On Healthcare Today

Engarde!!!

2011-06-21T07:48:00.000-07:00

I promise that I won't dwell on this issue but this morning there was an ABC News article (here) that briefly reviews cyber attacks on Sony, Sega, Citibank, Lockheed Martin, the U.S.Senate & the CIA public website. Sen. Susan Collins (D-Maine) is quoted as saying that "...the computer systems of the Executive Branch agencies and the Congress were probed or attacked an average of 1.8 billion times per month last year (italics added)."

There will probably be EMR/EHR systems that are well-protected and others that will be more vulnerable. It's an ongoing battle. When the hacks are supported by governments they've even been referred to as acts of war. So, I think that we can expect there to be hacks of health care information. But there are many levels to this fight and even if a system is illegally entered the information within can be coded so as to make any use of the information difficult. That is the goal: Make it as difficult as possible and track and find those responsible. But we're not going to be able to prevent all of the hacks.

Daisy, Daisy...

2011-06-15T10:23:00.000-07:00

It’s no secret that coordination of care is one of the big problems facing the healthcare system. In concept, your primary care physician is the hub in your wheel of care. Each spoke representing a specialist or special venue of care (hospital, nursing home, etc). The problem is how to keep everyone informed and up-to-date on your health. If everyone knows how each provider views and treats you then you’ll get better care and be subject to fewer mistakes (like being prescribed two medications that shouldn’t be taken together). In practice, this has been impossible to do. Until now.

Enter information technology. By taking advantage of the same powers that allow you (and the financial institutions) to know your financial situation at any given time and from almost anywhere in the world; you and the healthcare system could know your healthcare situation. Thus is born the Electronic Medical Record (EMR) or Electronic Health Record (EHR).

For some this is a scary prospect. Fears of Big Brother knowing your health status and using this information to deny you insurance or even a job are not uncommon. While there are many legal protections there are no guarantees (See NY Times article on medical data breeches here).

Still, the upside is huge. If all the providers know your health situation they are less likely to inadvertently kill or harm you. Also, all of that health information is a potential boon to research in understanding and treating diseases (no need for researches to know who you are so information that could identify you is stripped away). Some have argued that as patients in the healthcare system we have an ethical obligation to share our information in order to help others benefit from the system in the way we hope to benefit.

The unfortunate aspect of EMR/EHRs is that our information can and will be stolen. Just as financial information about us can be stolen. Just as any information about us can be stolen. There are no guarantees. But in order to improve the treatments we all will need; we must move judiciously forward.

A Bit More Background

2011-06-08T16:58:00.000-07:00

The Institute of Medicine (IOM) in Crossing the Quality Chasm listed 6 areas in need of improvement:

Safety—avoid injury to patients from the care that is in tended to help them
Timeliness—reduce waits and harmful delays
Effectiveness—provide services based on scientific knowl edge to all who could benefit and refrain from providing ser vices to those not likely to benefit (avoiding overuse and underuse, respectively)
Efficiency—avoid waste
Equitability—provide care that does not vary in quality be cause of personal characteristics such as gender, ethnicity, geographical location, and socioeconomic status
Patient centeredness—provide care that is respectful of and responsive to individual patient preferences, needs, and values

These are the areas that I hope to write about in this blog. I'll write about each area (in no particular order). And I'll try to cover each in terms of its background, challenges, possible solutions & progress. From time to time I'll also write about the quality improvement movement in healthcare. I may also write about one-off topics that are of interest to me. My goal is to write about the healthcare delivery system today in a way that is understandable to the non-expert; addressed to the current and/or future patient rather than the professionals.

Why Healthcare Today?

2011-06-06T20:53:00.000-07:00

There is a revolution happening in healthcare in the United States. A report by the Institute of Medicine, Crossing the Quality Chasm, in 2001 (and backed up by numerous reports since then) documented that the U.S. healthcare system is less than it could or should be. Among the problems are:

Patients don't get the care that research says that they should;
Treatments are delivered in many different settings and too often the healthcare providers are not able to share information or coordinate care;
Millions of Americans are injured each year by preventable errors and mistakes
Healthcare is expensive in the US and other countries deliver the same or better care for less money.

The good news is that there is a massive effort underway to correct this situation. I thought that by writing about the progress of this effort I may be able to inform others of strides we are now making. There is much happening and much to be yet determined. It's an exciting time in healthcare.

Laissez les bons temps rouler!!!!

2011-06-03T19:13:00.000-07:00

I took a look at the obesity and diabetes rates for the county in which I saw the diabetes lifestyle magazine, Diabetes Forecast: Contra Costa county in northern California.

Obesity was 24%. Diabetes was a mere 6.6%.

From 2004 to 2008 obesity in Coco county (as it is affectionately referred) rose about 2% and diagnosed diabetes rose .4%.

