Wednesday, May 30, 2012

Telehealth pilot helps patients with kidney disease

PARIS – A remote telehealth pilot has shown promise for patients living with chronic kidney disease (CKD), yielding positive trial results in both patient satisfaction and patient support.

The pilot was also awarded the Innovation Prize this month in the telemedicine category at Hit Paris, France’s annual health IT tradeshow.

In a collaborative effort among Grenoble University Hospital, Calydial dialysis centers of France and AGDUC health center in France, patients living with CKD were selected to take part in a trial using remote patient monitoring technology provided by Canadian-based telecommunications provider, TELUS and Orange, the French communications company.

Patients in their homes were given e-tablets, connectivity and software to monitor their vital signs, manage their medication and treatment protocols and provide feedback to their care team. Early positive results have demonstrated the potential to replicate this solution across other institutions and for other chronically ill patients.

The pilot uses a network-centric, multi-function application that allows patients with conditions that require daily monitoring to coordinate with their healthcare providers from home. Patients and caregivers are able to access the application through a secure wireless network.

Kasra Moozar, vice president, TELUS Health Solutions explained that TELUS, has “ more than 10,000 patients using its remote patient monitoring technology to manage their chronic condition from the safety and comfort of their own home." Moozar said that the technology allows them to turn “information into better health outcomes for citizens."

"Telemedicine has the power to transform the way that healthcare is delivered, said Thierry Zylberberg, executive vice president, Orange Healthcare. “These telemedicine solutions can have a positive impact on care quality for chronic disease patients and care delivery for healthcare providers."

Sunday, May 27, 2012

HIE market still a little like the 'Wild West'

CAMBRIDGE, MA – Healthcare organizations have been very focused over the last two to four years on rolling out their electronic health record strategy, which has been driven largely by the meaningful use incentives. Today, however, Integrated delivery networks (IDNs) are starting to recognize that their EHRs alone will not solve every problem – especially care coordination issues between IDNs.

“We’ve seen much more of a focus with the IDN this year on what do we do next, what is the platform that enables us to leverage the EMR that we’ve invested in and build a more connected healthcare system,” said Paul Grabscheid, vice president of strategic planning for Cambridge, Mass.-based InterSystems. “We see much more interest than ever before among healthcare providers doing more to connect with their patients through patient portals and community-building capabilities.”

[See also: HIE as a verb: ONC wants to move quickly on data exchange]

IDNs want to get the most complete, most useful and usable information about patients from different systems to their clinicians when they need it to identify, for example, a population that’s important to them or identify patients who are in that population in order to systematically deliver better quality care, according to Grabscheid.

This business and clinical requirement has made health information exchange (HIE) attractive to IDNs and large providers because the value of HIE is its ability to intelligently aggregate patient data from multiple sources and present a comprehensive view of the patient’s medical status and history.

It comes as no surprise then that the larger market for HIEs is with IDNs and larger providers.

[See also: HIE on the upswing]

“It’s a younger market that is not so well crystallized yet,” Grabscheid observed.

As he sees it, despite the growth in this segment of the market, what’s lacking is a common understanding which software is needed to solve those problems and how best to solve those problems.

“There’s a lot of opportunity for education in the market and a lot of experimentation,” Grabscheid said. “It’s still a little bit of the Wild West.”

Grabscheid pointed out that simply exchanging pieces of data does not leverage the full value HIEs can deliver. He highlighted three IDNs that are looking to take advantage of InterSystem’s HealthShare’s HIE platform. A data model takes all the information accessible through HealthShare and makes it available for analysis via the analytics core technology. Key performance indicators or metrics can then be measured, and those results can be translated into charts and reports and onto dashboards to help clinicians and other users make sense of the data.

One IDN, which comprises 10 hospitals and 20 service sites, and also serves as a payer, is looking to connect its internal and external systems, which include Cerner and Epic EHRs, as well as create comprehensive patient records for provider and patient portals. One of the goals of the IDN is to reduce readmissions for its congestive heart failure patients through the use of analytics. Finally, the IDN wants to link to the regional HIE in its area.

A six-hospital IDN with a large primary/specialty care network is leveraging the HIE platform to streamline multi-payer administrative transactions; enable comprehensive record sharing between acute and primary care providers; alert clinicians of events to ensure safer, more effective care transitions; increase the effectiveness of primary care, specialist, and acute-site referrals; and automate public health reporting to local, state and federal authorities.

A large urban health system, comprising hospitals, clinics, skilled nursing facilities and home health, and serving more than one million patients, has a plan to connect its multiple EMRs, financial systems and more than 500 applications in order to present a consolidated patient record across the enterprise. Once that is accomplished, the IDN will connect to the seven regional health information organizations (RHIOs) in the area.
 
All three are leveraging the HIE platform for multiple initiatives that involve connectivity, interoperability, analytics, and quality measuring and reporting, which will deliver business and clinical benefits that surpass the EMR’s capabilities.

“They’re trying to figure out what they can see right now,” Grabscheid said, of the three IDNs. “But the one thing they know for sure is there’s more change coming,” he added, referring to the upcoming presidential election. “The most important thing in healthcare right now is staying nimble so that as the rules change you can react,” he said. “Trying to guess what is happening and start doing that is too tough. The key is to keep flexible.”

Katie Beckett Defied The Odds, Helped Other Disabled Kids Live Longer

Hide caption Katie Beckett, 32, inserts a small suction device into her tracheotomy tube to help clear her lungs and throat. Twenty-nine years ago, President Ronald Reagan heard about a little girl who had spent most of her life in a hospital. That little girl was Katie, then just three years old. John Poole/NPR Hide caption Nurse Vicki Hagen comes over to Beckett's apartment in Cedar Rapids, Iowa, to help fit her with a vibrating vest that helps clear mucous from her lungs twice a day. Studies have shown that, almost always, it costs less to care for someone at home than in a nursing home or hospital. John Poole/NPR Hide caption On the wall of her apartment are pictures of Beckett as a child with President Reagan. Reagan created the "Katie Beckett waiver" that changed the Medicaid rules to allow severely disabled children and adults to get government-funded care in their own homes. John Poole/NPR Hide caption Beckett (left) and her mom Julie go to a restaurant in Cedar Rapids, Iowa, once a week to catch up. Beckett is now famous among children's advocates and travels the country with her mom working for laws and programs in favor of homecare. John Poole/NPR

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A few years ago, I asked a 13-year-old girl who was receiving care for cystic fibrosis on a Medicaid program known as the "Katie Beckett waiver" if she knew who Katie Beckett was. "Probably some kind of doctor," the girl said.

It was a logical guess. But Beckett was another child with a significant disability, and she changed health care policy for hundreds of thousands of other children with complex medical needs. On Friday, Beckett, at age 34, died in Cedar Rapids, Iowa, of complications from her disability.

Beckett had spent most of the first three years of her life living in an Iowa hospital because she needed to breathe on a ventilator much of the day. Medicaid would only pay for the expensive treatment if she stayed in the hospital.

In 1981, President Ronald Reagan heard about her situation and changed the rule so she could go home. As Reagan noted, it cost significantly less � about one-sixth as much � for Beckett to receive the care at home, instead of in a hospital.

 

When she was just 5 months old, she contracted viral encephalitis, a brain infection, and went into a coma. After recovering, she had partial paralysis that left her unable to breathe without a ventilator much of the day.

Heard On Weekend Edition Saturday

May 19, 2012

Katie Beckett Leaves Legacy For Kids With Disabilities [2 min 59 sec] Add to Playlist Download  

At the time, federal officials figured there were, at most, one- or two-hundred children like Beckett around the country. Most of them were not expected to live very long. But since then, more than a half-million children have received life-extending medical care at home under the Beckett waiver.

Improved medical technology, and close attention from nurses, aides and parents � all made possible by the funding � have allowed these children to grow up with improved health, despite having severe disabilities.

Now the issue is that the state and federal waiver program ends by age 21, and children are outliving their generous health care.

These disabled children are often leading pretty normal lives. Beckett did. She went to college. She lived in her own apartment, even though she still relied on nurses who, for an hour every night, arrived to give her breathing treatments. She still needed the ventilator to breathe, up to 15 hours a day.

Still, living with complex health care needs is not easy. As Beckett explained in 2010 to a group of health care workers, "Just because you reach a certain age does not mean that you are miraculously cured of all the things you have endured."

Timeline

Milestones In Long-Term Care Policies

Over the past few years, she suffered from a series of illnesses and was forced to put off taking the classes she needed to get the teaching degree she wanted. There were many hospitalizations over the years, and her mother, Julie Beckett, said she often feared for her daughter's life. But Katie's death Friday was unexpected. She died in the same Cedar Rapids hospital where she once made history.

Katie and Julie became known as national advocates for people with disabilities. On Katie's 32nd birthday, she and her mother were in Washington to speak to a meeting of child health workers. Later that morning, Katie, in an interview with me, said she valued being a role model but was happiest back home in Cedar Rapids, where she could lead an anonymous, normal life. "In Cedar Rapids, it's quite different," she said. "I'm the girl that they see drinking a latte at Barnes & Noble. I'm not the girl from the newspaper, from the television station."

