Have you taken the challenge yet? “What challenge?”, you ask. The Health 2.0 Developer Challenge or those on Challenge Post. These sites take advantage of the recent US initiative to make health databases available to the public.
Since 2010, both sites have hosted challenges sponsored by organizations, corporations, and the government. Some have monetary prizes, some just offer recognition. The goal is to bring software programmers, designers, and health care experts together for rapid application development. There are two types of developer projects: 1) challenges, which overseas team collaboration to build specific requested tech solutions, and 2) code-a-thons. Code-a-thons are typically one day or weekend events that spur teams to rapidly create new applications and tools to improve health care.
Health 2.0 and Challenge Post make it easy to form teams with their community boards and resources. Check out the wide array of challenges posted on their sites. Compare goals, deadlines and prizes. Make new contacts, enjoy the thrill of creativity, and the pride of helping find real solutions to health care issues. Several have December 31, 2011 deadlines, so check out the fun and competition, and register today!
containers that ring, play music and send emails to remind people to take sixteen different medications when loaded only once in two or three months. Another medication lid glows when it is time to take a pill and then records the time the bottle is opened and the pill was taken.
Multiple pedometers and sensors track steps, galvanic skin response, brain waves, and pulse and are easily synched with smartphone apps that forward reports to your doctor. Sensors can be placed in carpets, slippers, kitchen drawers and refrigerators to track movement of elders living alone. Reports can be sent to specified caregivers. One sensor tracks sleep patterns when placed in an arm band and then placed under your smartphone in the morning to sync and download and email the report. Airstrip Tech links doctors with EMTs in ambulances to follow monitors as the patient travels to the hospital. Two 5 minute Rapid Fire product demo sessions reviewed over 25 new products.
Several websites help patients track their medical information. Patients determine what they want to share and with whom. Some are open source; some are created by private companies. Patient groups like ePatient Dave and Patients Like Me encourage sharing collective medical information to foster a faster learning curve to how to best treat patients and diseases in the US and abroad.
I had the distinct honor of speaking on a panel about game play.
My expertise comes from creating and consulting on multiple smartphone apps related to food and nutrition. Gamification was a hot topic in multiple sessions, mentioned frequently as a terrific means to engage and educate patients. Interesting to me was the fact that some telemedicine products and apps already include game play. This is mostly in the form of Q&A or true/false questions. To celebrate Breast Cancer Month in October, a colleague, Nadine Fisher, MS RD LD, and I created the Apple app Breast Cancer Care. We included five true/false games and one food photo match game.
Many of the products I saw at Connected Health are first generation this year. One company rep said there were only a handful of tech vendors exhibiting last year. This year there were five exhibitor rows lining a hotel ballroom. This business is exploding. I have seen the future of medicine, and it is exciting and often fun. Games are a great hope to advance the health of the world for patients, caregivers, and professionals.
Here’s a link to a blog post about the panel on which I spoke. I was the only RD on the program.
Games for Health Project originated in the United States in 2004.
Ben Sawyer was instrumental in its foundation and development into the force that it is today. It’s annual meeting draws hundreds of global participants each year in Boston.
So it was exciting news this year when Games for Health announced a European partner. It’s first meeting will be held in Amsterdam on October 24 and 25. The central theme is: How games and simulations can improve health(care) and make it affordable. The program is dynamic includes topics on five core tracks:
Cognitive and emotional health
Exergaming, active gaming and fitness
Medical/Education and training
So if you are looking for an excuse to visit Amsterdam, the Games for Health Europe conference is a must do. It will be exciting to watch this innovative group develop and deliver fresh ideas and research on health games for the European health community.
Nick Yee, PhD, a research scientist at the PARC (the Palo Alto Research Center) has published studies that show how people’s behaviors change when they use avatars. One study notes how players engage when offered tall, attractive avatars, versus shorter, less attractive ones. He suggests that people will exercise longer and better when offered fit looking avatars.
James Watt, PhD is a serious games researcher at the University of Connecticut. He explains that social interaction is relative to masked identity. Group communication is best when there is also social interaction. So how about creating an avatar-likeness with body movements that still provides anonymity? Microsoft Xbox recently released Avatar Kinect that scans participants and then creates a general look-alike avatar of themselves – including body movements.
Players might not mind sharing personal attributes with friends, but would players feel comfortable revealing their size, hair color, and mannerisms to strangers, too? This remains to be seen, as medical professionals brainstorm about health applications. Consider in-home avatar group therapy sessions, patient education classes, addiction support groups, or parent clubs. Now layer on a health gaming twist. How about a virtually engaging game of Nutrition Jeopardy? The possibilities are tremendous! What kind of avatar health games do you envision? This field is wide-open for development. Game on!
Strong research is the foundation of the health professions, and health game development is no different. When a person’s health is being manipulated, then people expect the method or product to be well researched before being recommended. After all, the physician’s oath is, “First, do no harm …”
From the start, early thought-leaders recognized that progress in this emerging industry needed to rely on health professional collaboration based on sound, scientific research to prove efficacy. This is what researchers call, “the scientific method.” Developers, designers, funders, and players want to see supportive data. Multiple colleges and universities have stepped up to take the task, and many privately funded developers eagerly share their methods and results to further the cause. Unfortunately, researchers publishing their results has been a problem. Traditional scholarly journals do not target video games for health — until now.
Mary Ann Liebert, Inc, publishers of scores of well-respected peer-reviewed scientific journals have announced plans to publish Games for Health: Research, Development, and Clinical Applications this fall. Games for Health will be a peer-reviewed journal and has a stellar editorial board line-up. The Liebert press release stated the journal would be published bi-monthly and would be “dedicated to the development, use, and applications of game technology for improving physical and mental health and well-being. The Journal breaks new ground as the first to address this emerging, widely-recognized, and increasingly adopted area of healthcare.”
