip replacements and other elective surgery,� Ms. Al-Mehairi said.

This article is from the New York Times.

Women doctors paid less: reluctant to push for raises?

CHICAGO(AP)�Women physician-scientists are paid much less than their male counterparts, researchers found, with a salary difference that over the course of a career could pay for a college education, a spacious house, or a retirement nest egg.

To get the fairest comparison, the study authors took into account work hours, academic titles, medical specialties, age and other factors that influence salaries. They included only doctors who were involved in research at U.S. medical schools and teaching hospitals, all at the same stage in their careers. And they still found men's average yearly salaries were at least $12,000 higher than women's.

Over a 30-year career, that adds up to more than $350,000.

The results are sobering and "disappointing. I think we have much work to do," said lead author Dr. Reshma Jagsi, a breast cancer radiation specialist and researcher at the University of Michigan.

Why the big disparity?

Two women who have been prominent in medical research say this: Men tend to be more aggressive at self-promoting and asking for pay raises than women.

"Male faculty members are willing to negotiate more aggressively. It may be social and cultural. It seems to be fairly deep-rooted," said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital and a professor at Harvard Medical School.

Manson, who as a division chief helps makes salary decisions, says men much more frequently than women ask her for salary increases and promotions.

Dr. Julie Gerberding, former head of the federal Centers for Disease Control and Prevention, agrees.

Gerberding did infectious disease research at the University of California at San Francisco before joining the CDC and says early in her career she was bothered that relatively few women held high-paying leadership positions in academic medicine.

"There were some moments when I was angry, but that was motivating. I thought it was an intolerable situation and it just motivated me to work harder," said Gerberding, who left CDC in 2009 and now heads Merck & Co.'s vaccine unit.

She and Manson declined to say if they think they've been paid less than male counterparts.

While previous studies have found that female doctors are frequently paid less than male doctors, many observers have assumed that's often related to having children � working fewer hours, or choosing less time-consuming, lower-paying specialties to allow time for child-rearing.

The new study did find more women in less lucrative specialties, including pediatrics and family medicine, and more men in the highest-paying fields, including heart surgery and radiology. But it still found salary inequities even among women and men without parental responsibilities, in similar jobs.

The findings are from a mailed 2009-10 survey of 800 doctors who had received prestigious federal research grants in 2000-03. The findings appear in Wednesday's Journal of the American Medical Association.

Women's yearly salaries averaged almost $168,000, compared with $200,400 for men � a difference of more than $32,000. Taking into account academic rank, choice of medical specialties and other factors that could affect salary, the difference wound up being $12,194.

Dr. Peter Ubel, the study's senior author and a Duke University professor, said there's no formula for pay increases; doctor-researchers don't automatically get a raise every time one of their studies is published. That makes the decision-making process more subjective, he said.

About equal numbers of men and women attend and graduate from medical school. But women make up a tiny portion of leadership positions at medical schools. And Jagsi said people in hiring positions may be biased, perhaps unconsciously, toward hiring men.

Ann Bonham, chief scientific officer at the American Association of Medical Colleges, a national group that represents U.S. medical schools and teaching hospitals, said medicine isn't the only field with gender differences in salaries. Medical schools are aware of the problem and are moving to ensure that decision-making on salaries "is a fair process and transparent. Nobody intends to be unfair in distributing resources," Bonham said.

Gerberding praised the study for raising awareness.

"Institutions need to take this information seriously and take a hard and closer look at their own salary parity issues," she said. Career advancement often depends on having a strong mentor and sponsor, so women and men in leadership positions at medical schools and teaching hospitals should make sure they're actively advocating for qualified women and suggesting them for promotions, Gerberding said.

Friday, June 15, 2012

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.

11 technologies pegged as best to tackle chronic disease

CAMBRIDGE, MA – Health policy institute NEHI has identified 11 emerging technologies that have the potential to improve care and lower costs for chronic disease patients, especially those in at-risk populations.