Sen. Tom Harkin, the Democrat from Beckett's home state of Iowa and one of the chief authors of the Americans with Disabilities Act, said Katie is a symbol of what the disability civil rights law set out to establish. "It's about making sure that we don't separate out people with disabilities, but make them part of the families, making them part of the communities, part of the schools � just an integral part of society. That's what Katie fought for all of her life."

Joseph Shapiro is a correspondent for NPR News Investigations. Katie Beckett's story was part of the "Home or Nursing Home" series, which explored the struggle for the disabled and elderly to receive care at home.

AxSys provides NHS with enhanced clinical IT platform

AxSys Technology has unveiled its enhanced Excelicare clinical IT platform to provide NHS Trusts and primary care providers with a cost-effective way to build patient records electronically.

Excelicare has the functionality of a portal and also works as a health information exchange. It enables multi-disciplinary care coordination, supporting disease management and delivering clinical applications through its platform. The platform also includes a patient portal complete with personal health record and an advanced clinical explorer that allows enterprise-wide viewing of integrated patient information.

The Salisbury NHS Foundation Trust is using Excelicare to replace departmental systems with custom clinical solutions created using the clinical care process modeler. This allows one clinical platform to support many different clinical specialties.

“Today’s NHS needs clinical software more than ever before," said Pradeep Ramayya, MD, CEO of AxSys. "With Excelicare you don’t need a big budget, or have to rip out and replace existing systems, as is often the case with a new electronic patient record. With the drive towards integrated and coordinated care, the new Excelicare platform allows healthcare organisations to further raise their ability to share relevant clinical information and coordinate care across boundaries."

Saturday, May 26, 2012

Stronger Benefits for Seniors, Billions in Savings This Year

Two years ago, President Obama signed the Affordable Care Act and provided important relief to seniors, including a 50% discount on brand-name prescription drugs for those in the coverage gap known as the �donut hole.�

Prior to the passage of the new health care law, people on Medicare also faced paying for preventive benefits like cancer screenings and cholesterol checks out of their own pockets. �Now, these benefits are offered free of charge to beneficiaries.

These new benefits are already making a difference in communities across the nation. �Before 2011, David Lutz, a community pharmacist from Hummelstown, PA, described customers, �splitting pills, taking doses every other day, missing doses, stretching their medications,� noting that not taking their medications as prescribed was not good for their health. �

But, according to David, this has begun to change since the passage of the Affordable Care Act. �People cannot take their medications if they can�t afford them. This [Affordable Care Act] will make them affordable and they�ll take their medications on time, the way they�re supposed to, which will improve their health,� Lutz says. �There�s no question about it.�

In 2010, for example, those who hit the donut hole received a $250 rebate � with almost 4 million seniors and people with disabilities receiving a collective $1 billion. ��In 2011, Medicare beneficiaries received more than $2.1 billion in savings � averaging $604 per person last year � from the 50% discount on brand-name drugs in the donut hole.

And today, we have more good news. Even more seniors and people with disabilities on Medicare have benefited from these important measures:

In 2010 and 2011, over 5.1 million people on Medicare saved over $3.2 billion on prescription drugs in the donut hole. �In the first four months of 2012 alone, more than 416,000 people have saved $301.5 million � an average of $724 a person so far this year.In the first four months of 2012, 12.1 million beneficiaries on traditional Medicare received at least one free preventive service. �This includes over 856,000 who have taken advantage of the Annual Wellness Visit � a new benefit that allows patients to meet with their doctors once a year to develop and update a personalized prevention plan. �In 2011, over 26 million beneficiaries in traditional Medicare � received one or more preventive benefit free of charge.

These new benefits will increase over time. �In the coming years, the automatic discount on drugs in the donut hole will expand, and by 2020 the donut hole will be closed completely. And Medicare is growing stronger in other ways as well. Doctors and hospitals are beginning to receive new incentives to provide better care to patients �improving patient safety and lowering costs. �The new law also invests more resources in fighting Medicare fraud, to protect the trust fund, and keep Medicare secure for longer.

Thanks to the Affordable Care Act, seniors and people with disabilities are enjoying a Medicare program that is stronger and working better for David�s community and others all across the country.

Health information laws made clear on new GWU website

WASHINGTON – A new website, which clarifies federal and state laws pertaining to health information, developed by researchers at The George Washington University's Hirsh Health Law and Policy Program, launched Wednesday.

The website, Health Information and the Law (HealthInfoLaw.org), serves as an online resource where organizations, consumers and healthcare providers alike can find a clear, comprehensible picture of current health information laws, policy changes and legislation.

[See also: RWJF launches new site with quality info on doctors, hospitals]

HealthInfoLaw.org, a Legal Barriers project funded by the Robert Wood Johnson Foundation, offers a lucid list and comparative analysis of regulations and laws relating to health information exchange, the shift to EMRs, confidentiality, HITECH, the ACA and HIPAA, to name a few.

“The laws are very opaque to a lot of people and difficult to navigate, and we wanted to create a resource that would translate laws themselves and complicated issues for people on the ground who are trying navigate them," says Lara Cartwright-Smith, co-director of the Legal Barriers project and assistant research professor in the GW Department of Health Policy.

The project has "a multi-aim," says Jane Hyatt Thorpe, also a co-director of the Legal Barriers project and associate research professor at the GW Department of Health Policy. "We’re hoping to help the activities going on at the local, regional and state level in terms of community organizations and other organizations working to transform care delivery.”

[See also: HIE on the upswing]

Cartwright-Smith adds, “We don’t want to limit the audience.” The audience may consist of “policymakers; it might be individual providers, consumers or organizations trying to implement health reforms and need to know the laws pertaining to them.”

Sara Rosenbaum, Harold and Jane Hirsh Professor of Health Law and Policy at GWU School of Public Health and Health Services explained in a news release why the website is so significant today:

"Health information law exists at the intersection of many crucial and related fields: law, healthcare, public health, market competition, consumer protection, information technology, and health insurance." she said. "A modest change in any of these fields can trigger a daunting set of issues and challenges. HealthInfoLaw.org offers keys to understanding the laws that govern health information and their implications for health care, consumer rights and population health." 

Friday, May 25, 2012

Homeland Security zeroes in on medical device vulnerabilities

WASHINGTON – Even as they promise better health and easier care delivery, wireless medical devices (MDs) carry significant security risks. And the situation is only getting trickier as more and more devices come with commercial operating systems that are both Internet-connected and susceptible to attack.

That’s according to a bulletin circulated by the U.S. Department of Homeland Security (DHS) this week, which explains that part of the problem is that the FDA cannot regulate who uses medical devices or how they are used – including, most notably, how they're connected to networks.

Devices include implantable medical devices, external medical devices, portable computers such as iPads, tablets, and smartphones – all of which are creating what DHS referred to as an “expanding attack surface.”

[See also: Breaches epidemic despite efforts at compliance, says Kroll.]

“Instant connectivity of these devices to the Internet or a Health Information System (HIS) that could be compromised if not protected with the latest anti-virus and spyware,” the DHS bulletin explained. “MDs like smartphones and tablets are mini-computers with instant access to the Internet or linked directly to a hospital’s network. The device or the network could be infected with malware designed to steal medical information.”

To that end, DHS breaks out five main points of entry for wireless mobile devices:

Insider: The most common ways employees steal data involved network transfer, be that email, remote access, or file transfer.Malware: These include keystroke loggers and Trojans, tailored to harvest easily accessible data once inside the network.Spearphishing: This highly-customized technique involves an email-based attack carrying malicious attack disguised as coming from a legitimate source, and seeking specific information.Web: DHS lists silent redirection, obfuscated Javascript and search engine optimization poisoning among ways to penetrate a network then, ultimately, access an organization’s data.Lost equipment: A significant problem because it happens so frequently, even a smartphone in the wrong hands can be a gateway into a health entity’s network and records. And the more that patient information is stored electronically, the greater the number of people potentially affected when equipment is lost or stolen.

[See also: The Challenge of Encrypting BYOD Devices.]

DHS described a presentation at last year’s Black Hat conference in which a security researcher, himself diabetic, demonstrated how to disrupt and jam an implanted insulin pump without the user being any the wiser. What’s more, some medical devices contain personal information that could be stolen and sold for illegal uses – as do electronic medical records when stored on unencrypted devices.

In the bulletin, DHS holds up the Department of Veterans Affairs as an example of how to mitigate wireless MD risk – one that federal agencies as well as private health entities could learn from.The VA, of course, has been blazing a mobile devices trail.

After more than 180 cyber attacks on VA MDs, the agency isolated such devices from its main network by creating a Virtual Local Area Network (VLAN) replete with access control lists that enable only authorized users to access the main network, thereby protecting clinical data because those same devices are effectively disconnected from other areas of VA’s network.