The Games for Health journal and it’s accompanying online presence is a welcome home for the health video games community. For more information check out www.liebertpub.com
Organized by the the IU School of Informatics at Indiana University–Purdue University Indianapolis (IUPUI), the 2nd annual Midwestern Conference on Health Games conference will be held in Indianapolis on October 28, 2011. Abstracts are being accepted now. The submission deadline is June 1. 2011. For more information please contact Vicki Daugherty at firstname.lastname@example.org or 317-278-4123.
Tonight, President Obama spoke to the nation about his plans for healthcare reform. He outlined how he plans to reform the current system and how he plans to pay for it including cutting over $100 billion worth of subsidies to insurance companies as part of Medicare.
Few key points:
He also touched upon the need to increase health IT and move way a fee for service system to a team-based approach to deliver healthcare.
Full Text: Obama’s Remarks on Health Care
(without question/answer session)
Following is a text of the prepared remarks by President Obama before his White House news conference on Wednesday, as released by the White House.
Good evening. Before I take your questions, I want to talk for a few minutes about the progress we’re making on health insurance reform and where it fits into our broader economic strategy.
Six months ago, I took office amid the worst recession in half a century. We were losing an average of 700,000 jobs per month and our financial system was on the verge of collapse.
As a result of the action we took in those first weeks, we have been able to pull our economy back from the brink. We took steps to stabilize our financial institutions and our housing market. And we passed a Recovery Act that has already saved jobs and created new ones; delivered billions in tax relief to families and small businesses; and extended unemployment insurance and health insurance to those who have been laid off.
Of course, we still have a long way to go. And the Recovery Act will continue to save and create more jobs over the next two years – just like it was designed to do. I realize this is little comfort to those Americans who are currently out of work, and I’ll be honest with you – new hiring is always one of the last things to bounce back after a recession.
And the fact is, even before this crisis hit, we had an economy that was creating a good deal of wealth for folks at the very top, but not a lot of good-paying jobs for the rest of America. It’s an economy that simply wasn’t ready to compete in the 21st century – one where we’ve been slow to invest in the clean energy technologies that have created new jobs and industries in other countries; where we’ve watched our graduation rates lag behind too much of the world; and where we spend much more on health care than any other nation but aren’t any healthier for it.
That is why I’ve said that even as we rescue this economy from a full-blown crisis, we must rebuild it stronger than before. And health insurance reform is central to that effort.
This is not just about the 47 million Americans who have no health insurance. Reform is about every American who has ever feared that they may lose their coverage if they become too sick, or lose their job, or change their job. It’s about every small business that has been forced to lay off employees or cut back on their coverage because it became too expensive. And it’s about the fact that the biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid.
So let me be clear: if we do not control these costs, we will not be able to control our deficit. If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket. If we do not act, 14,000 Americans will continue to lose their health insurance every single day. These are the consequences of inaction. These are the stakes of the debate we’re having right now.
I realize that with all the charges and criticisms being thrown around in Washington, many Americans may be wondering, “What’s in this for me? How does my family stand to benefit from health insurance reform?”
Tonight I want to answer those questions. Because even though Congress is still working through a few key issues, we already have agreement on the following areas:
If you already have health insurance, the reform we’re proposing will provide you with more security and more stability. It will keep government out of health care decisions, giving you the option to keep your insurance if you’re happy with it. It will prevent insurance companies from dropping your coverage if you get too sick. It will give you the security of knowing that if you lose your job, move, or change your job, you will still be able to have coverage. It will limit the amount your insurance company can force you to pay for your medical costs out of your own pocket. And it will cover preventive care like check-ups and mammograms that save lives and money.
If you don’t have health insurance, or are a small business looking to cover your employees, you’ll be able to choose a quality, affordable health plan through a health insurance exchange – a marketplace that promotes choice and competition Finally, no insurance company will be allowed to deny you coverage because of a pre-existing medical condition.
I have also pledged that health insurance reform will not add to our deficit over the next decade – and I mean it. In the past eight years, we saw the enactment of two tax cuts, primarily for the wealthiest Americans, and a Medicare prescription program, none of which were paid for. This is partly why I inherited a $1.3 trillion deficit.
That will not happen with health insurance reform. It will be paid for. Already, we have estimated that two-thirds of the cost of reform can be paid for by reallocating money that is simply being wasted in federal health care programs. This includes over one hundred billion dollars in unwarranted subsidies that go to insurance companies as part of Medicare – subsidies that do nothing to improve care for our seniors. And I’m pleased that Congress has already embraced these proposals. While they are currently working through proposals to finance the remaining costs, I continue to insist that health reform not be paid for on the backs of middle-class families.
In addition to making sure that this plan doesn’t add to the deficit in the short-term, the bill I sign must also slow the growth of health care costs in the long run. Our proposals would change incentives so that doctors and nurses are free to give patients the best care, not just the most expensive care. That’s why the nation’s largest organizations representing doctors and nurses have embraced our plan.
We also want to create an independent group of doctors and medical experts who are empowered to eliminate waste and inefficiency in Medicare on an annual basis – a proposal that could save even more money and ensure the long-term financial health of Medicare. Overall, our proposals will improve the quality of care for our seniors and save them thousands of dollars on prescription drugs, which is why the AARP has endorsed our reform efforts.
Not all of the cost savings measures I just mentioned were contained in Congress’s draft legislation, but we are now seeing broad agreement thanks to the work that was done over the last few days. So even though we still have a few issues to work out, what’s remarkable at this point is not how far we have left to go – it’s how far we have already come.
I understand how easy it is for this town to become consumed in the game of politics – to turn every issue into running tally of who’s up and who’s down. I’ve heard that one Republican strategist told his party that even though they may want to compromise, it’s better politics to “go for the kill.” Another Republican Senator said that defeating health reform is about “breaking” me.