Each of the technologies are profiled in NEHI’s new report, “Getting to Value: Eleven Chronic Disease Technologies to Watch,” published with support from the California HealthCare Foundation. The report also identifies lessons learned about the role of technology in creating value and offers an overview of some of the barriers to adoption.

[See also: $103M in government funding targets chronic disease]

The “technologies to watch” target a range of chronic illnesses, including diabetes, asthma, stroke and heart disease, and reflect the growing emphasis on empowering patients to monitor their own care through the use of mobile platforms, social networking and home-based telehealth technologies.

“Nearly half of all American adults have at least one chronic illness,” said NEHI president Wendy Everett. “And these 11 emerging technologies hold the promise of greatly helping them manage their disease and connect with their doctors in real time.”

The 11 technologies on NEHI’s watch list include:Tele-stroke careVirtual visitsMobile asthma management toolsIn-car telehealthExtended care eVisitsMobile clinical decision supportMedication adherence toolsSocial media promoting healthMobile cardiovascular toolsHome telehealthMobile diabetes management tools

[See also: Pennsylvania hospital strengthens fight against chronic disease]

“These 11 technologies have the potential to extend care of chronic diseases beyond a doctor’s office to places where patients spend a great deal of their time - on their Smartphones, personal computers and in their cars,” said Everett. “And they are helping physicians get real-time data about their patients and, in some cases, share resources where staffing or financial constraints limit proper chronic disease management.”

Everett said the technologies address three big problems currently facing healthcare: chronic disease, quality care and patient engagement.

"More than 75 percent of the nation’s total medical costs are spent on chronic disease,” said Everett. “Patients need to be an integral part of their care if we are to increase the quality and decrease the cost of care.”

Of the 11 technologies identified, the three with the most “significant evidence attesting to their clinical and financial benefits” are extended care eVisits, home telehealth and tele-stroke care, said Everett.

“If successful policy interventions are undertaken to surmount barriers, these (three) technologies would be primed for widespread adoption,” she said, noting that the main benefits of these technologies are that they don’t have high cost barriers to use; they leverage mobile and telehealth technology and social media for monitoring patient health; and they allow for the collection of aggregate data.

Thursday, June 14, 2012

Stimulus package a vote away from becoming a law

WASHINGTON – The House voted Friday afternoon to approve the final version of the $787 billion economic stimulus bill by a 246-183 vote, according to CNN reports.

A final Senate vote was expected by Friday evening, leaving the bill awaiting only President Barack Obama's signature to become law. Obama has said he would like to sign the law in a televised ceremony on Monday.

According to CNN, no House Republicans voted in favor of the bill, and seven Democrats voted against it.

The bill will need three Republican votes to pass in the Senate. Maine Sens. Olympia Snowe and Susan Collins and Sen. Arlen Specter from Pennsylvania are expected to support the bill.

The bill is loaded with money for healthcare reform and the advancement of healthcare IT. It includes $19 billion for healthcare IT and more than $100 billion for healthcare measures including funding to help beef up state Medicaid coffers and subsidies to help unemployed workers afford healthcare coverage through COBRA.

"The economic stimulus package represents a significant step forward for the advancement of healthcare in the United States," said Harry Greenspun, chief medical officer for Perot Systems. "These funds should significantly advance patient safety and care while creating good paying jobs in the health IT sector, especially if we can achieve the goal of developing an electronic health record of every American."

Tuesday, June 12, 2012

From glow caps to cell scopes, mobile health future is near

CHICAGO – The future is getting closer for emerging mobile technologies to take a critical role in engaging consumers to make better health decisions, and in equipping providers with tools to obtain more data from their patients to improve outcomes.

Two early examples are contact lenses that can send and receive data, and vital signs sensors capable of continuously monitoring the wearer.

[See also: Mobile health app market in growth mode]

A “super” convergence of technology and market trends is opening up new ways to coordinate care and manage personal health, said Mike Wisz, a health IT consultant.

