92648

Drug Industry Critic Joins the FDA – Dr. Sydney Wolfe

According to this article in the Wall Street Journal, he is the Ralph Nader of the Pharmaceutical business and now steps in to even a bigger role.  This probably is going right along with the desire for transparency I might guess. 

Right now, the FDA, like all of us, is having the same issues as everyone else, too much information, but by today’s standards, we cant afford to over look any details at the FDA, as the drug business is a far cry from where it was 10 years ago too.  The FDA with their new computer systems might be able to filter and analyze faster than what had been possible in the past too.  If that is the case and everything is clean and on the table, then Dr. Wolfe may not be as big of a critic as he has been in the past.  He also spoke out about silicone breast implants and stated saline was still safer in one of his campaigns, although after 14 years they were re-approved by the FDA. 

It’s the way the world operates today, if there’s information available, we want it, and to this I might add the algorithms needed today to analyze applications for approval from both the drug and device side are also going to get a bit more complicated, which brings me right back to a post I made a while back.  I never thought this post would carry any weight but with many recent posts, I keep finding myself referring back as it seems to fit.  BD

The 2 New Hot Words in Healthcare: Algorithms and Whistleblowers

The pharmaceutical industry has a recurring nightmare: Drug-safety crusader Sidney Wolfe becomes a player at the Food and Drug Administration.

Dr. Wolfe also has a nightmare: One of his children goes to work for a drug maker.

Of the two, the doctor is sleeping more soundly.

Over three decades, Dr. Wolfe, head of the health group at advocacy organization Public Citizen that Ralph Nader founded, has helped push 16 drugs off the market and slap restrictions on several multibillion-dollar products. He has been so hostile to the FDA under President George W. Bush that he decried its 100th-anniversary celebration in 2006 as a "propaganda campaign" to hide its "unprecedented assault on the American public."

A Wolfe in Regulator's Clothing: Drug Industry Critic Joins the FDA - WSJ.com

Charles Rosen of UCI – Association for Medical Ethics leader, perhaps our next Surgeon General?

 imageIn southern California he was known as a whistle blower, but when you read the items mentioned, it was something any concerned physician would do; however when he went to the press is when it all caught fire.   I live in Orange County and remember portions of this when it occurred.  The portion on the missing clinical trial information on one quarter of the participants could have been due to the methods used for collecting data as well, but hopefully now we are on the trail to have all this done electronically.  Recently I posted about some clinical trial information still being done on paper.  The big item though is the ethics portion of the issue and his stance on being impartial and getting a true picture.

The website he established lists physicians who are accepting money or perks from the manufacturers of the medical devices.image  With all of this that has been in the press recently and the desire for true transparency, he was perhaps just a bit ahead of his time, as now everyone wants to know.  BD 

Sure, he had just testified in the U.S. Senate about what he sees as unethical marketing in the medical device industry. Yes, he's a well-respected surgeon and founding director of the Spine Center at the UC Irvine. And he does run a Web site – ethicaldoctor.org – that lists the names of physicians who accept money from the medical device industry.

But just two years ago, Rosen also was nearly fired from his job at UCI. And that came after he'd resigned as chief of surgery at another Orange County hospital, a protest, of sorts, about not being told about the possible use of dirty surgical tools in the operating room.  And, in recent years, colleagues at UCI and across the nation have railed against him.   Rosen's first clash with the business side of medicine happened in 2000. He was chief of surgery at Garden Grove Hospital when he learned, days before a key inspection, that the hospital's surgical sterilizing machines had been malfunctioning for months.

But the incident that pushed Rosen to become a full-blown industry watchdog came in 2004, when he was researching a new artificial spinal disk called Charite, a product made by Johnson &Johnson subsidiary DePuy Orthopedics. image

Rosen says he found a key clinical trial for the product didn't include data from about a quarter of the participants. He also says he found that some of the doctors who authorized the study doubled as paid consultants for the manufacturer.

So when political people, really important political people, started mentioning Charles Rosen and U.S. Surgeon General in the same sentence, Rosen was … flattered.

Still, in two years, could he go from outcast whistle blower to U.S. Surgeon General? Really?

From medical outcast to Surgeon General? | rosen, says, medical, industry, surgeon - Life - OCRegister.com

Steven Pinker, Harvard Professor of Psychology talks about his genome, what he found out, what he learned, and how the psychological interpretations are somewhat still up for discussion

“Steven Pinker is Harvard College professor of psychology at Harvard University and the author of “The Stuff of Thought: Language as a Window Into Human Nature.”

Steven Pinker was one of the first 10 volunteers to have his genome sequenced.  This is a rather lengthy, but well worth reading article on what he found out about himself and how the process took place under the direction of George Church.   The image below shows pictures of the first 10 individuals who in turn have made their records public as part of the agreement to further the science.

Interpreting the Genome - understanding all the data

image 

One other individual who as participated is  Dr. John Halamka, CIO of Beth Israel Deaconess/Harvard.  He has also spoken about how his results were analyzed and the information he obtained from the process.  You can find his blog here and under the blog roll on the site.  His picture is the first one on the second row.

When you read through some of the information discovered, and the way he describes what it meant and some potential contradictions or perhaps items that were a bit more complicated than anticipated, it drives home the point that the interpretation of the expressions are also very complicated as there’s a lot of information to examine and analyze and compare against other information derived. 

One example is when he finds out he has a lower rate for prostate cancer he is relieved a bit as anyone would be; however, when linked to other available studies he found out differently; some of his genes did have an elevated risk for prostate cancer, so the interpretation is very much key here and having all the information to re-evaluate against other information derived from the expressions.   

