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FDA and Nestle May Not Be Agreeing on Transparency – Cookie Dough Update

6/26/2009 12:05:00 PM  ,  

We live in a world today where transparency rules and by not working together creates issues such as this story seems to relate.  image

Cookie Dough – Don’t eat even if you bake the FDA Says

I still say we need automated reporting on this through the FDA and have written about it many, many times on this blog.  It won’t cure all but will keep everyone on the same path with achieving safety goals with food and drug processing to send an inspection report automated to the FDA.  We still seem to be so wrapped up in calling Cheerios a drug though, a distraction perhaps.  There’s a widget on this page showing the peanut butter recalls and contamination that was created to warn consumers, so maybe some pro-active instead of reactive technology could come to the rescue here and allow FDA inspectors the ability to better organize their priorities too on what could be deemed urgent inspection situations, business intelligence for safe food and drugs.  Having a bank of servers collecting company audit information on safety before batches are released and packaged could save both time and lives.  BD

FDA May Need Major Restructuring – Catch up with Technology

Inspection reports from a Nestle USA cookie dough factory released Friday show the company refused several times to provide Food and Drug Administration inspectors with complaint logs, pest-control records and other information.
The records, which date back to 2004, were made public after Nestlé's Toll House refrigerated, prepackaged cookie dough was discovered to be the likely culprit in an E. coli outbreak that has sickened 69 people in 29 states, according to the latest estimates from the federal Centers for Disease Control. The CDC is investigating the outbreak along with the FDA.

The FDA conducted two inspections in 2007. The first in February detailed six minor issues, including tools and equipment being stored in a hand washing sink in the Toll House preparation area, a water leak from the same sink and a hole in a steam line.
In November, the FDA returned to the facility to check to see if those issues had been corrected. During that inspection, the company refused to allow inspectors to photograph anything and also did not allow any review of production records or complaint files as per the company's policy.

Nestle refused FDA information, reports show - Los Angeles Times

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Mayo Clinic - Reducing Tumors with Hormone Therapies Before Surgery for Prostate Cancer

6/26/2009 11:45:00 AM  ,  

Tumors with 2 individuals who didn’t have many other options were treated with a hormone process called androgen ablation at the Mayo Clinic which removes testosterone and radiation.  Both men are now cancer free, a miracle for the 2 who’s cancer was spreading into their abdominal areas.  Again, this was a study of only 2 individuals but certainly shows some real progress.  Treatment came first and then surgery and the comments from the surgeon somewhat speak for themselves as he had a hard time finding the cancer.  image

If this type of therapy can work on other types of cancers, it appear we are seeing some remarkable progress in the battle to cure cancer.  BD

For years it’s been medicine’s Holy Grail — a cure for cancer. Doctors at the Mayo Clinic aren’t saying they’ve found it, but they think they may be getting close.

Two patients whose prostate cancer had been considered inoperable are now cancer-free, doctors say. The men were treated using an experimental drug therapy that was used in combination with standardized hormone treatment and radiation therapy.

The men were participating in a clinical trial of an immunotherapeutic agent called MDX-010 or ipilimumab. In these two cases, physicians say the approach initiated the death of a majority of cancer cells and caused the tumors to shrink dramatically, allowing surgery. In both cases, the aggressive tumors had grown well beyond the prostate into the abdominal areas.

"The tumors had shrunk dramatically," said Dr. Michael Blute, Mayo urologist, co-investigator and surgeon, who operated on both men. "I had never seen anything like this before. I had a hard time finding the cancer. At one point the pathologist, who was working during surgery, asked if we were sending him samples from the same patient."

Mayo Clinic Announces Cancer Cure Breakthrough

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I Robot (Soundtrack) – DaVinci Robotic Prostate Surgery Show

Quality of Life for Prostate Cancer Patients Study Released from UCLA Jonsson Cancer Center

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Oracle Moves to Cloud Computing with Software As a Service

6/26/2009 11:28:00 AM  ,  

With the recent acquisitions to include Sun Microsystems, the company certainly has many options and ways to go with this.  Oracle has been known for growth over the years by purchasing and bringing software companies into the fold.  This article makes reference to comments made last year, perhaps before the entire cloud situation was understood and it’s potential.  With virtualization, it’s an entire new ballgame here and healthcare is right up there in the forefront.  Amazon and Microsoft are 2 big competitors in the cloud business.  image

Cloud computing take a bit of planning and engineering to bring several platforms together for the ultimate end result.  BD

Following his outburst against cloud computing last year, it appears that Larry Ellison has warmed up to the cloud computing model, if not the buzz phrase itself. Oracle's CEO yesterday said it's a goal to become the software industry's "number one on-demand application company."

Ellison last year lambasted cloud computing, referring to the hype around it as "idiocy," "gibberish," and "crazy." As I pointed out at the time, however, Oracle was moving into cloud computing even as its leader railed against it. During a conference call yesterday with analysts to discuss Oracle's financial results, Ellison provided evidence that Oracle is indeed making progress on this front and has ambitious goals in the software-as-a-service market.

"We think we can be the number one applications company, the number one on-premise application company, and the number one on-demand application company. That's our goal," he said.

Oracle Moves A 'Little Bit' Into Cloud Computing - Plug Into The Cloud - InformationWeek

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Oracle Adds Life Sciences Software Company – Conformia

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Steve Jobs – Why Does His Health Need to be So Tightly Tied to the Stock Market and the SEC

6/26/2009 11:11:00 AM  ,  

With the focus on the economy today, this is a prime example of where some of our heads seem to be today, in the money cloud perhaps instead of imageshowing a little compassion and humanly concern.  Sure, when you are in a public position there are demands and some loss of privacy, but when you look at what happened yesterday with Michael Jackson, these are real people who have stress too.  Does anyone realize that the press and opinions in the press have an effect on the individual?   When Mr. Jobs became ill, was it the interest in his well being or the SEC wanting an inquisition that took center stage?  