“Clinical workflows will be impacted by changing care delivery that becomes more preventive. The basic idea is to keep patients out of the hospital,” he said at a recent HIMSS online briefing. “We’re going to see more pieces deployed, used, worn, ingested and implanted, and it’s going to be a data tsunami."

The flood of mobile health technologies and devices can be viewed as an eco-system. Sensors and other medical devices that measure person-specific information may be attached to or embedded within the body or work within the person’s home. Many emerging software applications also run on mobile or Web-based platforms for use by the patient.

[See also: Mobile health monitoring market on the rise]

Platforms are emerging that offer easier ways to communicate the patient’s information from all these devices and applications through gateways, which can include home health hubs, mobile phones and other machine-to-machine devices, said Wisz. They deliver information to the cloud, where systems may aggregate the data for physicians to access and use.

Some providers are testing or adopting remote patient monitoring systems but hurdles persist, such as who pays for the technology, concerns about privacy and security, and the fact that providers are already busy with meaningful use and other mandated changes, he said.

Mobile product designers are moving beyond touch screens and multi-touch interfaces to experiment with new forms and systems, like Google glasses for “third eye” capability, said Rob Campbell, CEO of Voalte Inc., a provider of mobile clinical communications technologies.

Wearable computing will likely deliver ways to manage information and interact with the world. “For example, personal see-through devices could overlay computer-generated visual information on the real world in real time allowing immediate hands-free access to information,” he said.

The first step to this always accessible information will be deployed through see-through glasses. Ultimately, a much less cumbersome display of augmented reality will come in the form of contact lenses.

In the future, contact lens systems may receive data from external platforms, like mobile phones, to provide real-time notifications and event alerts. As contact lens bio-sensors advance they may alert the wearer of a health anomaly occurring in the body.

The long-term goal is to create a display that can be comfortably worn in the form of a contact lens, which will include a pixel array for imaging. An antenna can be connected with a wireless network. “They’ve even figured out how to monitor tears for glucose levels,” he said.

Some devices start out in acute care but new versions could eventually make their way outside of the hospital, Wisz added.

“With the trend for devices getting faster, smaller and cheaper, many are looking forward to using the devices as a monitoring system for the patient across the continuum of care," he said.

A platform for comprehensive vital signs monitoring, for instance, keeps clinicians connected to their patients that are in the hospital anywhere within the facility. Patients wear comfortable body sensors that allow for better freedom of movement outside of traditional ICU-monitored environments. Eventually systems like these will be modified for use outside of the hospital to enable early detection of potential problems, Wisz said.

Some of the growing connected smartphone devices include:Blood diagnostic product that uses high resolution imaging sensor that lets users snap photo of a blood smear from finger prick to determine if it detects malariaCellscope that attaches to smartphone so that doctors, and eventually parents, can take photos inside of a child’s ears to determine if there is ear infectionAdaptor and system software for eye test for glasses through which user receives measurements needed for eyeglasses for nearsightedness, farsightedness and astigmatismVoice, alarm and text messaging with consumer-grade usability for major smartphone platforms to improve physician and nurse communications within healthcare facilities to improve coordination of care and alerts among the care teamGlow-caps on standard medication pill bottles that use light and sound reminders and follow-up phone call or text message so patients don’t miss a dose to assure medication adherence.

[See also: Mobile health developers see bright future ahead]

Monday, June 11, 2012

RPSGB responds to pharmacists gaining access to patient records

LONDON – UK pharmacists will gain access to patients' electronic Care Record for the first time under plans by NHS IT chiefs. Access has previously been limited to general practitionerss.

In a key step towards Government proposals for pharmacies to take on more clinical work, pilots are being considered in community pharmacies across the country.

The Royal Pharmaceutical Society of Great Britain's Director of Policy and Communications, David Pruce said: "Pharmacists are highly-trained healthcare professionals, with unique expertise in medicines use. Community pharmacists are highly accessible to the public, and well-placed to provide a range of healthcare services."