The related reading below has several additional posts and background information on the human genome and sequencing processes.  The interview I did a short while back with Dr. Patrice Milos from Helicos gives quite a bit of information on the machine process portion of the business, one I really enjoyed doing as well.  This is very interesting as more of the initial 10 volunteers come forward and enlighten the rest of us on what effects the information has and perhaps where the next level may be.  BD 

Last fall I submitted to the latest high-tech way to bare your soul. I had my genome sequenced and am allowing it to be posted on the Internet, along with my medical history. The opportunity arose when the biologist George Church sought 10 volunteers to kick off his audacious Personal Genome Project. The P.G.P. has created a public database that will contain the genomes and traits of 100,000 people. Tapping the magic of crowd sourcing that gave us Wikipedia and Google rankings, the project seeks to engage geneticists in a worldwide effort to sift through the genetic and environmental predictors of medical, physical and behavioral traits.

The Personal Genome Project is an initiative in basic research, not personal discovery. Yet the technological advance making it possible — the plunging cost of genome sequencing — will soon give people an unprecedented opportunity to contemplate their own biological and even psychological makeups. We have entered the era of consumer genetics. At one end of the price range you can get a complete sequence and analysis of your genome from Knome (often pronounced “know me”) for $99,500. At the other you can get a sample of traits, disease risks and ancestry data from 23andMe for $399. The science journal Nature listed “Personal Genomics Goes Mainstream” as a top news story of 2008.

 image

Only a portion of my exome has been sequenced by the P.G.P. so far, none of it terribly interesting. But I did face a decision that will confront every genome consumer. Most genes linked to disease nudge the odds of developing the illness up or down a bit, and when the odds are increased, there is a recommended course of action, like more frequent testing or a preventive drug or a lifestyle change. But a few genes are perfect storms of bad news: high odds of developing a horrible condition that you can do nothing about. Huntington’s disease is one example, and many people whose family histories put them at risk (like Arlo Guthrie, whose father, Woody, died of the disease) choose not to learn whether they carry the gene.

The two biggest pieces of news I got about my disease risks were a 12.6 percent chance of getting prostate cancer before I turn 80 compared with the average risk for white men of 17.8 percent, and a 26.8 percent chance of getting Type 2 diabetes compared with the average risk of 21.9 percent. Most of the other outcomes involved even smaller departures from the norm. For a blessedly average person like me, it is completely unclear what to do with these odds. A one-in-four chance of developing diabetes should make any prudent person watch his weight and other risk factors. But then so should a one-in-five chance.

It became all the more confusing when I browsed for genes beyond those on the summary page. Both the P.G.P. and the genome browser turned up studies that linked various of my genes to an elevated risk of prostate cancer, deflating my initial relief at the lowered risk. Assessing risks from genomic data is not like using a pregnancy-test kit with its bright blue line. It’s more like writing a term paper on a topic with a huge and chaotic research literature. You are whipsawed by contradictory studies with different sample sizes, ages, sexes, ethnicities, selection criteria and levels of statistical significance.

I also have genes that are nothing to brag about (like average memory performance and lower efficiency at learning from errors), ones whose meanings are a bit baffling (like a gene that gives me “typical odds” for having red hair, which I don’t have), and ones whose predictions are flat-out wrong (like a high risk of baldness).

My Genome, My Self - Steven Pinker Gets to the Bottom of his own Genetic Code - NYTimes.com

Genomics Related Reading:

Personalized medicine will rely on IT – It’s all about Software
Complete Genomic Sequence $5000 Next Year – Wholesale

Helicos BioSciences and Personalized Medicine - Featured Interview with Dr. Patrice Milos

How Hot is Genomics and the Sequencing Machines?
Cerner Incorporates Genomics Into Electronic Medical Records
Scripps, Navigenics, Affymetrix and Microsoft team on groundbreaking health study – Personalized Medicine
MDVIP Physicians Partners with Navigenics to Provide Personal Genetic Tests for Preventive Medicine
Genome Database Will Link Genes, Traits in Public View – George Church
BT and the X PRIZE Foundation Team Up to Inspire World Changing Innovations – Personalized Medicine Sequencing
Those Incredible Men and their Gene Machines..Personalized Medicine in the making…
The Polonator - the DNA Machine for $150,000
Personalized medicine will rely on IT – It’s all about Software
Single Cell Gene Sequencing from Helicos – How it works
How Hot is Genomics and the Sequencing Machines?
Cerner Incorporates Genomics Into Electronic Medical Records
Scripps, Navigenics, Affymetrix and Microsoft team on groundbreaking health study – Personalized Medicine

Desperate Hospitals – January 2009 Update

It’s time for another unfortunate update to the Desperate Hospital series since last updated in November, and the related reading below has the links to the entire listings.

First and foremost, the story at the top of the list is probably one of the worst hit hospitals with the employees not getting paid in Pennsylvania, but hopefully the bankruptcy judge will see to ensure they are the first in line.  This is difficult as when paychecks are expected and folks are living paycheck to paycheck, their bills don’t get paid, snowball effect. 

Most of the updates here involve layoffs and cutbacks, although there are a few on the line as far as which direction issues will go.  Hospitals all over the country are scrutinizing budgets and putting of purchases this year in view of the suffering economy.  One group of 2 hospitals even had trouble keeping the electricity turned on due to payment problems and have been purchased by a larger health institution.  BD 

Aliquippa, Pennsylvania – Hospital closes and stiffs employees on last paychecks

ALIQUIPPA — Commonwealth Medical Center employees who said they were stiffed for their final paychecks after the Aliquippa hospital filed for bankruptcy last month rallied Friday to publicly protest a court ruling that permits pay for hospital executives.
About 250 workers and supporters turned out at the American Serbian Club in Hopewell Township, appealing to the public and officials for help in their dilemma.
The hospital closed Dec. 13, claiming it no longer had financing to continue operations. More than 200 employees were laid off, and the hospital still owes them a total of $482,900 for the final weeks they worked, according to bankruptcy documents.

 

Oregon Layoffs

The unemployment rate is the biggest driver of charity care, said Diana Gernhart, associate hospital director, finance, for OHSU Healthcare. Companies are also increasingly asking workers to shoulder a bigger load of health care costs. The result is that more low-income workers need help.

“We know demand will continue to rise and the payer mix will continue to shift,” Gernhart said.

