Researchers at the Fraunhofer Institute for Manufacturing and Advanced Materials in Dresden have developed a titanium "foam" that may be a better material to use than solid titanium in orthopedic implants. Because of its porous structure, the researchers believe bone will better grow into the implant which itself will be lighter due to less material used.

The titanium foam is the result of a powder metallurgy-based molding process that has already proven its value in the industrial production of ceramic filters for aluminum casting. Open-cell polyurethane (PU) foams are saturated with a solution consisting of a binding medium and a fine titanium powder. The powder cleaves to the cellular structures of the foams. The PU and binding agents are then vaporized. What remains is a semblance of the foam structures, which is ultimately sintered. "The mechanical properties of titanium foams made this way closely approach those of the human bone", reports Quadbeck [Dr. Peter Quadbeck of the Fraunhofer Institute for Manufacturing and Advanced Materials IFAM in Dresden]. "This applies foremost to the balance between extreme durability and minimal rigidity." The former is an important precondition for its use on bones, which have to sustain the forces of both weight and motion. Bone-like rigidity allows for stress forces to be transmitted; with the new formation of bone cells, it also fosters healing of the implant. Consequently, stress can and should be applied to the implant immediately after insertion.

In the "TiFoam" project, the research partners concentrated on demonstrating the viability of titanium foam for replacement of defective vertebral bodies. The foam is equally suitable for "repairing" other severely stressed bones. In addition to the materials scientists from the Fraunhofer institutes IFAM and IKTS – the Institute for Ceramic Technologies and Systems in Dresden – physicians from the medical center at the Technical University of Dresden and from several companies were involved in developing the titanium foam. Project partner InnoTERE already announced that it would soon develop and manufacture "TiFoam"-based bone implants.

Press release: Titanium foams replace injured bones

Researchers at the Fraunhofer Institute for Manufacturing and Advanced Materials in Dresden have developed a titanium "foam" that may be a better material to use than solid titanium in orthopedic implants. Because of its porous structure, the researchers believe bone will better grow into the implant which itself will be lighter due to less material used.

The titanium foam is the result of a powder metallurgy-based molding process that has already proven its value in the industrial production of ceramic filters for aluminum casting. Open-cell polyurethane (PU) foams are saturated with a solution consisting of a binding medium and a fine titanium powder. The powder cleaves to the cellular structures of the foams. The PU and binding agents are then vaporized. What remains is a semblance of the foam structures, which is ultimately sintered. "The mechanical properties of titanium foams made this way closely approach those of the human bone", reports Quadbeck [Dr. Peter Quadbeck of the Fraunhofer Institute for Manufacturing and Advanced Materials IFAM in Dresden]. "This applies foremost to the balance between extreme durability and minimal rigidity." The former is an important precondition for its use on bones, which have to sustain the forces of both weight and motion. Bone-like rigidity allows for stress forces to be transmitted; with the new formation of bone cells, it also fosters healing of the implant. Consequently, stress can and should be applied to the implant immediately after insertion.

In the "TiFoam" project, the research partners concentrated on demonstrating the viability of titanium foam for replacement of defective vertebral bodies. The foam is equally suitable for "repairing" other severely stressed bones. In addition to the materials scientists from the Fraunhofer institutes IFAM and IKTS – the Institute for Ceramic Technologies and Systems in Dresden – physicians from the medical center at the Technical University of Dresden and from several companies were involved in developing the titanium foam. Project partner InnoTERE already announced that it would soon develop and manufacture "TiFoam"-based bone implants.

Press release: Titanium foams replace injured bones

Bacteria may be having a renaissance. Back in the days of the discovery of penicillin, doctors gleefully handed out antibiotics like they were candy and patients were more than happy to munch them down. They were quite effective too, but bacteria rapidly became resistant. Doctors and scientists worry that we are approaching a time where if we don't come up with novel antibiotic mechanisms, we will face an epidemic of untreatable bacterial infections. MRSA, methicillin-resistant staphylcoccal auerus, is probably one of the biggest fears.

John Rennie wrote about this issue in the PLoS blog The Gleaming Retort. He describes two strategies scientists are using to try to come up with new weapons in the great antibacterial war. So, naturally one of the first things they turned to was cockroach brains. A group from the University of Nottingham reported a 90% MRSA kill rate utilizing compounds extracted from cockroach and locust brains that were not harmful to human cells. The logic behind their research is that insects have no adaptive immune system (antibodies, lymphocytes etc...), but they are able to survive extremely harsh, contaminated and frankly disgusting environments. Researchers theorize they must rely on extremely potent anti-microbial compounds in order to survive. It is unclear though why these compounds would only be in the nervous system, and the study has not yet been subject to peer-review.

The other strategy is to study a cannibalistic species of bacteria, Bacillus subtilis. Under harsh conditions, the bacteria releases a compound called SDP that causes neighboring bacteria to commit suicide and release precious nutrients. Researchers at UCSD were able to use this compound to neutralize MRSA at a concentration similar to the popular antibiotic Vancomycin.

John Rennie, however, had some reservations, which he sums up very nicely below:

Also, although the idea of novel antibiotics derived from insects that live in germ-ridden circumstances sounds appealingly sensible, I can’t help but be reminded of this story from a couple of weeks ago about novel antibiotic compounds found in frog skin. Which also makes perfect sense, doesn’t it, because frogs, too, need special resources to help them survive in filthy, microbe-rich water.

Unfortunately, that story also reminded me about this story from 2008 about antibiotics from frog skin. Or this one from 1999. Or the stories I wrote about Michael Zasloff and Magainin Pharmaceuticals, which was trying to develop novel antibiotics from frog skin more than 20 years ago.

The stories behind certain drug candidate molecules are so fun and compelling and sensible that you can’t help but think they will work out. And sometimes they do. But more often, they don’t, no matter how great the stories are.