"Access to care records by pharmacists will improve patient safety because pharmacists will be able to view the patient record, and be fully aware of what care a patient is receiving elsewhere," he said.

"Access to care records will strengthen pharmacists' ability to make the best possible decisions for their patients, and will enable them to develop new health promotion and screening services, for the benefit of patients and doctors alike," Pruce said.

"Like other trusted healthcare professionals, pharmacists have a duty of confidentiality to their patients. Pharmacists already have access to care records in a variety of settings, including hospital wards and GP surgeries. Access to electronic care records in the community pharmacy will not present a risk to patient confidentiality," he added. "As the subject of their patient records, it is ultimately the patient's decision concerning which health professionals can view their records. However, we believe patients and doctors will experience a clear benefit when pharmacists are able to access their records."

Sunday, June 10, 2012

Maine's HIE goes to Dell's cloud for image-sharing

PORTLAND, ME – A picture is worth a thousand words, the old saying goes. Today, HealthInfoNet, Maine's statewide health information exchange, is launching a pilot that will put both images and words at the fingertips of healthcare providers – the better to make the right decisions for their patients.

Working with Dell, HealthInfoNet will create what its officials say is the nation’s first statewide medical image archive.

[See also: Maine HIE to match outcomes with cost]

"This is totally a cloud-based offering, which will be a subscription model, where we will charge on a per-study basis to put the studies in the archive, and have the ability to pass forward those images to anywhere they are needed – have the ability to provide business continuity and even disaster recovery if needed," explains Jerry Edson, former CIO at Maine Medical Center and now a HealthInfoNet consultant.

HealthInfoNet already provides image reports, but with the new archiving system it will be able to offer up the images themselves. It’s "something providers have asked for and told us will better support their treatment decision-making," says Todd Rogow, director of information technology at HealthInfoNet.

The pilot will last through the summer, "to be sure you know that everybody can touch it, feel it. They can be confident that it’s working the way that it needs to work," says Edson. "In the fall, we will move from the initial participants of the pilot to the statewide rollout."

[See also: Maine receives grant to connect behavioral healthcare to HIE]

In addition to leveraging the HIE, the service prepares Maine’s providers for sharing images through the NwHIN Direct and Connect systems, Rogow notes. It also supports the development of accountable care organizations and other shared-risk models.

"As the concept of ACO starts to come into place," says Rogow, "a service like this fits very well and is very needed."
An estimated 1.8 million medical images (X-rays, mammograms, CT scans, MRIs etc.) are generated in Maine each year, totaling more than 45 terabytes of data. The organizations participating in the pilot generate 1.4 million of those images.

Today, the images are stored in a number of electronic archives at separate locations and mostly shared between non-affiliated providers by copying the images to CDs.

By consolidating the images into a single archive, HealthInfoNet estimates that Maine’s providers stand to save $6 million over seven years through reduced storage and transport costs.

"When a patient has an X-ray or MRI at a facility outside our system, it can take days for their doctor at Maine Medical Center, for example, to get a copy of that image," says Barry Blumenfeld, MD, CIO at MaineHealth. "This new service will save time for our providers and their patients. With instant access to a patient’s images, medical staff can treat them much faster and the patient won’t have to take the time to pick up and deliver CDs."
Officials note there are several additional benefits of having images stored in one place. First, easier access to past image studies should lead to fewer repeat tests, meaning less cost and less radiation exposure for patients. Also, HealthInfoNet will be able to link each image with a single patient identifier through its HIE Master Person Index, making it easier for providers to search for all of a patient's prior images when needed to track changes over time. For example, a radiologist wants to see all of a woman’s past mammograms, not just her most recent, to better detect changes in her breast tissue.
To build and operate the new cloud-based archive, HealthInfoNet selected Dell through a rigorous RFP process that involved vetting by both Maine clinicians and health information technology professionals. Dell manages one of the world’s largest cloud-based clinical archives through its Unified Clinical Archive solution, with more than 71 million clinical studies, nearly 5 billion diagnostic imaging objects and supporting more than 800 clinical sites.
HealthInfoNet, Dell and the pilot group of Maine healthcare organizations will work together over the summer to confirm the system design and integrate the service with existing PACS systems and the HIE. HealthInfoNet expects to end the pilot phase in the fall and expand the service statewide by 2013.