So let me be clear: This isn’t about me. I have great health insurance, and so does every Member of Congress. This debate is about the letters I read when I sit in the Oval Office every day, and the stories I hear at town hall meetings. This is about the woman in Colorado who paid $700 a month to her insurance company only to find out that they wouldn’t pay a dime for her cancer treatment – who had to use up her retirement funds to save her own life. This is about the middle-class college graduate from Maryland whose health insurance expired when he changed jobs, and woke up from emergency surgery with $10,000 in debt. This is about every family, every business, and every taxpayer who continues to shoulder the burden of a problem that Washington has failed to solve for decades.
This debate is not a game for these Americans, and they cannot afford to wait for reform any longer. They are counting on us to get this done. They are looking to us for leadership. And we must not let them down. We will pass reform that lowers cost, promotes choice, and provides coverage that every American can count on. And we will do it this year. And with that, I’ll take your questions.
The ONC policy committee on meaningful use has published an updated matrix on the subject. It can be found here.
Someone in the GOP needs to learn how to use Microsoft Visio, or the Democrats need to come up with a better plan for improving our healthcare system.
If you believe this nightmare chart created by Congressman Kevin Brady’s office (R-Texas 8th District), then you’ll need a PHD in obfuscation to figure out what the Democrats are planning. More likely, however, is that Brady is painting an overly bleak picture of what a government plan might look like.
Jokes aside, as this battle continues to play out, both sides are sticking to their guns; however, the Obama administration believes it has the trump card: 60 votes. Bloomberg News is reporting that “Obama Open to Partisan Vote on Health-Care Overhaul.”
We’ll follow how this plays out, and keep you apprised of any interesting happenings.
UPDATE July 22, 2009:
A graphic designer, Robert Palmer, took it upon himself to “correct” the republican nightmare chart and made it significantly easier to understand. The updated chart, along with a PDF can be found on Mr. Palmer’s Flickr page. He also penned a note to Representative Boehner:
Dear Rep. Boehner,
Recently, you released a chart purportedly describing the organization of the House Democrats’ health plan. I think Democrats, Republicans, and independents agree that the problem is very complicated, no matter how you visualize it.
By releasing your chart, instead of meaningfully educating the public, you willfully obfuscated an already complicated proposal. There is no simple proposal to solve this problem. You instead chose to shout “12! 16! 37! 9! 24!” while we were trying to count something.
So, to try and do my duty both to the country and to information design (a profession and skill you have loudly shat upon), I have taken it upon myself to untangle your delightful chart. A few notes:
- I have removed the label referring to “federal website guidelines” as those are not a specific requirement of the Health and Human Services department. They are part of the U.S. Code. I should know: I have to follow them.
- I have relabeled the “Veterans Administration” to the “Department of Veterans’ Affairs.” The name change took effect in 1989.
- In the one change I made specifically for clarity, I omitted the line connecting the IRS and Health and Human Services department labeled “Individual Tax Return Information.”
In the future, please remember that you have a duty to inform the public, and not willfully confuse your constituents.
California 53rd District
The Certification Commission for Healthcare Information Technology (CCHIT) has responded to the Office of the National Coordinator’s recently released Meaningful Use matrix [pdf]–and responded with a vengeance.
The bottom line: “CCHIT recommends that meaningful use measures be either simplified for 2011, or postponed until 2013.”
Its recommendation was formed by comparing the CCHIT 2008 criteria against the meaningful use matrix prepared by the National Coordinator’s Workgroup on Meaningful Use and finding that while many of the 22 proposed objectives are fully supported by the current certification, at least 8 have minor to major gaps with the CCHIT 08 criteria.
The commission argues that “the lag between a decision to invest in EHR technology and its full, meaningful use in a provider organization is 1 to 2 years at best, and more typically, 3 to 5 years,” and for this reason it recommends postponing the 2011 measures until 2013. It isn’t that some EHRs do not currently meet the standards drafted for 2011 (MTBC’s EMR does), it’s that CCHIT criteria does not currently cover or test for all of the proposed 2011 measures. Additionally, CCHIT does not believe that the marketplace is fully ready to support some of the reporting standards outlined in the draft.
As always, we will continue to cover this story as new developments arise and as key shareholders continue to weigh in with comments and responses.
Why don’t you let us know what you think? Should the 2011 measures be postponed until 2013?
When you buy a car, the manufacturer usually offers some kind of warranty on your purchase e.g. bumper-to-bumper coverage for 50,000 miles or 5 years, whichever comes first. Or coverage for 100,000 miles for the power train and 50,000 miles bumper-to-bumper. Some are now offering oil changes for life, free car washes, dry cleaning, or the salesman will pick up your kids from soccer practice if you make a purchase now. Ok, maybe they won’t pick up your kids, but you will please! buy now?
Francois de Brantes, a nationally known advocate of health care quality, is hoping to bring warranties to healthcare. He and a few associates penned an article in Health Affairs describing the benefits of a new payment model for physicians which may inspire physicians to improve patient outcomes by putting their skin (and money) in the game.
The warranties which de Brantes proposes–Prometheus Payment as he’s called it–flip the current medical billing payment model on its ear. Prometheus Payment offers set fees to providers for recommended services, treatments and procedures. However, unlike the current system where all fees are covered by third-party payers, the provider now becomes a party in the payment process by assuming fiduciary responsibility for outcomes–should patients develop an avoidable outcome, providers become responsible for half the costs. The warranty is based on the costs of these avoidable outcomes and is risk adjusted for elderly or frail patients.
de Brantes and his co-authors explain that “the warranty concept has filtered into the self-pay portion of health care, such as corrective eye surgery, general cosmetic surgery, and dental care, which are often based on a global fee that includes any necessary rework by the provider. But it has taken much longer for warranties to appear in the third-party payer system.” They argue that with this global-fee model, overall costs in the healthcare can be reduced while improving outcomes for patients by making (and paying) the provider for any expenses before, during, and after the procedure.
