Drug delivery methods are changing in many ways to inhalants if possible.  Why, because they can be used with devices that report data to enforce compliance, perhaps easier than swallowing a chip and watching its “Fantastic Voyage”.  If you don’t get that last remark you are too young to remember.  These folks that I correspond with in the UK and in Massachusetts at Cambridge have some pretty exotic devices too and they state that drug delivery lies with new technology.  They have their own blue tooth inhaler out there. 

The Future of Drug Delivery Lies with Technology – Panel of Experts From Cambridge Consultants

On the OptiNose page you can see where there is an inquiry section for pharma or biotech companies to get in touch to evaluate the nasal delivery system.  Also, guess what, the inhalers take either powder or liquid and are either in multi or single use devices.  I hope it is sealed to avoid inhaling other drugs that perhaps are not legal out there.  This is one more example where inhaled drugs are making their way into treatment plans today.  Sinusitis can also be treated with the inhaler.  BD

Oslo, April 7, 2010: OptiNose, a leader in nasal drug delivery systems, is pleased to announce the publication in Cephalalgia of results from its Phase II clinical study investigating the efficacy and tolerability of its novel, intranasal drug/device product for the treatment of migraine.

Sumatriptan powder in 10mg and 20mg doses administered intranasally using OptiNose’s bi-directional delivery device was highly effective in treating a single attack of moderate or severe migraine. The proportion of patients pain-free at two hours was 54% for the 10 mg dose, 57% for 20 mg and 25% for placebo (P< .05). These results compare very favorably with published figures of 26-42% for liquid sumatriptan nasal spray and 35.6% for zolmitriptan nasal spray and higher than the 28% /29% reported for oral triptans. In addition to high efficacy, OptiNose’s bi-directional powder delivery eliminates drip-out and reduces the bitter taste associated with conventional nasal triptan products.

About OptiNose Bi-directional Delivery Devices:

OptiNose’s unique breath actuated devices deliver intranasal drugs to targeted regions in the nasal cavity, including the sinus openings and the olfactory region. This is achieved without any risk of lung deposition, unlike traditional nasal inhalers, nasal sprays or nebulizers. The Company offers both single and multi-use intranasal delivery devices for liquid and powder formulations. Core patents have been granted in Europe and the US. Variants of the basic delivery system are available for powder and liquid delivery. The technology has been successfully tested in a number of clinical trials to date including gamma scintigraphy studies to confirm highly superior deposition, studies evaluating the immune response to conventional antigens, trials showing excellent effects in chronic sinusitis with and without nasl polyps and studies evaluating the delivery of CNS active compounds. The results have confirmed the superiority of the technology compared to traditional nasal sprays.

OptiNose’s novel intranasal sumatriptan product highly effective in treating migraines | BreakThrough Digest Medical News

Technorati Tags: OptiNose, nose, inhaler, migraine, treatment, drugs, medical devices drug delivery

Here we go again, a missed opportunity for consumer and patient safety.  I wrote to the FDA today one more time so maybe I may have an open ear?  I’ll just keep posting as stories emerge.  Sales were 2 billion on the strips so is there not a little room in profit here to add some consumer safety to ensure we have a “real” product. 

I have also written to several device and drug companies too.  How deaf can those ears get?  Last time it was insulin pumps with recalls and now we have strips so the diabetes industry certainly looks like a big target for black market products.  I have also had some nice comments from both attorneys and pharmacists on this idea too.  I don’t know about you but I would love to just scan with my cell phone and be rest assured that I have an authentic product in my hands.

Insulin Pump Problems and Recalls – FDA Get Those Tags Out There So Consumers Can Identify Them Easily with Cell Phones  

One more time we can address the fact that the FDA has no way of recalling devices in an efficient manner and monitoring drugs.   So if this happens to be the case here it would be a lot easier if a system were put in place for recalls.  People die because they use or are implanted with recalled and faulty devices that miss getting off the shelf. Watch the video and see how easy it is for the consumer.  I had a doctor tell me how much he likes using Microsoft Tags in his golf magazine, so he can see how to improve his swing and thought this was a good idea too, he’s already using Tags with no problem. 

With a cell phone, we have no shortage of scanners that the manufacturer could put on the packaging as well as an online data base on the internet.  I have other information on how these encrypted Tags can used for adding information to Personal Health Records too.

We have another case of tech denial here it seems and the fear of the word “change”.  Look at the Becton Dickinson recall with catheters and something like this would have made it simple and lowered the chance that someone would die due to the fact that a product was missed and not pulled from use. 

Before surgery – scan that stent!  If it has been recalled the information would be updated to immediately let your know. 

Tags for Use in Healthcare – Medical Stents, Medications - One Scan Away From Safety Information in Real Time

The beauty of all of this is the simplicity for the user, open program and scan with phone – that’s it.  BD

Federal prosecutors are investigating a Florida man accused by Johnson & Johnson of selling counterfeit and potentially deadly versions of its diabetes-care products.

If charges are brought, it could become the first U.S. criminal case arising from the health-care giant's four-year global manhunt. J&J has waged an aggressive battle to bust a counterfeiting ring stretching from China to Pakistan to the U.S., following the discovery of fake copies of J&J's OneTouch diabetes test strips on the U.S. market in 2006.

The case shows how manufacturers of prescription drugs and medical products—and government authorities—are stepping up their fight against fake or stolen products. Last month, the federal government charged two people with illegally importing fake versions of GlaxoSmithKline PLC's weight-loss drug Alli.