In three paragraphs he summarizes a major problem facing medical technology and public perception nowadays. There is so much to be excited about and to spend money on, but it is very difficult and rare for exciting medical technology to make it to market and become useful to people. We'll take the glass is half full approach though... half full of delicious life-saving cockroach brains.

The Gleaming Retort: Filthy Places for Antibiotics

Image credit: Matt Reinbold

(hat tip: SCOPE Blog)

Bacteria may be having a renaissance. Back in the days of the discovery of penicillin, doctors gleefully handed out antibiotics like they were candy and patients were more than happy to munch them down. They were quite effective too, but bacteria rapidly became resistant. Doctors and scientists worry that we are approaching a time where if we don't come up with novel antibiotic mechanisms, we will face an epidemic of untreatable bacterial infections. MRSA, methicillin-resistant staphylcoccal auerus, is probably one of the biggest fears.

John Rennie wrote about this issue in the PLoS blog The Gleaming Retort. He describes two strategies scientists are using to try to come up with new weapons in the great antibacterial war. So, naturally one of the first things they turned to was cockroach brains. A group from the University of Nottingham reported a 90% MRSA kill rate utilizing compounds extracted from cockroach and locust brains that were not harmful to human cells. The logic behind their research is that insects have no adaptive immune system (antibodies, lymphocytes etc...), but they are able to survive extremely harsh, contaminated and frankly disgusting environments. Researchers theorize they must rely on extremely potent anti-microbial compounds in order to survive. It is unclear though why these compounds would only be in the nervous system, and the study has not yet been subject to peer-review.

The other strategy is to study a cannibalistic species of bacteria, Bacillus subtilis. Under harsh conditions, the bacteria releases a compound called SDP that causes neighboring bacteria to commit suicide and release precious nutrients. Researchers at UCSD were able to use this compound to neutralize MRSA at a concentration similar to the popular antibiotic Vancomycin.

John Rennie, however, had some reservations, which he sums up very nicely below:

Also, although the idea of novel antibiotics derived from insects that live in germ-ridden circumstances sounds appealingly sensible, I can’t help but be reminded of this story from a couple of weeks ago about novel antibiotic compounds found in frog skin. Which also makes perfect sense, doesn’t it, because frogs, too, need special resources to help them survive in filthy, microbe-rich water.

Unfortunately, that story also reminded me about this story from 2008 about antibiotics from frog skin. Or this one from 1999. Or the stories I wrote about Michael Zasloff and Magainin Pharmaceuticals, which was trying to develop novel antibiotics from frog skin more than 20 years ago.

The stories behind certain drug candidate molecules are so fun and compelling and sensible that you can’t help but think they will work out. And sometimes they do. But more often, they don’t, no matter how great the stories are.

In three paragraphs he summarizes a major problem facing medical technology and public perception nowadays. There is so much to be excited about and to spend money on, but it is very difficult and rare for exciting medical technology to make it to market and become useful to people. We'll take the glass is half full approach though... half full of delicious life-saving cockroach brains.

The Gleaming Retort: Filthy Places for Antibiotics

Image credit: Matt Reinbold

(hat tip: SCOPE Blog)

Scientists at Northwestern University have stumbled serendipitously onto a method to create nanostructures called metal-organic frameworks... which also happen to be edible. Metal-organic frameworks are metals connected in a highly organized crystal structure that allows for the trapping, storage, and controlled release of gas (i.e: hydrogen or carbon dioxide) or other molecules. These structures have been proposed as a possible new targeted drug delivery system that can be seen on imaging. They also have many non-medical uses such as for gas purification and for gas storage.

Usually metal organic frameworks are made from toxic petroleum-based products. The secret to Northwestern's great gastronomical success is gamma-cyclodextrin, a sugar produced from corn starch. Add in a little alcohol in the form of Everclear (no joke), and the scientists accidentally ended up with a huge breakthrough.

More from the press release:

“They taste kind of bitter, like a Saltine cracker, starchy and bland,” said Ronald A. Smaldone, a postdoctoral fellow at Northwestern.

“The metal-organic framework technology has been around since 1999 and relies on chemicals that come from crude oil,” explained Ross S. Forgan, also a postdoctoral fellow in Stoddart’s lab and co-first author of the paper. “Our main constituent is a starch molecule that is a leftover from corn production.”

For their edible MOFs, the researchers use not ordinary table sugar but gamma-cyclodextrin, an eight-membered sugar ring produced from biorenewable cornstarch. The salts can be potassium chloride, a common salt substitute, or potassium benzoate, a commercial food preservative, and the alcohol is the grain spirit Everclear.

With these ingredients in hand, the researchers actually had set out to make new molecular architectures based on gamma-cyclodextrin. Their work produced crystals. Upon examining the crystals’ structures using X-rays, the researchers were surprised to discover they had created metal-organic frameworks -- not an easy feat using natural products.

“Symmetry is very important in metal-organic frameworks,” Stoddart said. “The problem is that natural building blocks are generally not symmetrical, which seems to prevent them from crystallizing as highly ordered, porous frameworks.”

It turns out gamma-cyclodextrin solves the problem: it comprises eight asymmetrical glucose residues arranged in a ring, which is itself symmetrical. The gamma-cyclodextrin and potassium salt are dissolved in water and then crystallized by vapor diffusion with alcohol.

The resulting arrangement -- crystals consisting of cubes made from six gamma-cyclodextrin molecules linked in three-dimensions by potassium ions -- was previously unknown. The research team believes this strategy of marrying symmetry with asymmetry will carry over to other materials.

Read more here...

Abstract in Angewandte Chemie International Edition: Metal-Organic Frameworks from Edible Natural Products

Scientists at Northwestern University have stumbled serendipitously onto a method to create nanostructures called metal-organic frameworks... which also happen to be edible. Metal-organic frameworks are metals connected in a highly organized crystal structure that allows for the trapping, storage, and controlled release of gas (i.e: hydrogen or carbon dioxide) or other molecules. These structures have been proposed as a possible new targeted drug delivery system that can be seen on imaging. They also have many non-medical uses such as for gas purification and for gas storage.