“Healthcare and Public Health Sector IT Administrators need to address the gap between security and mobile device use,” wrote DHS officials. “Areas of concern include unmanaged mobile device access, authentication of users requesting access to a hospital’s web server, how to secure mobile devices with health information, unsecured wireless connectivity or cellular networks and protection against unauthorized breach of lost and/or stolen devices."

Thursday, May 24, 2012

Two new directors join Allscripts board

CHICAGO – Allscripts on Wedenesday, named two independent members to its board of directors. The board had been left decimated last month after its chairman Phil Pead was fired and three board members resigned in protest after a turbulent quarterly meeting.

Allscripts moved quickly to name a new board chairman – Dennis Chookaszian, a member of Allscripts' board since September 2010, formerly chairman and CEO of CNA Financial Corporation.

[See also: Web First: Q&A with Allscripts CEO Glen Tullman]

Now, Allscripts has named Paul M. Black, former chief operating officer of Cerner Corp., and Robert J. Cindrich, former senior vice president and chief legal officer for the University of Pittsburgh Medical Center (UPMC), as directors, effective immediately.  Black will serve on the board’s compensation committee and Cindrich will serve on the board’s audit committee. The Board is now set at seven directors.

"We are pleased to add two new independent directors of such a high caliber," said Chookaszian. "Paul and Robert bring an outstanding combination of operational, governance and healthcare industry experience, which make them excellent additions to our Board. We believe their contributions and insights will be invaluable as the Company executes on its plan to deliver value for our customers, drive long-term growth and build shareholder value."

"Allscripts has well-respected solutions, a broad and unique client base, and a compelling vision for an open, connected, community-based, individually coordinated level of care," said Black. "I’m optimistic about the market opportunity before us and looking forward to collaborating with the board and management to execute the company’s plan to enhance the client experience, improve healthcare outcomes and deliver value for customers, team members and shareholders."

[See also: Allscripts in skid mode as shares plunge, chairman ousted]

"Allscripts has an exciting opportunity to build on its leading position in the growing market for healthcare information technology," added Cindrich. "Having spent years with one of the largest and most respected integrated delivery networks in the world, I believe I can bring a unique client perspective to management and the board. I look forward to working with my fellow directors and drawing upon my experience to help the Board and management team implement the Company’s strategic plans."

Black currently serves as operating executive of Genstar Capital, LLC, a private equity firm, and as senior advisor at New Mountain Finance Corp., an investment management company. Prior to joining Genstar, Black spent more than 13 years with Cerner and retired as its chief operating officer in 2007 after helping build it into a $1.5 billion company. He also served as chief sales officer and is credited as instrumental in the company’s double-digit organic growth. Prior to Cerner, Black was with IBM from 1982 to 1994 in a number of senior sales and professional services leadership positions.

Black was most recently elected to the board of directors of Haemonetics Corporation, a global healthcare company dedicated to providing innovative blood management solutions. He also serves on the boards of Saepio, Inc., Truman Medical Centers, and Genstar portfolio company, Netsmart Technologies. He has served as a director with several New Mountain portfolio companies.

Prior to UPMC, Cindrich served as a judge of the United States District Court for the Western District of Pennsylvania for 10 years. Prior to that appointment, he was active as an attorney in both government and private practice. His government practice includes serving as chair of the Pennsylvania Legislative Reapportionment Commission, 1992-93; United States District Attorney, Western Pennsylvania District, 1978-81; and Assistant District Attorney, Allegheny County, 1970-72. While in private practice, he served as defense counsel in business and commercial litigation.

Cindrich currently serves as a director of Mylan Inc., a leading generics and specialty pharmaceutical company. 

Allscripts’ incumbent directors, including Black and Cindrich, will stand for re-election at the annual meeting of stockholders on June 15. Stockholders of record as of the close of business on April 24, 2012, will be entitled to vote. Information on all director nominees can be found in the company’s proxy statement, which has been filed with the Securities and Exchange Commission and will be mailed to all stockholders of record.

[See also: Allscripts: Debacle or silver lining?]

Study: 96% of restaurant entrees exceed USDA limits

If you plan to chow down tonight at a big chain restaurant, there's a better than nine-in-10 chance that your entree will fail to meet federal nutrition recommendations for both adults and kids, according to a provocative new study.

A whopping 96% of main entrees sold at top U.S. chain eateries exceed daily limits for calories, sodium, fat and saturated fat recommended by the U.S. Department of Agriculture, reports the 18-month study conducted by the Rand Corp. and funded by the Robert Wood Johnson Foundation.

"If you're eating out tonight, your chances of finding an entree that's truly healthy are painfully low," says Helen Wu, assistant policy analyst at Rand who oversaw the study. It examined the nutritional content of 30,923 menu items from 245 restaurant brands across the USA. "The restaurant industry needs to make big changes to be part of the solution," she says.

The restaurant industry is "employing a wide range" of healthier-living strategies, says Joan McGlockton, vice president of food policy at the National Restaurant Association. Among them: putting nutritional information on menus, adding more healthful items and launching a 2011 program at nearly 100 brands in more than 25,000 locations that offers children's meals in line with 2010 dietary guidelines.

How much is too much? These USDA recommended limits were used to measure against main entrees:

No more than . . .

667 calories
35% of calories from fat
10% of calories from saturated fat
767 mg sodium

Source: USDA

Even then, the restaurant industry-supported "Healthy Dining" seal of approval is too generous on sodium, Wu says. It allows up to 2,000 milligrams of sodium for one main entree, while the USDA's daily recommended limit for most adults is 2,300 milligrams, she says.

Other highlights of the study, which is posted on Public Health Nutrition:

�Appetizers can be calorie bombs. Appetizers � while often shared � averaged 813 calories, compared with main entrees, which averaged 674 calories per serving, Wu says.

�Family restaurants fared worse than fast-food. Entrees at family-style restaurants on average have more calories, fat and sodium than fast-food restaurants. Entrees at family-style eateries posted 271 more calories, 435 more milligrams of sodium and 16 more grams of fat than fast-food restaurants, Wu says.

�Kid "specialty" drinks often aren't healthy. Many drinks offered on kids' menus have more fat and saturated fat on average than regular drinks. While regular menu drinks had a median of 360 calories, the median number of calories in kid specialty drinks, such as shakes and floats, was 430. The message to parents, Wu says: "It's the little extras you order that add up."

Saturday, May 19, 2012

Patients use digital media to share their stories

NOTTINGHAM, England – Patients who received treatment at the UK's Nottingham University Hospitals NHS Trust are sharing their stories online in a new video library launched on the Trust website.

Called "Patient Stories", the library contains five short films where patients share their experiences of illness, treatments and the services they received. The five films can be viewed at http://www.nuh.nhs.uk/patientstories/.

The stories, gathered during several one-to-one interviews, use video, audio and images to help convey the views and opinions of patients or healthcare professionals about people's care.

Margaret has suffered with angina for several years. In one 12-month period Margaret had 11 attacks. After each attack Margaret would call for an ambulance by dialing 999.

"Because I had called for an ambulance so many times over such a short period, I really did wonder if dialing 999 after each attack was the right thing to be doing," she said. "I am so grateful that the medical staff assured me that calling an ambulance is exactly right considering my condition. I hope others will get the same reassurance from listening to my story."

Kerry Bloodworth, Assistant Director of Nursing, said, "These patient stories have the potential to make a hospital visit to NUH less daunting or frightening by showing the personal experiences of other patients."

The four other stories include 36-year-old Bryan who made a fantastic recovery after a severe stroke; mum-of-one Jane, who beat breast cancer; Sue from Nottingham, who after major surgery has recovered from bladder cancer; and Francis, aged 82, who received appropriate and timely treatment at the stroke unit at the City Hospital campus and is now back at home with her husband Bill.

Friday, May 18, 2012

Healthcare IT can 'bail out' hospital budgets

SHERBORN, MA – Hospitals and health systems across the country are shedding workers or implementing hiring freezes as their budgets get tightened.

It is precisely during these times that they should deploy healthcare IT throughout their enterprise so patient safety and quality of care are not impacted, said Margaret Mayer, director of marketing for Boston Software Systems.

Hospitals need to focus on four specific areas to bail out their budgets:

Areas to automate manual tasksOpportunities to improve the complex revenue cycleMaterials management efficiencyTechnologies that offer high and quick ROI

Process improvement with the help of healthcare IT will save money and time, Mayer said. "For the people remaining, there's more work to do, but now they can do more work more accurately and quickly," she added.

By automating manual tasks, hospitals may find that patient care is often enhanced, Mayer said. Staff at Newport News, Va.-based Riverside Health System was spending hours updating their registration system to log out patients in the emergency department.

Deploying Boston WorkStation reduced that process from eight hours to less than one, freeing up full-time employees for other tasks. Equally important, physicians can get updated patient data on a daily basis from the ED.

Hospitals must also look for opportunities to improve their revenue cycle and create efficiencies in material management, Mayer said. By exchanging electronic files with its suppliers, insurers and other third parties, Baton Rouge, La.-based Woman's Hospital is automating such tasks as processing orders.