Besides making records readily accessible, says Jim Champagne, executive director, Dell Healthcare Services, Dell executives are proud that they were able to build a model that is self-sustainable financially.

"You don’t have to go out for a bunch of grants in order for that to be self-sustaining," he says. "We’re offering here to the providers not only the tools to exchange, but also a cost-effective archive and cost-effective disaster recovery solution around it that makes sense financially from cost of ownership.”

Dell has operates two data centers and one on the West Coast, where data is stored and managed.

Champagne says Dell has more than 10,000 interfaces to connect with the PACS in the marketplace today.  Dell has worked with small regional facilities and IDNs that share information across multiple collaborative hospitals, "but nothing at the level that we’re seeing in this partnership across the entire state," says Champagne.

[See also: Maine practice celebrates its meaningful use status]

Saturday, June 9, 2012

Don't let meaningful use dictate EMR choices, IDC tells small practices

FRAMINGHAM, MA – A new report from IDC Health Insights rates the best EMR vendors for small physician practices -- and warns that the short-term incentives of meaningful use shouldn't overshadow those offices' long-term care strategies.

The study, "IDC MarketScape: U.S. Ambulatory EMR/EHR for Small Practices 2012 Vendor Assessment" assesses 11 products from nine vendors aimed at helping small physician practices qualify for meaningful use incentive money. In its report, IDC weighs in on which vendors are well-positioned today through current capabilities – and which are best positioned to gain market share over the next one to four years.

Vendors included in the report are: ADP AdvancedMD, Allscripts, athenahealth, eClinicalWorks, Greenway Medical Technologies, LSS (MEDITECH), Lumeris, Optum (OptumInsight) and Practice Fusion.

IDC experts say they expect the U.S. market to move from less than 25 percent adoption in 2009 to more than 80 percent adoption by 2016. That growth will be primarily influenced by regulatory stipulations and government incentives under the American Recovery and Reinvestment Act (ARRA).

But additional trends will include the quality of care improvements that result from using EMRs/EHRs in ambulatory practices, their growing capabilities and use of cloud computing, the use of mobile devices in ambulatory practices and the consolidation of provider vendors as market saturation increases, according to the report.

ARRA offers "an unprecedented opportunity for providers in small practices to garner federal incentives for demonstrating meaningful use of clinical applications that will help to improve the quality of care, enhance patient safety and prepare their practices for the future," said Judy Hanover, research director at IDC Health Insights.

But EMR technology – to say nothing of the many federal requirements and deadlines for achieving meaningful use and the disruptions of business, workflow and practice patterns necessitated by its adoption – can "present complex issues and challenges" for small physician practices, she said.

"If providers allow the constraints of meaningful use to dictate their technology choices and limit the goals for implementation," said Hanover, "they may only see the short-term incentives and not the long-term strategic advantage that an EHR can bring to their practices and may fail to compete under healthcare reform."

With hundreds of small practice EMR/EHR vendors participating in the market, IDC officials say the vendors included in the report were carefully selected to include the top five market leaders in the U.S., and a selection of additional vendors that offer compelling technology, strategies or services, such as advanced software-as-a-service (SaaS) offerings, innovative pricing or service options, platforms or architecture capabilities.

The report seeks to highlight the attributes and key capabilities physicians should look for when selecting an EMR/EHR, and offers a guide for using best practice-based approaches to leveraging an EMR/EHR to build competitive advantage in small practices.