Prosecutors Investigate Distributor of Counterfeit Johnson & Johnson OneTouch Product - WSJ.com

Technorati Tags: FDA, Insulin pumps, Medtronics, Johnson and Johnson, Becton Dickinson, technology, cell phones, recalls, medical devices, tech denial, mobile communications, Microsoft Tags, bar coding, diabetes, Roche

The device, called the LINX Reflux Management System, is being studied at UC San Diego Medical Center as part of a US and European multicenter clinical trial.  Today Europe has announced their approval for the device.  The link below gives some additional details from my post last year. 

Implanted Medical Device for GERD (Gastroesophageal Reflux Disease) in Trials

In many areas devices are competing with drugs and with this 20-30 minute procedure and successes it is having, we may have another winner in the device versus drug competition.  BD 

Magnetic Device Studied As Treatment For Heartburn And Acid Reflux

Torax Medical Inc. won CE Mark approval in the European Union for an implantable device that treats patients suffering from acid-reflux disease.

The company’s Linx device is intended for patients with gastro-esophageal reflux disease, which occurs when stomach juices flowing upward into the esophagus. The disease is caused by defects in the esophageal sphincter muscle, which typically prevents acid and bile from entering the esophagus.

Torax Medical wins CE Mark for GERD device | MassDevice - Medical Device Industry News

Technorati Tags: Torax, GERD, Acid Reflux, Medical Devices, healthcare, clinical Trials, Gastroesophageal Reflux Disease), LINX™ System, CE Mark

This is interesting and a deal was made here so Teva has a 180 day exclusive.  On one hand we have Teva in court with Merck over Singulair and on the other hand here, they get a deal.  Teva is probably the most aggressive pharma company today with challenging patents.

Merck and Singulair – More Legal Battles Besides Teva With Patent Challenges

Both companies share one big common interest and that is the pursuit of Biosimilar Drugs – the Biotech side of generic drugs.  This is still undecided in Congress as far as I know and there’s a lot of big players such as Amgen and many others in this lobbying effort in Washington. 

Merck Purchases Insmed – Biosimilar Biotech Drug Company

“The terms "Biosimilar" or "Follow-on Biologic" refer to products that are marketed after expiration of patents, which are claimed to have similar properties to existing biologic products. Due to the complexity of biologics, a product can only be made that is similar, but not identical.”  BD

NEW YORK, April 7 (Reuters) - Teva Pharmaceutical Industries Ltd (TEVA.TA) said on Wednesday it won U.S. approval for its generic versions of Merck & Co's (MRK.N) blockbuster blood-pressure drugs Cozaar and Hyzaar.

Teva, the world's biggest generic drugmaker, also said it will have 180 days to market the generics exclusively, an award generally given to companies that challenge patents first. Israel-based Teva (TEVA.O) said it was launching sales immediately.

An exclusivity period can allow generic companies a window of significant sales before rivals rush in and pricing freefalls.

UPDATE 1-Teva wins U.S. approval for generics of Merck drugs | Reuters

Related Reading:

Generic biotech drugs discussed in Congress – Bio Similars

Merck Purchases Insmed – Biosimilar Biotech Drug Company

Merck and Teva Go to Court over Singulair Going Generic

Healthcare Patents – How Long and How Much is Becoming a Challenging Question

Pfizer Suing Teva To Block Generic Version of Viagra Until 2019 Instead of 2012 Expiration Date – Viva Teva

Technorati Tags: Teva, Merck, patents, intellutual property, healthcare, pharma, drugs, generic drugs, hypertension, Hyzaar, Cozaar

We now have some updated information on where the traveler’s insurance can be purchased.  Below is a listing for the US and a full listing can be viewed here. 

Cuba Mandates All Visitors Will Be Required to Buy Traveler’s Medical Insurance – Effective May 1, 2010

The new law goes into effect May 1st this year.  If travelers arrive without it, visitors will be required to purchase at the airport in Cuba upon arrival.  BD 

United States
AIR AMBULANCE PROFESSIONALS
EUROP ASSISTANCE INTERNATIONAL (LOS ANGELES)
MEDEX
MERCURY INTERNATIONAL ASSISTANCE
MONDIAL ASSISTANCE
MONEY GRAM
NATIONAL JETS
NATIONAL AIR AMBULANCE
ON-CALL INTERNATIONAL (IAG)
USA ASSIST-DEMOCRACY CENTER
WORLD NET
WORLDWIDE ASSISTANCE SERVICES (WASHINGTON)

The Cuban government announced in March that all travelers arriving in Cuba from May 1 and beyond would be required to purchase Cuba health insurance.

In early April the list of approved Cuba health and medical insurance providers was released.

Travelers arriving in Cuba shall have a travel insurance policy that covers medical expenses or a policy for medical expenses with coverage in Cuba.

The insurance policy should be purchased in the traveler’s home country but for those tourists arriving without proper coverage, they will be required to purchase an appropriate policy from a Cuban insurance company at the airport, port or marina where they arrive.

Visitors from the US will have to purchase medical travel insurance from Cuban insurance companies before they arrive in Cuba. The coverage can be purchased from a travel agency associated with Havantur-Celimar in Cuba. US insurance companies do not provide coverage in the Cuban national territory.

