Health Populi

America's primary health care backbone needs reinvestment and re-imagining

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 05 Nov 2009 16:58:00 +0000

59% of U.S. physicians say their patients have difficulty paying for health care and medicines.

The foot soldiers of American health care are front-line primary care physicians (PCPs). Compared to their colleagues in ten other developed countries, American PCPs say their nation is far behind other countries' health systems in at least three ways:

Patients' access to health care
The use of financial incentives to improve quality
The use of health information technology, where U.S. physicians say 46% of doctors use EMRs versus over 90% of doctors in Australia, Italy, the Netherlands, New Zealand, Norway, Sweden, and the U.K.

The Commonwealth Fund has published A Survey of Primary Care Physicians in 11 Countries, 2009: Perspectives on Care, Costs, and Experiences, published on November 5 2009 in Health Affairs. The survey sampled 10,000 PCPs in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the U.K., and the U.S. The data was collected between February and July 2009.

Health Populi's Hot Points: The main difference between the U.S. health system and the comparison systems surveyed in this report is America's lack of a primary care backbone. The health systems globally with the best health outcomes have resilient, strong primary care infrastructures. The primary care backbone in the U.S. is suffering from a lack of reinvestment and re imagination. The promise of a patient-centered medical home for every American is one vision for re-energized primary care in the U.S. Aligning incentives toward primary care would at once attract talent to the PCP pool which is needed based on projected deficits for primary care professionals in the U.S.; and, the access problems that American doctors point out in the survey would abate.

As the population in the U.S. ages and more health citizens live longer with more complex chronic conditions, the demand for more primary care access and new models for delivering the care will only increase.

Americans want to use email for all sorts of health apps

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 05 Nov 2009 12:09:00 +0000

59% of Americans want to receive test results via email. 1 in 2 would like to use email to request prescription refills, confirming appointments, telling doctors about their conditions, and asking questions about new conditions.

Email is now the preferred communications medium for consumers in health.

Second to email, using doctors' websites would also be welcomed by many health consumers, especially for prescriptions and appointments. Physicians' websites are somewhat less desirable communications platforms for communicating about personal health conditions. It is still too early for consumers en masse to embrace text messaging in health.

Women were more likely than men to embrace these new media platforms for communicating with physicians.

Lightspeed Research conducted a survey on Americans' attitudes on communicating with physicians to save time and money in August 2009 among 1,000 respondents.

Health Populi's Hot Points: As much as Americans say they'd embrace email communication with their doctors, there are two impediments in the current market: first, most physicians aren't 'there' yet, according to the surveyed consumers; and second, at least one-half of consumers aren't willing to pay for this service. 49% of consumers polled said they were unwilling to pay for an email consult; 31% said they'd be willing to pay if it were covered by insurance.

In addition to many convenience factors, a key benefit cited by 49% of consumers was that they would have a written set of instructions from the doctor to which she can refer. Such written instructions can get to the major challenge of health literacy and "patient ADD" that addles physician-patient communications in today's harried/hurried world.

The emergence of the patient-centered medical home, bundled payments, and paying physicians to manage conditions should break down these two key impediments. In the meantime, physicians and payers can tap into services already available that connect patients such as those from Medem, Medfusion, and RelayHealth.

CDHP and HDHP Plan Enrollment Still Tiny in 2009

jane@think-health.com (Jane Sarasohn-Kahn) — Wed, 04 Nov 2009 10:14:00 +0000

On one hand, it can be said that enrollment in consumer-directed and high-deductible health plans in 2009 grew by 33% in the past year. On the other hand, the total proportion of Americans enrolled in private plans who was in a CDHP or HDHP was 4%.

While this represents growth by definition, it's instructive to look at the chart and note that 34% of employers did not offer employees an HDHP or CDHP in 2009 -- up from 28%. That is, substantially fewer employers offered a consumer-directed plan this year compared to the previous 3 years this survey has been conducted.

The Employee Benefits Research Institute (EBRI) takes a detailed dive into the state of account-based health plans in the November 2009 issue of EBRI Notes.

Health Populi's Hot Points: A growing proportion of Americans with access to private health insurance through work is eligible for account-based health plans like CDHPs and HDHPs. However, most of these workers choose to stay in more traditional health plan types. People are slow to change to new plan types when they know the devil they know.

EBRI notes that for those employees who have opted into CDHPs and HDHPs (the 4%), their account fund balances continue to grow. EBRI believes that's due in part to these workers increasing their contributions to the health plan accounts in the case of workers with family-coverage. Contributions for employee-only (single) coverage actually fell in 2009.

EBRI notes that it's in the larger employer groups where there is growth in CDHP enrollment, and in fund balances where employers make greater contributions.

