Archive for May, 2009

David Kibbe & Mark Leavitt : Openness vs. Opacity

May 30, 2009 · Filed Under general · 14 Comments

Background information:

The Certification Commission for Healthcare Information Technology (CCHIT) is currently in a monopolistic situation since it is, for the last few years, the only entity allowed to certify EHRs.
The HITECH act of ARRA mentions specifically the requirement to use “certified” EHRs to be able to collect federal money to implement EHR at both doctor offices and hospitals. The next few months Dr. David Blumenthal will have to decide who will be entitled to do these certifications (Dr. Blumenthal is the National Coordinator for Health Information Technology. In his role he is charged with the implementation of HITECH). With at least $20 Bn. at stake, CCHIT will have enormous powers, if it remains a monopoly.
Questions have been raised over time about the connection between CCHIT and HIMSS, the Health IT professional society, a vendor-sponsored organization.

This week the Healthcare Blog got on fire, thanks to an angry, vitriolic drive-by post from Dr. Mark Leavitt, former Secretary of the DHHS (innacurate) and current chair of CCHIT:
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Getting health insurance with a pre-existing condition

May 29, 2009 · Filed Under found on the net · 3 Comments

Thanks to Amy Tenderich (@DiabetesMine) for mentioning this CNN Empowered Patient entry that could be of real use to many:

“Tips for getting insurance when you have a pre-existing condition ”

The tips:
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Atul Gawande examines why health costs are high some places and lower others

May 28, 2009 · Filed Under ethics, general, hc's problem list, news & gossip, policy issues, reforming hc, trends & principles · 13 Comments

Atul Gawande, MD As soon as you can, stop what you’re doing and devote 20-30 minutes to reading Atul Gawande’s important new article in the June 1 New Yorker, The Cost Conundrum: What a Texas town can teach us about health care.

I don’t claim to be an expert about cost issues but in my year-plus of listening to US healthcare discussions I’ve heard enough to know, from common sense, that it’s a big stinking tangled mess. The results are so dysfunctional that all signs indicate that the root cause must be perverse incentives. But the question is, where?

Every whichway you turn in these discussions people have a ready explanation for why they’re not at the root of the problem. Gawande appears to do a superb job of carefully selecting matched pairs of cities and situations to reveal whether the proposed issue does in fact make any difference. Care quality? No. Overall health of the population? No. And so on.

Gawande is a surgeon and a superb writer who knows his way around an argument. My gut says that from this moment forward nobody can claim to be well versed in health reform issues – and informed choice – if they haven’t absorbed this 7,800 word article.

Adopting a Style for Improved Health Outcomes

May 27, 2009 · Filed Under pt/doc co-care, pts as teachers, reforming hc · 1 Comment

Not Your Father’s Doctor-Patient Relationship – A Positively Revolutionary Approach

In pediatrics, research has shown that not all parenting styles produce equal outcomes. Researchers often categorize parenting styles into four groups according to parents’ level of expectations for their children and their level of empathy, their responsiveness to their children’s cues.

What would high expectations look like? Parents of first graders, for example, might expect their children to not interrupt while adults are talking, to cooperate smoothly with unexpected changes in plans, and so on. I’ve paid most attention to these parenting styles and their effect on teaching children to enjoy eating healthy foods.

Those who have high expectations and demands but who are not very sensitive, warm, or responsive to their children are called authoritarian. They tend to be critical. They focus more on shortfalls than on successes. When it comes to feeding, they tend to be strict. They pressure their children to eat certain foods, while placing other foods off limits—at least until the veggies are eaten. This approach is dramatically ineffective at achieving desired goals. In spite of such well-meaning efforts, the children of authoritarian parents tend to eat fewer fruits and vegetables and, when studied, have the highest odds of being overweight by first grade of any of the four parenting styles.

Parents who are very sensitive and responsive, but who don’t maintain high expectations, may be too permissive or indulgent. Their children may be a bit better off nutritionally than the children of authoritarian parents, but they may still be likely to emerge overweight and with an unhealthy diet. Even though these parents clearly care, the outcomes are no better than for children of neglectful parents — parents with low expectations and low responsiveness

Children of both permissive and neglectful parents are about twice as likely to end up obese as the kids of parents who display both high expectations for their children’s best behavior and high empathy to their wants and needs.

Authoritative parents are warm, sensitive, and emotionally responsive, while maintaining high expectations for their children and setting firm boundaries. These parents are tuned in to their children’s unique needs and temperaments. They are supportive of their children’s successes, no matter how small. They understand and acknowledge their child’s perspective. They respect their children. They interact warmly and avoid language that seems like a put down.. They don’t get irritated easily.