Usually metal organic frameworks are made from toxic petroleum-based products. The secret to Northwestern's great gastronomical success is gamma-cyclodextrin, a sugar produced from corn starch. Add in a little alcohol in the form of Everclear (no joke), and the scientists accidentally ended up with a huge breakthrough.

More from the press release:

“They taste kind of bitter, like a Saltine cracker, starchy and bland,” said Ronald A. Smaldone, a postdoctoral fellow at Northwestern.

“The metal-organic framework technology has been around since 1999 and relies on chemicals that come from crude oil,” explained Ross S. Forgan, also a postdoctoral fellow in Stoddart’s lab and co-first author of the paper. “Our main constituent is a starch molecule that is a leftover from corn production.”

For their edible MOFs, the researchers use not ordinary table sugar but gamma-cyclodextrin, an eight-membered sugar ring produced from biorenewable cornstarch. The salts can be potassium chloride, a common salt substitute, or potassium benzoate, a commercial food preservative, and the alcohol is the grain spirit Everclear.

With these ingredients in hand, the researchers actually had set out to make new molecular architectures based on gamma-cyclodextrin. Their work produced crystals. Upon examining the crystals’ structures using X-rays, the researchers were surprised to discover they had created metal-organic frameworks -- not an easy feat using natural products.

“Symmetry is very important in metal-organic frameworks,” Stoddart said. “The problem is that natural building blocks are generally not symmetrical, which seems to prevent them from crystallizing as highly ordered, porous frameworks.”

It turns out gamma-cyclodextrin solves the problem: it comprises eight asymmetrical glucose residues arranged in a ring, which is itself symmetrical. The gamma-cyclodextrin and potassium salt are dissolved in water and then crystallized by vapor diffusion with alcohol.

The resulting arrangement -- crystals consisting of cubes made from six gamma-cyclodextrin molecules linked in three-dimensions by potassium ions -- was previously unknown. The research team believes this strategy of marrying symmetry with asymmetry will carry over to other materials.

Read more here...

Abstract in Angewandte Chemie International Edition: Metal-Organic Frameworks from Edible Natural Products

There's another event coming up later this month: 2010 Healthcare Mobile Technology Symposium in San Antonio, Texas. This event is for healthcare providers interested in discovering new solutions for mobile technology in their industry. It looks like they're going to have some great speakers at this event.

The Healthcare Symposium is an invitation-only event.

As we learned from the previous post outlining the Medicare EHR incentive program, it is absolutely imperative that everyone (especially potential eligible providers) draw a clear line between Medicare and Medicaid’s requirements, time lines and payments. This post will serve to outline the basics of the Medicaid EHR incentive program to give providers a trusted source [...]

I'm still naive and vain enough to be impressed when something I wrote makes it to a real publication, i.e., a professional operation hoping to sell copy or at least advertising, and not self-published like my blog.

The good people at AdvanceWeb recently asked me to write a piece on the available iPad radiology viewers.  Since their budget didn't allow them to buy me my own iPad, I stole my son's while he was in Australia and proceeded to download any and all viewing apps I could find.  At this stage, most are dedicated to the iPhone, but they work adequately well on the iPad.  There were a few pleasant surprises in this little technical odyssey, including the discovery of Calgary Scientific, which seems to "get it" far better than most in this particular venue.

I have to let you know that the title of the piece was selected by the editors over at AdvanceWeb.  Let's hope the demise of the Sharper Image stores has no bearing on the success of my writing.

To avoid copyright problems, and to keep from having to reproduce the images in the article, I will simply provide you the link to the AdvanceWeb site:

http://imaging-radiation-oncology.advanceweb.com/Features/Articles/The-iPad-Radiologys-Sharper-Image.aspx

I hope you find it interesting.  Let me know if I've inspired you to go out and buy an iPad!

This is a short guest blog by Dr. Bruce Beckwith, Chief of Pathology, North Shore Medical Center, Salem, MA. Dr. Beckwith will be providing more details about DICOM in a talk at Pathology Informatics 2010 that will be held in Boston on 19-22 September (see: Enabling Digital Pathology - Whole Slide Imaging in DICOM). Please contact him if you want more information or would like to get involved with the DICOM pathology working group. Such input is always valued.

The approval of Supplement 145 (Whole slide microscopic image object definition) coupled with the prior approval of Supplement 122 in 2008 (Pathology specimen module) means that the DICOM standard now has the pathology concepts and image objects that are necessary for vendors to implement a digital pathology workflow, including AP-LISs, slide scanners, PACS, and viewers. This will allow robust interoperability of products and systems from multiple vendors and also storage of pathology images in standard hospital PACS systems.

The good news is that the standards are now available. However, there is still much work to be done. It typically takes years for new features in the DICOM standard to be adopted by vendors. I expect that the digital pathology vendors will change quickly but it may take much longer for the currently installed PACS systems to be upgraded. In addition to PACS, the AP-LIS vendors will need to become aware of these changes and add support in order to have a seamless workflow. Such an environment has already been achieved in radiology. 

The IHE-Pathology group is continuing to work on integration profiles supporting digital pathology. For those not familiar with IHE, you can think of these profiles as high level implementation guidelines. We would like to see pathology imaging vendors take part in the IHE Connectathons such as the one that took place earlier this year.

One of the roles of pathologists is this process will be to communicate to the vendors with whom they work that DICOM compliance will be a necessary feature of future pathology imaging products just as it is in radiology today. They also need to educate the PACS administrators about this issue well in advance of the time that they intend to start storing hospital pathology images in these imaging systems.
 