For an unscientific comparison I looked at a state with among the highest rates of obesity and diabetes: Louisiana. I chose a mid-state parish, Grant parish. In 2008, adult obesity in Grant County was almost 32% and diabetes was 10.7%. Obesity rates rose over 4% and diabetes rose over 2% from 2004 to 2008.

The rates are going up in both places but faster in Grant county than in Coco county. What accounts for the difference? Diet? Exercise? Genetics? Diagnostic practices? Is it median household income? Coco county's is about $78,000 vs Grant parish at about $39,000.

Do the grocery chains in Grant parish have Diabetes Forecast for sale? If not, is this another example of income-based health disparity?

I don't have the answers but I'll have some of that Louisiana food! Just not every night.

Obesity and Diabetes

2011-06-03T17:55:00.000-07:00

In my last post I mentioned that I had seen a magazine directed at people with diabetes. I was surprised to see such a magazine in a chain grocery store. I knew that diabetes was on the rise and I also knew that the rise in obesity was believed to be tied to the rise in diabetes. So I decided to take a look at some of the numbers.

These graphs from the CDC seem to illustrate the correlation between diabetes and obesity.

Percent of Adults Over 20* with Diabetes

Percent of Adults Over 20* with Obesity

Of course, it is not enough to show that two disorders are related. Research must demonstrate that one disorder causes the other (or contributes to the cause).

Go here for another cool graph from the CDC showing the rise of obesity across our nation.

* See the CDC website for a detailed definitions and methodology.

The Forecast Does Not Look Good

2011-06-01T18:39:00.000-07:00

Standing in the checkout line at a local grocery store I noticed that next to the celebrity gossip and fashion mags they were selling Diabetes Forecast: The Healthy Living Magazine. This made me think that there must be a pretty good market for such a mag and so I went to the Diabetes Association website for some numbers.

They report that almost 26 million people in the US--8% of the population have diabetes. This group of consumers is growing and there were almost 2 million new cases of diabetes in adults in 2010. And the chart from the CDC show, diabetes is on the rise.

Since diabetes is a lifelong disease this group of consumers isn’t going to be cured in the near future. But they will have problems: EYE (cataracts, damage to the retina, glaucoma, swelling of area around the retina); FOOT/SKIN (small sores to ulcers that may eventually require amputation); HEART/BLOOD VESSELS (high risk of heart attack, narrowing/hardening of the arteries that supply blood to legs/feet, high blood pressure, high cholesterol, stroke); NERVE PROBLEMS (pain or numbness in the feet, stomach, intestinal, heart problems) and, OTHER (infections, kidney disease/failure, erectile dysfunction).

I guess there will be no shortage of articles for the Diabetes Forecast.

Second Smallest State Chooses to be First

2011-05-28T14:46:00.000-07:00

The 49th populous state, Vermont, is the first state to sign into law a single payor health care system. The system still needs to be designed but is slotted to begin in 2014. According to the NYT, all 600k residents would be eligible for the system. Vermont has about 200k uninsured/underinsured. The state plan is called Green Mountain Care.

A mark, a yen, a buck, or a pound

2011-05-28T12:59:00.000-07:00

From the Commonwealth Fund (Health Care Costs 101)

It's Good for You, It's good for Me

2011-05-26T19:31:00.000-07:00

Sutter Health, serving Northern California, has joined 15 other health systems in the High Value Healthcare Collaborative (HVHC). The goal is to improve health care, lower costs, and move best practices out to the national provider community. According to today's press release, HVHC will focus on nine increasingly prevalent treatment areas that have a wide variation in rates, costs and outcomes. They include total knee replacement, diabetes, asthma, hip surgery, heart failure, perinatal care, depression, spine surgery and weight-loss surgery.

Why are such efforts important? You'd think that if there was an effective treatment for specific illness that everyone would get that treatment. Right? But that happens only about 50% of the time, according to the Quality Alliance. Also, patients have different outcomes and are charged different rates depending on where the patient lives, which doctors and hospitals provide their health care, and their racial/ethnic status.

Now, the reasons for this situation are probably many and are not currently known. Hopefully, the HVHC, by sharing real-life data, will begin to develop some answers to these questions that have been dogging US Healthcare for over 30 years.

See the Quality Alliance website for more information.

Organizational Innovation

2011-05-25T19:27:00.000-07:00

I came across a brief article out of Duke University. The authors suggest that healthcare organizations must hurdle the tendency for mature organizations to maintain the status quo. In addition, healthcare organizations operate in a highly regulatory environment that inhibits innovative delivery of care. To achieve organizational innovation senior leaders must be dynamic and regulations will need to be modified. “Sacred cows” will have to be sacrificed. What’s that you say? I couldn’t hear you, I was listening to my 8-track.