Each product was evaluated against 25 criteria in two category measures for success: strategies and capabilities. Within each of these criteria, IDC Health Insights has weighted specific features of the product or the product's vendor that are particularly significant for purchasers of the software and for users. As part of its evaluation, IDC included customer references for all of the products included in the assessment.

Access the IDC Health Insights report here.

Friday, June 8, 2012

Join Us for an Online Women’s Health Town Hall

As part of our focus on women�s health, the White House and the U.S. Department of Health and Human Services (HHS) would like to invite you to participate online in a Women�s Health Town Hall on Thursday, June 7, 2012. The event will be streamed live from the White House from 10 a.m. to 11:30 a.m. ET.�

The event will be an interactive, open dialogue about how the health care law, the Affordable Care Act, is improving the health of women and their families.�

Do you know how the law affects you, your mother, and your daughter?

Here are some highlights:

The law requires insurance companies to cover people with pre-existing conditions, and means the end of women being denied or charged more for coverage just because they�re women.It also zeroes in on ensuring access to preventive services like mammograms and blood pressure screenings by making them available without a co-pay.It strengthens the Medicare program by cracking down on fraud, waste and abuse and closing the prescription drug gap known as the �donut hole,� which means lower prescription drug costs for all seniors.

We encourage you to send us what you want to know about the law. Submit questions using the Twitter hashtag #WomensHealth or on the Facebook page.�

Participants include:

Valerie Jarrett, Senior Advisor to the President and Chair of the White House Council on Women and GirlsKathleen Sebelius, Secretary of Health and Human ServicesTina Tchen, Executive Director of the White House Council on Women and Girls and Chief of Staff to First Lady Michelle ObamaCecilia Mu�oz, Director of the White House Domestic Policy CouncilMayra Alvarez, Director of Public Health Policy, Office of Health Reform, Health and Human ServicesCaya Lewis, Counselor to the Secretary of Health and Human ServicesJudy Waxman, Vice President of the National Women�s Law CenterMargarita Bertsos, Health Editor of REDBOOKKelly Wallace, Chief Correspondent and Executive Director of Digital Video of iVillage

Mark your calendar!

Wednesday, June 6, 2012

RAC program off hold and back on track, CMS says

WASHINGTON – The Centers for Medicare & Medicaid Services announced last week that it will resume implementation of its Recovery Audit Contract (RAC) program.

The program, which searches for improperly billed Medicare claims, was placed under a stop order in November, due to protests from potential contractors over the award process. The protest has now been resolved and the program will be underway in 2009, as scheduled.

CMS awarded RAC contracts last October and plans to roll out the RAC program in phases through 2009 in four regions:

Region A, awarded to Diversified Collection Services, Inc. of Livermore, Calif., covers Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and New York. Region B, awarded to CGI Technologies and Solutions, Inc. of Fairfax, Va., covers Michigan, Indiana and Minnesota. Region C, awarded to Connolly Consulting Associates, Inc. of Wilton, Conn., in Region C, covers South Carolina, Florida, Colorado and New Mexico. Region D, awarded to HealthDataInsights, Inc. of Las Vegas, Nev., in Region D, covers Montana, Wyoming, North Dakota, South Dakota, Utah and Arizona.

Additional states will be added to each region in 2009. PRG-Schultz, Inc. and Viant Payment Systems, Inc. will  be added as subcontractors, CMS officials said in a recent announcement.

The federal government reports it recovered nearly $700 million in improper Medicare payments through its RAC pilot program, conducted from 2005 to 2008.

The RAC program was made permanent under the Tax Relief and Health Care Act of 2006, which requires the Department of Health and Human Services to expand the program to all 50 states by no later than 2010.

"The RAC demonstration program has proven to be successful in returning dollars to the Medicare Trust Funds and identifying monies that need to be returned to providers," CMS officials said. "It has provided CMS with a new mechanism for detecting improper payments made in the past, and has also given CMS a valuable new tool for preventing future payments."