The abstract to the Health Affairs article reads:
How health care providers get paid has implications for the delivery of care and cost control; the topic is especially important during an economic downturn with persistent growth in health spending. Adding “warranties” to care is an innovation that transfers risk to providers, because payment includes allowances for defects. How do such warranties affect patient care and bottom lines? We examine a proposed payment model to illustrate the role of warranties in health care and their potential impact on providers’ behavior and profitability. We conclude that warranties could motivate providers to improve quality and could increase their profit margins.
I find two points interesting.
This whole idea adds a new wrinkle to medical billing. As your billing service, we’d not only be incentivized to help you collect more money but also provide you tools to provide better patient care. Great news for you, we have a CCHIT-certified EMR which provides just the tools you need. Find out more here.
We will keep you posted if this model crops up at any payers near you.
Read more about Prometheus Payment:
On June 16 the Workgroup on Meaningful Use presented its recommendations on the definition of Meaningful Use. They prepared a preamble describing their overall path to this definition and a matrix to organize their recommendations for each year. For those who have been under a rock for the past 6 months, “meaningful use” is the defining measure by which the incentive payments included in the American Recovery and Reinvestment Act (ARRA) will be determined.
With this working definition, vendors, physicians, and hospitals can better plan for implementation and delivery of technology and services to achieve the measurable goals outlined by the Workgroup.
Meaningful Use for Whom?
First it is important to note that “meaningful use” will have different meanings for hospitals and for groups in private practice. The preamble states “some features and capabilities will be recommended as required in an ambulatory setting before similar functions are expected to be widely used in the hospital.” This means that proving “meaningful use” will be a more rigorous exercise for private practices than it is for hospitals. However, private practices have a broader range of options and lower barriers of entry (cost, availability of technology, shorter implementation time frames, etc) when it comes to implementing technologies which can deliver “meaningful use.”
Let’s go over some of the measures which are planned for 2011 and look at some examples of each item. More details for each of the items below can be found in the matrix. John Halamka, MD of the CareGroup Health System of Harvard Medical School and the chairman of the US Healthcare Information Technology Standards Panel (HITSP) said in Healthcare IT News that this matrix still needs to be populated with the most up to date standards and an implementation guide. These details will help vendors and physicians alike ensure that their software meets these measures. Expect this in July.
Each of the items below has associated metrics which will need to be reported to verify meaningful use; for example, one of the objectives calls for reminders to patients for preventive/follow-up care. In order to prove meaningful use, the EMR application must be able to provide a reporting of the percentage of patients over 50 with annual colorectal screening. Keep in mind that each of the items below has an associated measure (found in the matrix) which will require reporting to an authorized agency.
Items marked with a Yes! indicate that the MTBC EMR helps your practice meet or exceeds these measures.
Now that you know the definition of Meaningful Use what should you do now? The answer is simple: get an EMR. Ok it is not that simple, but you will be happy to know that you have plenty of options in the marketplace. Dr. Halamka writes, “Hospitals and Clinician offices now know what is expected for 2011, so the time is now to begin your software implementations.” Never before have there been so many EMRs which provide such a high level of functionality and interoperability. Today’s major differentiators are not function, but price and service.
MTBC Can Help
MTBC’s CCHIT certified EMR (free to MTBC medical billing clients) can help your practice meet the goals of 2011. Click here to find out more about MTBC’s unified medical billing and practice managagement services.
However, if “free” is not your bag, you have plenty of other options beginning at the $1,000 range and your imagination as the only limit. Vendors have become very creative in their pricing with new options emerging such as monthly subscriptions, charges for each fax sent from the EMR, hosting fees for web-based applications, fees for technical support by email, server replacement plans (a la replacement plans sold by big box stores), 50¢ per 100MB of storage, and many others.
MTBC’s EMR rivals those of its competitors because it is implemented, supported, and updated completely free of charge of its premium medical billing clients. To find out more about how MTBC’s EMR can help you meet the goals of Meaningful Use, request a demo today and, if you are not currently an MTBC billing client, find out how you can download a free trial.
Watch this space for more information regarding meaningful use and its impact on the healthcare IT.
The government might as well argue that, since handicapped people can crawl on all fours or ask for help from strangers, there's no need to make buildings wheelchair accessible, the court said.Justice delayed is justice denied; get to stepping, Mr. Snow!
Three fiscal quarters into my new role at work I am pleasantly surprised to discover that CDHPs have quietly evolved from a disingenuous cost-sharing scheme foisted on workers by employers (see the Pollyannaish video, below) to a proactive, multifaceted approach intended to achieve “a pluralistic system that empowers patients and demands accountability from individuals and the health system, while adequately supporting the needs of the disadvantaged.”
Moreover, the criteria for determining whether or not these lofty goals are met are both simple and progressive:
Granted, the above is only Wye River Group’s take on the matter, but given that it comes directly from their An Employers’ Guide to Healthcare Consumerism which was published in 2006 I am inclined to take them at their word and note this as a sea change in suppliers’ attitudes towards the healthcare crisis in this country.
What Wye River Group refers to as healthcare consumerism is a synthesis of old and new ideas as well as delivery and payment models in the healthcare market. It encompasses consumer-driven health plans, value-based benefit design techniques, and good old-fashioned managed care (as opposed to managed access and/or managed costs).
Despite its name, healthcare consumerism isn’t mutually exclusive of government involvement. Indeed, the techniques it espouses could go a long way towards making the already superior healthcare model in place for US military veterans that much more cost-effective and efficient – not to mention portable to state and local governments and private industry.