The SEC Probe and Steve Jobs – Inquiring Investors?

We live in a world today of transparency, but demand privacy when it comes to healthcare, so can we perhaps entertain taking Mr. Jobs off the chopping block here and allow some human dignity as he has some very serious illnesses that don’t need to be played out into a circus for investors as it’s hard enough to focus on getting well for anyone.  Maybe he needs a PHR to decide what to share as he desires to keep everyone at will?  He would definitely be a first in this area too as I don’t see any other role models stepping forward that preach to us about transparency.  In the meantime, can we leave him alone and focus on what he’s doing now that he is returning to work instead of his health?  BD

Steve Jobs’ health is the center of a discussion about CEO privacy — again! And once again it is a divisive issue. Doubt me? See the comments on my friend Joe Nocera’s post. They say he hates Jobs, that he is using his illness for his own publicity and worse. Many claim to be Apple investors, saying that because they are fine with what Jobs is doing, Nocera should be.

And people wonder why they lose money in the stock market …

CEO privacy on health matters is typically complicated. Putting personal issues aside, a CEO that goes into too much detail about his health problems can unnecessarily undermine his ability to lead. If a CEO is hospitalized for an asthma attack do his investors have a right to know? Untreated asthma attacks kills people all the time. I side with the privacy advocates on that one.

When Will Steve Jobs Level With His Investors About His Health? | Epicenter | Wired.com

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Laptops in Canada Stolen with Medical Information on over 300,000 patients – Security Breach

6/26/2009 10:44:00 AM  ,  

This appears to be the story of the week.  I wonder how much longer employees will be able to download and use local patient records without connecting to a secured server, where your odds are much better as far as security.  The records were not encrypted.  Granted, there are problems all over, but those associated with hardware can be prevented.  Last week it was Blue Cross shipping paper too, with charts and information being sent to an individual who had no idea why she received them and called authorities.  and I thought they were paperless!  image

There are also situations like this one below, where the time was taken to encrypt, but the passwords were taped on the drives, duh!  Something to think about if you are transporting medical information around on a USB drive.  There’s a huge need for education with security in all areas.  BD

If You Take the Time to Encrypt Medical Information – Don’t Tape the Passwords on the Container or Flash Drive – NHS Security Breach

Don’t Lose that USB Drive – Microsoft Office Live Video

ALBERTA, CANADA – Two laptops containing the health information of more than 300,000 people were reported stolen from Alberta Health Services, leading the information and privacy commissioner of the Canadian province to question the organization's level of security.

The laptops were stolen from a research lab at the University of Alberta Hospital earlier this month, according to the Edmonton Journal.

Information on the laptops included names, birth dates, personal health numbers and lab test results for communicable and reportable diseases that reportedly were not encrypted.

Canadian commissioner questions security following laptop theft | Healthcare IT News

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Medical records in Garbage Truck and Landfill – Baptist Medical Center in Alabama

USB Memory Stick Round 2 – More Medical Record Information on a Lost Drive
Security tightened over data loss – Flash Drives Can be One of HealthCare’s Biggest Nightmares
Healthcare Workers Sharing Music and they could also be sharing Medical Records and Files
Medical records turn up online – MRecord transcription services

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Sanofi Patent Protections Expiring – Looking to Joining the Generics

6/26/2009 10:26:00 AM  ,  

Just recently Johnson and Johnson stated they too were considering selling branded generics abroad overseas.  I think with technology and drug R and D being on the fast track, patents today and in the future may not enjoy the same time frames as have been granted in the past, again due to economics and getting more affordable drugs to the market place.  The generic manufacturers are getting a bit more aggressive with their challenges as well as seen with this recent post with Teva challenging Merck with Singulair.  Teva has even generated a video about the subject.  BD image

Merck and Teva Go to Court over Singulair Going Generic

Another large drug maker is poised to expand its generic medicine business. This time it’s French-based heavyweight Sanofi-Aventis that wants to sell more in generics, particularly in the faster-growing emerging markets, writes the WSJ. As part of this push, it recently bought two generic-drug companies in Latin America, and a Czech generics maker Zentiva last year.

Like others in the industry, Sanofi faces the loss of patent protection on key products, including its lucrative anti-clotting drug Plavix, which brought in $8.6 billion in sales for it and its partner Bristol-Myers Squibb last year. Thus, Sanofi is set to reorganize its generics business and is following through on previously signaled cuts to its R&D spending as well.

Sanofi to Dive Further into Generic Drug-Making Pool - Health Blog – WSJ

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Death of teen may help inspire national law with MRSA – Why Not Inspire National Technology Too?

6/26/2009 10:05:00 AM  , ,  

The law requiring screening of patients for MRSA is a good idea, but only half the battle.  Not too long ago I wrote about a technology solution so I guess the paradigms of incorporating technology into healthcare are still so very slow to be adopted.  This technology gets everyone to “wash” their hands. image

So the solution in my opinion needs more teeth, in other words, part 2 to have real success as part one alone with a law is only a band aid.