CMS officials said the RAC pilot program had "a limited financial impact on most providers," with the vast majority of hospitals in the pilot states impacted by less than 2.5 percent to their bottom line.

Some lawmakers have challenged the program, however, saying RACs are paid to find overpayments, which would affect their impartiality.

Friday, June 1, 2012

TEPR's advocacy for online resources includes a story of survival

PALM SPRINGS, CA – The effort to develop social networking tools for healthcare took a personal turn at this week's TEPR+ conference in Palm Springs, Calif.

During Monday's opening session of the Medical Records Institute's Towards the Electronic Patient Record (TEPR+) conference, attendees were introduced to Dave deBronkart, a Nashua, N.H. businessman who recently survived renal cell cancer - and who attributes his victory in part to being an ardent Web surfer.

deBronkart was diagnosed in 2007, at age 57, when a tumor was spotted in his lung during a routine shoulder X-ray. The cancer was later found to have spread from his kidneys to his lungs and other parts of his body. In researching his condition online, he said, he learned that he had about 24 weeks to live.

deBronkart's physician, Danny Sands, MD, of Brigham and Women's Hospital in Boston, had earlier directed deBronkart to the hospital's PatientSite interactive Web site, seeing it as a means of keeping in touch with his patient when  he wasn't in the office (and when deBronkart moved to Minnesota for a few years). Following the cancer diagnosis, Sands connected deBronkart with - an online network organized by the Association of Cancer Online Resources.

"I lurked for two or three days, listening to what other people were saying, before deciding to post a message," deBronkart said. Within hours of his first posting, he said, he was in touch with other cancer patients, sharing advice and resources.

"I needed to know what my options were," he said.

deBronkart learned of a risky treatment for renal cell cancer using Interleukin-2. He also learned that the side effects to the intravenous treatment were "often severe and rarely fatal." Within days of posting a request for information on, he said, he received 15 firsthand accounts.

During his treatment in Boston, deBronkart kept friends and family notified of his progress through a page on CaringBridge, an online portal for those undergoing medical treatment. He posted notes, photos and traded messages.

This past year, deBronkart learned that one of the five tumors in his body had vanished and the other four are shrinking. He has begun a blog ("e-Patient Dave"), extolling the virtues of the active, Web-educated healthcare consumer, and will do something this summer that he didn't think he'd live to do - walk his daughter down the aisle at her wedding.

Telehealth pilot helps patients with kidney disease

PARIS – A remote telehealth pilot has shown promise for patients living with chronic kidney disease (CKD), yielding positive trial results in both patient satisfaction and patient support.

The pilot was also awarded the Innovation Prize this month in the telemedicine category at Hit Paris, France’s annual health IT tradeshow.

In a collaborative effort among Grenoble University Hospital, Calydial dialysis centers of France and AGDUC health center in France, patients living with CKD were selected to take part in a trial using remote patient monitoring technology provided by Canadian-based telecommunications provider, TELUS and Orange, the French communications company.

Patients in their homes were given e-tablets, connectivity and software to monitor their vital signs, manage their medication and treatment protocols and provide feedback to their care team. Early positive results have demonstrated the potential to replicate this solution across other institutions and for other chronically ill patients.

The pilot uses a network-centric, multi-function application that allows patients with conditions that require daily monitoring to coordinate with their healthcare providers from home. Patients and caregivers are able to access the application through a secure wireless network.

Kasra Moozar, vice president, TELUS Health Solutions explained that TELUS, has “ more than 10,000 patients using its remote patient monitoring technology to manage their chronic condition from the safety and comfort of their own home." Moozar said that the technology allows them to turn “information into better health outcomes for citizens."

"Telemedicine has the power to transform the way that healthcare is delivered, said Thierry Zylberberg, executive vice president, Orange Healthcare. “These telemedicine solutions can have a positive impact on care quality for chronic disease patients and care delivery for healthcare providers."