All travelers shall present an insurance policy, certificate or traveling assistance card valid for the time they will stay in Cuba.  The Cuban Tourism Office or Asistur can provide more information. Asistur is open 24 hours a day at (53 7) 866-8527, 866-8339, 867-1315. Fax (53 7) 8-66-80, e-mail: asisten@asistur.cu ; seguros@asistur.cu

Cuba health and medical insurance update - Cuba Travel News - Havana Journal

Technorati Tags: Cuba, health insurance, travel, Fidel Castro, medical, emergency, hospital, traveler's insurance

As drugs continue to come off patents, so goes the the big revenue pots of the past.  I don’t know exactly where all the economists are getting the “good” word today when companies continue to use technology to replace and do work that humans have done. 

I used this article in a prior post but feel it’s appropriate here.  As technology and the economy and available funds going to Main Street continue to dwindle, nothing is getting a whole lot better. 

This is truly a disparity compared to how we have always valued life and fellow humans here in the US, but as well as the economy, life is unfortunately getting very impersonal too.  We talked about this years ago with computers doing what we have done, but the day where massive changes are taking place seems to be upon us.  Doctors will get more information from the computer these days rather than a face to face meeting it appears.  BD 

In response to generic threats on two older meds - the Ambien CR sleeping pill and Aplenzin antidepressant - and declining sales of the Actonel osteoporosis med - the big drugmaker notified employees that 400 positions, mostly sales reps, are being eliminated. The move is the latest cutback by Sanofi-Aventis, which is grappling with the same patent cliff as rivals.

To cope, Sanofi is outsourcing sales for Aplenzin, which is a not a substantial revenue generator, and restructuring its promotional arrangement with Warner-Chilcott (see this) for Actonel, which notched $264 million in sales and is a declining product (see page 85 here). The bad news - and a source says there will be more - was delivered by way of email from Jerry Durso, Jerry Durso, vp of the specialized therapeutics business unit.

Sanofi-Aventis Lays Off 400 Employees // Pharmalot

Technorati Tags: Sanofi-Aventis, Ambien CR, cutbacks, pharma, generic drugs, sales, marketing, prescriptions

This is a big hospital with 400 beds and during 911 took care of many patients too.  The hospital has been here for over 160 years.  Some services will remain and most of the land may need to be sold to pay off debt.  This is kind of sad, and last August here in Los Angeles we also watch a hospital that sat right in the middle of Century City where man of the big Fortune 500 corporation headquarters are located close their doors too, same issues, money.  Century City though was abosolute state of the art, complete with a DaVinci robot for surgery. 

Desperate Hospitals - Century City Doctors Hospital (Los Angeles) begins shutting down, others file Chapter 11 to reorganize

Big business does not appear to have a big charitable heart when it comes to hospitals that save lives any more.  BD

St. Vincent's Catholic Medical Center, the last Catholic general hospital in New York City, has voted to close its inpatient and acute care centers, effectively closing the hospital after more than 160 years.

The vote, confirmed by a hospital spokesman, came as St. Vincent's has struggled for six months with a budget deficit and has perched on the brink of bankruptcy, just a few years after emerging from an earlier bankruptcy filing. The hospital has tried for months to find a partner or new owner. A potential deal with Mt. Sinai Medical Center fell through last week.

The State of New York pumped $9 million in emergency loans so the hospital could keep running and meet its payroll, Gov. David Paterson's office said.

St. Vincent's Hospital in New York to Close - WSJ.com

Technorati Tags: Desperate Hospitals, New York, St. Vincent, bankruptcy, Catholic Healthcare, New York City

Austin Merrit offers his opinions and reasons for speculation below and who he thinks are potential candidates.  I guess only time will really tell the story.  If you have read here often enough then you may have read some of my interviews with those in Healthcare at Microsoft and are familiar with HealthVault and Amalga.

Austin Merrit is from Software Advice, a web site that helps physicians choose electronic health records software offers his opinions and reasons for speculation below and who he thinks are potential candidates.

I have included most of his post but you can continue on at the link at the bottom to see the rest of what he has to say on the topic and who he believes could be potential companies as they exist today.  BD 

Microsoft Dynamics is largely present in just about every software market but medical. And they’re missing out big time. The United States healthcare IT market is growing at about 13% per year and is expected to reach $35 billion in 2011¹. The biggest opportunity for growth in the industry is among ambulatory care physician practices, partly due to the Stimulus Bill requiring the use of electronic health records (EHR) systems by 2015.

You would think Microsoft would be in such a promising industry, but you won’t find a Microsoft EHR available. The primary reason why is that EHRs are highly specialized, and Microsoft’s main products (Dynamics, CRM, and SharePoint) don’t come anywhere near the needs of physician practices. It would be very difficult for Microsoft to build an EHR from scratch and introduce it to the market. So what should Microsoft do to enter the industry? Acquire a current player.

Such an entry into the medical market would mimic the acquisition spree that Microsoft conducted between 2000 and 2002, when it acquired Great Plains, Navision, Damgaard, and several related vendors. These systems were re-branded and offered as Microsoft Dynamics. Before these acquisitions, Microsoft was not present in the enterprise resource planning (ERP) application market. Its only ERP presence was as an infrastructure vendor, licensing SQL Server databases and related platforms to support application rollouts. However, this lack of application presence gave competitors such as Oracle and SAP the opportunity to squeeze Microsoft out of the ERP infrastructure market by pushing Unix, Oracle databases and IBM DB2. By acquiring several applications, Microsoft was able to drive sales of its SQL Server and Windows Servers directly, in addition to the Dynamics applications themselves. This strategy proved effective in giving Microsoft a multi-billion dollar share of the lucrative ERP market.