This allows staff to work with more vendors and offer high-value services to its departments such as searching for higher quality items at cost savings across more vendors. Woman's Hospital is able to handle the additional volume of work despite having only two buyers for medical and surgical purchasing.

Automation across the enterprise has helped Woman's Hospital reduce its minimum order penalties and save an estimated $355,000 in contract management processes in fiscal year 2006.

Especially in this recession, hospitals should invest in technologies that offer high and rapid ROI, said Mayer.

Riverside Health System partnered with the State of Virginia to match its patient population with the state's death registry. The process saved staff more than 350 hours per year, as well as improved patient satisfaction and community relationships.

The combined ED registration and state registry synchronization has saved Riverside more than $25,000 and more than 2,400 staff hours per year.
"The bottom line to bailing out a budget is to look for ways to maximize savings with a minimum investment," said Mayer.

Thursday, May 17, 2012

New Health Care Law Helps Expand Primary Care Physician Workforce

We wanted to make sure you didn�t miss the good news. On Monday at the Eisner Pediatric and Family Medical Center in Los Angeles, Secretary Sebelius announced that the National Health Service Corps (NHSC) awarded $9.1 million in funding to medical students at schools in 30 States and the District of Columbia who will serve as primary care doctors and help strengthen the health care workforce.

The National Health Service Corps� Students to Service Loan Repayment Program, made possible by the new health care law, the Affordable Care Act, provides financial support to fourth year medical students who are committed to a career in primary care in exchange for their service in communities with limited access to care. This program provides loan repayment assistance of up to $120,000 to medical students (MDs and DOs) in their last year of education. In return, they commit to serve in a health professional shortage area upon completion of a primary care residency program.

Secretary Sebelius visited the Eisner Pediatric and Family Medical Center, which serves more than 26,000 patients each year. During a tour followed by a panel discussion about community health centers, doctors at the center said that the National Health Service Corps has helped them remain at the clinic. They have been able to continue serving their community without worrying about being able to make their monthly loan payments.

One of the Students to Service awardees this year is Eric Schluederberg, a 4th year medical student at Western University of Health Sciences in Pomona, California, who appeared at the Eisner Pediatric and Family Medical Center with Secretary Sebelius. Eric has a very compelling story inspired by his fianc�e who has Spina Bifida.

�I always knew my calling was primary care, � Eric said. �I�m not a social researcher, and I�m not an economist. But it seems that there are a lot of underserved people in this nation, and that providing sound primary care is a good economic investment. For example, ensuring that pregnant women know to take folic acid supplements is one way to prevent the cost of the numerous surgeries required to help someone with Spina Bifida become an independent member of society.�

And medical students all across the country will go in to communities that need help the most thanks to this funding.

Anna Gladston, a student at Michigan State University � College of Osteopathic Medicine has seen firsthand the need for expanding the primary care work force.

�As a resident of the city of Detroit I see how poor access to care can really ruin an individuals' health and life,� Anna� said.� �Throughout my training I have met individuals who have not seen a doctor for over half their life and have let a problem that could've been treatable reach a level that is beyond repair because they didn't have a doctor to go to or they didn't have insurance.� So much of the world health problems could be prevented and that is why I love primary care.� So that we can cut disease off at the pass, preventing it before it starts.�

Monica Mitcham, a student at the University of Texas � Medical Branch at Galveston is also a recipient of the NHSC award and speaks passionately about the importance of primary care in underserved communities.

�Having grown up in a resource-limited, poverty-stricken east Texas town and experienced first-hand the toll that access barriers can take on entire families, a seed of determination to bridge the socioeconomic health care divide was planted within me from an early age,� Monica said. �Several years later, as a young lady facing the challenges of becoming a first generation college student, I reflected once again on the importance of primary care in underserved communities. These humble beginnings taught me an important lesson and cultivated within me a strong desire to dedicate myself to community building and strengthening through reaching out to all age groups as a family physician.�

Thanks to the Affordable Care Act, this new program is allowing medical students to pursue their passion for primary care and serve some of the country�s most underserved rural and urban communities, by relieving a tremendous debt burden.

For more information, about the National Health Service Corps, check out this page.

Monday, May 14, 2012

Pfizer settles lawsuit involving Celebrex

SALT LAKE CITY�Pfizer Inc. has settled a lawsuit filed by Brigham Young University over development of the blockbuster painkiller Celebrex for $450 million, according to a regulatory filing Tuesday.

Terms of the settlement weren't disclosed in an announcement by the drug company and the Mormon Church-owned school in Utah.

However, Pfizer said in a regulatory filing with the U.S. Securities and Exchange Commission that it was taking a $450 million charge against first-quarter earnings to settle the case.

BYU and Pfizer battled for six years over the discovery of an enzyme that led to the development of Celebrex, a breakthrough in the treatment of arthritis and inflammation. A jury trial had been set to start May 29 in U.S. District Court in Salt Lake City.

BYU had sought a 15 percent royalty on sales of Celebrex, or about $9.7 billion. The university also could have sought billions of dollars more in punitive damages and interest.

BYU's lawsuit said a chemistry professor, Daniel Simmons, discovered the genetic workings of the drug in the early 1990s. It accused Pfizer of violating a research agreement the school made with predecessor companies.

As part of the settlement, BYU plans to endow a Dan Simmons Chair in recognition of his lifelong work advancing human health.

"We are pleased to resolve this matter and the uncertainty of litigation and to be in a position to support Dr. Simmons' research efforts at BYU," Pfizer said in a brief statement. Neither side would comment further.

In court filings, BYU said it had a research agreement with Monsanto Co., later acquired by Pfizer, for the development of a "super aspirin" � a drug that could reduce pain and inflammation without triggering gastrointestinal effects. Simmons claimed to have discovered an enzyme that caused those side effects, and the new drug works to disable it.

According to BYU, Simmons' research was critical in the development of Celebrex, yet Monsanto and successor companies gave the chemistry professor no credit or compensation.

In court filings, Pfizer claimed it met all of its obligations under the Monsanto agreement. It argued BYU's lawsuit had no merit and that the school and Simmons were trying to capitalize on the commercial success of Celebrex.

Pfizer had claimed that Simmons did not contribute to the development of the drug. Last week, Pfizer accused lawyers for BYU of trying to taint a jury pool by briefing Utah media outlets on the upcoming trial.

The drug company responded by asking a federal judge to postpone or move the trial out of Utah. But all that changed Tuesday with what Pfizer called an "amicable" settlement.

Saturday, May 12, 2012

6 keys to SSL and choosing the right cloud provider

Cloud computing is quickly changing the IT landscape, perhaps most prominently in healthcare.

But, according to a recent whitepaper by digital certificate provider GeoTrust, cloud services also pose "significant potential risks for enterprises that must safeguard corporate information assets while complying with a myriad of industry and government regulations."

With that said, GeoTrust helped outline six keys to understanding SSL and choosing the right cloud provider for you.  

1.Recognize the additional security challenges cloud technologies pose. Although there are obvious benefits of cloud technology, compliance and data privacy have slowed enterprise adoption, according to the report. "An IDC survey of IT executives reveals that security is the #1 challenge facing IT cloud services," it read. The report added that Gartner Research identified seven specific areas of security risk associated with enterprise cloud computing, and organizations should consider several of them when selecting a provider. They include access privileges, regulatory compliance, data location, and monitoring and reporting. "To reap the benefits of cloud computing without increasing security and compliance risks, enterprises must ensure they work only with trusted service providers that can address these and other cloud security challenges," it read. "What's more, when enterprises move from using just one cloud-based service to using several from different providers, they must manage all these issues across multiple operators."

2.Learn the ins and outs of SSL. Secure socket layer (SSL) is a security protocol used by Web browsers and servers to help users protect data during transfer. According to the report, it is the standard for establishing trusted exchanges of information over the Internet. "Without the ubiquity of SSL, any trust over the Internet simply would not be possible," it read. SSL delivers two services that help solve some cloud security issues, such as SSL encryption and establishing a trusted server and domain. Understanding the "SSL handshake," said the report, means knowing the importance of public and private key pairs as well as verified identification information. "[I]t can begin a secure session that protects data privacy and integrity," the report read. 

[See also: Cloud computing myths vs. risks.]

3.Take steps to ensure data segregation and secure access. Data segregation risks are "ever-present" in cloud storage, according to the report. "With traditional onsite storage, the business owner controls both exactly where the data is located and exactly who can access it," it read. "In a cloud environment, that scenario is fundamentally changed; the cloud service provider controls here the servers and the data are located." But a proper implementation of SSL can secure sensitive data. To ensure this, the report advised a potential cloud provider should provide three things: encryption, authentication, and certificate validity. "Businesses should require their cloud provider to use a combination of SSL and servers that support … 128-bit session encryption," it read. "[They] also should demand that sever ownership be authenticated before one bit of data transfers between servers." 