There are few people as skeptical of for-profit payers as I am, but in light of this evolution of thought in the consumer-driven healthcare space I am open to – and hopeful at the prospect of being – proven wrong.
Hi Jeff,Here's the photograph in question:
I am delighted to let you know that your submitted photo
has been selected for inclusion in the newly released
second edition of our Schmap Northwest Guide:
If you like the guide and have a website, blog or personal
page, then please also check out the customizable
widgetized versions of our Schmap Northwest Guide, complete
with your published photo:
Thanks so much for letting us include your photo - please
enjoy the guide!
Managing Editor, Schmap Guides
It ain't so.
Every first-year high school debate student learns about fallacious arguments. It's a requirement and something you had better learn well unless you want your argument to fail, your proposal to lose, and what little social standing there is to be had from membership on the debate team to be negated by having your ass publicly handed to you by an even bigger geek at a public (albeit most likely unattended) public event.
I speak from experience here.
As the saying goes, things change.
In our modern era of corporate media, where a powerful and wealthy few dictate what constitutes both entertainment and news, as well as their bastard offspring - infotainment, the validity and coherence of one's argument doesn't matter; volume does.
Volume can be measured in decibels (talk radio), eyeballs (Drudge Report), Nielsen Ratings (Fox News, Desperate Housewives), circulation (The National Enquirer), or some combination thereof. Health Care News apparently knows how to pump-up the volume: according to their masthead they reach 53% of all healthcare professionals.
I know that healthcare is a business, and that even the most selfless non-profit organization has to figure the bottom line into the equation somewhere, but it is my sincere hope that when most healthcare professionals and the organizations they work for need to get a feel for the pulse of the nation on important questions of the day, they'll keep in mind that Charmin is a better quality paper than The Heartland Institute's propaganda organ is.
Why am I being so hard on Health Care News? For starters, they have a widget on their site that is a consistent part of their navigational structure that declares Crichton is Right! This is a reference to science fiction author and 2006 American Association of Petroleum Geologists Journalism Award-winner Michael Crichton, whose novel State of Fear denies the science of the greenhouse effect and slanders The New Republic Senior Editor Michael Crowley.
With both John McCain and Barack Obama in favor of joining some version of the Kyoto Protocols and enacting some sort of carbon cap-and-trade system, this ranks The Heartland Institute right up there with holocaust deniers and The Flat Earth Society in my book.
Is this unfair of me? Am I painting with an overly broad brush? Am I resorting to unjustified Ad Hominem attacks and throwing the baby out with the bathwater just because I think Michael Crichton is a despicable human being and corporate drama whore who is trading on name recognition in lieu of long-since-gone talent?
I don't think so.
Here's a critique of their three-article, red-letter Single-Payer expose'.
Better yet, read the original articles independently of my critiques, and decide for yourself.
Meanwhile, I will be tackling all three of Health Care News' extremely fallacious and biased articles one-at-a-time over three posts. First up:
This article attempts to paint a picture of what universal healthcare in the United States will look like by describing in lurid detail what's going on at the bottom of the barrel in Russia's healthcare system.
For this article alone, the fallacies include:
Many state-run hospitals, particularly in remote areas, do not have hot water, and some do not have running water at all. Even the most basic medicines are often in limited supply.This is an attempt to form a Post Hoc fallacious argument. It fails in this regard, however. Awful Facilities actually Confuses Causes and Effect - the Russian Federation is the successor to the collapsed Soviet Union and the product of more than a decade of economic decline before its recent economic stabilization. Consequently, it's healthcare infrastructure isn't a shambles because the country's national, single-payer healthcare model is a failure; the country's national, single-payer healthcare model is a failure because the country's healthcare infrastructure is a shambles!
Healthcare is far too important to leave to politicians - be the autocrats or Democrats [sic]," said John R. Graham, director of health care studies at the Pacific Research Institute.Did you spot the Ad Hominem fallacy? It's tricky because it's also an example of Guilt by Association. In the above statement, the poor state of the Russian healthcare system is the fault of the autocrats, who are synonymous with Democrats! Since all Democrats are autocrats, and autocrats can't be trusted to administer healthcare, then obviously neither can the Democrats.
"The Russian 'free healthcare for all' system is nothing of the sort," said Jeff Emanuel, research fellow for healthcare policy at The Heartland Institute and managing editor of health Care News. "Instead, it is simply another program built on governmental taking of taxpayer fund and mismanagement of the services it promises to provide."You see, in the neoconservative fantasy land that Jeff Emanuel lives in, any single failed government program from any government anywhere is proof that all government programs from all governments everywhere will fail! And be sure to take a good look at just who Jeff Emanuel is: the editor of the very publication the article appears in! While this isn't a logical fallacy, it certainly makes him a less than objective - and therefore credible - subject matter expert for this particular piece.
Despite the fact that there is currently no legislation before Congress to institute a national, single-payer healthcare system, nor a presidential candidate from either party intending to introduce one (a Factual Error), even if universal coverage and a national, single-payer system were the same thing (which they are not), citing only Russia as a representative example of such a system is not only a Biased Sample fallacy, it also grossly distorts the success of the many other national, single-payer healthcare plans of every other industrialized country, all of whose citizens enjoy a comparable or superior degree of health and wellness than the average American does from healthcare systems that universally consume fewer resources and produce comparable or superior outcomes to our own.
(It is also insulting to the intelligence of anyone who has been paying attention since 1991 and knows that for all of our problems, the United States and the keystone republic of the former U.S.S.R. have about as much in common as William McGuire and Mother Theresa when it comes to infrastructure and other assets to bring to bear on their respective national healthcare concerns!)
In fact, according to the CIA World Factbook, as of 2007, per capita GDP in the Russian Federation was $14,600 - less than .33% (one-third) of per capital GDP in the United States of American ($46,000) during the same period!