Setting its sights on the medical market, Microsoft is starting to squeeze its way in with a few smaller acquisitions and developments of its own, mainly Amalga and HealthVault. However, these current medical offerings are on the periphery of the market and do not really target the sweet spot: electronic health records for physician practices. An intelligent acquisition of a large EHR player would provide a key piece of the puzzle for Microsoft’s entry into the medical market.

 

Microsoft Dynamics is largely present in just about every software market but medical. And they’re missing out big time. The United States healthcare IT market is growing at about 13% per year and is expected to reach $35 billion in 2011¹. The biggest opportunity for growth in the industry is among ambulatory care physician practices, partly due to the Stimulus Bill requiring the use of electronic health records (EHR) systems by 2015.

Acquired by Microsoft in 2006, the Amalga family of products (Hospital Information Systems, Life Sciences, and Unified Intelligence System) addresses hospital administration, data aggregation for biotechnology firms, and information connectivity to large enterprises. Microsoft may be planning to expand Almaga’s presence or may be looking to acquire another vendor to complement it. Regardless of Microsoft’s strategy, Amalga still would not address the physician practice EHR market.

Microsoft EMR: It’s Not Just a Matter of When, It’s a Matter of Who

Technorati Tags: Microsoft, EHR, healthcare, Health IT, Amalga, ambulatory EHR, opinion, technology

I don’t think this is putting anyone in in the “poor” house as almost everyone knows that Part D Medicare is some of the most profitable business out there for HMOs, managed care organizations, and IPAs.  Here’s a post from a couple months ago where this small Venture Capital backed HMO Carrier made profits of 1 Billion for 2009.  Do you think anybody is hurting here.  Just for comparison, big pharma company Merck posted profits of 460 million last year.  

Bravo Health – Venture Capital Backed Medicare Senior Health HMO Carrier Sees Profits of 1 Billion for 2009

However, in speaking with an IPA not too long ago, they told me they break even on the commercial HMO part of their business and the Medicare Part D billing “is” their only profit since the commercial side payments have been drilled down so low.  Is there a lot of profit from the government being made by commercial businesses, it sure looks that way.  We have an HMO in California called CareMore and that is all they do too, Part D with Medicare. 

CareMore Live On TriZetto's Clinical CareAdvance System Algorithms - Healthcare Business Intelligence

CareMore Health Plan Invests in Business Intelligence for Acute and Chronic Illness Management

Just a short while back, 2008, HMO carriers in California made profits of 4 billion.  CareMore is also working at drilling down the algorithms of cost and you can read more at the link below, which is basically talking about a “hospitalist” type of doctor that makes house calls for seniors. 

Health Plan Hospitalists Keeping Re-Admissions Down by “Leaving” the Hospital – “The Extensivist”

Private equity firms are investing and as a matter of fact the big company CareMore has partnered with is ran by a Private Equity company in the UK.  They are also all about numbers and algorithms to create profits so you can read about what they are calling their “killer” PHR they are offering with Payer information and access to who in total, I’m not quite sure.  Trizetto partners with Ingenix, the wholly owned subsidiary of United Healthcare. 

TriZetto Group, Owned by Apax Partners-London Based Private Equity Firm, Rolls Out Payer Based PHR

Healthcare claim denied, there’s an app for that in managing denial processes, quote from the website below, “streamline” denial management.  Makes you wonder as a consumer at times when disputing denied claims how you can stack up your information as you need to just get care, but this is the reality of some of the processes denied claims go through and the business intelligence strategies created for ultimate risk management that consumers have to battle, the algorithms of healthcare for profit.  

“The Emdeon Denial Manager solution allows providers to organize and manage remittance inventory; helps staff arrange, prioritize and monitor denials and underpayments; and allows the accurate reporting and viewing of the denied and adjusted amounts. With the information produced by Emdeon Denial Manager, providers streamline the denial management process by determining root causes, patterns and process breakdowns responsible for denials, and establishing corrective steps to prevent future revenue loss or delay.”

With all the hatches coming down you can expect the algorithmic parameters to get tighter too so patient and doctors may both be seeing more red tape and difficulties in getting some claims paid. 

Healthcare Reform Bill – Expect “Fraud Algorithm” Use to Increase With “Scoring” the Insured With Our Leadership Trapped Embellishing Old Paradigms

The link above will explain a bit more of how some of the processes work.  BD

April 6 (Bloomberg) -- UnitedHealth Group Inc. and Humana Inc. are among the insurers who will receive the same payment rates in 2011 as this year for administering health plans for the elderly, according to rules issued by Medicare.

The health-care overhaul signed by President Barack Obama last month mandated a freeze in payments in the Medicare Advantage program, the U.S. Centers for Medicare & Medicaid Services said in a statement posted yesterday on its Web site. Before the announcement, the program was expected to account for 14 percent of earnings next year at Minnetonka, Minnesota-based UnitedHealth and 42 percent for Louisville, Kentucky-based Humana, Dave Shove, a BMO Capital Markets analyst based in New York, said March 31 in a note to clients

Medicare Payments Frozen for UnitedHealth, Humana (Update2) - Bloomberg.com

Technorati Tags: Trizetto, healthcare, PHR, personal health records, payers, claims, reimburements, EOB, business intelligence, healthcare cost, Ingenix, CareMore, algorithms, fraud, Medicare Part D

So much for privacy, wonder if California is doing this, probably not with our current economic standing.  It also makes you wonder if other states are doing the same.  In every state all over your medication records are sold for profit, so now this?  If you see below the records can help insurance companies underwrite and determine premiums based on what medications you are taking and this is geared heavily towards employers offering benefits in this area. 