Real Time Monitoring of When you Washed your Hands – Don’t Touch that Patient Until You Have Washed Your Hands

 
“When the employee comes within 2-3 feet of a patient bed,  a proximity sensing bed monitor wirelessly verifies that the healthcare worker badge is illuminated.  If the badge is not illuminated when it comes into the proximity of the bed monitor, the badge vibrates a reminder to the healthcare worker to wash their hands. The illuminated green LED light gives the patient "peace of mind," knowing that the healthcare worker’s hands have been washed.”

We appear to still be on the long path of learning the art of collaboration and still of the opinion that laws will be the fix.  This is one of the reasons we need the “smart” people in high places that can see beyond just creating laws and embrace more of an encompassing solution.  If the hospitals can’t afford the solution to washing hands, how are they going to afford the end result, and we all lose at that point with 43% of the hospitals in the US operating in the red.  UCI certainly got the hint with their new facility with sinks located everywhere and the monitoring system added on would one big plus to enforce for both clinician and patient safety.  BD

After 15-year-old Nile Moss died at the Children’s Hospital of Orange County-Mission from a drug-resistant staph infection, his mother dedicated herself to changing the rules for how hospitals screen for the infection.

Nile’s Law was passed in California in 2008, and now Carole Moss is in Washington to show her support for recently proposed national legislation that would require hospitals to screen patients entering high risk units, take additional precautions to prevent the spread of the methicillin-resistant Staphylococcus aureus (MRSA), and report institutional infection rates.

Death of O.C. teen may help inspire national law - Total Buzz - OCRegister.com

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First it was the Ties and now go the White Coats for Doctors

Real Time Monitoring of When you Washed your Hands – Don’t Touch that Patient Until You Have Washed Your Hands

Economic woes cause hospitals to skimp on infection prevention – Funds and Money Required

Hand Washing Secret Shoppers Patrol the Hospital To Help Prevent Never Never Events

Germ-Zapping Keyboard – for use in Hospitals to help prevent the spread of MRSA, C Diff, and other bacterial infections

Stuffing Paper Hospital Gowns in Gloves helping reduce the spread of MRSA

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We Lost Michael Jackson (Rest in Peace) – Overdose?

6/26/2009 01:10:00 AM  ,  

This has been one sad week for Hollywood and now Michael Jackson, sad and he will be missed as he was an icon in the entertainment world.  Another article said he was dancing and practicing last night, rehearsing for his tour.  He didn’t show until 10 when 7 was the time scheduled and the report stated he was “listless”, but those at the Staples Center where the rehearsal was held said that was normal.  BDimage

Life & Style reports that Michael Jackson was taking a cocktail of up to seven prescription drugs in the months before his death. 

The star had been taking prescription painkillers including anti-anxiety drugs Xanax, Zoloft and painkiller Demerol in recent months, sources close to Jackson told Life & Style. The insider close to the star said he took a suspected overdose of drugs on Thursday morning, which caused respiratory and cardiac arrest.

And a Jackson family lawyer told CNN he "feared" the drugs could kill the pop star. CNN's interview with the source follows the jump. The cause of his death is still unknown, but an autopsy is scheduled for this coming Friday afternoon. Michael was transferred from UCLA Medical Center to the coroner’s office via a Los Angeles Sheriff's helicopter shortly after 6pm

Report: Overdose of prescription drugs may have killed Michael Jackson - Kansas City Star

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Farrah Fawcett Passes Away after long battle with cancer

6/25/2009 03:00:00 PM  ,  

Not only did she have a battle with cancer but fought for her privacy too at UCLA.  She fought back a few years ago only to have the cancer return.  BD

Farrah Fawcett’s death today after a lengthy battle with anal cancer, which eventually spread to her liver, spotlights a rare type of the imagedisease.

Anal cancer will strike an estimated 5,300 Americans and cause 710 deaths in 2009, according to the National Cancer Institute. One in 624 men and women will be diagnosed with cancer of the anus, anal canal, or anorectum during their life, which translates to a 0.16% lifetime risk of anal cancer.

It is distinct from — and much less common than — colorectal cancer. Nearly 150,000 Americans are expected to be diagnosed with colon or rectal cancer this year, and about 50,000 will die. One in 19 Americans will be diagnosed with colon or rectal cancer. The five-year survival rates for the two diseases are similar, however, at around 65%.

Farrah Fawcett’s Death Spotlights Rare Cancer Type - Health Blog – WSJ

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Farrah Fawcett Speaks Out About the Lack of Privacy at UCLA

FAWCETT FORGIVES MEDICAL RECORDS LEAK LADY

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U.S. Marshals Seize Generic Drug Products Manufactured by Caraco Pharmaceutical Laboratories Ltd.

6/25/2009 02:39:00 PM  ,  

The company manufactures generic drugs such as equivalents for Fosamax, Zyrtec, Vicodin, to name a few.  The notice also stated that diabetes medicine metformin, and the pain reliever tramadol are safe to continue and that all defective drugs they feel have been seized.  The factory is located in Michigan.  BD 

U.S. Marshals, at the request of the Food and Drug Administration, today seized drug products manufactured by Caraco Pharmaceutical imageLaboratories Ltd. (Caraco), at the company’s Michigan facilities in Detroit, Farmington Hills, and Wixom. The seizure also includes ingredients held at these same facilities. “The FDA is committed to taking enforcement action against firms that do not manufacture drugs in accordance with our good manufacturing practice requirements,” said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research. “Compliance with these standards prevents harm to the public.”

This action follows Caraco’s continued failure to meet the FDA’s current Good Manufacturing Practice (cGMP) requirements, which assure the quality of manufactured drugs. Through this seizure, the FDA seeks to immediately stop the firm from further distributing drugs until there is assurance that the firm complies with good manufacturing requirements.