Despite the enormous differences between the two counties, the average life expectancy at birth for all Russians is 84.5% that of their American counterparts, a difference of only 15.5%. Based on these numbers, if the United States were to adopt the horrific Russian healthcare system in its current form in its entirety tomorrow, but maintain current U.S. healthcare spending levels, median life expectancy at birth for all Americans would exceed 129 years!
|Life Expectancy at Birth||Russian Federation||United States of America|
Now, I know that this is a Misleadingly Vivid example, but then again so is Health Care News' representation of the Russian healthcare system as a legitimate cautionary tale for healthcare reformers in the United States looking to implement some form of universal coverage or otherwise assure care is made available to nearly 50 million of their fellow uninsured citizens.As I pointed-out above, Rina Shah bases her entire article on a Factual Error when she presents the situation in Russia as an example of a failed universal healthcare system. However , Russia's implementation of universal healthcare is a national, single-payer universal healthcare system; there are no proposals for implementing such a system in the United States from either political party or presidential candidate.
Research conducted by Moscow's INDEM think tank in 2004 showed Russians spent some $600 million each year on under-the-counter payments to health care providers. The Russian Academy of Sciences' Open Health Institute more recently estimated rampant corruption siphons off as much as 35 percent of the money spent on health care nationwide annually.Do you see the Strawman here? The figures presented above only proves that Russia's healthcare market is inadequately policed; it doesn't prove that universal or single-payer healthcare systems are inherently corrupt or result in substandard wages for healthcare professionals. The average pay of Russian healthcare professionals is also something a Red Herring: compensation of individual healthcare practitioners is not an indicator of the likelihood of an overall healthcare market's ability to function efficiently, as the performance of healthcare markets from Canada to Cuba clearly show.
Low wages are another problem. Yearly salaries of physicians average $5,160 to $6,120, while nurses average $2,760 to $3,780. This often results in underpaid physicians accepting bribes for higher-quality care.
Reforms drafted this spring by the Russian Federal Assembly include placing higher emphasis on primary care, shutting down numerous substandard hospitals, scaling down the scope of free medical assistance guaranteed by the state, and increasing physician salaries by reimbursing doctors according to the number of individual treatments given instead of by the number of hours worked.Do you see what's going on here? The reforms proposed by the Russian government are never addressed. Instead, they are summarily dismissed.
"Instead of forcing people to pay into this failed program, Russia's government should allow the market to influence the health care system, which it can begin to do by allowing its citizens to choose how their own health care money is spent," Emanuel said.
So-called "universal" health care does not actually exist, says Graham.
"At best, in a functioning democracy like Canada or Britain, it results in unequal access to health care by government rationing, lack of investment in innovation, and shortage of medical professionals," Graham pointed out. "At worst, in a country with little democratic bona fides, it results in the situation we are seeing in Russia."The author has taken great pains to paint an unfavorable, ugly, and frankly prurient (from a healthcare policy perspective) picture of Russia's national, single-payer healthcare system. Having savaged the concept generally (i.e.: Poisoned the Well), Rina Shah sees no reason to bother backing up the claims made in the concluding paragraph about the failings of universal healthcare systems in functional democracies, which are better and more realistic models for potential universal healthcare solutions in the United States. Which was clearly her intention all along.
For too many physicians, that conversation is hard to have, and families, too, are reluctant to initiate a discussion about what Mom or Dad might want until they're in a crisis, which isn't the best time to make these kinds of decisions. Ideally, that conversation should begin at the kitchen table with family members, rather than in a doctor's office.It's a conversation you need to have wherever and whenever you can, and the more people you can rope into it, the better! Make this conversation a part of your Thanksgiving weekend, there will be a right moment, you just might not realize how right it was until you begin the conversation.
The audit program serves as a new part of OCR’s health information privacy and security compliance program. OCR will use the audit program to assess HIPAA compliance efforts by a range of covered entities, Audits present a new opportunity to examine mechanisms for compliance, identify best practices and discover risks and vulnerabilities that may not have come to light through OCR’s ongoing complaint investigations and compliance reviews. OCR will broadly share best practices gleaned through the audit process and guidance targeted to observed compliance challenges via this web site and other outreach portals.The OCR HIPAA Audit Program page also provides detail on when the audits will begin, who will be audited, how the audit process will work, and what will happen after the audit. The information indicates that they will select a broad range of covered entities for the first round of audits and that business associates will be included in future audits.
On June 5, 2009 and June 30, 2009, HHS began investigations of two separate complaints alleging that the Covered Entity was in violation of the Privacy and/or Security Rules. The investigations indicated that the following conduct occurred (“Covered Conduct”):
(i) During the period from August 31, 2005 to November 16, 2005, numerous Covered Entity workforce members repeatedly and without a permissible reason examined the electronic protected health information of Covered Entity patients, and during the period from January 31, 2008 to February 2, 2008, numerous Covered Entity workforce members repeatedly and without a permissible reason examined the electronic protected health information of a Covered Entity patient.More information and background can be found in the iHealthBeat article, UCLA Health System Agrees to Pay $865K over Privacy Breaches, including a link to a statement on the settlement issued by UCLH Health System.
(ii) During the period 2005-2008, a workforce member of Covered Entity employed in the office of the Director of Nursing repeatedly and without a permissible reason examined the electronic protected health information of many patients.
(iii) During the period 2005-2008, Covered Entity did not provide and/or did not document the provision of necessary and appropriate Privacy and/or Security Rule training for all members of its workforce to carry out their function within the Covered Entity.
(iv) During the period 2005-2008, Covered Entity failed to apply appropriate sanctions and/or document sanctions on workforce members who impermissibly examined electronic protected health information.