Two weeks ago, OHSU announced sweeping cuts to cope with a $30 million gap caused, in part, by lower-than-expected growth in paying patients.

 

In Georgia Riverdale Hospital Gets a Bail Out

Clayton County’s only hospital will stay open and employees will keep their jobs — with little risk taxpayers will end up paying the bill.

The Clayton County Commission voted unanimously Tuesday to back a $40.2 million bond for Southern Regional Health System.

The vote means the 331-bed Riverdale hospital will not default on its loan, which is due to SunTrust Wednesday.

“We feel it is a great victory for the county and the community,” said Dr. Raju M. Vanapalli, an orthopedic surgeon at Southern Regional. “We can continue to provide the care that is expected of us.”

Even with the county’s help, Southern Regional is still struggling financially, Dodson said. The hospital has hired a management consulting company to trim fat and restructure the facility.

 

Wheeling, WV – layoffs coming

WEIRTON - Weirton Medical Center is reducing its work force, a move expected to save the hospital $2 million a year.

The exact number of layoffs is unknown, but WMC officials said the equivalent is 36 full-time employees.

Officials at Wheeling Hospital and Ohio Valley Medical Center in Wheeling and at East Ohio Regional Hospital in Martins Ferry said Wednesday that there are no plans to lay off employees at their facilities. However, they cited other measures being used to monitor their bottom lines.

Weirton Medical Center's cuts will occur during the next six months and include union, non-union and management positions in various departments. Dr. Joseph Endrich, president and chief executive officer, said a five-month operational review was conducted to identify areas where patient care could be provided more efficiently at a lower cost.

 

In Athens, GA – trouble finding a buyer for the hospital

Williams acknowledged that Doctors Hospital of Georgia, which is affiliated with Marietta-based EDT Group Inc., had a few banks reject loan requests.

However, the potential buyers also were worried about the hospital's financial losses last year, he said. The most recent figures given to the group before negotiations began showed a $300,000 loss just for October, he said.

"Officially the hospital withdrew the letter, but it was pretty much a reciprocal thing," Williams said.

Slocum said a down economy - which has swelled the ranks of the unemployed and uninsured - has caused BJC's rough patch.

"We're in the same boat as everyone else is," Slocum said. "The economy is really, really tight right now."

 

Hospitals in Nebraska Lay off employees

To weather the economic storm, hospitals are cutting staff. Good Samaritan has cut 32 jobs in Kearney, and St. Francis another 22 in Grand Island. At St. Francis Medical Center, that's less than two-percent of the hospital's 1,200 jobs.

CEO Dan McElligott said, "Even though it's a small percentage of our overall workforce it's still a very painful process, not only for people who are let go, but everyone who had to do layoffs, and also people who are still going to be here. We don't want to minimize the impact on those people."

Most cuts are behind the scenes, in the lab, marketing department, and other support services. Frontline nursing positions are unaffected. The hospital's CEO said they'll try to rehire staff or help them find work.

 

Central Kansas Medical Center cuts 10-15% 

The realities of the national economic downturn have hit home for Central Kansas Medical Center as the hospital administration announced Wednesday it would lay off approximately 50 employees, representing 10 to 15 percent of the workforce and touching all of its operations. Notifications went out to the affected employees Wednesday and Thursday.

The hospital is facing the same challenges as other health-care providers all across the country, CKMC President and Chief Executive Officer Sharon Lind said. These include people delaying elective surgeries and other procedures, increasing bad debt and skyrocketing charity care costs.

According to the Kansas Hospital Association's 2008 annual report, the total amount of unsponsored care (bad debt or charity care) increased from just over $400 million in 2003 to nearly $950 million in 2007. In the same time frame, total non-reimbursed care climbed from $3.9 billion to $4.9 billion.

 

Arizona hospitals face severe financial crunch

Arizona hospitals are facing a severe financial crunch as more patients delay medical care, don't pay their full bills or lose their health insurance.

The triple dose of bad economic medicine means some facilities are delaying expansions and cutting costs to ride out the recession. In an industry that embarked on a $3.3 billion building spree this decade, the Phoenix area's largest hospitals suddenly have turned frugal.

Health care has been one of the Phoenix area's largest sources of new jobs in recent years, viewed as a haven for workers even in recessionary times. But now hospitals are scaling back hiring, cutting temporary positions and paring budgets.

Byron said the non-profit hospital system has not tallied its end-of-year finances yet, but he expects large increases in charity care and a drop in paying patients seeking elective procedures.

"We are looking at challenges brought on by the economic crisis, and difficult decisions have to be made," Byron said

 

University of Chicago Medical Center  – Layoff of hundreds of employees

Crain’s) — University of Chicago Medical Center plans to lay off hundreds of employees as it works to cut up to $100 million in costs, or about 7% of its budget.

CEO James Madara confirmed late Friday that the 600-bed hospital plans a major restructuring amid growing financial pressures from the flagging economy.

He would not specify the number of job cuts, although a person familiar with the plans said the Hyde Park medical center hopes to reduce its workforce of 10,000 employees by roughly 10%. Dr. Madara said attrition would account for a large portion of any job cuts that are made.

 

imageIn Carson City, Nevada – Layoffs

CARSON CITY (AP) -- A Carson City hospital has laid off 30 workers in a budget-cutting move spurred by the faltering economy.

Carson Tahoe Regional Healthcare is providing severance for the employees.

Hospital spokeswoman Cheri Glockner says the organization has 1,232 employees and the 30 affected workers would be the first considered for rehiring when conditions improve. She says patient care would not be affected by the layoffs.

 

In Arkansas – Baptist Health Takes over hospital to keep it open and running

Baptist Health said Tuesday that it will assume operations of Stuttgart Regional Medical Center with a long-term lease agreement beginning on Thursday. 

The facility's name will become Baptist Health Medical Center-Stuttgart.

Arkansas Business first reported in September that Baptist Health would take over the hospital. Baptist Health has grown while other hospitals in Arkansas have struggled.