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

Does the word privacy really exist one starts to wonder.  In the article, why do the government employees get to be exempt here, good question posed.  BD   

Ingenix already shows profits over a billion every year for it’s division of United Healthcare, so this looks to be more analytical data to increase those levels.  Again, we are over run with analytics to the point to where in short time there will be additional protests and potential riots. 

Over the past five years, the state of Oklahoma has raised more than $65 million by selling its citizens' personal information including names, birth dates, driver's-license numbers, and more. As further proof of a rotten situation run amok, the state's now trying to shield public-sector workers from those same privacy-trampling practices to which private-sector citizens are subject.

From an article in NewsOK.com:

While the state earns money selling records that include birth dates, lawmakers and some labor groups are working to shut off access to birth dates of public employees to the public, The Oklahoman and others working on the public’s behalf. Senate Bill 1753, by Sen. Debbe Leftwich, D-Oklahoma City, and Rep. Randy Terrill, R-Moore, would exempt government worker birth dates from the state’s Open Records Act.

Leftwich, Terrill and supporters of the bill claim releasing birth dates could endanger the safety of employees and lead to identity theft. They have provided no evidence of such harm being done in the past as a result of birth dates being public.

Oklahoma Sells Citizens' Data And Makes Millions - Global CIO Blog - InformationWeek

Technorati Tags: Privacy, records, Oklahoma, healthcare, healthcare reform, medicaiton records, profits, wellness tools

Is greed creating anger?  Is ignorance allowing greed to grow?  Those are just a couple questions popping around in my mind today.  When one is in a very public position, and especially those that make decisions that impact the well being of the rest of the nation, well this is what happens to have protection from the angry frustrated folks, who’s numbers within the last year seems to have seen an increase. 

Congressional Death Threats Are Bi-Partisan – Please Stop the Political Show And Get In Touch With Reality

Medicare situation solved yet on pay cuts and COBRA- No, but Congress is addressing now something most IT professionals did years ago when Napster came out, peer to peer sharing on government employee computers, go figure.

Breaking News: House Passed a Bill to Prevent Government Employees From Using Peer to Peer File Sharing!

At HIMMs 2009 we came away with this news and on this blog I write about this quite a bit too.  The decisions always seem to opinionate from the area of “its for those guys over there”, but wait, don’t we all have health, so why is this? 

U.S. Congress has an inadequate understanding Value of Health IT – HIMMS Opening Session

About 2 years ago I wrote about the 2 hot trends in Healthcare and it certainly still stands today, algorithms and whistleblowers, as they generate money, press and attention, but don’t fully cure our healthcare issue.

The 2 New Hot Words in Healthcare: Algorithms and Whistleblowers

Do we have enough folks with “hands on” experience as consumers in Congress or those who are let’s say “willing” to try some hands on as a consumer, which I think we all still fall into that category.  I see this all over the place though, a CEO who would not if it were the last thing on earth left to do, touch Tablet PC or an IPad as they think it is still “not cool” or something they don’t believe they need to be bothered with, but if they do, a great light bulb goes on to enable them to see how technology is changing the world today. 

Obama's Healthcare Economic Plan – Leaders with “Hands On” Technology Experience and Algorithms Needed

The scientists have been making a stab at the effort and they probably have a bigger understanding from many angles.

Scientists gather to chart out a 'total reboot' for medicine – Science and Medicine Coming Together

I guess in short, “greed” requires a lot of security these days, especially for those who are the “non participants” and repeat what they hear instead of a little “doing”action, what I call “Magpie Healthcare”. 

Would Someone Explain Data Aggregation and “High Frequency Healthcare” to the US Congress

Wall Street and Health insurers certainly have some great technology and algorithms they use, so much that it creates perhaps profit areas where they should not exist and use up money that could go to the bottom line on providing care to all. 

HealthCare Reform Revolves around Participation, Perception and Education For Success

If we don’t take time and educate and work with our citizens to help explain and understand the complicated system we have built or find a way to uncomplicate things (either of which would work in my book), then outrages and the need for security will continue I think for those who in the positions to make monetary and morality decisions that effect all.  Celebrities deal with this, but most of their need for security is due to people wanting to be close to them and see role models in many.

Speaking of such, where’s our role models in Congress?  Do they exist?  We have a President who had some first hand experience with the “ugly” side of insurance first hand that he speaks of here and there, and that memory is not going away any time soon as it is real, just like the need to collaborate and create a system for the US. 

Perhaps the other CEOs will be increasing their security too, paid for with health insurance premiums of course.  BD 

It’s no secret that WellPoint (WLP) CEO Angela Braly has been front and center during the long healthcare debate. In late February, she was summoned to Washington to testify before Congress and explain why some customers of WellPoint subsidiary Anthem Blue Cross were expected to see their premiums jump by 39%. In posts like this one on Firedoglake, Braly and her company were virtually hung in effigy.

So perhaps it’s not much of a surprise to read about sharply increased security costs for Braly in the proxy that WellPoint filed late Friday. Last year, the company spent $151K to provide additional security to Braly “in light of growing concerns regarding the safety of Ms. Braly and her family as a result of the national health care debate.” The $151K covered “personal security during travel, a security-enhanced vehicle and in-home security.” A quick skim of the 2008 proxy shows that these expenses appear to be new.