Since January 2009, Caraco has initiated voluntary recalls of drug products to protect the public from potentially defective medications. The recalls involved manufacturing defects, including oversized tablets and possible formulation error.

Seizure of drug products is an effective remedy when there is evidence of continued poor compliance with cGMPs. Following a drug product seizure, companies often agree to a wide range of changes and improvements to their drug manufacturing practices at their facilities.  The FDA has determined that the seizure of Caraco's drugs may create a shortage of one product, choline magnesium trisalicylate oral tablets, which are commonly used as pain relievers.

U.S. Marshals Seize Drug Products Manufactured by Caraco Pharmaceutical Laboratories Ltd.

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Integrative Oncology Care – UCLA Jonsson Comprehensive Cancer Center Opens

6/25/2009 01:26:00 PM  ,  

NEW CENTER PROVIDING INTEGRATIVE ONCOLOGY CARE OPENS AT UCLA’S JONSSON COMPREHENSIVE CANCER CENTER

This looks to be a great idea with family interests and help involved as well as the patient.  In just looking around the website, there seems to be everything from supplements to community groups.  Additional information can be viewed here on video.  BD 

A new center providing leading-edge integrated care to cancer patients and their families launched today at UCLA’s Jonsson Comprehensive Cancer Center, offering such services as art therapy and QiGong, one-on-one and group counseling and advice on nutritional, spiritual and complementary approaches to healing.image

            Formerly the Ted Mann Family Resource Center, the Simms/Mann-UCLA Center for Integrative Oncology is designed to help patients and family members optimize wellness and assist them in dealing with challenges during and after their cancer treatment. 

“Cancer affects the mind, the body, the soul and the emotions. At our new center, we are committed to treating the whole person, not just the disease,” said Anne Coscarelli, a psychologist and the center’s founding director. “A cancer diagnosis should not be faced alone. Everyone needs information, guidance and support during treatment, recovery or recurrence.”

Most patients, Coscarelli said, want to feel as well as they can despite the challenges that come with a cancer diagnosis. Patients also often want to combine modalities and need the most accurate information available about nutrition, supplements, mind/body approaches and psychological concerns.

            Dr. Mary Hardy, the center’s medical director, advises patients on nutrition and dietary supplements and can suggest complementary therapies such as massage and acupuncture. She evaluates each patient individually and tailors her advice based on their lifestyle, treatment regimen and emotional and physical condition.

“When patients develop cancer, everyone offers advice. They often get overwhelmed and confused and that’s stressful,” Hardy said. “I’m here to be a reliable, authoritative source of information about the staggeringly broad array of dietary supplements and alternative therapies available today.”

Prior to seeing Hardy, patients fill out an extensive, seven-page questionnaire that covers everything from their lifestyle, stress levels, food supplements and family medical history to their sleeping habits. Hardy reviews the questionnaires and the patients’ medical records prior to seeing them. In visits that last between 75 and 90 minutes, Hardy offers advice on how to get through treatment and prevent cancer recurrence.

            That’s exactly what Robert Flutie was seeking when he showed up at the Simms/Mann center after his diagnosis of Stage II Hodgkin’s lymphoma in December. Once there, he had private therapy sessions with a counselor who was a lymphoma survivor and could relate to what he was going through. Before he started chemotherapy, he met with Hardy, who gave him nutritional advice and suggested vitamins and supplements that would help restore cellular energy, guard against infection by helping his weakened immune system recover and protect Flutie against chemotherapy-induced cardiac damage.

            “The people and resources at the center are extraordinarily helpful and invaluable,” said Flutie, 45, a father of three from Pacific Palisades who is president of FLUTIEentertainment, a Beverly Hills-based talent and brand management firm. “The center serves as a bridge that takes a patient from the lonely, frightening world of cancer treatment to the comforting embrace of a community rich with compassion, knowledge, information and caring.”

            Flutie said the center helped make what might have been a miserable experience into one that was much better than he ever expected.

            Spring Verity, 69, also of Pacific Palisades, agrees. Just two months after she lost her husband to esophageal cancer, Verity was diagnosed in September 2004 with both breast and ovarian cancers. Although normally a very private person not inclined to seek assistance, Verity realized this was something she could not deal with on her own.

            “I knew I needed help,” she said, and she sought it at the Simms/Mann center.

            She met with a counselor, who insisted she join a support group for women recently diagnosed with breast cancer. Verity resisted, unwilling to share her fear and acute sadness. The counselor encouraged her and, finally, Verity agreed. It was the best decision she ever made.

            “I absolutely would not have gotten through this experience if not for the people at the center,” Verity said. “I was terrified of chemo and didn’t know what to expect, but the women in the group helped to prepare me. The group also was a safe place to cry. Family and friends want to help, but letting out your emotions in front of them can be difficult. The group offered unconditional support and love and it was immensely comforting to be there.”

            After she finished therapy, Verity joined “Looking Ahead,” a group for women who had completed treatment and had no signs of disease. Although the group disbanded after it had run its course, the women still meet once a month at each other’s homes to keep in touch.

            “The Simms/Mann center was there when I needed it, and I will be forever grateful for that,” she said.

            The center also offers a psychiatry program with a part-time faculty member from the UCLA Department of Psychiatry, who sees patients to evaluate their need for medications. Additionally, beginning in July of 2009, a spiritual support program will provide a chaplain and interns trained in oncology to offer holistic spiritual care to patients and families of all faiths, as well as those without religious affiliation.