 

In Hammonton, New Jersey – Trying to figure out how to keep the hospital open

HAMMONTON — William B. Kessler Memorial Hospital officials have ended their effort to raise $5 million worth of loans from the community.

Despite that action, Kessler will stay open beyond Jan. 16, the deadline hospital officials established for raising the money they said was necessary to complete a restructuring.

Kessler, which opened in 1964, emerged from Chapter 11 bankruptcy in December 2007. Rossi said the hospital was expected to lose $4 million in 2008.

 

In Bangor, Maine – layoffs to avoid bankruptcy

The top administrator at Blue Hill Memorial Hospital has announced an undetermined number of staff layoffs in an effort to stave off bankruptcy.

In a letter released to employees and news outlets Wednesday, interim administrator Dr. Erik Steele said a number of belt-tightening measures, including staff reductions, must be undertaken if the hospital is to continue serving the people of the Blue Hill peninsula.

 

In Stafford, CT – filed bankruptcy and threatening to cancel Aetna contract

Johnson Memorial Hospital in Stafford, which filed for federal bankruptcy protection two months ago, is threatening to end its contract with Aetna by Jan. 31 if “certain financial demands” are not met, a spokeswoman for the health insurance company said Friday.

“We’re trying to improve our rates of reimbursement, and what we’re seeing is some negotiating tactics on both parts,” he said. “We want a higher reimbursement rate, because now we have a rate that is at or below our costs, so obviously we can’t afford to continue and we need to be paid equitably.”  “People can still come to Johnson, even if Aetna does cancel the contract,” he said. “They’d just be out of network, which just means it will cost Aetna more.”  56 full time jobs to be cut.

Footnote:  See what issues Prime Healthcare has with billing out of network charges in California. 

 

In Natchez, MS – Hospital filing bankruptcy to pay debtors

He said the bidder has requested the hospital not be made available for auction once the hospital declares bankruptcy.

The hospital is not bankrupt, however, the facility will use bankruptcy as a means to repay its debtors.

Phillips said the fact that the bidder doesn’t want the hospital to be re-opened to bidding speaks to their seriousness as bidders.

 

In St. Louis – Two Hospitals sold – both had problems keeping electricity on with payment problems

A Florida health care company has purchased Forest Park and St. Alexius hospitals of St. Louis, hospital officials announced Wednesday.
Success Healthcare LLC of Boca Raton, Fla., founded in August, took over operations at the struggling hospitals on Dec. 10. The company owns one other hospital with two campuses in Southern California.

St. Alexius had a net income of $842,000 and Forest Park posted a loss of $2.3 million in 2006, the latest figures available, according to the Missouri Department of Health and Senior Services.
Both hospitals have had a series of troubles in recent years.
Forest Park and AmerenUE reached a deal in February to keep the hospital's electricity running after repeated problems with payments.

Related Reading:

Desperate Hospitals – Updated November 21, 2008
Homeless patient spent hospital money on crack
Pacific Health to buy Anaheim Memorial
Memorial Health Services Announces Sale of Anaheim Memorial Medical Center
Desperate Hospitals: Chicago Hospital Hangs For Sale Sign
Desperate Hospitals - Hawaii- What is happening to our Hospital System?
Desperate Hospitals - August 29 (Continued)
More Desperate Hospitals - Miami, FL and Cape Cod, MA
A hopeful prognosis - Desperate "California" Hospitals
Desperate Hospitals - Century City Doctors Hospital (Los Angeles) begins shutting down, others file Chapter 11 to reorganize
New New Jersey law to pinpoint financially troubled hospitals - "Desperate Hospitals"
Desperate Hospitals? (As Featured today in the WSJ)
The battle of the medical bills where nobody but the insurers win
Hospitals protest new California rules on patient balance billing
Cape Cod hospital gets $10M gift
Bankruptcy Bug Hits Hospitals – Desperate Hospitals
Desperate Hospitals – September 2008
Desperate Hospitals: Hospitals in Hands of Voters - Arkansas

President-Elect Urges Electronic Medical Records – comments by Dr. Bill Crounse of Microsoft

This is a great article and good comments from Dr. Bill Crounse at Microsoft. from ABC News.  If you read this blog often enough, you will find several posts relating back to his blog, as his posts are informative and he works hard at keeping interested readers up to date, not only here in the US, but he also shares imageinformation from his travels and speaking engagements on what is happening outside the US.  

You can find his blog here, or under my Blog Roll Section on the page, and here’s a link to his post for today. 

  image

Last year I had the opportunity to talk with Dr. Crounse at HIMMS and we covered a lot of topics, and one thing of course we both have in common is that we are both avid Tablet PC fans, you will see quite a few posts on his blog relative to Tablets as well.  At HIMMS there were a lot of tablet pcs being shown in various booths, but I used my unit to work the show, in other words with every booth I visited, I had a business intelligence file already set up in One Note so I could take notes in real time with all I visited with, Tablet PC, a great tool for working conventions. I was impressed as Dr. Crounse knew me as the “Medical Quack”, one huge compliment for me in knowing where this blog reaches at times.

HIMMS 2008 Summary - Getting organized is the trick

While at the show (with my tablet pc) I had an old demo version from Microsoft running on the tablet, and this was just before the public release on the Common User Interface project, and it drew a lot of attention.  I still keep seeing this YouTube video I made still popping up occasionally on websites today.  I even got a little carried away with doing a speech recognition demo on the floor, which of course was not perfect, but rather just showing another way of interacting with a computer for input of medical records. 

Back to the discussion at hand with medical records, one other thoughts that I have too on the subject is that it is a very complicated situation today.  As software algorithms continue to grow in complexity, so does the software, and that is everywhere we turn today.  This is rapidly presenting a need for standards and simplicity of use for the healthcare industry.  image

Cost of course is a big ticket today with the state of our economy and something that can’t be overlooked, but where software developers can join force is to create a simpler, yet dynamic method for clinicians to use.  Code Plex is a portion of Microsoft that is free and donated open source code available to any developer to work with and within Code Plex there is what is called “A Common User Interface” that any software company can download and develop.