X PRIZE Blog Rally:
$10M for Health Care Innovators

May 26, 2009 · Filed Under general · 6 Comments

Scott Shreeve, MD, Senior Health Advisor at The X Prize Foundation and frequent THCB contributor, has asked the health care blogosphere to take part in this blog rally in order to raise awareness about the Healthcare X Prize Foundation competition and encourage public participation in the prize design. Pass the word around and feel free to post this to your own blog if possible.

We are entering an unprecedented season of change for the United States health care system. Americans are united by their desire to fundamentally reform our current system into one that delivers on the promise of freedom, equity, and best outcomes for best value. In this season of reform, we will see all kinds of ideas presented from all across the political spectrum. Many of these ideas will be prescriptive, and don’t harness the power of innovation to create the dramatic breakthroughs required to create a next generation health system.

We believe there is a better way. Read more

The power of listening and being heard

May 25, 2009 · Filed Under positive patterns, pt/doc co-care, trends & principles · 5 Comments

This is a special occasion for me, a guest post by Dr. Louise Glaser.

Louise is a pediatrician in the Kaiser Permanente system, where among other things she’s Chief of Leadership and Communication Development in the Sacramento area. I met her a year ago at the annual Conference for Global Transformation (CGT), and again this May.

This year she was one of the presenters. Using her training in transforming relationships and conversations, she’s been developing courses for staff at her 1,000-provider medical center, so she has some serious street-level experience in what works.

Another great reason to be a participatory e-patient

May 20, 2009 · Filed Under news & gossip, pt/doc co-care, trends & principles · 4 Comments

The Boston Globe had a brief interview with me last Monday, and commenter “MikeScanlon” gave a great additional reason to go “e”:

Doctors are required to respond to a lot of things – health insurance requirements, liability insurance requirements, rules and regulations of all sort – and finally, the assumptions about their patients that they must make when individual acquaintance is lacking; Yet each patient is an individual.

Unless the patient participates actively in their health care, and partners with their doctor, they leave the doctor no choice but to make a standard set of decisions, which includes assumptions about the patient’s ability to deal with the science and to follow regimes. It is a frustration on both sides I would think.

The equation is simple: help your doctor care for you by caring for your doctor and understanding her, or his, position and needs.”

Will The Great Recession Create Millions of e-Patients?

May 19, 2009 · Filed Under general, hc's problem list, news & gossip, trends & principles · 18 Comments

Another post about healthcare “creepware” from Opaque, Inc.

While reading the Wall Street Journal health blog, I saw this disturbing piece of information:

In a new survey conducted by Mercer, the employee benefits consulting shop, nearly half of the 428 employers polled said they plan to shift more health costs to employees in 2010.

Further, 20% of the companies surveyed said that they planned “to switch to a high-deductible or “consumer-directed” health plan.”

For many of us the term Consumer-Directed Health Plan (CDHP) means very little, if anything at all. But based on what Mercer says, we’d better find out, because the news is not cheery for anyone who plans to use the healthcare system. (That would be you.)
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Participatory Medicine: What Is It For You?

May 18, 2009 · Filed Under general · 32 Comments

As the meme is now firmly accepted, I thought we ought to have another round of definition crowdsourcing.

If you use the term please stop here for a minute and let us know what it means to you.

I will summarize the responses and use the results to update the wikipedia page on Participatory Medicine.

Thank You!

Meaningful Use: The Elephant IS In The Room

May 18, 2009 · Filed Under general, medical records, policy issues, reforming hc, trends & principles · 18 Comments

Comparative Effectiveness: a comparison of the impact of different options that are available for treating a given medical condition for a particular set of patients. Such studies may compare similar treatments, such as competing drugs, or they may analyze very different approaches, such as surgery and drug therapy. The analysis may focus only on the relative medical benefits and risks of each option, or it may go on to weigh both the costs and the benefits of those options.

I am afraid that by focusing so much on HITECH and on the definition of Meaningful Use and Certification on this blog we have been missing on the most important part of the “ARRA” stimulus package , the initial $1.1 bn. funding of Comparative Effectiveness Research (CER) to be spent by Sep. 2010. Specifically some of the $400 millions to be used at the discretion of the DHHS Secretary that must be allocated to encourage the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data. It certainly looks like the national implementation of EHRs may become fully intertwined with CER.

The minimum definition of “Meaningful Use” as defined in ARRA includes e-prescribing, electronic exchange of medical information and interoperability. These are also the necessary elements to start implementing a national CER strategy. There is just too much at stake this time to think it won’t happen.

e-Patients should become informed about the potential impact of CER for future care. Please read the summary of the “Listening Session of the Federal Coordinating Council for Comparative Effectiveness Research” from April 14, 2009 to get a better understanding why we, the patients & patient groups, must get directly involved in helping to develop the CER private/public infrastructure & activities.

A project of the