WellPoint’s CEO gets extra security… | footnoted.org

Technorati Tags: Security, WellPoint, Algorithms, heatlh insurance, Congress, tech heathens, high frequency healthcare, Magpie Healthcare, Obama, healthcare reform, denia, greed

This sounds quite similar to what we have going on here in the US with costs and claims being scrutinized.  In reading here too it says they have a “complicated payment system”.  What is interesting though on their practice in reading here is that if the insurer opens up a claim and it is not found to be erroneous and is in fact correct and fair, the insurer has to pay the hospital $300.00 for the invasion of their inquiry. 

Patients are having to be charged extra, but I do not think it is anywhere to the extent of what we see here.  Last year I spoke with a professor from Germany in Health IT and we compared a lot of notes and things are different and they have a public plan.  You can read more about my conversation with Professor Dr Horst Kunhardt at the link below and see a screenshot of the EHR he wrote that is used in hospitals in Germany.  

World Medical Tourism Conference 2009 – A Learning Awareness

You can also read here about where HealthVault is going in Germany.

Microsoft HealthVault and Siemens Bringing PHR Platform to Germany – And a Look at a German EHR

From my prior post:

“I think this will make perfect sense with integrating HealthVault for use with connecting to German EMR Systems.  Back in October of 2009 I had the opportunity to meet many different representatives from different countries at the World Medical Tourism Conference and one of the most interesting was Dr. Kunhardt from Germany, from the University of Deggenndorf.  Here’s a portion of that post below with some links to an active sample German EHR. 

This is the work of Mr. Prof. Dr. Horst Kunhardt, Department of Business Informatics, University of App. Sc. Deggendorf and you can use the link here to a live demo to see how it works.  I was curious having written an ambulatory EMR years ago myself just to see how it all came together.  The system is created with open source software with my SQL and PHP for the demo shown.   If you want to read up a bit more on German Medical Tourism, here’s a link to follow.”

Overbilling by hospitals is costing Germany's statutory health insurers up to €1.5 billion a year even as insurers are pushing up fees to plug funding shortfalls, an internal paper from their peak body has revealed.

Insurance agent tops list of unpopular jobs

The document from the National Association of Statutory Health Insurers (GKV) said the overcharging usually arises from mistakes but adds hospitals may be fudging bills to gouge extra money from insurers.
Losses of such magnitude are unacceptable given the tough financial circumstances health funds are facing, the association argued. They are demanding hospitals be penalized for lodging incorrect bills.

The clinics are in these cases obliged to return the overcharged amounts to the insurer. On average, this amounts to €1,100, according to the report. But in some cases it can be much more.  The association said the complicated payment system meant there was no incentive to make sure bills were correct.

The nation’s statutory health insurers, who cover the vast majority of people in Germany, are facing a financial shortfall of €4 billion this year. Several funds have already announced they will have to charge their members extra.

___________________________________________

The least popular professions in Germany are insurance agent followed by career politician, according to a survey released this week.  Almost 30 percent of the survey participants also said they would strictly advise their children against taking up the insurance trade.  Here’s how the Germans voted on their top 10 least favorite jobs. 

1. Insurance agent
2. Politician
3. Long-haul trucker
4. Street sweeper
5. Farmer
6. Elementary school teacher
7. Custodial worker
8. Banker
9. Doctor
10. Journalist

Hospital fleecing costs billions, insurers claim - The Local

Technorati Tags: Germany, health insurance, insurance agent, medical tourism, medical billing, healthcare, cost, Dr Horst Kunhardt, EHR, PHR, HealthVault

This might serve to be one great process as a way to journal the unstructured data, in other words text that is not perhaps normally tabled in a data base.  In addition physicians could easily search, review and update patient information.  With information added by physicians it is important to see his/her opinion in how they evaluate the situation and why.  Sometimes checking a template box doesn’t always allow for this further detailed explanation and the “internal wiki” could serve as the template format to make this process a bit more streamlined.  Dr. John Halamka has written about a pilot program at his blog, “Life as a Healthcare CIO” about the project. 

We all need information available quickly today and in a format where we can get to what information we need quickly.  If you have used Wikipedia on the web to find information, I think you can probably agree the format is easily searchable and information is found quickly, so why not try the format with the unstructured text documentation in a patient chart?  I like the idea here too that there’s only one exam, one assessment, etc. so repetition is avoided and we can possibly cut right to the chase without again having to read a battery of free hand text entries. 

If you do not know what a SOAP note is, check out Wikipedia and see what it says, and while there see how the format might lend itself to becoming part of an electronic medical record chart.  Quote below from Wikipedia on the definition of a SOAP note. 

“The SOAP note (an acronym for subjective, objective, assessment, and plan) is a method of documentation employed by health care providers to write out notes in a patient's chart, along with other common formats, such as the admission note. Documenting patient encounters in the medical record is an integral part of practice workflow starting with patient appointment scheduling, to writing out notes, to medical billing. Prehospital care providers such as EMTs may use the same format to communicate patient information to Emergency department clinicians.”

As always, great thinking and innovation from Dr. Halamka at Beth Israel/Harvard Medical, the “geek doctor” as he calls himself.  You can read the full post and additional comments here. 

I’m going to have to follow this one along as he might be on to something big here, as he is one of the most innovative and forward thinkers and doers when it comes to Health IT and I am glad we have his advice and input on all the committees where he serves, both in government and educational areas of Health IT.  BD  I can almost bet he will also have it working on an IPad too, why not.  BD   

There is a great article in the March 25, 2010 of the New England Journal of Medicine "Can Electronic Clinical Documentation Help Prevent Diagnostic Errors?" by Gordon D. Schiff, M.D., and David W. Bates, M.D. in which the authors note:

"Free-text narrative will often be superior to point-and-click boilerplate in accurately capturing a patient's history and making assessments, and notes should be designed to include discussion of uncertainties."