AMA Supports National Childhood Obesity Awareness Month

For immediate release:
Sept. 2, 2010

Reiterates the importance of getting all family members involved in making healthy food choices and increasing physical activity

CHICAGO – Today, the American Medical Association (AMA) announced its support for National Childhood Obesity Awareness Month and renewed its commitment to help improve the health of our nation’s children.

“Obesity kills more Americans every year than AIDS, all cancers, and all accidents combined. It is causing health problems in children that were unthinkable 30 years ago. That is why the AMA is working to halt the spread of obesity,” said AMA Board Member Mary Anne McCaffree, MD. “As physicians, we know the importance of instilling healthy habits early in a person’s life and getting all family members involved in making healthy food choices and increasing physical activity.”

The AMA Healthier Life Steps toolkit is a comprehensive online tool designed to ignite greater discussion between patients and physicians about healthy lifestyle choices and empower patients to jumpstart a healthy eating and exercise plan that works for them. Patient screening checklists, intervention plans, motivational tools and other program components can be downloaded free of charge from the AMA’s website.

“Making healthier lifestyle choices like eating healthier and getting adequate exercise, dramatically reduces the risk for obesity and its health complications,” said Dr. McCaffree. “The AMA is committed to obesity prevention and reduction and will continue working to provide patients and physicians with the resources they need to combat obesity.” 

I thought I would wander along to the NEHTA web site to see just what was available on the PCEHR given the dearth of information available from DoHA. I have discussed what we had a few weeks ago, during the election campaign, here: http://aushealthit.blogspot.com/2010/07/we-have-utter-madness-afoot-at-doha.html Here is what I found from NEHTA: http://www.nehta.gov.au/coordinated-care/whats-in-pcehr What is a PCEHR? A Personally Controlled Electronic Health Record (PCEHR) is a secure, electronic record of your medical history, stored and shared in a network of connected systems. The PCEHR will bring key health information from a number of different systems together and present it in a single view. Information in a PCEHR will be able to be accessed by you and your authorised healthcare providers. With this information available to them, healthcare providers will be able to make better decisions about your health and treatment advice. Over time you will be able to contribute to...

This is the initial part of the post - read more by clicking on the title of the article. David.

The videos are actually very good and the second video shows the actual procedure and nipping the polyp, so if you have never seen one, Dr. Oz shared his.  The videos walk you through the whole process, even the first video is drinking that awful tasting stuff to clean out for the next day.  Lot’s of flush noises in that video   The preparation is not fun by any means. 

Dr. Oz Has Colon Polyp (Pre-Cancerous Growth) Found During Routine Colonoscopy–He Follows His Own Advice and Is A Good Role Model for The Rest of Us (A Rare Find Today)

Just follow the links below to watch each episode.  When this article says it’s behind the scenes, it really is and very informative.  BD 

Dr. Oz takes you behind the scenes of his routine colonoscopy and the shocking outcome he never expected: the discovery of a precancerous polyp. Watch Dr. Oz as he deals with the reality of his diagnosis and emphasizes the need for preventive screenings. Learn more about the test that saved his life and what you can do to save your own.

Click here to watch Part 1: Dr. Oz at home as he prepares for his first colonoscopy.

Click here to watch Part 2: Witness the actual procedure and the moment when Dr. Oz’s physician discovers the precancerous polyp.

Click here to watch Part 3: Dr. Oz’s physician delivers the diagnosis: an adenomatous polyp, the kind that would have likely developed into cancer if left undetected and untreated.

Click here to watch Part 5:  Dr. Oz discusses how colonoscopy is a major preventive measure in protecting your health and explains the colon cancer risk factors.

Click here to watch Part 6: See how colon cancer grows and spreads through the body, and how a colonoscopy is performed.

Dr. Oz's Colonoscopy, Pt. 4 | The Dr. Oz Show

The article states a tool designed by McKesson is the software of choice that many hospitals use to guide the decision making process. As a patient if you are kept for observation, given a bed, meal, etc. that does not mean you have been “officially admitted as an inpatient”.

The software is known as InterQual and recent filings with the SEC called it a “trade secret” – and what do we call this?  The algorithms that are trade secrets. 

There are other companies that make software that does the same thing and they patent their algorithms too so we don’t know exactly how this works.  Again  depending on the descriptions here, patients are not always told if they have been officially ‘admitted as an inpatient”.  Medicare requires patients to be notified but again if they have bed and meal, they think they have been admitted. 

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?

Medicare requires a 3 day inpatient stay, so when patients are not formally admitted, they don’t pay.  In this example here, the patient ended up in a nursing home and a big bill, because they went from being under observation without an official inpatient status, and then they get a huge bill that is not covered.  If the patient is there for observation, they get outpatient benefits. 

Now from the hospital billing side, this gets confusing too with a biller making errors with billing inpatients when in fact the patient was there for observation.  Later on audits come in and guess what, fraud it detected. 

Doctors are complaining that this locks up the system and when patients need to be kept for observation it creates problems and again there’s the bill the patient receives too.  This is one more area you might inquire about as a patient too, ask if you are there for observation or if you have been admitted so you can figure out what you might be exposed to for additional billing.  BD 

After Ann Callan, 85, fell and broke four ribs, she spent six days at Holy Cross Hospital in Silver Spring. Doctors and nurses examined her daily and gave her medications and oxygen to help her breathe. But when she was discharged in early January, her family got a surprise: Medicare would not pay for her follow-up nursing home care, because she did not have the prerequisite three days of inpatient care.

"Where was she?" asks her husband, Paul Callan, 85, a retired U.S. Army colonel. "I was with her all the time. I knew she was a patient there."

But Holy Cross had admitted her only for observation. Observation services include short-term treatment and tests to help doctors decide if the patient should be admitted for inpatient treatment. Medicare's guidance says it should take no more than 24 to 48 hours to make this determination.