So what is so important about standards and a common user interface – let me put this bluntly, it’s called ease of use and functionality.  Let’s take Dr. Smith who is on staff at 3 hospitals, each of them using a different medical records software system. Did I get your attention yet?

Well as we all complain about healthcare being so slow to adapt medical records, this one scores one big negativity factor for the doctors, does this doctor, who’s primary job is to take care of us, need to learn 3 different software systems, and how about the time it takes him.  Ok, we all go through software updates everywhere we go today, but keep in mind all the information about each patient that is flowing today to a physician.  It’s an administrative nightmare for the physician, no matter how you look at it and it’s no wonder the frustration and non-participation levels are high, put yourself in those shoes.   I have done my own little survey in asking doctors how they would feel if the screens and data entry were all the same at any hospital they happen to be on staff at or have a working relationship, do you think any of them said “no” I wouldn’t like that, of course not.  I think one would have to be a bit crazy to say I like having 3 different input screens to learn, agree?

So what we are talking about here is not only medical records, but a system that can work and have a familiar face at any facility.  The Common User Interface, as being developed by the NHS is something that should not be overlooked as much of the work is already done!  Do we really need to re-invent the wheel?   It does make me somewhat wonder if software developers are trying to do just that when reading articles such as this one, wondering what is going on here, are they trying to start from scratch? 

GE, Mayo Clinic, others to develop health record technology

I have a multitude of articles on the blog discussing the Common User Interface, again free for taking and developing to perhaps one day bring the same dynamic data entry screens and processes to every hospital and physician’s office across the US.  Years ago I wrote a very simple EMR before the complexities of today and have followed the progress and am an active contributor and moderator on EMR Update, a site discussing electronic medical records.  The physicians at EMR Update came to know me around there a few years ago and we have a great exchange of technical and clinical information where input from both sides can lead to solutions and you will also find this blog syndicated there as well. 

Dr. Crounse on his blog also has a nice informative post about the Common User Interface with links to the MSDN technical pages.  When you stop and think about it, the interface makes sense and I wonder where the delay is myself with developers who might not be taking a serious look at coming together to make the process easier, you have to think of the end user today with simplified software screens, otherwise it’s just another overloaded software system. Me, being a consultant too, just from my tiny corner of the word, how many software systems do I have to learn to be able to give support?  I feel the same as the doctors on this one.  (grin).

It just makes one wonder why perhaps we might not be a little more united in this effort to create a product that would have simplicity, dynamics, and something that would only require training on one interface, as the back end software could still function and query as usual.  The related reading below references many of my past posts on the subject and even one on a small developer in New Zealand who doesn’t even write code with a Microsoft product, but is making use of the interface with his project. 

In short, when it comes down to a system that will work, why don’t we all get together and take advantage of some valuable resources that are here today, built for the future and make it easier for the healthcare individuals we rely on to guide us to better healthcare? 

image

In a related technology story, I found my post on Vanderbilt’s internal website, relating back to another solution for the instant detection of Sepsis, using Microsoft technology and the University is ready and willing to share with all. Dr, Crounse also has an in depth post on his blog that can be found here. 

I also had a chance to talk with Hemang Patel from Microsoft’s mobility area of healthcare at HIMMS. You can view a couple videos here on Dr. Crouse's blog that have been posted in the past about healthcare as related to cell phone platforms. 

One more item worth mentioning too is the availability of Microsoft Technical Centers, 16 locations where you can get free architecture help and get software up and running much faster.  Facilities as such might be able to help with programming of the Common User Interface too.  I have been to the facility in Irvine, and the link above mentions many of the local Irvine employees of Microsoft that I have the opportunity to learn from and interact with.  You get to see some very exciting technology too, see the link below about Microsoft Surface.

Hospital Operator Demos Health Care Application For Microsoft Surface

And more item worth a short note, I was able to fold DNA protein on Surface while there one day for a meeting.  I mentioned this with my interview this week with Rosetta Genomics and he was very interested as well in how this could be done, as they work with microRNAs. 

Long and short of all of this is that hopefully the Obama team will investigate and maybe find that most of the answers being sought out for solutions are already here, they just need to be instituted with a CTO that can get the job done for us and last but not least, we do have a couple good personal health records solutions that are there and available for consumers today.  My blog has many posts over the last year as well as permanent links for anyone to get started. 

The solutions are there for integration and technology today, standards and perhaps unifying our efforts to become less fractured will be the answer and again, I hope the Obama team is doing their homework here, and in time we will have a better idea of the direction we are heading without having to take time to re-invent the wheel.  BD 

In the latest step toward the computerization of Americans' medical information, President-elect Barack Obama said in a speech Thursday that the government will push for electronic health records for all Americans within five years in order to save both dollars and lives.

Dr. Bill Crounse, senior director of worldwide health for the Microsoft Corporation, said that he is "thrilled that President-elect Barack Obama is stepping forward to carry the torch" with regard to the development of electronic medical records for all Americans.

"The opportunity here is so much bigger than just electronic medical records," he said. "The opportunity is really to think in entirely new ways about how you do health care."

Microsoft could well be one of the major players in the eventual development of such a system. The company launched a beta program of

an online medical records program called Healthvault in 2007. The company now has partnered with Kaiser, the American Heart Association, the Cleveland Clinic and others in creating a user-accessible program and laying an infrastructure for others to build upon.

Crounse said that it is little surprise that few doctors -- particularly primary care doctors -- are stepping forward to invest what he says could be $25,000 in a system for electronic medical records.

"We're asking them to step up and spend a lot of money on electronic medical records. The doctors will say that a lot of the benefits of these systems accrue to everyone but the doctor."

While he said that the benefits for doctors are there -- primarily in the form of improved patient safety and care -- this perception could give many doctors pause.

Ideally, Crounse and Robb both noted, these records would let patients manage their medical particulars in much the same way as they manage their financial matters online.