Today's inpatient charges are a collection of SOAP notes written by the medical student, intern, resident, fellow, attending, and consultants largely for billing and medico-legal purposes.

What if the chart was recast as a communication vehicle for the entire team that summarized the day's events and collective wisdom on next steps?

Our answer - a daily Wiki entry for each patient authored by the entire team and signed/locked by the attending at the end of each day.

Clicking on any patient name will bring up the daily Wiki. Each member can add documentation, revise existing text, and leverage the work of others on the team until the attending makes the final edits and signs/locks the day's documentation. Just like a wiki, a complete journal shows all all edits/changes/deletes, so no information is lost. Importantly the day's wiki entry has one physical exam, one assessment, and one plan - not 17 repetitive entries saying the same thing that often appears in today's paper charts.

A daily patient Wiki as unified clinical documentation, exchanged with the team, other providers, and the patient. I bet even the free-text naysayers will agree that this should be part of the clinical summary!

Life as a Healthcare CIO: Rethinking Clinical Documentation

Technorati Tags: BDMIC, healthcare, technology, Health IT, Wiki, clinical notes, documentation, physicians, medical records, EHR, SOAP notes

Colbert is usually full of humor and this is no exception but there’s a very serious focus here on how the prosthetic arm is helping people who have lost their arms.  This is fascinating as Dr. Kamen states users are doing things that we can’t do with our own arms, so a real positive incentive.  I like the “high five” at the end of the show too. 

Colbert asks will we be fighting these robots some day too? 

Technology is doing wonderful things today for those who have for years suffered with the lost of limbs to give back some personal freedom.  This is a great video.  BD

The Colbert Report	Mon - Thurs 11:30pm / 10:30c
Dean Kamen
www.colbertnation.com
Colbert Report Full Episodes Political Humor Health Care Reform

Dean Kamen showed up on The Colbert Report last night to show off Luke -- the advanced prosthetic arm he's been working on with DARPA and the Defense Department for the past few years. Besides the requisite Segway jokes (and Colbert's are pretty funny, we'll give him that), it's pretty heart-warming to see Kamen and his crazy awesome arm hanging out with our favorite faux Republican. Just more proof that Colbert is a major gadget nerd.

Dean Kamen shows off his prosthetic arm on The Colbert Report – Engadget

Technorati Tags: Segway, Colbert Report, healthcare, technology, prosthetics, Darpa, Dean Kamen, habndicapped

Well so much for trying to hold down premiums to where they could be affordable I guess.  235 of the 274 proposed premium increases were denied.  I wonder if this will spread to other states as well.  We could have all the states jump in on this action before long and time will tell. 

In a related story in Texas we have investors of a now defunct physician owned hospital suing the insurance companies, Aetna, Blue Cross, Blue Shield and Humana and a few more for boycotting  Houston Town and Country Hospital.  One thing we don’t have a shortage of is lawsuits in healthcare.  Who knows we may end up with a single pay system by default at this rate.  BD 

Yesterday, the Massachusetts Association of Health Plans, which represents Harvard Pilgrim Health Care, Tufts Health Plan, Fallon Community Health Plan, Health New England and Neighborhood Health Plan, teamed up with Blue Cross Blue Shield of Massachusetts to fire back.

Their complaint accuses Murphy of acting illegally when he imposed a rate cap and when he tied premiums to the medical consumer price index, which has no actuarial significance.

MAHP said the rates that the health plans filed for April 2010 “are actuarially sound, which is the basis upon which the decision should have been made.

The state’s six health insurers filed suit yesterday against Massachusetts Division of Insurance Commissioner Joseph G. Murphy, saying he acted illegally when he told insurers to charge many of their customers the same premiums they did last year - effectively capping rates.

Health insurers sue state - BostonHerald.com

Technorati Tags: health insurance, Massachusetts, healthcare, healthcare reform, legal cases, insurance commissioner, lawsuits

This is one item you are supposed to leave inside instead of having to remove.  The collagen in the patch comes from horses tendons.  The whole idea here is to cut down bleeding during cardiovascular surgery. 

It rolls up and goes into the endoscope for minimally invasive procedures as well.  It can be used for other types of surgeries as well, such as spleen surgery, ovarian surgery and surgery for rectal cancer.  BD 

FDA has approved TachoSil, an absorbable fibrin sealant patch for use in cardiovascular surgery to prevent mild and moderate bleeding from small blood vessels, when standard surgical techniques are ineffective or impractical.

Manufactured by Nycomed Austria of Linz, TachoSil is a ready-to-use surgical patch composed of a dry collagen sponge made from horse tendons, and coated with fibrinogen and thrombin. At the site of a wound, the two proteins, through a series of chemical reactions, produce fibrin, a stringy, white, insoluble protein that allows a clot to form.

The TachoSil patch is biodegradable and breaks down inside the body within four to six months. TachoSil is not intended for use within blood vessels.

Nycomed said that the plasma used to manufacture TachoSil is collected from US donors who have been screened and tested for diseases transmitted by blood. The fibrinogen and thrombin used in the surgical patch undergo additional manufacturing processes to remove impuri ties, including bloodborne viruses. The collagen taken from horse tendons undergoes a separate step to remove impurities, including equine viruses.