4.Keep regulatory compliance in mind. "When it comes to secure and confidential data, businesses are burdened with a slew of regulations," read the report, with HIPAA being the most notable for healthcare organizations. "When an organization outsources IT to a cloud service provider, the organization is still responsible for maintaining compliance with [HIPAA] and any other applicable regulations – and possibly more depending on where the servers and the data are at any given moment." The report mentioned since the enterprise IT manager can't rely solely on the cloud provider to meet requirements, he/she should require the provider to seek some compliance oversight. "Cloud computing providers who refuse to undergo external audits and security certifications are signaling that customers can only use them for the most trivial functions," the report read.

[See also: Cloud computing, digital signatures speed clinical trials.]

5.Know that not all SSL is created equal. The "chain of trust" when employing a cloud provider should also extend to their security provider, according to the report. "The cloud vendor's security is only as good as the reliability of the security technology they use," it read. Furthermore, organizations need to make sure their cloud provider uses an SSL certificate that can't be hacked. In addition to ensuring the SSL comes from an authorized third party, they should demand security requirements such as a certificate authority that safeguards its global roots, a certificate authority that maintains a disaster recovery backup, a chained hierarchy supporting their SSL certificated, global roots using new encryption standards, and secure hashing using the SHA-1 standard, "to ensure that the content of certificated can't be tampered with." 

6.In the end, go with what you know. "SSL is a proven technology and a keystone of cloud security," the report read. "When an enterprise selects a cloud computing provider, the enterprise should consider the security options selected by that cloud provider." Knowing that a cloud provider uses SSL, said the report, can go a long way toward establishing confidence. Also, when selecting a cloud service provider, enterprises should be very clear with their partners regarding handling and mitigation of risk factors not addressable by SSL. "Cloud providers should be using SSL from an established, reliable and secure independent certificate authority," it read. 

Follow Michelle McNickle on Twitter, @Michelle_writes

Friday, May 11, 2012

Stakeholders urge comparative effectiveness to reform U.S. healthcare

WASHINGTON – Comparing the effectiveness of various drugs, treatments and devices will be the key to reining in out-of-control healthcare costs, according to top healthcare leaders who spoke Dec. 4 at the eHealth Initiative's Fifth Annual Conference.

Gail Wilensky, senior fellow at Project HOPE and former Health Care Financing Administrator, said the way Medicare is structured today, "it is impossible to be efficient." Wilensky is also the former chair of the Medicare Payment Advisory Commission.

What America needs is comparative effectiveness of bundled treatments needed for a single condition. Medicare shouldn't pay for one treatment or intervention at a time, she said.

Wilensky called it a dynamic process where "the role of IT will very much be that of an enabler." The idea is to reward doctors who provide high quality care at lower costs. Data on best practices will be compared and conveyed via healthcare IT.

Wilensky predicted support from Congress and the Obama administration for comparative effectiveness, but said it would likely come in incremental legislative packages.

Under the Bush administration, Department of Health and Human Services Michael Leavitt has pushed value-based healthcare similar to the comparative effectiveness mentioned at the eHealth Initiative Conference.

Thursday, May 10, 2012

Docs plead with CMS for relief from deadlines, penalties

CHICAGO – The American Medical Association (AMA) and state and national medical specialty societies are pleading with the government for relief from regulation and impending penalties.

The groups sent a letter to the Centers for Medicare & Medicaid Services (CMS) saying they are worried about an onslaught of overlapping regulations that affect physicians. Programs with overlapping timelines include the value-based modifier, penalties under the eprescribing program, physician quality reporting system (PQRS) and the electronic health record incentive program that is part of the meaningful use program  - and the transition to ICD-10.

[See also: Stage 2 rule means lost year of interoperability, coalition says]

“Facing all of these deadlines at once is overwhelming to physicians, whose top priority is patients,” said AMA President-elect Jeremy Lazarus, MD. “We have asked CMS to develop solutions for implementing these regulations in a way that reduces the burden on physicians and allows them to keep their focus where it should be – caring for patients.”

Physicians said that without needed changes from CMS, they must transition to the ICD-10 coding system; spend significant time and resources implementing EHRs into their practices; work to successfully participate in the Medicare e-prescribing program; meet EHR meaningful use standards; and participate in the Physician Quality Reporting System (PQRS) – all within a short amount of time.

“In addition to these upcoming deadlines, physicians who treat Medicare patients are also currently facing a drastic cut of about 30 percent on January 1 from the broken Medicare physician payment formula,” Lazarus said. “The combination of these financial burdens could prevent physicians from making the investments needed to transition to new models of care delivery and improve the value and quality of care in the Medicare system.

[See also: CMS promise on ICD-10 stirs the pot][See also: AMA mounts campaign to halt ICD-10]

Smokers dodge cigarette tax by switching to pipes, cigars

WASHINGTON�American smokers have shifted to pipe tobacco and large cigars since federal taxes on cigarettes were increased in 2009, a new government report concludes.

Sales of pipe tobacco and large cigars, both taxed at a lower rate, have soared as smokers have adjusted their buying habits to the new price structure.

The shift cost the federal government $615 million to $1.1 billion in uncollected tax revenue from April 2009 to September 2011, the report said. It did not estimate how much individual states may have lost in uncollected taxes.

"That's real money and a tax avoidance scheme Congress ought to be interested in stopping," said Gregg Haifley, associate director of federal relations at the American Cancer Society's Cancer Action Network. "It's also counterproductive for the public health benefit of tobacco taxes."

Monthly sales of pipe tobacco increased from about 240,000 pounds in January 2009 to more than 3 million pounds in September 2011, the Government Accountability Office found. Monthly sales of large cigars more than doubled, from 411 million pounds to more than 1 billion pounds.

Pipe tobacco is used increasingly to make relatively inexpensive cartons of roll-your-own cigarettes in machines installed in neighborhood smoke shops around the nation.

Congress raised taxes on roll-your-own tobacco and cigarette packs in April 2009, making them equal. It enacted a smaller increase for pipe tobacco.

Congress began taxing small cigars at the same rate as cigarettes. Manufacturers of small cigars increased the weight of many of their products, so they would qualify as lower-taxed large cigars, even though they often are just slightly larger than cigarettes and have filters. Premium handmade large cigars retail for $3 to $20 or more each, but "smaller factory-made cigars that meet the legal definition of a large cigar can cost as little as 7 cents per cigar," the GAO reported.

Liggett CEO Ron Bernstein, whose company sells discount cigarettes that are taxed at the higher rate, said his company estimates the tax loopholes have cost the government even more. About 2.7 million people purchased roll-your-own cigarettes last year, and that could reach 3 million in 2012, he said, citing data from the Treasury Department and Centers for Diseases Control and Prevention.

In a written response to the report, Treasury officials noted that the numbers "are not actual losses of revenues, but rather your estimates of the revenue increases if Congress were to change the law to eliminate the disparities."

That's the GAO's recommendation: fix the disparities.

According to the GAO report, a woman representing one tobacco company said she knew of no difference between the roll-your-own tobacco her firm formerly produced and the pipe tobacco it switched to making � other than the federal excise tax.

Sen. Tom Harkin, D-Iowa, has 15 co-sponsors for legislation that would eliminate the tax disparities to help fund the Individuals with Disabilities Education Act, but the bill is stuck in the Senate Finance Committee.

6 reasons to manage and archive your social media

Social media's use in healthcare is without a doubt growing. But as organizations learn how to leverage these tools, a recent whitepaper by Osterman Research makes clear organizations also need have plans in place to both manage and archive their social media use. 

The report describes six reasons organizations should consider managing and archiving their social media.

1.Its use is growing, along with the use of enterprise social media. Recently published statistics show an ever-growing use of sites such as Facebook, LinkedIn, Twitter, Tumblr, and more. In fact, Pinterest, the newest platform, had nearly five million unique US visitors in November 2011, according to the report, and roughly 20 million users in March 2012. In addition, 19 percent of organizations surveyed are using an enterprise-grade social media platform, although, this is significantly less than the number of those using consumer-focused tools. "Despite the comparatively low use of enterprise-grade social media platforms at present [there will be] significant growth is the market for these tools," read the report. This is due to decision makers recognizing the value of social media for collaboration, knowledge sharing, skills discovery, and more, as well as decision makers recognizing the significant level of threats they face from the unregulated use of non-enterprise tools in a workplace context. 

2.Recent trends have more discovering its business benefits. When managed properly, the report shows social media can create a sense of community and affirmation for employees, business partners and others within the organization. "It can provide a means of information sharing and gathering that is simply not possible with other corporate tools," the study read. "Moreover, if organizations can create the appropriate environment within their organization, viewing it as an integral component of their larger corporate culture, they can speed decision-making and improve the quality of corporate decisions." With the proper use of social media, organizations can also leverage their employees to serve as "an amplification channel" for message the company is looking to promote on a wide scale, according to the report.

[See also: Social media insights from a digital strategist.]