            Patient support groups available at the center include:

· Women Together- For women being treated for early stage breast cancer

· DCIS - For women diagnosed with ductal carcinoma in situ

· Living Beyond Limits - For patients diagnosed with recurrent or metastatic disease

· Looking Ahead - For people finished with treatment who have no evidence of disease

· Healing Through Art - To help patients explore and express through art the issues associated with cancer

· Look Good, Feel Better - To help manage physical changes associated with cancer therapy

Support groups and workshops for patients and their family members include:

· Mind/Body Approaches to Coping with Cancer – Teaches patients and their partners or adult family members techniques to help manage stress

· Lung Cancer Support Group - Open to patients with lung cancer and their partners/caregivers

· Meditation: Inner Healing - Employs guided imagery, music, color, and movement to optimize emotional, physical and spiritual well-being

· QiGong - Practice of the ancient Chinese art to restore health and prolong life

· Couples Together - For patients and their partners to explore the experience of cancer, what it means and how it affects their relationships

            Groups for family members and friends of cancer patients include:

· Husbands (Partners) of Women With Cancer - For men/women who live with women diagnosed with cancer to help them support their partners and take care of themselves

· Family and Friends - For friends and family members of individuals with cancer

· Grief Work - For men and women who have experienced a recent loss of an adult family member to cancer

The center also offers Insights into Cancer, monthly lectures for cancer patients. Topics range from traditional Western medicine to complementary approaches, mind-body healing and other coping techniques. Some of the topics that have been covered include the emotions and the immune system, cancer vaccines, environmental exposures and cancer, spirituality and cancer and novel treatments. Additionally, the center runs Reflections, a consultation suite and boutique that offers resources, information and products to help manage the physical changes brought about by cancers and their treatments.

For more information, visit www.simmsmanncenter.ucla.edu/index.asp.

            UCLA's Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2008, the Jonsson Cancer Center was named among the top 10 cancer centers nationwide by U.S. News & World Report, a ranking it has held for nine consecutive years. For more information on the Jonsson Cancer Center, visit our website at http://www.cancer.ucla.edu.

-UCLA-

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Medicare Fraud Arrests – What’s Being Done for the Future

6/25/2009 12:07:00 AM  ,  

Nobody likes fraud, and good to see the law catch up with those that make it difficult for others.  The one item that is finally mentioned here is not having update computer systems to track some of this or prevent it in the first place.  One particular story from last year was the fraud committed by billing with doctors credentials that are dead, obvious crime all the way around. 

The dead doctor issue appears to be something that a data audit function could satisfy, but until the fraud was uncovered, the bills kept coming and got paid.  This is just one more way technology can pay for itself with healthcare.  BD

Probe finds dead doctors used in Medicare scams

Home Medical Equipment Providers Are Appalled by 'Dead-Doctor' Scam


Medicare Fraud Case - CBS News Video

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'Deinstallation' of EMRs in Phoenix – Study

6/24/2009 11:47:00 PM  ,  

This is hopefully not a change in the wrong direction here.  The state of Arizona has been very pro electronic records, but the economy is affecting growth for additional installations, mostly in the small practice offices.   Some of the other reasons for cancelling contracts include training issues along with functionality needs.  If an EMR is installed without proper training, there’s a big chance for failure, that one I can certainly vouch for, as it needs to be done for the entire office staff as it does disrupt the way business has been done, but the rewards are great.  Lack of support can contribute and money needed for support falls right in there too, so in one way or another, it appears to all come back to money.  BD

PHOENIX – The state of Arizona and the Phoenix area have experienced a high adoption rate for electronic medical records, but this has imagebeen followed by a "deinstallation" of the technology, according a report by HealthLeaders-InterStudy.

Physician groups in Phoenix are canceling their EMR contracts as a result of training, functionality or affordability issues. This is especially prevalent among smaller physician groups, the report says.  

The report said "deinstallation" due to financial issues is not unique to  physician groups or to Arizona. For example, in areas like Miami, where the economic downturn is threatening the profitability of hospitals, adoption of EMRs has been slow because of a lack of funding for such capital projects.

Study: 'Deinstallation' of EMRs in Phoenix could be a trend | Healthcare IT News

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Health Insurance Underwriting Practices With Prescription Data – How Does This Work

6/24/2009 09:29:00 PM  , , ,  

Somebody brought up this question the other day on how do insurance companies get your medication information.  The information below goes image back to a post I did about 3 months ago on the two main companies that provide the information for the insurers.  I’ll add a little bit more this time to perhaps explain a little better about the process.  In order to qualify for insurance your medication records get evaluated.  You will need to sign a HIPAA form allowing the company access, otherwise chances are if you don’t, you may not be given approval to be covered, kind of how the process works. 

It was not until recently when the FTC investigated and stated that both companies need to provide a copy of the analysis they provided to the insurer to you, so you could see how your medications were analyzed and if you were in the “red”, “yellow’ or “green”zone, just like a stoplight.  Of course anyone taking cancer drugs sticks out like a sore thumb, so anyone taking some of the drugs will be scrutinized.  Read this next sentence very carefully, you sign a HIPAA statement to give access but that seems to be where HIPAA somewhat begins and ends.

“HIPAA does not give the Department of Health and Human Services the ability to directly investigate or hold accountable entities, such as pharmacy benefit managers or companies such as Ingenix and Milliman, who are not covered by HIPAA.”

You can read the statement from Milliman about Intelliscript here.

image

“Does this process make it more difficult for consumers to get insurance?
No.  There is nothing new about consumers authorizing the release of their medical records, including prescriptions, to insurers.  This standard process has been in place for decades, helping insurers make good decisions about rates and insurability.”

You can read more about Ingenix MedPoint here. 