FDA Clears Biodegradable Sealant Patch For Cardiovascular Surgery - Medical Devices Business Review

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This is not a bad idea as long as done correctly and not used to further “grade” doctors, otherwise we may have even more leaving the profession.  As the article states this is work in progress and technology has impacted some doctors more than others.  If you look at cardiology for example on where it was 10 years ago compared to today, there’s a big difference. 

At some point technical skills, and I am assuming this means some type of health IT knowledge maybe on the agenda.  10 years ago we didn’t have all the interventional procedures we have today with heart disease and failure.  BD

ATLANTA - The next time you're at the doctor's office, take a peek at those certificates hanging on the wall. Like gallons of milk, some of them are expiring.

For the first time since leaving medical school, many doctors are having to take tests to renew board certification in their fields — 147 specialties from dermatology to obstetrics.

They used to do this once and be certified for life. That changed in the 1990s — doctors certified since then must retest every six to 10 years to prove their skills haven't gone stale.

For some specialists, like the doctors who push tubes into heart arteries to unclog blockages, this is the first year many are going through retesting.

The recertification tests are a work in progress. In the future, some boards plan to include assessment of a doctor's communication skills with patients. Eventually, testing may include rating a doctor's technical skills and directly observing performance, said the cardiology college's chief education officer, Joseph Green.

Doctors face ‘expiration dates’ of specialties - Health care- msnbc.com

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For years Microsoft fought the anti trust lawsuits and paid out a lot of money.  I can’t tell you how many people thought Office was free.  That goes back to when the original trial was loaded on computers and through court cases Office was no longer loaded directly but we had the free version called “Works” instead.

Office Starter is new and will be replacing Works on computers and there’s an easier process to get started and an easier way to upgrade.  This will be available at the retail level too when Office 2010 rolls out in a couple months.  When you start out the free version is there with a stripped down version of Excel and Word, again the very basics. 

This is an interesting move but I’m sure competition from open source and Google maybe pushed the button here a little, but again this is replacing the free “Works” program that nobody really used much or knew it was there from my experience.  I have used Office Live now for quite a while and am very happy with it as it coordinates and synchronizes with my desktop software.

Microsoft Offers Free Web-Based Office Extension - Software as a Service

Also, while I am on the subject of Office, if you are a student you can purchase the full on professional versions of Office for $59.95 with an “edu” email address or be enrolled on the list of education institutions listed with a minimum of .05 course credit. 

This is another good page to reference as you can also get a copy of Windows 7 Professional for $29.95, again for students who meet the criteria. 

This is called the Ultimate Steal Deal. BD 

 

SAN FRANCISCO--Microsoft has a new plan to make more money from Office: give it away.

With Office 2010, one of the biggest changes is how many ways there are to get Microsoft's most profitable software program for free.

In addition to the free, browser-based Office Web Apps, Microsoft is also offering PC makers the ability to install a basic version of Office on new computers. The new program, Office Starter, includes a stripped-down version of Word and Excel. PC makers, retailers and Microsoft can all make money if the PC buyer later upgrades to a paid version of Office.

To make buying that full copy of Office easier, Microsoft plans to flood stores with options to buy the product. In addition to the traditional boxed copies of the suite, Microsoft is also planning to sell "product key cards" that can be used to upgrade a single copy of Office (boxed copies can be used for two or three computers, depending on the edition).

Microsoft's big gamble with free Office | Beyond Binary - CNET News

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Back when this patent was given it was done to protect the research and development areas to recoup their investments, but today as things are changing rapidly, not only in genomics, but in medical devices and with drugs too, the long standing patent protections are coming under fire. If you read here often enough there’s a lot of posts about patent wars.  One example is Johnson and Jonson with Boston Scientific with “stent wars” and the millions spent on this, not to mention the billions awarded with violations.  Does the average patient care – no.  A patient just wants to be able to afford the care, device and medication.

Myriad's BRCA (DNA Breast Cancer) Patent Ruled Invalid Today – US Patent and Trademark Office Also Off the Hook

This could open the door for other companies to enter the market.  Up until this decision, Myriad was the only company worldwide that could perform the DNA genetic analysis test and the cost was around $3000.00.  Additional pressure was given by the insurance industry for patients to have the test as well.  By one company not having a monopoly, this can open the door for additional break throughs and further the treatment of both breast and ovarian cancer by having the information to build upon. 

In the case of Myriad, technology and advancements have changed so rapidly that the patent is now prohibiting the advancement of new research and potential cures and targets.  The test is around $3000.00 and insurance companies are now balking too about paying.  In the video you hear about how in Europe some are ignoring the patent and women are getting tested for around $300.00 instead. 

What do I keep saying is that we have a new left curve every day with technology, here’s a good example that financials are also being disrupted in structure as well, so what do we do, keep the patent and sit and wait on progress?  I don’t think we are a world today that’s going to take that for an answer.  One pharma company that is in court challenging and winning a lot of patent cases is Teva.  They have done a pretty good job with some of them and let’s face it, patents may not be all but gone, but the length of time is certainly non sustainable with today’s fast evolving world of technology and Health IT with an unstable economy.   BD 

Related Reading:

Myriad Unveils Prolaris Genetic Test To Predict Prostate Cancer Recurrence

Myriad's BRACAnalysis Tests Scrutinized by Insurance Carriers – Many Do Not Qualify and Myriad Marketing Questioned

Patented Genes - 60 Minutes - CBS News

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