And Webb added that considering the current state of the country's health-care system, the time is ripe for change -- and government finds toward this effort would be money well spent.

ABC News: President-Elect Urges Electronic Medical Records in 5 Years

Related Reading:

HIMMS - Informative and Influential People

Lawmakers Consider Adding Health IT to Stimulus Package – We Need some Congressional Algorithms

New federal study shows barriers to healthcare IT - All over the place
Bill Gates Testifies before Congress - more technology education needed before the US falls behind....
How electronic records reach your doctor – Integrated through the Hospitals
EHR Adoption Remains Off in the Distance – Getting way to complicated
Clinical Trials in the US – Begin involving the physicians and patients at the point of care to achieve greater success and participation with Personal Health Records
Microsoft Technology Centers – Software Solutions with Assistance and Guidance
Common User Interface – Update and walk through video
Healthcare leaders favor personal networks (Personal Health Records) to RHIOs for data exchange
Social Security likes PHRs too – wanting to work with EMR and PHR software with pilot program

Computer technology can cut into personalized patient care with complexity and complicated user interfaces

Personalized medicine will rely on IT – It’s all about Software

Scripps, Navigenics, Affymetrix and Microsoft team on groundbreaking health study – Personalized Medicine

EHRs need Standard Templates – So Let’s Look at the Common User Interface Project, a lot of the work is already in progress and partially completed

Common User Interface – EHR Development Work in Progress

Selling the bitter EMR pill (HIMSS meeting) ...IT and IS, CIOs and CEOs...Quit Chopping Trees to find the answer...

FDA scientists plea for agency reform – Technology will help with Transparency

One of the real benefits of technology is that with software, 10 people can collaborate and review the same files, big breakthrough or surprise here?  Of course it is and with having transparency instead of a paper folder tucked away somewhere, this will do wonders.  Managers and scientists alike will be able to collaborate and know what the other is doing at all times, like a nice Share Point Server can do. 

As reported earlier this year some reports were still being written in longhand on paper!  You can see my somewhat sarcastic call out to Intel below to get all the folks at the FDA some “classmates” (inexpensive computers) that would be affordable if money and budgets were the issue (grin). 

Collaboration and Transparency are the name of the game today and it involves everyone using technology, like it or not, it’s part of the world we live in today.  BD 

From a post earlier this year:

Next bunch, the FDA, they too were writing studies up long hand up until not too long ago and I can reflect back on a somewhat sarcastic comment I made in February about helping the FDA with some inexpensive "Classmate" computers from Intel.  It is absolutely amazing what folks "don't" and "won't" work with.  So, now we have 2 entities still writing up studies and results in long hand, doctors wrote them up that way, FDA analyzes and wrote up a long hand report, so what's up with this!  Sounds like we have a 2 part issue here.

And one more: 

On a prior post it was noted that the FDA needs some new technology...as the article states that key employees were still writing these things out in longhand...on paper...as technology continues to grow, those in responsible positions could certainly benefit with some technology updates, at least with hardware for a start...

Hello Intel...anybody listening...maybe Craig Barrett...could we get some Classmates over there to help out??  BD

The scientists say managers have demanded and intimidated FDA scientists to manipulate data, the Wall Street Journal reports, and honest employees can't act with integrity without fear of reprisal. "There is an atmosphere at the FDA in which the honest employee fears the dishonest employee," the letter states. The scientists say they've taken their concerns to Commissioner Andrew von Eschenbach and others, but no action was taken.

FDA scientists plea for agency reform - FiercePharma

Related Reading:

Medicine is a Low Tech Business - Clinical Studies still done on paper too!

FDA Head: We're Boosting I.T.

Study Calling For Medical Device Information To Better Serve Patients And Doctors from the FDA

Teva to Distribute Three Rosetta Genomics Cancer Diagnosis Tests in Israel and Turkey

If you read my interview with Rosetta earlier this week, you will know how important these tests are in diagnosing “cancer of the unknown primary” imagewith lung cancer tumors.  In case you missed it, here’s the link below:

Rosetta Genomics Interview – microRNA for Diagnosing Lung Cancer Tumors

Rosetta Genomics – Today I had the opportunity to speak with and interview Ronen Tamir, Chief Commercialization Officer, at Rosetta to find out how microRNA is helping diagnose and treat cancer. 

miRview™ squamous is a microRNA-based molecular diagnostic test that accurately differentiates squamous from non-squamous non-small cell lung cancer (NSCLC).

miRview™ mets is a microRNA-based molecular diagnostic test that identifies the tissue-of-origin of metastatic tumors.

miRview™ meso is a microRNA-based molecular diagnostic test that differentiates malignant pleural mesothelioma from peripheral adenocarcinomas of the lung or metastatic carcinomas involving the lung pleura.

The tests are making it able to locate the source of cancer for many patients where the diagnosis has never been found and will lead to better coordinated treatment plans for lung cancer.  BD

NEW YORK (GenomeWeb News) — Rosetta Genomics has inked an agreement under which Teva Pharmaceutical Industries will distribute three of the company’s microRNA-based molecular diagnostic cancer tests in Israel and Turkey.

Rosetta Genomics Chief Commercialization Officer Ronen Tamir said that because Israel has provided its citizens with health insurance under the National Health Law it is “a very attractive market,” adding that Turkey is “a country with significant market potential.”

GenomeWeb News: Teva to Distribute Three Rosetta Genomics Cancer Dx Tests in Israel, Turkey

TrialX.org – Clinical Investigator Sign up Now Available – Integrates with HealthVault and Google Health PHRs to locate available clinical trials based on health records

As the project has been progressing, the site is now open for investigators to sign up. The related reading section below will give more details on how TrialX will work with the PHRs to find a trial that is suited for you, based on your health records.