And unless patients spend at least three consecutive days as an inpatient, Medicare will not cover follow-up nursing home expenses after discharge.

"Under a set of rather arbitrary definitions, which are very vague and difficult to understand and apply, we have to decide who's an inpatient and who's an outpatient when sometimes the distinction can be two or three points in their sodium level or the amount of IV fluids they are receiving," he told CMS officials at an information-gathering session Aug. 24.

If the distinction isn't always clear to doctors, it's even more elusive for patients.

Growing Number Of Patients Find A Hospital Stay Does Not Mean They’re Admitted - Kaiser Health News

Overall Dr. Berwick is a breath of fresh air with innovative thinking and I hope he gets a chance to work on some of these long seeded problems with Medicare as it has been years since CMS has had a director.  I get the feeling that we have folks in Congress that prefer to keep stirring the pot rather than see if someone can make some progress here.  These are times like we have never lived through before so you can’t compare past performances of others to what we are dealing with today. 

Senate GOP Demanding to Hear From Berwick – Perhaps They Would Learn More About Healthcare if They Asked Some Intelligent Questions….

If he does not get confirmed by the Senate at sometime, his job runs out at the end of the year 2011 so what a pressure cooker situation with less than 2 years to jump in here.  Keeping the Senators happy and working on creating solutions to this big problem all at once is a big task, especially when the Senate is full of “non participants”.   I think he’s smart enough to realize we need some human touches in all of this and not just running a bunch of new software out there – we are up to our ears in hearing that and self included with too many scatterings with “innovation”.  A little more collaboration and working together in technology solutions would be a welcome change at this point.  Right now with role models this is about as good as we get, doctors texting while driving, congressmen using cell phones while driving and doing a radio show.   

Surgeon Frank Ryan Dies in Car Crash–Lost Control While Texting and Tweeting–Plastic Surgeon for Many Celebrities

At least we see Dr. Berwick with some technology in hand at times, which is more than I can say for others in administration and HHS, so perhaps there’s hope on the horizon with a good role model here.  BD 

WASHINGTON — Newly installed Medicare chief Donald Berwick, keeping a low public profile after encountering controversy over his appointment, is moving quickly behind the scenes to seed the US health care system with 100 to 300 sites to test new models of caring for patients.

In Massachusetts, private insurers such as Blue Cross and Blue Shield have begun expanding the use of global payments for the care of diabetes, high-blood pressure, and cardiovascular disease. Bay State political leaders, seeking ways to control costs in the Commonwealth’s pioneering health care initiative, are considering whether to expand the adoption of such systems.

Unless he can win over some GOP senators, who voted uniformly against the health care law, Berwick won’t be able to win a 60-vote confirmation in the Senate and will be forced to leave office when his recess appointment expires at the end of 2011

Medicare head pushes health care test sites - The Boston Globe

This program is for affordable healthcare for children.  Most of the counties affected here are in northern California or Mid-state.  I wonder if is is part of the effect of our California budget cuts being able to pay?  BD

Blue Shield of California recently announced it will no longer provide coverage for 15,000 Healthy Families patients in 15 counties. Effective October 1, the insurer is pulling its Healthy Families HMO product out of nine counties (Alameda, Marin, Placer, San Joaquin, Santa Clara, Santa Cruz, Solano, Sonoma, and Yolo) and its EPO product out of six counties (Butte, Kings, Madera, Merced, San Luis Obispo and Stanislaus counties).

Patients were notified of these changes in July and were given the opportunity to select a new plan. If they did not select a plan by the August 31 deadline, they were automatically transferred to the default "community provider plan" (CPP) for their county. Patients will have until October 31 to switch to another plan if they are dissatisfied with the CPP. For a list of available plans by county, visit the Healthy Families website.

Blue Shield pulls out of Healthy Families in 15 counties

First of all if you are the biggest Medicaid prescriber I would expect more than 3 employees on staff.  In addition, they were not doctors and many charges were billed with patients not seen and when they were see, they were not physicians.  BD

Medicare Fraud – Criminals Do a Better Job With Filing Claims And Coding Than Providers

The problem with catching some of these folks is that they study the billing processes and bill better than real doctors, they know the data routine unfortunately.  BD

Sept. 7 (Bloomberg) -- The biggest prescriber of drugs for Medicaid patients in New Jersey ran a medical practice that used phony physicians to see patients, according to a Federal Bureau of Investigation arrest complaint.

Yousuf Masood, 46, billed Medicaid, the government insurance program for the poor and disabled, for thousands of visits by patients who either got no services or were seen by three employees who had no medical license and posed as doctors, according to the FBI complaint.

New Jersey Medicaid Doctor Used Non-MDs, FBI Says - BusinessWeek

This is the 3rd year for this event and Michael Douglas has announced he will be there via a taped segment.  Other attendees will include Dr. Oz, Christina Applegate and more.  I have included some posts here and there on the Quack that give updates on where the money raised is going.  You can also visit the website to find out more and donate.

Stand Up to Cancer Grants Go to 2 Arizona Doctors and Their Teams to Turn Science Into Cures for Cancer

Unless you have missed the news he has been under radiation treatment therapy for throat cancer.  Ironically this month, his new movie, “Wall Street, Money Never Sleeps” is due out later this month. 

"Wall Street: “Money Never Sleeps"- “Greed is Good- Now It’s Legal – Its About the Game – Everybody’s Drinking the Same Kool-Aid” – The Move Trailer

We wish him the best on his recovery and will see him this Friday as the fund raiser will be broadcast simultaneously on all networks..  BD

In addition to the bevy of stars already signed up for this week’s “Stand Up to Cancer” telethon, actor Michael Douglas will also participate in the event, which will raise funds for cancer research.

The 65-year-old star of the upcoming movie “Wall Street: Money Never Sleeps” was recently diagnosed with a tumor in his throat, and is currently enduring a bout of radiation and chemotherapy. “It’s a fight,” he told People magazine of his treatment. “It knocks you out.”