There’s also a flash presentation where you can view the process here. 

image 

“By increasing understanding of potential disease conditions and relative risk, MedPoint enables underwriters to more accurately project future claims costs on a case-by-case basis.”

Again, I am attempting to share some information here to create an awareness of how this all comes together so consumers are not in the dark.  When you look at the information presented you can see that the big emphasis of course is on cost and this is being calculated with “business intelligence” software with algorithms created for decision making processes.  It is some very detailed data.

The only way to stay out of the radar is to usually get a $4.00 generic prescription filled and pay cash without using a discount or club member card.  This will also come back to potentially haunt your physician though as they undoubtedly get hammered as to why certain patients are not taking their medications.  They hear it all the time when data is not available for tracking and affects their pay for performance bonuses, which most just write off anyway as their primary concern is patient care, big reason why the physician/patient relationship is so important   You can read more at the link below. 

When Pay for Performance and $4.00 Generic Prescriptions Hit the Wall

For information outside the realm of medications, there’s the MIB where most carriers share patient information.

The link below is also very informative with addressing the de-informationing of data in data bases which is being done more commonly today, but also addresses the fact that all it takes is a query connected to another data base to find a match.   That part I know about having written programs and SQL code and it’s not hard to do once you determine which unique identifier column you will need to use from the tables. 

The search for John Doe – Who’s running the queries (Algorithms) and wants to know

Anyway, I hope this answers the question posed on where the information comes from, how it gets used, and most importantly how pharma medication data bases do not fall under the auspices of HIPAA as some may think.  The data bases have been accumulated and updated for years before electronic medical records came around and likewise information from them has been sold as well as giving pharmaceutical representatives the data they need to sell by being able to identify the physicians writing prescriptions and for which drugs.  Now that they represent a valuable module in a healthcare records, it will be interesting to follow the progress and see if rules, laws, regulations and paradigms will change. 

Just like data used in any business today, the data is feeding far more areas and not just used for internal operations, but widely spread through out healthcare and matched and analyzed with other relative patient data that constitutes an electronic medical record.  This is an example of “business intelligence” so if you have heard that term on mining and analyzing data this is one example on how information is used.  BD

Health Insurance Underwriting procedures – Data Mining to Cherry Pick and some are listed on the Web

With the Ingenix story in the news the last few weeks, there are a couple of other data sources out there that are used to mine your medication and health records data. Part of the reason that is is all coming to light is due to the fact the data is now trying to be used in a constructive basis, for good healthcare and with all of this comes out what’s being going on somewhat behind the scenes for years.  The data bases have been sold for years for risk management purposes and do not fall under HIPAA.

Milliman's Intelliscript or Ingenix Medpoint are the 2 big data miners that find out when you apply for health insurance what your medication rap sheet has been for the last 5 years.  By applying for insurance, you sign a release to allow the companies to mine the information, no signature and permission, then probably no insurance will be written for you; however, the release you sign is HIPAA compliant, whatever that constitutes at this point.  

The Medical Quack: Health Insurance Underwriting procedures – Data Mining to Cherry Pick and some are listed on the Web

Related Reading:

The AMA and the California Medical Association file legal suit – WellPoint and Ingenix
Ingenix Publishes Episode Treatment Groups Methodology – Recreating themselves?
The search for John Doe – Who’s running the queries (Algorithms) and wants to know
Prescriptions risk score used to deny health insurance
Prescription Data Used To Assess Consumers - No Privacy Unless You Pay Cash...
What is the MIB - Medical Insurance Bureau - and how does it affect qualifying for insurance?
Health Care Insurers Suggest Algorithms and Business Intelligence solutions to provide health insurance solution
Health insurer accused of overcharging millions – United Health Care/Oxford Insurance 50 Million Fine

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Whales, Turtles and Other Wildlife with Cancer

6/24/2009 08:00:00 PM  ,  

Not too long ago it was in the news that Tasmanian devils have a form of contagious skin cancer working it’s way around.  In this story it talks about more water creatures, turtles whales, etc. that are developing cancerous tumors.  Studies are being conducted to perhaps find the virus that is suspected for causing some of the cancerous tumors, and it appears that polluted water ways are of no help either, but we probably already knew that.  BD

Tasmanian devils threatened by contagious skin cancer

A newly published paper in the July edition of Nature Reviews Cancer compiles information on cancer in wildlife and suggests that cancer poses a conservation threat to certain species. The WCS authors highlight the critical need to protect both animals and people through imageincreased health monitoring.

"Cancer is one of the leading health concerns for humans, accounting for more than 10 percent of human deaths," said Dr. Denise McAloose, lead author and Chief Pathologist for WCS's Global Health program. "But we now understand that cancer can kill wild animals at similar rates." 

Many species living within polluted aquatic environments suffer high rates of cancerous tumors, and studies strongly suggest links between wildlife cancers and human pollutants. For example, the study cites the case of beluga whales in the St. Lawrence River system. These whales have an extraordinarily high rate of intestinal cancer, which is their second leading cause of death. One type of pollutant in these waters—polycyclic aromatic hydrocarbons (or PAHs)—is a well-known carcinogen in humans, and PAHs are suspected carcinogens for beluga whales as well. Fish in other industrialized waterways, including brown bullhead catfish and English sole, also exhibit high levels of cancer.Other virus-induced cancers can affect the feeding ability or eyesight of wildlife. Green sea turtles—a migratory species in oceans across the globe—suffer from fibropapillomatosis, a disease that causes skin and internal organ tumors. A virus is suspected as the cause these tumors, and environmental factors such as human-manufactured carcinogens might exacerbate their severity or prevalence.