You can also do a general search from the widget on the blog as well, but the benefit of using the PHR records is that is will cut to the chase and find those that are a true fit and the software will initiate the formatted letters and correspondence with the investigators, so less work for the other end as well and the investigator will have all your information up front, when you decide to make contact. Investigator submissions for sign up will need to be verified. The website also has alerts for both sides that can be customized for notifications. BD

From the website:
image
Why create an account on TrialX?
  • Specify your clinical trials
  • Communicate with potential participants for your clinical trials
  • Get statistics on your trial views and matches
Listing of your trials on TrialX is completely FREE!

TrialX allows any clinical trial investigator to sign up and make their clinical trials available to Internet users. In this help section, we provide answers to commonly asked questions for the Investigator Sign Up page.

What does Institution Name Field Mean?

We require that you provide us information about the organization/institution that you are affiliated with and under which perform your clinical research work.

What if I'm affiliated with multiple Institutions?

We require only one institution during Sign Up. You can add multiple institutions for all your trials, anytime after you signup.

I cannot find my Institution name in your list. What do I do?

TrialX allows investigators to enter any institution that they are affiliated with. Simply click on the institution field section and enter your institution. The "Find institution" listing is only meant to save your time in entering your institution information.

Why does it say that my username xxx@yyy.com is already taken

Your account already exists on TrialX. You may have registered before and we provide only one account per email. Please go to Forgot Password page and we will email you instructions to recover your password.

Why do you require my institution email address as username?

We allow any email address as the username but providing your institution email address will help us verify your affiliation with the institution and expedite the process of approving your listed trials. We strive to provide potential participants with accurate information and need to verify the investigator submissions.

TrialX.org - Connecting Participants to Clinical Trial Investigators

Related Reading:

Clinical Trials and Personal Health Records – New Resources on the Medical Quack

Clinical Trials in the US – Begin involving the physicians and patients at the point of care to achieve greater success and participation with Personal Health Records
Study Predicts Big Savings from PHRs (Personal Health Records) – Best Kept Secret in Healthcare?
Are electronic and personal health records inevitable? – Sure they are but we need education and mentors to make it work!
Surveys Said: Hospitals Cutting Back on I.T. – Time to Get your PHR
Technology “It’s for Those Guys Over There” said the CEO – I Don’t Do Digital Notes
Changing Paradigms – Personal Health Records Showing Real Value – Ask Aetna

Zoom (ZIPI) Add in for Microsoft Outlook – Zoom Address Book in Outlook

It has been a while since I have posted about software that I like and use.  This has to be one of the biggest time savers for locating individuals.  When sending an email, after you have installed the add on, a new screen will appear.  The first tab does a search through your Outlook Contacts, and in the image below, I did a simple look up for myself.  ZIPI for Outlook creates an entire index of all your contacts in Outlook as well and they are NOT shared with what is on the web.  Additional professional services are available for companies as well. 

image

image

Now the second tab will use the web to find me and my Zoom profile is not complete yet for searching other than the blog, but it did find another Barbara Duck, but anyway you get the idea here, as it will mine the web for you in Zoom.

image

Now I did a search by occupation, typed in doctor and had over 400 entries appear, and of course you would want to filter more than this, and this was only done for a demo.

image

But if I wanted to email any of them, the email addresses are ready to go.  Great way to find additional business people in Zoom.  This sure makes it easier to have it contained in Outlook rather than having to go to the web for a quick look up.  BD

 image

http://www.zoominfo.com/

California Supreme Court bans ER 'balance billing'

This is good news for patients in not having to battle the insurance companies, but perhaps not so good for the doctors, as the president of the CMA (California Medical Association) states below, I guess I have to go to court.

But when you look at this, it should not be a battle between doctors and patients to begin with, it’s the other party, the insurance carriers who imagecreated the situation.  With contracts getting lower all the time and the need to almost have an attorney these days to interpret what is covered and for how much, how can anyone win here.  Similar battles with payments from insurers are going on in Massachusetts with Tufts getting ready to end their contracts with Blue Cross, so it’s back down to “will  someone please pay this bill”. 

Will Greed lead to Meltdown of the Health System?

Health Insurance Reserves – How much is in the till, could it be 1 or 2 trillion nationwide?

I certainly want to have a physician available to take care of me, and yes I feel he/she should be paid for their time too, but when complicated algorithms or formulas are run after the fact, like a Monday morning quarterback of sorts, how can you win?   Sure, there could be room for errors and those issues should be looked at, but again it’s the risk management formulas that tend to be ruling healthcare today and not the pursuit of better healthcare.  If the HMOs contracts were not so low on compensation and complicated, then none of this would have probably ever taken place.  BD

The California Supreme Court ruled Thursday that emergency room doctors can’t bill patients when their health plan doesn’t pay enough to cover their bills.

In an unanimous ruling in Prospect Medical Group v. Northridge Medical Center, the high court said the matter must be resolved between doctors and patients, therefore prohibiting doctors from “balance billing” patients to recover their costs.

Gov. Arnold Schwarzenegger, whose Department of Managed Care issued regulations last year banning the practice, applauded the court action. So did the HMO industry. Doctors blasted it for forcing doctors and hospitals to eat the cost of emergency medical care HMOs refuse to cover.

“As a trauma surgeon, my No. 1 priority is to save lives and protect the health of my patients,” CMA president Dr. Dev GnanaDev said in a press release. “This court ruling basically says if I do my job as I see fit and HMOs don’t want to pay, tough luck, go to court. I signed up to be a doctor, not a lawyer.”

State Supreme Court bans ER 'balance billing' - Sacramento Business Journal:

Related Reading:

Desperate Hospitals – Updated November 21, 2008
Hospitals Put Patients' Debt Up for Auction
Judge Rules on Balance Billing in California – Physicians not be able to balance bil
Health Care Insurers Suggest Algorithms and Business Intelligence solutions to provide health insurance solution
Doctors fight balance-billing ban on out-of-network costs to survive
Medical Bills You Shouldn't Pay - The balance billing issue is alive and well
Will Greed lead to Meltdown of the Health System?
California Health Insurance Companies Spend $10.3 Billion On Administration And Profit
Insurers' reserves criticized

Atlanta Hospitals to Grady Memorial – Can’t Help as we have our own issues

They did come to the table with some ideas, but the five other other hospitals said no to a tax to help out.  The related reading has some past articles about the history of recent and financial struggles of Grady Hospital in Atlanta.  BD

Metro Atlanta hospitals turned down Grady Memorial Hospital’s request for $30 million over five years to help the safety net hospital imageoffset its ballooning indigent care tab.