Douglas, who will participate via a taped segment, will join previously announced stars Reese Witherspoon, Sofia Vergara, Christina Applegate, Michael C. Hall, Jim Parsons, Gabrielle Union, Seth MacFarlane, David Boreanaz and Mandy Moore for the hour-long program.

Michael Douglas will ‘Stand Up to Cancer’ – The Marquee Blog - CNN.com Blogs

For your consideration, here are the latest hand-picked links that didn't make to our posts:

Losing weight may pollute the blood ... [New Scientist]

Stem cell plaintiffs blast NIH chief, question total funding freeze ... [Nature Blogs]

US stem-cell chaos felt abroad ... [Nature]

FDA has App Stores Under Surveillance ... [jkOnTheRun]

In Feast of Data on BPA Plastic, No Final Answer ... [nytimes.com]

How Much Does Defensive Medicine Cost? One Study Says $46 Billion ... [WSJ]

Social media pose ethical unknowns for doctors ... [American Medical News]

Medtronic Launches Resolute Integrity Drug-Eluting Stent In Europe ... [Medtronic]

UK red tape bars iPhone medical devices ... [mobihealthnews]

WideMed sleep monitor granted CE Mark ... [Globes]

Brainsway signs with Montreal's McGill University ... [Globes]

Vocera's Expanding Mobile Health Care Services for Smartphones ... [Enterprise Mobile Today]

Bristol-Myers agrees to buy ZymoGenetics ... [AP]

St. Jude Medical Signs Equity Investment and Option to Purchase Agreement with CardioMEMS ... [St. Jude Medical]

Research yields promising malaria drug candidate ... [NIH]

Study shows how insulin stimulates fat cells to take in glucose ... [NIH]

Production of Sticky Proteins May Explain How Malaria Evades the Immune System ... [HHMI]

Researchers decode function and protein content of the centrosome ... [Max Planck Society for the Advancement of Science]

DNA-assisted solution processing for high-performance thin-film transistors ... [Nanowerk]

Prostate cancer screening: current status and future perspectives... [Nature Reviews Urology]

Forget What You Know About Good Study Habits ... [nytimes.com]

Johns Hopkins Investigates: Race, Insurance Status Cited In Uneven Death Rates Among Pedestrians Hit By Cars... [Johns Hopkins]

Reading Arabic 'hard for brain' ... [BBC]

Magic mushrooms reduce anxiety over cancer ... [New Scientist]

For your consideration, here are the latest hand-picked links that didn't make to our posts:

Losing weight may pollute the blood ... [New Scientist]

Stem cell plaintiffs blast NIH chief, question total funding freeze ... [Nature Blogs]

US stem-cell chaos felt abroad ... [Nature]

FDA has App Stores Under Surveillance ... [jkOnTheRun]

In Feast of Data on BPA Plastic, No Final Answer ... [nytimes.com]

How Much Does Defensive Medicine Cost? One Study Says $46 Billion ... [WSJ]

Social media pose ethical unknowns for doctors ... [American Medical News]

Medtronic Launches Resolute Integrity Drug-Eluting Stent In Europe ... [Medtronic]

UK red tape bars iPhone medical devices ... [mobihealthnews]

WideMed sleep monitor granted CE Mark ... [Globes]

Brainsway signs with Montreal's McGill University ... [Globes]

Vocera's Expanding Mobile Health Care Services for Smartphones ... [Enterprise Mobile Today]

Bristol-Myers agrees to buy ZymoGenetics ... [AP]

St. Jude Medical Signs Equity Investment and Option to Purchase Agreement with CardioMEMS ... [St. Jude Medical]

Research yields promising malaria drug candidate ... [NIH]

Study shows how insulin stimulates fat cells to take in glucose ... [NIH]

Production of Sticky Proteins May Explain How Malaria Evades the Immune System ... [HHMI]

Researchers decode function and protein content of the centrosome ... [Max Planck Society for the Advancement of Science]

DNA-assisted solution processing for high-performance thin-film transistors ... [Nanowerk]

Prostate cancer screening: current status and future perspectives... [Nature Reviews Urology]

Forget What You Know About Good Study Habits ... [nytimes.com]

Johns Hopkins Investigates: Race, Insurance Status Cited In Uneven Death Rates Among Pedestrians Hit By Cars... [Johns Hopkins]

Reading Arabic 'hard for brain' ... [BBC]

Magic mushrooms reduce anxiety over cancer ... [New Scientist]

Back in July of 2009 a judge ordered the unsealing of documents relating to how the drug was marketed, etc.  Pfizer who now owns Wyeth and all the related issues is disputing the report. DesignWrite, a medical communications company in Princeton, N.J., proposed to Wyeth a two-year plan that would include the preparation of about 30 articles for publication in medical journals.

Wyeth Used Ghostwriters - Video of the Premarin Horses

One of the biggest issues with the Women’s Health Initiative was the fact that the study rolled bio identical and the Wyeth drugs that are made from pregnant horse urine all into one category.  On this blog and in other places in the news we have all questioned the fact that there have not been any numbers comparing the two and perhaps Wyeth/Pfizer didn’t want this either?  Sales of Premarin and Prempro continue to decline.  Below you can see some of the discussions and links I had with Dr. Erika Schwartz about bioidentical hormones.

Hormone Therapy Said to Increase Risk of Ovarian Cancer – Were Bio Identicals Considered?

This is a good opportunity to mention a new documentary that is coming out soon and is available for screenings, Hot Flash Havoc, all about menopause and giving women the information they need to make decisions.  The Trailer for the movie is below and once I see the entire movie I’ll be writing more.