(v) During the period from 2005-2009, Covered Entity failed to implement security measures sufficient to reduce the risks of impermissible access to electronic protected health information by unauthorized users to a reasonable and appropriate level.
Those who fail to learn from history are doomed to repeat it, or so the saying goes.
My controversial piece on Silicon Valley missing the point of healthcare last summer doesn’t seem so controversial now, as I recently got some validation from others closer to the action than I am. First, reDesign Mobile analyst Rocky Agrawal wrote in VentureBeat that Silicon Valley might be “too smart for their own good,” building products more suited for highly educated techies than for the masses. Last week, former Apple and PepsiCo CEO John Sculley suggested at the Digital Health Summit at 2012 International CES that technology for its own sake is rather useless if you don’t understand the market you’re targeting.
“”The thing that is missing is getting the people with the domain expertise aligned with the people with technological know-how to turn ideas into branded services,” Sculley said, as I report in InformationWeek Healthcare and in tomorrow’s MobiHealthNews.
After raking Rock Health over the coals in my commentary last summer, I offered qualified praise to the San Francisco-based investor/business accelerator for healthcare start-ups last month on this blog. “I was pleasantly surprised to see that the majority of the 15 companies are aimed at either healthcare providers—an important constituency largely missing from the first Rock Health class—and on treatment of truly sick patients.” I wrote.
“I never thought I would say this, at least not before the end of 2011, but kudos to Rock Health for making a real effort to figure out the complex healthcare industry and to add some substance to what heretofore had been all style.”
Tomorrow, I am planning on attending the kickoff event for Healthbox, a similar healthcare business accelerator that differs from Rock Health in at least one key way: it is not in Silicon Valley, but right here in down-to-earth Chicago. Does that make a difference? Well, the kickoff isn’t at a hotel ballroom or Healthbox’s office, it’s in an artsy space called the Ivy Room, in the heart of River North, an area usually populated by more tourists than locals.
I sure hope I’m not in for an over-the-top extravaganza that will highlight cool, direct-to-consumer apps with a snowball’s chance of catching on with the entities that actually pay the bills for healthcare. I want to believe there’s something real here, which is why I’m giving up at least a couple hours of my time to see the presentations. Please tell me that Chicago isn’t becoming a Silicon Valley clone, but rather the hub of health IT innovation it could be.
For what it’s worth, here is the list of companies scheduled to present tomorrow: UnitedPreference, DermLink, SwipeSense (“a comprehensive hand-hygiene solution,” whatever that means, The Coupon Doc, CareWire, Iconic Data, PaJR-Patient Journey Record (helping hospitals avoid 30-day readmissions, potentially making it a Big Deal), CareHubs, Corengi (linking diabetics to clinical trials) and PUSH Wellness. I see real potential in at least four of those, possibly more.
Other locales may get more press in this industry, but the Chicago area has a surprisingly strong community of health IT vendors.
It is well known that Allscripts is headquartered at the Merchandise Mart. GE Healthcare, while based just outside Milwaukee, maintains a large IT center in northwest suburban Barrington, Ill. CDW, based in Vernon Hills, Ill., runs its healthcare division from a downtown Chicago office. Numerous smaller vendors dot the area, too. And then there is Merge Healthcare, a medium-sized firm that historically has specialized in software for medical imaging.
Last week, I visited Merge’s home office in the Aon Center, an iconic skyscraper previously known as the Amoco Building and, before that, the Standard Oil Building. There, CEO Jeff Surges gave me a history of the company and talked about changes in the company and in the health IT field in general. Then, I turned on my video camera so Surges, sporting an orange necktie, could explain why Merge has adopted orange as its company color.
Following my interview with the CEO, Gilbert Gagné, also wearing an orange tie, gave me a demo of Merge iConnect Access, an image viewing system than works through any Web browser. I got the iPad portion of the demo on video, too.
I shot this in 720p high definition, but only uploaded it at 360p to save time. Let me know if you want HD so the iPad screen appears a little sharper.
As I first mentioned in August, John Lynn and I had the thought that it would be great if Twitter co-founder and HIMSS12 keynote speaker Biz Stone would show up at John’s 3rd annual New Media Meetup. Stone didn’t respond to our halfhearted attempt back then, but now the conference is less than two months away, and I have to imagine he will be making his plans soon, if he hasn’t done so already.
HIMSS social media guru Cari McLean also would love for Stone to meet and greet conference attendees at the HIMSS Social Media Center after his keynote on the morning of Tuesday, Feb. 21, per her tweet in response to one of mine:
That means that now is the time to put social media to work to get Stone to make a couple of appearances. Stone’s Twitter handle is @Biz. Tweet away, using the hashtag #BizatHIMSS12 and perhaps add #hcsm (for healthcare social media). Blog about this effort. Post on LinkedIn, Facebook and Google Plus. I may even make a YouTube video. Let’s impress Stone with the power of social media and get him to mingle with the masses in Las Vegas.
Have you made your reservations for HIMSS12 yet? If you’re just starting to plan, you might not have noticed some quirks with the schedule and the venue this time around.
For one thing, the mega-health IT conference in Las Vegas is not at the massive Las Vegas Convention Center, but rather at the Sands Expo Convention Center and the adjacent Venetian hotel. Remember, the 2012 HIMSS conference was supposed to be in Chicago, but the organization switched it to Sin City a couple years ago after vendors complained about high costs at Chicago’s McCormick Place for HIMSS09. (The defection of HIMSS and one other large trade show actually prompted the Illinois General Assembly to legislate changes to some of the work rules at McCormick Place, after which HIMSS agreed to hold its 2015 and 2019 conferences there.)
The last-minute nature of the relocation is changing a lot of the dynamics.