3.There is a lack of social media policies across organizations. The vast majority of organizations don't have detailed and thorough social media policies in place, the report said. For example, when surveyed, organizations told how Facebook, Twitter, LinkedIn, and blogging ranked last in developed policies, behind the Web, email, and personal smartphones. "Moreover, even where policies exist, many organizations do not enforce compliance rules in a methodical and meaningful way," it read. For instance, in 2012, the survey found just 13 to 20 percent of organizations monitored posts to Facebook, Twitter, and LinkedIn, while enforcing corporate compliance rules. "Further, 76 percent to 83 percent of organizations either ask individuals to comply with corporate policies focused on Facebook, Twitter, and LinkedIn, but do not screen for content, or they do nothing."

Continued on the next page.

Biopharmaceutical company expected to merge with MyMedicalRecords.com

SAN DIEGO – Biopharmaceutical company Favrille, Inc. and MyMedicalRecords.com say their merger is now expected to close in the new year.

The two companies signed a definitive merger agreement in November.

"As we had announced earlier this month, two significant conditions for closing the merger, MMR's stockholder vote and settlement with creditors holding more than 85 percent of the dollar value of all of Favrille's known creditor claims, have been accomplished," said John P. Longenecker, president and CEO of Favrille. "We are now pleased to announce that a third significant condition, completion of the audit of MMR's financial statements for the years ended 2005 through 2007, is well underway, with completion expected in early January. We anticipate closing the transaction in January 2009."

Favrille, a San Diego-based company, develops and commercializes patient-specific immunotherapies for the treatment of cancer and other diseases of the immune system.

MMR, headquartered in Los Angeles, offers a consumer-centric personal health record that is available direct to consumers on a free trial basis through its Web site.

"Health information technology and the management of PHRs are at a revolutionary turning point," said Robert H. Lorsch, CEO and president of MyMedicalRecords.com. "Giving consumers the ability to maintain their medical records securely online leads to higher quality care at reduced costs. MMR's proprietary technologies enable consumers and healthcare professionals to create and access a PHR anywhere in the world. We believe this transaction with Favrille will give MMR broader access to the investment community, which is essential to our sales and marketing strategy and continued expansion of our customer base."

The merged company will be focused on continuing to build and develop the MMR brand as the premier online PHR for consumers and healthcare professionals, officials said.

Consumer beefs with red meat put producers on defensive

ADAIR, Iowa�Veteran cattleman Dave Nichols has a recurring thought some mornings when he awakens.

"After hearing everything so bad about beef and livestock, I wonder why I'm such a bad guy," said the 72-year-old cattle producer. "Some days, I feel like a tobacco farmer."

Nichols represents the future and optimism of the cattle industry. This spring he oversaw the birth of 1,200 calves on his spread in Adair County, up about 200 from previous years, and has sold 400 bulls to other producers for seedstock.

Until a recent dip, cattle prices were at record highs. Beef exports hit record levels in 2011. Yet, cattle producers feel they're on the defensive in a public relations struggle.

The controversy over lean finely textured beef, derisively known as "pink slime," is a here-we-go-again battle in the defensive war the livestock industry has fought for four decades. The original hit to red meat began with scientific warnings about the connection between animal fats and heart disease in the 1960s, which became mainstream recommendations by cardiologists to reduce red meat consumption.

That's been followed by a barrage of blows, some more tied to personal beliefs and changing food preferences than scientific evidence. Cattle producers fear their industry could go the way of Big Tobacco, where warnings of health risk eventually shriveled sales. The average American eats 22 % less red meat (defined as beef, pork, lamb and veal) than 40 years ago.

The latest controversy was fed by social media, catching the industry by surprise. Meat packers have added the ammonia-treated beef scraps to ground beef for two decades, with few known problems.

The uproar caused the closing of Beef Products Inc. plants in Waterloo, Iowa, and two other locations in Kansas and Texas, putting 660 people out of work.

A beef processor went into bankruptcy last week, citing lost demand for beef trimmings. On the Chicago Board of Trade, cattle futures prices dropped 8 % from early March.

"And to think that a big reason the trimmings are put into the ground beef is to make it more affordable to middle- and lower-income people to feed their families," said Nichols, who has sold his cattle to 22 different nations around the world.

Factors lead to falling demand

Iowa Gov. Terry Branstad has called for Congress to investigate the "smear campaign" behind the latest controversy. Yet, the domestic decline in beef eating �and the larger consumer concerns over industrialized agriculture � has been growing for years. Were it not for the booming export markets, cattle producers would face shrinking demand.

The forces against beef have included:

� A push toward more whole-grain and vegetable diets beginning in the 1970s. Schools and consumers are embracing "Meatless Mondays" as part of a trend toward healthful eating.

� Criticism from the environmental movement unhappy about the large amounts of nitrogen and pesticides needed for production of corn livestock feed.

� A more powerful animal rights movement, which has used undercover videos to portray livestock producers as abusers of farm animals.

Reaction to 'pink slime'ALDI: No longer selling.BURGER KING: Quit using in December.COSTCO: No longer selling.DAHL�S FOODS: Say the store has never carried the product.FAREWAY: Says it has never used.HY-VEE: Announced they would cease carrying the trimmings, but then reversed itself and will carry the product, with signs labeling it �lean finely textured beef.�MCDONALD�S: Quit using in December. RED ROBIN: Says it has never used.TACO BELL: Quit using in December.TARGET: No longer selling.WAL-MART STORES INC.: The company said its Walmart and Sam�s Club stores will begin selling meat that doesn�t contain the trimmings. It did not say it would stop selling beef with the filler altogether.WENDY�S: Says it has never used.

Wayne Pacelle, president of the Humane Society of the United States, took his agency from its traditional role as protector of the nation's dogs and cats into a political activist organization that has pushed, with partial success, voter referenda against animal confinements.

Cattle producers who can live with claims that red meat is unhealthy climb the walls over the animal cruelty accusations.

"We treat our cattle better than pets," said Vince Graham, a cattle producer. "If necessary, we get up at 2 a.m. to get out and tend to cattle. During calving we hardly sleep."

Another producer, Faye Binning, asserts that cattle producers are on the right side of the conservation story. "We hear that Iowa needs more grasslands," she said. "Who plants most of the grass? It's the cattle producers, because we need it."

Yet, the health concerns over beef eating have been harder to fight. Cattle producers like Nichols remember warily how a sharp decline in cigarette smoking in the last half-century was prompted by package warnings, then a ban on television advertising.

Ulka Agarwal, chief medical officer for the Physicians Committee for Responsible Medicine, said of the red meat industry, "the evidence is stacked against them, that red and processed meat are dangerous."

The Physicians Committee in recent years has put up an in-your-face billboard in Des Moines proclaiming a link between rectal cancer and eating bacon.

All the medical, diet and cultural trends have had an effect.

Cattle producers in Iowa and the rest of the U.S. have gotten the message about reduced demand. The USDA put the total U.S. cattle inventory in January as 90.8 million head, 2 % below a year earlier and the lowest inventory of all cattle and calves since the 88.1 million on hand in 1952.

The smaller number of animals means fewer packinghouse jobs. Even before the issue exploded last month, Iowa learned of the probable closing of the original Iowa Beef Processors plant at Denison. The closing will cost 400 workers their jobs.

Changing menus, shifting tastes

However, beef is still a symbol of power and success.

"I don't hear people say they want to go out and celebrate good fortune by eating a salad," said John Lawrence, longtime head of the Iowa State University Beef Institute and now head of ISU's Extension Service.

Yet, Lawrence and Iowa Secretary of Agriculture Bill Northey acknowledge that red meat consumption is down, partly as a function of reduced production, but also in changing eating habits.

While Branstad has protested against Hollywood and the media on several occasions during the latest dispute, Northey points to a more basic reason why anti-meat sentiment seeps into popular thinking.

"We're less connected to the sources of our food today," Northey said. "Even in Iowa most people are a generation or two removed from the land. Fifty years ago everybody knew where beef and pork came from. Today they don't, and when you show a video of meat processing on network TV or on the Internet, it can disturb people."

What's ahead

The beef industry doesn't see demand rebounding. Supplies are expected to remain static in the foreseeable future, and processors continue to contract. Where a sow hog can produce up to 20 piglets a year, cattle reproduction is much slower.

A calf born this spring won't be ready to give birth until summer 2013, and the nine-month gestation period would bring the new animal into the world in 2014.

Prices will stay relatively high. U.S. cattle prices increased 25 % last year, driven primarily by a 30%increase in beef exports.

The beef industry is putting its hopes on newer and different cuts of beef that will reflect different consumer tastes.

David Dahlquist of Des Moines, a nationally recognized public artist and teacher, says the "foodie" movement among chic urbanites might bring about a new impetus for beef.

"I know a lot of foodies, and they like beef," Dahlquist said. "Most of them aren't vegetarians. They like beef. They just want it in different cuts."

Meanwhile, cattle producers plan to focus on doing what they do best.