Wildlife faces cancer threat

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LabCorp and MyMedLab Connect with Microsoft HealthVault PHR

6/24/2009 06:02:00 PM  , ,  

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Recently I have covered quite a bit about Quest Diagnostics and I thought I should also make mention that Labcorp also connected to the HealthVault.  I am not sure if they connect with Google Health yet, but it would make sense for this to happen if not as 23 and Me uses Labcorp for their sequencing. 

The National Genetics Institute is a subsidiary of LabCorp.  In other related news Labcorp is purchasing Monogram Biosciences, who is in the business of molecular diagnostic products for infectious disease and cancer testing. 

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Laboratory Corporation of America Holdings (LabCorp) and Microsoft Corp. recently entered into a strategic relationship that will enable eLabCorp healthcare providers to electronically export laboratory test results directly to their patients’ HealthVault records.

LabCorp provides leading-edge medical laboratory tests and services through a national network of primary clinical laboratories. The eLabCorp Web-based application streamlines the test order process for healthcare providers by delivering online test ordering and result retrieval capabilities. eLabCorp connectivity with HealthVault will empower LabCorp to provide innovative online services to their patients.

imageOnce test results from eLabCorp are stored in the patient’s HealthVault record, the patient will be able to accurately track historical test results and share that information with treating physicians and people they trust.

 
“eLabCorp is a secure, Web-based solution for test ordering and result retrieval.  With numerous management and tracking features, eLabCorp is designed to work seamlessly with existing office workflow.

The online test ordering capability allows orders to be entered electronically in the provider’s office, saving resources and streamlining the order entry process. Electronic result reports are easy to read and accessible from anywhere a high-speed Internet connection and standard Web browser are available.

eLabCorp integrates with many practice management systems (PMS) for easy retrieval of patient demographics, eliminating the need for reentry of information. This feature saves time and helps to reduce clerical errors.”

You can also use mymedlab who works with LabCorp too and enter your own lab orders with a prescription from your doctor.  BD

Patients can order up their own lab tests on line with MyMedLab.com with a referring physician and you get a free PHR to boot

So now one can order up and set up your time with a local lab, which is referenced on the site and in my area here it listed LabCorp locations as they are listed as a partner. This really is becoming a help yourself world when you need to order up your own lab work and can even pay online.

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LabCorp - Connect with eLabCorp

Related Reading:

LabCorp Takes Over as 23andMe's Genotyping Service Provider

National Genetics Institute Testing Services - Subsidiary of LabCorp....

Read More

Senate Testimony – Insurers Confuse Consumers and Dump Those Who are Sick, a Wall Street Run System

6/24/2009 05:42:00 PM  ,  

I am guessing this is probably a day that Mr. Potter didn’t particularly enjoy since he made a living through health insurance for years, but now that he is no longer an employee, he’s one like the rest of us, but has some good insight that perhaps we never get to see or hear.  We had these words from the president of Blue Cross this week, but again from the same angle, no change in business plans and no compassion for health care as it should be, still healthcare by the numbers.  I see more health insurance money going toward venture capital efforts these days too. 

In one area he somewhat confirms what I have been saying for years, those who invest and use technology take all the money and benefits away from those who don’t, Wall Street and Health Insurance invested heavily over the years with business intelligence software for decision making processes.

Former Health Insurance Insider to Testify Before Senate Commerce Committee

One item that I didn’t quite understand either was the X-Box competition to solve healthcare.  As you can see it’s taking a lot more than a 10 million dollar prize to solve this issue, so in my estimation this was perhaps a bone thrown out to offer money whereby the full answer can’t be realized from Blue Cross.  This doctor has a 65 million dollar prize for the solution to sterilizing cats and dogs without surgery and he said he offered 75 million as 10 was not enough to generate any serious interest.  Interesting note though, the doctor is an animal person who spent many years in orthopedic surgery and probably had some real good insurance battles under his belt helping patients, so thus he knew the dollar amount needed for his project and oddly enough his announcement came the day after the Blue Cross 10 million dollar news.  This post too was run through Fox News on the topic. 

I mention this as a reflection of the lack of sincerity and reality of the organizations we are dealing with.  How could a company think that by hanging a 10 million dollar carrot out there progress would be made, not to mention I think it somewhat insults the intelligence of others who want a serious and solid solution, with transparency and honesty.  image

I like and use technology to the hilt, but when it comes to a choice of having one of these in an office to fill in your medical information or getting people the healthcare they need with paying claims, someone else can foot the bill for the tablets and not require a health insurance venture capital organization investment, there are many more VCs out there.  If claims are paid and people are taken care of, then no problem if there are profits left over, but not the other way around. 

Below are a few excerpts from the testimony today.  BD

A guy who spent his career working for health-insurance companies went up to Capitol Hill today and unloaded on his former industry.

Here’s how he kicked off his testimony (online here) to the Senate Committee on Commerce, Science and Transportation:image

My name is Wendell Potter and for 20 years, I worked as a senior executive at health insurance companies, and I saw how they confuse their customers and dump the sick –- all so they can satisfy their Wall Street investors.

But what we have today, Mr. Chairman, is a Wall Street-run system that has proven itself an untrustworthy partner to its customers, to the doctors and hospitals who deliver care, and to the state and federal governments that attempt to regulate it.

Congress to industry: 'We need your help'

Those goals included covering all Americans; eliminating underwriting practices like pre-existing condition exclusions and cherry-picking; the use of community rating; and the creation of a standard benefit plan. Had the industry followed through on its commitment to those goals, I wouldn’t be here today.