From the website:

“Hot Flash Havoc has brought together the leading experts in women's health across the United States to help unravel the confusion surrounding menopause and the controversial Women's Health Initiative (WHI). Our experts include doctors, clinicians, researchers, journalists, and women's health foundations. They are some of the leaders in the fields of Women's Sexual Health, Heart Health, Bone Health, Mental Health, and Physical Health. Since perimenopause begins in a woman’s mid 30’s it is vitally important for women to get educated sooner than later, thus empowering them to become their own health care advocates for the "Second Act" of their lives.”

The website also has a few other videos to see as well.  Again, more later when I have seen the entire movie and am looking forward to it.  BD

(Reuters) - Drugmaker Wyeth used ghostwriters to play up the benefits and downplay the harm of hormone replacement therapy in articles published in medical journals, U.S. researchers said on Tuesday.

Dr. Adriane Fugh-Berman of Georgetown University Medical Center in Washington and colleagues analyzed dozens of ghostwritten reviews and commentaries published in medical journals and journal supplements, many of them using documents from judicial trials.

They said Wyeth, now owned by Pfizer, paid a medical communication company called DesignWrite $25,000 to ghostwrite articles on clinical studies, including four testing low-dose Prempro, the company's combination estrogen-progestin therapy.

Wyeth paid writers to promote hormone therapy: study | Reuters

The product is safe for humans but deadly for these snakes who are taking over the island and this way they can catch up with the snakes when they munch.

The snakes are wiping out bird populations on the island is not a native of the island but more than likely was brought here on ships or planes.  It has no natural predators so the population just grows. 

The dead mice also have radio transmitters so they can track the dead snakes to see if this method of attack works.  BD

Dead mice packed with acetaminophen, strapped to pieces of cardboard and dropped from helicopters may help control one of the big headaches for the Pacific island of Guam – the brown tree snake.

The U.S. Department of Agriculture last week began dropping the expired rodents packed with 80 mg of the generic equivalent of Tylenol on the forests of Naval Base Guam.

Since scientists discovered that the household pain reliever was deadly to the brown tree snakes, they’ve been trying to figure out how to get it to where many of the serpents live in the canopies of the island’s forests, according to a report in Stars & Stripes. The Tylenol-loaded mice are attached to two pieces of cardboard joined by paper streamers that snake exterminators hope will catch on tree branches, providing deadly snacks for snakes at those heights, according to the Stripes report.

Tylenol-loaded mice dropped from air to control snakes – This Just In - CNN.com Blogs

Ian Morrison hits the nail on the head with his newest commentary on Hospitals and Health Networks online site.  In “ The New Math ” Ian explains why business as usual in the healthcare industry just isn’t sustainable anymore.  While this has...(read more)

This is a large number of violations stacked up here by the State, 992,936 with a fine of 10k for each violation.  This could stand to be the largest fine in US history against a health insurance company.  United Health Group is appealing the process of course. 

When United took over Pacificare they stated they would maintain PacifiCare's workforce and relationships with providers.  Providers soon complained after the take over as claims were not paid timely, customer service suffered big time. I heard those complaints personally from office where I was consulting.  Seriously offices could not get answers and I over heard offices on the phone with their offices all the time.  United even came out and said they were going to get to be more user friendly. In Orange County, many employers are looking for new HMO contracts for their employees as the rate went up when converting over to a United policy from the old Pacificare and some hospitals won’t take Pacificare/United employer plans. 

Employers in Orange County Looking for New HMO Contracts as St. Josephs and Some Others Begin Cancelling Agreements with Pacificare (UnitedHeatlhCare) – Employer Capitation Contracts

I think in all honesty their problems were data related in combining the systems which is really not an excuse but this happens and is still happening all over the place. As sick patients, we don’t get any exceptions.  We also had the Ingenix Inquisition too with United and most all other major carriers using the Ingenix data base to pay doctors and consumers short on out of network charges, and this is only one case there’s a lot more filed all over the US.  Pacificare was part of this before and under United. 

AMA Announced Settlement of Class Action Suit of $350 Million with Ingenix (United Healthcare)

During the last 15 years most of the major health insurance carriers paid Ingenix to license the data base used for out of network charges so United made money both from consumers and other health insurance companies with the data base that “low balled”

Ingenix Data Base Has Some Long Reaching Legal Tentacles with Aetna, Blue Cross, Blue Shield, Humana

Headlines from 2008:

State intervenes in PacifiCare coverage dispute

United/PacifiCare fined record $3.5 million

With all of this said, there’s room for some fines for not taking care of business how much and what is up to the courts. 

IT’S ALL ABOUT THOSE COST EFFICIENCY ALGOIRITHMS THAT MAKE DECISIONS TO DRIVE PROFITS. 

Health Care Insurers Suggest Algorithms and Business Intelligence solutions to provide health insurance solution

Insurers live and die by the algorithms and United owns Ingenix who can develop some whenever needed. 

I think the stuff that really works on public impressions too are what happens at board meetings with no holding a limit on what executives are paid and no concern over how much they want to spend on lobbying as the board says go for it. 

UnitedHealth Shareholders Say We Don’t Care What Executives Earn and What Is Spent on Lobbying – Go For It

It is important to pay attention to their subsidiary actions too as this is shaping many of the directions where the company is headed to ensure profits and expand upon if possible.  The link below summarizes some of this in a prior post.  BD

UnitedHealth Group 2nd Quarter Profits for 2010 Rose 31% – Expects Revenues of 93 Billion for the Year

The health insurer violated state law nearly 1 million times from 2006 to 2008 after it was bought by UnitedHealth Group, the Department of Insurance says.

California regulators are seeking fines of up to $10 billion from health insurer PacifiCare over allegations that it repeatedly mismanaged medical claims, lost thousands of patient documents, failed to pay doctors what they were owed and ignored calls to fix the problems.
In court filings and other documents, the California Department of Insurance says PacifiCare violated state law nearly 1 million times from 2006 to 2008 after it was purchased by UnitedHealth Group Inc., the nation's largest health insurance company by revenue.