"What a great spring we had, with the warm weather," Nichols said, exhilarated by the new births. "Best spring for calving I can remember."

International interest grows

While Americans' taste for beef has hit a plateau, foreign countries are buying more U.S. beef than ever before. In 2011 exports of red meat species hit a record $11.5 billion after increases of 30% for beef and 17% for pork.

The demand hasn't cooled. Since January 1 red meat exports are up 2% from a year ago.

"Developing countries want more protein, and they associate red meat with economic progress and higher living standards," said Iowa Secretary of Agriculture Bill Northey.

The USDA's latest weekly export report for the week ending last Thursday showed the biggest customers for American beef since Jan. 1 are Mexico (37,000 metric tons), South Korea (32,000 metric tons), Japan (27,600 metric tons), Canada (22,200 metric tons) Vietnam (21,700 metric tons) and the former Soviet Union, 11,400 metric tons).

Wednesday, May 9, 2012

Compare International Medical Bills

Countries with governments and economies similar to the United States have come up with a variety of methods to make sure that all of their citizens receive health care. While residents in Europe and Japan may pay higher insurance premiums or taxes than Americans, in the end, when all costs are added up, Americans spend more money on health care per person with fewer people covered. (Data most recent available as of July 2008.)

Use the drop-downs below to compare countries.

On Daschle, expectations

WASHINGTON – In the wake of the election, Washington and healthcare stakeholders nationwide waited with bated breath to hear President-elect Barack Obama’s nomination for the next Department of Health and Human Services secretary.

The Nov. 19 nomination of former Sen. Tom Daschle (D-S.D.) seemed to strike the right chord and earn mostly praise.

Daschle is considered a strong proponent of healthcare reform and a capable bipartisan negotiator. Yet, there are those lingering questions. How much of a priority will he make healthcare IT? And more importantly, will he scrap the work that has already been done and start over? Millions of dollars are at stake for the electronic health record companies that have already invested in certifying their products.

HHS Secretary Michael Leavitt, finishing up the last few days of a term that began Jan. 26, 2005, deserves praise as a healthcare IT visionary. Daschle will have no small shoes to fill.

Under Leavitt’s leadership a federal advisory panel, the American Health Information Community, held 25 public meetings, all attended by Leavitt. Its 176 workgroups came up with 200 recommendations for Leavitt on how to advance healthcare IT. Under Leavitt’s direction, AHIC helped to develop a standards-based certification process that has now certified  more than 75 percent of the inpatient electronic health record market.

Though healthcare IT advancement is a bipartisan issue, Leavitt’s efforts were from the Republican camp. Some key Democrat lawmakers have eyed the notion of scrapping the Republican efforts for a new Democratic plan. No one will say for sure how much scrapping would be done, and it remains to be seen if any lawmaker could get such a notion through Congress. President-elect Obama has vowed $10 billion a year toward healthcare IT advancement, but he has not outlined the details of his plan yet.

Daschle, who awaits Senate approval, should have some wind in his sails when he starts work. Chairman Max Baucus (D-Mont.) and ranking Republican Chuck Grassley (R-Iowa) of the influential Senate Finance Committee have already begun a push for pay-for-performance on hospital inpatient care under Medicare. Care will be measured through healthcare IT.

The word from the public is healthcare reform. They voted for it, they want it. Almost unquestionably, stakeholders agree healthcare IT will be instrumental. Former speaker of the House and founder of the Center for Health Transformation Newt Gingrich expressed confidence in Daschle’s commitment to a fully electronic health system.

“Health-based health reform should encourage and incentivize the adoption of best practices that save lives and save money,” Gingrich said. “It should call for every American to have an electronic health record by December 2012.”

Telehealth provides help with neurology shortage

ROWLETT, TX – Finding certified neurologists is becoming more difficult as many hospitals face shortages in all areas. Through a service called Specialists on Call, some hospitals are getting neurologists to the patient’s bedside – fast.

Westlake Village, Calif.-based Specialists On Call Inc. (SOC) provides trained specialist physicians on call 24/7 to urban, suburban and critical access hospitals using videoconferencing technology. According to CEO Joe Peterson, MD, there are about 40 neurologists on staff, serving about 60 private community hospitals.

The SOC neurologists use videoconferencng technology from New York-based TANDBERG.

Tandberg’s equipment serves to “bring the right person to the right place at the right time,” says Joe D’lorio, government, educational and medical manager for healthcare at TANDBERG.

Lake Pointe Medical Center, a full-service 112-bed hospital in Rowlett, Texas, began using SOC’s services in its ED in April 2008.

Joanna Kestler, RN, director of emergency and outpatient services at Lake Pointe, says they use SOC about four to five times a month and can get a specialist to the patient’s bedside within 15 minutes.

“Like any technology it is not 100 percent immune to failure,” said Colin McDonald, MD, founder of SOC. “We have to protect against failure, and we do this through redundancy of the physician staff.”

Peterson says the redundancy plan consists of “two layers” of back-up physicians.

When a patient has a stroke, an important, quick decision ER physicians must consider is whether to administer a clot-busting drug called tissue plasminogen activator (tPA). This drug is given to treat patients with an ischemic stroke and must be administered within the first three hours after the start of symptoms.Kestler says SOC has helped them to administer tPA in two cases.

“It’s always a concern that patients may be skeptical (of videoconferencing), but once they see it, folks have been very receptive because of quality of feed and interactiveness,” said David French, MD.

“It’s a benefit to the community, especially as our area continues to grow,” he says.

The on call neurologist will have a phone conversation with the ER physician and review the patient’s medical history and CT scan before using videoconferencing to perform a nurse-assisted exam of the patient, Kestler says.  

Doctors in the ER use a secure portal, which is part of SOC’s infrastructure, to send patient information to the neurologists on call. A spokesman for the company says the infrastructure is known as “IronWorks” and it includes a 24/7 call center, a real time PACS, a clinical information and electronic medical records system, and the videoconferencing equipment.

Doctors Urge Their Colleagues To Quit Doing Worthless Tests

Nine national medical groups are launching a campaign called Choosing Wisely to get U.S. doctors to back off on 45 diagnostic tests, procedures and treatments that often may do patients no good.

Many involve imaging tests such as CT scans, MRIs and X-rays. Stop doing them, the groups say, for most cases of back pain, or on patients who come into the emergency room with a headache or after a fainting spell, or just because somebody's about to undergo surgery.

A child with low belly pain and suspected appendicitis? Don't rush her to the CT scanner. Do an ultrasound first. That will give the answer 94 percent of the time, is cheaper and doesn't expose the child to radiation.

 

Don't put heartburn patients on high doses of acid-suppressing drugs when lower doses and shorter courses will do, they say. You might just be making their symptoms worse when they try to stop the medicine.

An apparently healthy middle-aged guy with few cardiac risk factors comes in for a yearly exam and wants to know how his ticker is. Don't give him a full cardiac workup, with a treadmill test and fancy imaging. This kind of patient accounts for almost half of unnecessary cardiac screening.

Postpone repeat colonoscopies for 10 years if the first one is negative, or if it found and removed one or two early-stage colon polyps, the guidelines state. And stop prescribing antibiotics for mild-to-moderate sinus infections.

And here's one that raises some tricky questions: Most patients who are debilitated with advanced cancer shouldn't get more chemotherapy.

"When somebody is literally bed-bound and unable to walk or take care of himself, it's almost futile to use cancer-directed treatment and will probably have negative consequences," says Dr. Lowell Schnipper, a Boston cancer specialist who helped develop the new guidelines.

Schnipper tells Shots many cancer patients are getting chemotherapy in the last weeks of their lives. He says that does no good, makes patients miserable and may shorten their life.

The Choosing Wisely project was launched last year by the foundation of the American Board of Internal Medicine. It recruited nine medical specialty societies representing more than 376,000 physicians to come up with five common tests or procedures "whose necessity ... should be questioned and discussed."

The groups represent family physicians, cardiologists, radiologists, gastroenterologists, oncologists, kidney specialists and specialists in allergy, asthma and immunology and nuclear cardiology.

Eight more specialty groups will join the campaign this fall, representing hospice doctors, head and neck specialists, arthritis doctors, geriatricians, pathologists, hospital practitioners, nuclear medicine specialist and those who perform a heart test called echocardiography.

Consumer groups are involved, too. Led by Consumer Reports, they include the AARP, National Business Coalition on Health, the Wikipedia community and eight others.

The effort represents a growing sense that there's a lot of waste in U.S. health care, and that many tests and treatments are not only unnecessary but harmful.

Harvard economist David Cutler estimates that a third of what this country spends on health care could safely be dispensed with.

"That's certainly the number we use," Dr. Steven Weinberger, CEO of the American College of Physicians, tells Shots. "Most of us feel something like $750 billion or so could be eliminated from the system out of the $2.5 trillion or so that we spend on health care."

Weinberger says unneeded diagnostic tests probably account for $250 billion.

"I talk about this a fair amount around the country, and invariably physicians come up to me and recount their own anecdotes about overuse and misuse of care," he says.