On Dec. 15, Grady made its case for more support before top industry executives at a private meeting hosted by the Georgia Hospital Association (GHA). The hospitals sent Grady a letter on Jan. 6 to give their decision.

In the letter, obtained by Atlanta Business Chronicle, area hospitals disputed Grady’s assertion that they steer uninsured and underinsured patients to Grady.

“Our own internal data shows that in these troubling economic times, all hospitals throughout Metropolitan Atlanta are shouldering the growing burden of treating those who cannot pay,” the letter noted.

Metro Atlanta hospitals, in the letter, made clear they would oppose a new tax on them, but offered Grady help in other ways, including creating a “community indigent care consortium” to direct funds and other assistance to major Grady cost centers such as outpatient dialysis and radiation therapy.

Hospitals dismiss Grady's $30M request - Atlanta Business Chronicle:

Related Reading:

Human error to blame for Grady data breach

Nonprofit Hospital Battles to Protect Tax Exemption

Grady to other hospitals: Take your share of poor patients

Kaiser Permanente will donate $5 million to Grady Memorial Hospital - more desperate hospitals

Desperate Hospitals - Grady's financial cure in question

Grady Hospital Woes Hit Big Screens

Portrait of an ER at the Breaking Point

Harvard Physician Suggests Getting a Personal Health Record Account

Until all health care facilities are electronically connected, a PHR is the common denominator that will get the job done for you and your doctor. BD

What you can do to get personalized medical treatment - Howard E. LeWine, M.D., Harvard Medical School

image

Even with the limits that I describe, you and your doctor can very much personalize your medical care. Organizing your medical information is really the first step toward personalized medicine. An increasingly popular way to have your medical information in one place is to create a Personal Health Record. Google, Microsoft, and several insurance companies offer this service for free. This is your record and cannot be viewed by anyone without your consent. You decide who has access to your medical information.

How to keep the “Personal” in Personalized Medicine | Gather

Health Insurance Reserves – How much is in the till, could it be 1 or 2 trillion nationwide?

This is only one branch of one insurance company in Maryland, but it does make you wonder if all the “reserves” of all healthcare insurance companies were all added together nationwide, how big of piggy bank would we have? The story states this group sits on 1.7 billion.  There are even laws around that supposedly govern the amount of “reserves” to be on hand to keep a company from being insolvent, but that didn’t help AIG recently and with today’s state of affairs is there any guarantee, maybe ask Wall Street?   The Dow Jones employees were given a wage freeze today.

From a post last year, 3 carriers in the state of Washington found this group of 3 carriers had 2.2 billion and that was in the year 2006 so there might be a good chance the bank roll has increased a bit.  image

Insurers' reserves criticized

Update:  2 consumer groups disputing and want financial information relative to health care insurers in Washington...as the study finds 2.2 billion in cash surplus...if this is true I don't even want to think about how much California insurers might have.....insurers claim the figures are not correct...BD 

Anyway, just something to ponder and think about if all “reserves” for all health insurance companies across the US were lumped together, how much money just sits there, as it is not operating capital, or dividends paid to stockholders either, but there must be enough of a cushion as Blue Cross had enough to start a Venture Capital firm lately and I don’t see any insurers volunteering any relief funds to perhaps help out some of the charities that were recently hit by the Madoff Ponzi scheme.  I read somewhere too that these funds could be used to help out financially in the case of a world wide bird flu breakout. 

Beware of Geeks Bearing Formulas

Desperate Hospitals – Updated November 21, 2008

I write and read about so many having problems getting their needs met, those who have insurance, not to mention the non insured in this case that exist in growing numbers as well.  Hospitals are going broke and having to put their debt up for auction in some areas as they are not recession proof, they cut employees, cut back on purchases, expansions, and other areas, but the piggy bank never gets tapped.  Does risk management completely run healthcare?  Scary, but it sure looks like this is getting to be the case and it gets stronger every year.  Are there any algorithms around that might give us some transparent information?  Algorithms and Whistleblowers are still two hot words today in healthcare, hotter perhaps than they should be.  BD   

Physicians, health care advocates and government officials in Maryland and Washington, D.C., have long questioned the level of CareFirst BlueCross BlueShield's reserves.

Now Maryland's insurance commissioner will try to get an independent ruling on whether the plan's rainy day fund is more than is necessary for a rainy day. According to its most recent filing with the National Assn. of Insurance Commissioners, the company had nearly $1.7 billion in reserve.

Commissioner Ralph Tyler in December 2008 said his office would issue a request for proposals soliciting an audit of the reserves and hoped to have someone working on the project in early 2009. There is no word on when the audit would be complete.

AMNews: Jan. 5, 2009. Maryland insurance commissioner seeks audit of CareFirst reserves ... American Medical News

Related Reading:

Health Insurance feeling the pinch, well a little pinch

Madoff Scam Hits Harvard Medical School Grants and affiliate Beth Israel Medical Center

Wall Street Greed and Fraud Hits Boston Hospitals and Healthcare - donors bilked out of millions

Blue Cross/Blue Shield of Massachusetts reports $57.6 million profit for the 3rd quarter
BlueCross BlueShield Create New Venture Capital Organization
Health insurers reinvent themselves as money managers – Banks
California regulators to audit health insurers
Blue Cross Blue Shield starts new bank for customers

Insurer's Reserves Criticized
Private health insurance study finds disparity between profits, coverage
The 2 New Hot Words in Healthcare: Algorithms and Whistleblowers
Desperate Hospitals – Updated November 21, 2008
Hospitals Put Patients' Debt Up for Auction