I know that HIMSS has outgrown most of the convention centers in the country, to the point that only Las Vegas, Chicago, Atlanta, New Orleans and Orlando can accommodate it, but the Sands was a surprising choice. Believe it or not, the Sands-Venetian claims to be the third largest convention facility in the nation, with 1.8 million square feet of exhibition and meeting space. However, many exhibitors will be put in Hall G, on the lower level, a 380,000-square-foot space with just a 13.5-foot ceiling height. The upper halls have 32.5-foot ceilings, so I’m guessing the downstairs space is going to seem awfully claustrophobic.
(On the other hand, the Venetian is a lot more luxurious than your typical conference hotel. Plus, I once saw Chuck Norris and his brother playing craps there. He graciously did not injure me.)
Also, HIMSS12 ends on Friday, Feb. 24, instead of the usual Thursday. When I booked my travel last week, I thought this meant HIMSS was adding an extra day to what already has become an endurance test. But I looked again today and noticed that everything has been moved back a day. The freakshow otherwise known as the vendor exhibition runs Tuesday-Thursday instead of Monday-Wednesday, and most of the preconference events, typically held on the Sunday prior to the start of the main conference, are set for Monday, Feb. 20. Alas, I’ve already booked my travel to arrive Saturday, and who knows what it will cost to change my plans? On the other hand, it gets me out of Chicago for an extra day in the winter.
Does anyone have any insight about this scheduling shift? Is it because of the venue change, or a result of the fact that Vegas hotels normally jack up the rates on Friday and Saturday nights?
Of note, though, the HIMSS travel service is a better deal in 2012 than in most years, based on my experience. Go through the official channel and you won’t pay more for staying a weekend night. You also won’t have to pay any resort fees at the many properties now adding this mandatory charge, and they’ll throw in free Internet access, too. That sealed the deal for me.
My first impression of healthcare startup incubator/accelerator Rock Health was not a favorable one. I wrote in MobiHealthNews last July that the San Francisco-based organization founded by some hotshot, young Harvard MBAs demonstrated “yet another example of Silicon Valley arrogance.” I said that Rock Health was mostly targeting the young end of the market with cool, fitness-oriented apps, not the elderly and chronically ill who account for the bulk of the nation’s $2.5 trillion annual healthcare spend. That group wants things that are easy to use rather than fun and hip.
Needless to say, I was not invited to Rock Health’s Christmas party. I did share a quick “hello” nod with Managing Director Halle Tecco when I saw her in a meeting room at the mHealth Summit last month, though.
Even then, I wondered if Rock Health had changed its attitude at all, seeing that even the executives were outfitted in company t-shirts in the buttoned-down world of (just outside) Washington, D.C. (I once had a Capitol Hill press pass early in my career. The rules require members of the media to conform to the same dress code as members of Congress. That means a coat and tie for men, while women have to have jackets if they choose to wear slacks. An unwritten rule of D.C. in general calls for women to wear stockings if they go with a skirt, even if it’s 95 degrees and humid, which it frequently is in the summer.)
Today, though, I saw a clear sign that Rock Health is starting to learn from its earlier mistakes. MobiHealthNews reported on the incubator’s class of 2012, and I was pleasantly surprised to see that the majority of the 15 companies are aimed at either healthcare providers—an important constituency largely missing from the first Rock Health class—and on treatment of truly sick patients. One startup, for example, helps people being treated for breast cancer prepare for doctor visits, while another produces an EHR for home-health agencies. Good stuff in my critical eyes, though really, enough with the social networking to get people to exercise. There are too many of these platforms and apps already.
I never thought I would say this, at least not before the end of 2011, but kudos to Rock Health for making a real effort to figure out the complex healthcare industry and to add some substance to what heretofore had been all style.
Now it makes sense.
A couple weeks ago, I got the latest update from fictional EHR vendor Extormity:
Extormity to Federal Health IT Leaders – ‘Take a chill pill, fellas.’
Brantley Whittington, fictional CEO of make-believe electronic health record vendor Extormity, is urging Aneesh Chopra, Farzad Mostashari and Todd Park to tone down their optimism and exuberance about the clinical benefits and cost savings associated with implementing health information technology.
Whittington, speaking to reporters from the offices of a K Street lobbying firm in Washington, D.C., expressed dismay at the unbridled enthusiasm exhibited by White House, ONC and HHS officials. “For years, vendors like Extormity have worked hard to cultivate a healthcare IT culture that combines complexity with closed-mindedness, creating a pervasive and stifling sense of futility.”
“Instead of the sober and staid leadership we are accustomed to, these gentlemen are inspiring new models of industry development,” added Whittington. “The Direct Project is a great example of supercharged public/private collaboration designed to simplify the flow of health information without spending a dime of taxpayer money. This may benefit patients and providers, but the lack of convoluted infrastructure does little for the Extormity bottom line.”
“While I have been known to muster up some counterfeit fervor for shareholder meetings, the consistent passion and zeal demonstrated by these officials is proving disruptive to those of us dedicated to proprietary and expensive solutions,” added Whittington. “I suggest dialing back the levels on the gusto meter to preserve the status quo, stifle meaningful innovation and ensure consistent and sizable returns to a handful of large healthcare IT vendors.”
Chopra, Mostashari and Park are exuberant, that’s for sure. The first time I saw Park and Chopra share a stage together, I labeled them the “anti-bureaucrats.” I have since added Mostashari to that category. But it was only over the weekend that I learned that Mostashari and Chopra were getting down to the “Meaningful Yoose” rap from Dr. Ross Martin at a recent ONC meeting.
Perhaps this is why Mr. Whittington wants the anti-bureaucrats to tone it down. Or perhaps (more likely) extormity feels threatened by innovation. Yeah, let’s go with the latter.
N.B. I am writing this while 33,000 feet above northeastern New Mexico, just about to cross into the Texas Panhandle, on a flight from Tucson to Chicago. I love me some Wi-Fi in the sky!