Is This a Case for a New Law – Illegal Algorithms? How Do You Sleep at Night Rockefeller asked the CEO of United Health Care

Because dumping a small number of enrollees can have a big effect on the bottom line. Ten percent of the population accounts for two-thirds of all health care spending.1 The Energy and Commerce Committee’s investigation into three insurers found that they canceled the coverage of roughly 20,000 people in a five-year period, allowing the companies to avoid paying $300 million in claims.

They also dump small businesses whose employees’ medical claims exceed what insurance underwriters expected. All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year’s premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether.

Health insurers Say “No” to limiting rescissions – Congressional Hearings

An account purge so eye-popping that it caught the attention of reporters occurred in October 2006 when CIGNA notified the Entertainment Industry Group Insurance Trust that many of the Trust’s members in California and New Jersey would have to pay more than some of them earned in a year if they wanted to continue their coverage. The rate increase CIGNA planned to implement, according to USA Today, would have meant that some family-plan premiums would exceed $44,000 a year. CIGNA gave the enrollees less than three months to pay the new premiums or go elsewhere.

Congress Plans Incentives for Healthy Habits ,Wellness Programs, and Devices? How Potentially Intrusive and Disruptive Will It Get to Save Money?

There are many ways insurers keep their customers in the dark and purposely mislead them – especially now that insurers have started to aggressively market health plans that charge relatively low premiums for a new brand of policies that often offer only the illusion of comprehensive coverage.

Will Greed lead to Meltdown of the Health System?

The lack of candor and transparency is not limited to sales and marketing. Notices that insurers are required to send to policyholders—those explanation-of-benefit documents that are supposed to explain how the insurance company calculated its payments to providers and how much is left for the policyholder to pay—are notoriously incomprehensible. Insurers know that policyholders are so baffled by those notices they usually just ignore them or throw them away. And that’s exactly the point. If they were more understandable, more consumers might realize that they are being ripped off.

Former Exec: Insurers ‘Confuse Their Customers,’ ‘Dump the Sick’ - Health Blog - WSJ

Related Reading:

How Similar is Wall Street to the Health Insurance Business

Blue Cross President - Government-Run Health Plan In House Draft Bill Would Cause Tens Of Millions To Lose Employer Coverage They Currently Enjoy

Health Net Agrees to Stop Using Ingenix Database for Calculating Reasonable and Customary Fees
United Health Care Says Cheaper Efficient Doctors and Reducing Hospital Visits by the Elderly Would Help Reduce the Cost of Healthcare
AIG: You Bring the Nerds and the Algorithms and I’ll give you a AAA Rating…a little history from 1987
Health insurers Say “No” to limiting rescissions – Congressional Hearings
If you Lie – You Die said the Insurance Carrier (You did not report your acne)

Blue Cross Praised and/or Rewarded Employees Who Dropped Expensive Patients

BlueCross BlueShield Create New Venture Capital Organization
X PRIZE Foundation for HealthCare – Is the Incentive High Enough

Read More

Can Health Insurance Really Be 'Affordable' - ABC News Feature From Dr. Crounse from Microsoft

6/24/2009 03:30:00 PM  , , ,  

ABC News this week is focusing on health reform.  Dr. Crounse, Senior Director of Worldwide health wrote a post on his blog not too long ago, whichimage you can read here: 

Affordable Healthcare Insurance—Say What?

Watch the coverage this evening, this question will be running front and center. 

You would have to be living under a rock not to be aware of how badly we need reform and a new plan and some new paradigms to enter the picture as well.   There is a lot technology has to offer to substantiate some of the savings we are all looking for, and it required the word “change’ to have a substantial part in our vocabulary too.  Implementation is important as well and to create a successful transition, we need education first and the ability to learn a few new tricks along the way, to allow business models to evolve and change with the times.  I covered Dr. Crounse's post and added my 100 cents (not 2 because we need more than that today).   Right now we are at the crossroads of facing a sinking ship along the way if changes with both payers and technology are not substantially recalculated and reformed.  BD

imagePoliticians like to couple the adjectives "accessible" and "affordable" with the words "health care" when describing the goals of health care reform.  They say that with reform, all Americans will have access to affordable health "insurance."

I'd like to suggest that we eliminate the term "insurance" when talking about health care.

Watch "ABC News Primetime: Questions for the President -- Prescription for America," Wednesday, June 24, at 10 p.m. ET

Insurance protects us from experiencing an unexpected loss that is greater than our ability or willingness to pay.  I spend thousands of dollars a year on homeowner's insurance to protect me from financial catastrophe should my house be destroyed by fire or an earthquake.  I spend thousands more to insure my automobiles against theft and collision.  In both cases, I am pooling my money with tens of thousands or perhaps hundreds of thousands of other people to protect me from a loss that statistically only happens to a very few of those who are insured.

When it comes to discussing health care, I think politicians should start using a word other than insurance, and they certainly need to get rid of "affordable" in the same sentence. Yes, there's plenty of room to make health care "less expensive."

Health care reform should not be debated without a healthy dose of "tough love" on basic economics and a whole lot more details about what we'll really be getting with reform.  And for goodness sake, let's stop talking about "affordable" insurance. 

Dr. Bill Crounse is senior director of Worldwide Health for Microsoft Corporation.

Can Health Insurance Really Be 'Affordable'? - ABC News

Related Reading:

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

HIMMS - Informative and Influential People
Lawmakers Consider Adding Health IT to Stimulus Package – We Need some Congressional Algorithms

President-Elect Urges Electronic Medical Records - Chicago Sun Times (Medical Quack)

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