Proponents of the campaign are aware they're wading into dangerous waters. "There will be some ... that may demonize this campaign and infer the R-word � rationing," Daniel Wolfson of the ABIM Foundation wrote in December when the campaign was launched.

But rationing is the denial of care that patients need, Wolfson points out. The Choosing Wisely campaign aims to reduce care that has no value.

When an elephant forgets: the individual mandate

For nearly 20 years the GOP trumpeted the virtues of the individual mandate as a vehicle to get the 2 percent who could afford -- but refused to buy -- insurance in the pool. But once President Obama turned their talk into action, they went sour on the idea.

You'll be excused if you think � with the rhetoric surrounding the Supreme Court hearings�� that the individual mandate was the Democrats' idea.

Actually, it was conceived by Republicans who insisted that those without health insurance are milking the rest of us.

No free rides

Mitt Romney sees those folks as "free-riders" since hospitals are required to treat them regardless of their ability to pay. As Massachusetts Governor, he insisted on a mandate as a matter of fairness. Newt Gingrich spent��20 years�calling for a federal mandate. Senate Republicans�twice introduced bills that would establish a mandate,�but were unable to get one passed.

Making sausage: the hard work of governing

As a candidate in 2008, Barack Obama�opposed a mandate.�Efforts for compulsory health insurance have been attempted since 1915, and it's a goal that stymied Roosevelt, Truman, Johnson, Nixon and Clinton.�The German statesman Otto von Bismarck famously said, "politics is the art of the possible" and that's as good a reason as any for why President Obama adopted several long-championed Republican ideals, including the mandate, in the ACA.

Von Bismarck also famously decreed, "Laws are like sausages, it is better not to see them being made." Obama, time and again, reached out to craft a bipartisan health care bill, even if he wasn't able to arouse bipartisan support. The Republicans were like the barnyard animals in the story about�The Little Red Hen�� they didn't want to actually do any of the work to help solve our health care problems.

Many Democrats voted for the Affordable Care Act�(ACA) fully aware that it might cost them their seats in the mid-term elections.That's political courage.�In the mid-terms, we replaced a do-something Congress with a�do-nothing Congress.

Will these impotent lawmakers retain their seats this fall?�We deserve the government we vote for. See how they vote here.

Tuesday, May 8, 2012

Markle Foundation releases new policy guide for health IT

NEW YORK – The Markle Foundation has issued a new resource to help organizations implementing health IT navigate governance, individual consent, procurement and other areas related to secure information sharing.

The May 3rd release of the new Policies in Practice updates a similar resource, the Common Framework, released by Markle in 2006. Since then, the health IT landscape has dramatically transformed, Markle officials said. The passage of the HiTECH Act, new waves of regulation and increased investment in and adoption of health IT have brought both challenges and opportunities.

Markle gathered a diverse group of leaders with expertise in health information sharing, technology, privacy and consumer engagement to develop the Policies in Practice resources through a collaborative effort.

Markle President Zoë Baird Budinger said the foundation produced the guide to address some of the key issues and concerns expressed by those implementing health information sharing efforts at the local, state and regional level.

“The landscape for health information sharing is changing,” said Laura Bailyn, senior director for health initiatives at Markle. “As health information sharing needs and capabilities continue to evolve, it is critical to incorporate new knowledge and lessons learned.”

Bailyn emphasized that the Policies in Practice are not intended to replace the original Markle Common Framework, but to supplement it.

The new Policies in Practice addresses key laws and regulations; consent issues; individual access; governance and procurement.

Find a copy of the new Policies in Practice here.

 

Wisconsin offers four-year HIM degrees online

MADISON, WI – A consortium of four University of Wisconsin campuses is offering a new online Bachelor of Science in Health Information Management and Technology (HIMT) in an effort to address the state’s shortage of four-year degree holders in this field.

Students can receive their degrees through UW-Green Bay, UW-Parkside, and UW-Stevens Point. In addition, UW-La Crosse will contribute courses. Applications for fall 2012 are currently being accepted at himt.wisconsin.edu. It is the only HIMT degree in the UW System.

[See also: Indiana Tech to offer HIT courses online]

“This is a very timely degree, said David Schejbal, dean of the UW-Extension’s online and continuing education division. “The employment outlook is extremely positive for highly skilled professionals in the health information management and technology field,”

UW-Extension’s online and continuing education division coordinates the program.

According to the Bureau of Labor Statistics, employment of medical records and health information technicians is expected to increase 20 percent by 2018, much faster than the average for all occupations.

[See also: Philly college adds new health information degree program]

“Healthcare programs, electronic medical records and health information exchange are growing in number, size and complexity," said Jane Duckert, director of health information management at University of Wisconsin Hospital and Clinics. “Technological advancements require additional and expanded training for the profession. A degree program within Wisconsin will keep our state on the cutting edge of technology with its credentialed health information management professionals.”

The HIMT program offers two tracks to prepare students for careers in health information management and health information technology. The technology track prepares students for IT roles in the healthcare, health insurance and governmental fields. It’s the foundation for positions from health data analysis to insurance claims coordinator. The management track prepares students to be leaders in providing better patient care, administering computer information systems and managing patient information.

Online degree aimed at non-traditional students
Courses are fully online, and returning students who have already completed the first 60 credits of undergraduate work or have an associate degree can complete the program in as little as two years. The curriculum consists of 20 classes (60 total credits) and covers such topics as health and medical terminology, medical ethics, information technology in healthcare, health benefit plans and providers and leadership and change management in healthcare.
 
“This unique collaboration recognizes the state’s need to grow its pool of IT professionals,” said Dan McCarty, academic director at UW-Stevens Point. “Without the collaboration, one campus alone would not have had the resources to offer a degree like this.”

The HIMT program is accredited by the Higher Learning Commission. For more information please visit himt.wisconsin.edu.

[See also: AHIMA presses White House to include HIM in jobs bill]

Deconstructing Some Of The What-Ifs From The Supreme Court

When Kaiser Health News asked for questions during the Supreme Court arguments this week, one that didn't seem to get addressed in court was this:

What happens to people who have already benefited from the law? This would include seniors who got rebates in the Medicare prescription drug "doughnut hole," for example. Would they have to give the money back to ... the manufacturers? The government?

The answer, according to Tom Goldstein, publisher of SCOTUSblog, "The only phrase that comes to mind, and it's not exactly a legal one is: 'God only knows.' "

That's just for starters.

Watch Goldstein, legal analyst Stuart Taylor and NPR's Julie Rovner dissect this eventful week with KHN's Mary Agnes Carey.

Here's the video of their conversation:

CDC Says Helmets Are No Match For Tornadoes, But They Might Not Hurt

Enlarge Courtesy of the Stewart family

Noah Stewart shelters in the closet just 15 minutes before an April 2011 tornado demolished his house. Wearing the helmet may have saved his life, one doctor says.

Courtesy of the Stewart family

Noah Stewart shelters in the closet just 15 minutes before an April 2011 tornado demolished his house. Wearing the helmet may have saved his life, one doctor says.

Can a helmet protect you in a tornado?

The Centers for Disease Control and Prevention says there's no research on how effective helmets are in preventing head injuries during tornadoes.

But, in what looks like a first, the agency says, in effect, that it's not out of the question that they might help.

Last year, tornadoes claimed the lives of more than 500 people in the U.S. Some safety advocates say protecting your head with a sturdy helmet could help reduce injuries and deaths.

But when NPR's Russell Lewis asked the health gurus at the CDC about the merits of the approach, he didn't get much of an answer.

 

As he reported last week:

"The CDC website tells motorcyclists to wear helmets because they save lives; ditto for bicyclists.

But if a tornado is bearing down? The CDC recommends people use their hands to protect their heads. It makes no mention of a helmet.

For three months we tried to interview someone from the CDC, but the agency would only email a statement, which said: 'The scientific evidence from helmet use during tornadoes is inadequate to make a recommendation.' "

Today, the CDC issued a statement that affirms the importance of getting yourself to a safe place, such as a basement, or deep in a ditch or gully if you're outside. That's nothing new.

Can Helmets Cut Tornado Risks? heard on Morning Edition

April 27, 2012

Can Helmets Cut Tornado Deaths? CDC Isn't So Sure [4 min 32 sec] Add to Playlist Download  

But the agency says it recognizes that people facing down a tornado want to protect themselves however they can. "Individuals may decide to use helmets to protect their heads," the agency says. And it's not telling people to refrain from doing so.

Since time is likely to be short in a heavy-weather emergency, the agency recommends that you have a helmet ready to go in your emergency kit, if you think you'll want to use one. You don't want to be fumbling around for one as a funnel cloud draws near.

Of course, a helmet alone is no match for a tornado. "For those who choose to use helmets, these helmets should not be considered an alternative to seeking appropriate shelter," the CDC says. "Rather, helmets should be considered just one part of their overall home tornado preparedness kit to avoid any delay."

For more information on how to prepare for a tornado, the CDC has some advice here.