The state's accusations are spelled out in documents filed with a state administrative law judge who has been hearing testimony intermittently since last December. At the conclusion of the Oakland hearing, the judge will decide whether to recommend penalties.

California regulators seek up to $10 billion in fines from PacifiCare - latimes.com

Technorati Tags: PacifiCare,United Healthcare,health insurance,branding,HMO,Orange County,rebranding,St. Josephs Hospitals,algorithms fraud,subsidiaryies,capitation,contracts

New U.S. Hospital IT Data Released for Research Purposes

For five years, the Dorenfest Institute has provided historical data on health information technology use in the hospital market

The 2009 data on the U.S. hospital IT market and updated 2008 data from the HIMSS AnalyticsTM Database has been released by The Dorenfest Institute for Health Information Technology, Research and Education, managed by the HIMSS Foundation. The Dorenfest Institute provides a variety of detailed historical data, reports and white papers about information technology use in hospitals and integrated healthcare delivery networks at no charge to universities, students under university license, U.S. governments (local, state and federal), and governments of other countries that will be using the data for research purposes.
    
The newly released 2008 data from the HIMSS AnalyticsTM Database covers IT use in hospitals and integrated healthcare delivery networks. The release of the 2008 data expands the current library of the Dorenfest 3000+ Databases™ and Dorenfest Integrated Healthcare Delivery System Databases™ for the period 1986 through 2008, as well as many publications on IT use in the healthcare industry during that same time period.
    
The 2009 Annual Report of the U.S. Hospital IT Market, also now available in pdf format on the Dorenfest Institute Web site, presents the state of the U.S. hospital IT market. The report examines hospital budgets as well as financial, technology, and department environments and presents key findings on IT investment and enterprise resource planning. The data is from HIMSS AnalyticsTM Database. The 2005 through 2008 reports are also available on the site.

“These updated data and market reports, along with the legacy of the Dorenfest healthcare IT databases, support the critical research that is needed to improve outcomes from healthcare IT investment projects,” said Sheldon I. Dorenfest, president/CEO of the Dorenfest Group in Chicago. The Dorenfest Group is a leading consultant and source of knowledge about the healthcare information technology industry.

The Dorenfest Institute was formed in January 2005 to further the interest in and benefits associated with ongoing research in health IT. This followed a generous donation of his company and its historical data assets to HIMSS Foundation by Dorenfest to further the interest in and benefits associated with ongoing research in health IT.

The complete listing of databases and publications available from the Dorenfest Institute is available at www.himss.org/dorenfestinstitute, including an online registration form for access to all of the data. Contact foundation@himss.org for more information on the Dorenfest Institute.   

“With the release of this historical data from the Dorenfest Institute and HIMSS Analytics, the HIMSS Foundation continues to support universities and government agencies in their research efforts and study of health information technology and management systems,” said R. Norris Orms, FACHE, CAE, Executive Director of the HIMSS Foundation.

About HIMSS Foundation
Established in 1986, the HIMSS Foundation serves as the philanthropic arm of HIMSS, providing support and assistance to the organization, its members, and the industry. The HIMSS Foundation is an Illinois not-for-profit corporation organized and operated exclusively for charitable scientific and educational purposes within the meaning of Section 501 (c) (3) of the Internal Revenue Code of 1986. Projects that the Foundation supports include: scholarships for students in healthcare IT-related fields, and relief and assistance for need-based programs such as the Katrina Phoenix Project.

About HIMSS
HIMSS is a cause-based, not-for-profit organization exclusively focused on providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare. Founded 50 years ago, HIMSS and its related organizations have offices in Chicago, Washington, DC, Brussels, Singapore, Leipzig, and other locations across the United States. HIMSS represents more than 30,000 individual members, of which two thirds work in healthcare provider, governmental and not-for-profit organizations. HIMSS also includes over 470 corporate members and more than 85 not-for-profit organizations that share our mission of transforming healthcare through the effective use of information technology and management systems. HIMSS frames and leads healthcare practices and public policy through its content expertise, professional development, and research initiatives designed to promote information and management systems’ contributions to improving the quality, safety, access, and cost-effectiveness of patient care.

About The Dorenfest Group
The Dorenfest Group is a leading source of knowledge about the worldwide healthcare industry and its improvements needs. Providing a variety of consulting services throughout the world, The Dorenfest Group focuses these services on improving healthcare while reducing costs by helping its clients to improve work processes, management systems, and quality of medical care.

Agfa HealthCare, a leading provider of diagnostic imaging and healthcare IT solutions, has signed an agreement with the Ziekenhuis Oost-Limburg (ZOL - Eastern Limburg Hospital Group) for the installation of its ORBIS Care solution at all of its three sites.

Agfa HealthCare, a leading provider of diagnostic imaging and healthcare IT solutions, has signed an agreement with the Ziekenhuis Oost-Limburg (ZOL - Eastern Limburg Hospital Group) for the installation of its ORBIS Care solution at all of its three sites.

EMIS Group plc ("EMIS" or "the Group"), the UK's leading supplier of healthcare software and related services to GPs, has received full roll-out approval for its next generation system, EMIS Web. The approval covers the core GP functionality of EMIS Web and, as a result, EMIS is now able to initiate the controlled roll-out of the product.

EMIS Group plc ("EMIS" or "the Group"), the UK's leading supplier of healthcare software and related services to GPs, has received full roll-out approval for its next generation system, EMIS Web. The approval covers the core GP functionality of EMIS Web and, as a result, EMIS is now able to initiate the controlled roll-out of the product.

iSOFT Group Limited (ASX:ISF) announced an order from Dartford and Gravesham NHS Trust for Savience touch-screen kiosks to cut queues and free reception and nursing staff at the Darent Valley Hospital.