Still, the fund balances aren't big money: overall, 50% of the covered population has at least $1,000 in an account, and slightly less than one-half has less than $1,000 in their account. 9% of people don't even know how much they have sitting in their health account.

These findings from EBRI demonstrate another aspect of health care in the U.S. where there is substantial lack of consumer activation and engagement. When offered an innovation like a CDHP or HDHP, most Americans who access health insurance through private employers are still loathe to change.

How do less empowered American health citizens get through the flu season?

jane@think-health.com (Jane Sarasohn-Kahn) — Tue, 03 Nov 2009 14:08:00 +0000

As I nurse my flu symptoms, I'm struck in real-time by being a sick patient in a sick health system.

Last Friday 30th October, I was suffering classic flu symptoms and after 2 days of trying to muddle through with home remedies, homeopathic products and OTCs, I contacted my doctor's office first thing in the morning. I was told that my doctor was out for the day, and was referred to another physician in the practice.

By noon, that doctor had phoned in a prescription for Tamiflu to my pharmacy. The office told me to follow up with my doctor via phone after the weekend on Monday. I then drove to the pharmacy and picked up the oseltamivir phosphate capsules and swallowed the first of ten pills prescribed for a five-day period.

A compliant patient, I followed up yesterday by phoning my doctor's office. My call was given to the medical secretary responsible for my doctor's patients. Let's call her Mary. Mary asked me why I was calling -- was this 'just an FYI' for my doctor? I said, no, I was instructed by the doctor who prescribed the Tamiflu on Friday to report back to my own doctor on Monday when he would be back in the office and be able to directly consult with me.

My doctor's practice still doesn't use electronic health records; thus, Mary grabbed a piece of paper and scratched out notes based on what I was telling her about my condition and health status. It was a hurried conversation -- well, less of a conversation than a data dump by me -- with no assurance on my end that the information was getting transcribed completely or correctly.

Mary did not pull my paper file to catch up with my situation. She didn't access any notes in my file from last Friday's telephone encounter telling her that I was prescribed Tamiflu. She did not know I had trouble sleeping and so was bumming Ambien off of my husband's personal supply. When I told her I was doing just that, she berated me and told me what a terrible thing I was doing.
I had to laugh.

Mary told me to phone the office back at 4:45 pm if I hadn't heard from her before then. Presumably, she would put her scribbled note in front of my doctor, who could then follow up with me directly.

Of course, there was no phone call back to me by 4:45 pm, so I phoned the office again and asked for Mary. When she took the call, she didn't remember who I was, what my symptoms were, or even what doctor I was calling for. After a few seconds I said to her, "I'm the one you yelled at for taking the Ambien," she vaguely recalled my identity. Vaguely.

My patience lost, Mary finally 'heard' that in my voice and said she'd "rotate" my file to the front of the doctor's pile of records he was reviewing.

Around 7 pm, the doctor phoned me: he quickly got down to business with the question, "what's up? and once he learned my fever had abated on Saturday, he was glad I had been fever-free for over 48 hours. His business was done, and he said he'd phone in a script for Tussinex to help me sleep.

30 minutes later, my local CVS pharmacy phoned me to say they would be out of Tussinex until 1 pm today.

So much for a good night's sleep, at least from my doctor's point of view. For me, an Ambien did the trick once again, albeit that sleepy little pill was not what the doctor ordered.

Health Populi's Hot Points: I have a friend who is a senior executive with a pharmaceutical company who cannot find a swine flu vaccine for her young daughter in suburban Philadelphia. She is among the savviest health citizens I know and works for a company that makes vaccines.

I am a health economist and consultant who meets with and counsels some of the country's largest health plans, suppliers to the industry on the Fortune 100, provider groups, and government agencies. I live in a community with five medical schools and more MRIs per capita than in most of the nation.

I cannot imagine how health citizens less empowered than me make it in this chaotic, flu-ridden, vaccine-deficited world that is U.S. health care in November 2009.

Not much in the 1,900-page health reform bill will get to reforming overwhelmed, under-servicing medical practices any time soon. Certainly not in this devastating flu season.

In 14 states, over 1 in 5 women is uninsured

jane@think-health.com (Jane Sarasohn-Kahn) — Mon, 02 Nov 2009 13:34:00 +0000

Between 2007 and 2008, 18% of American women between 18 and 64 years of age were uninsured. 1 in 10 women in this age group were enrolled in Medicaid.

Two-thirds of women were covered by either employer-sponsored plans or public insurance such as Medicare and military-related plans, or ESI (employer-sponsored insurance).

Kaiser Family Foundation has published the latest data from the Urban Institute which pooled 2008 and 2009 iterations of the Current Population Surveys, based on the March 2009 Survey from the Bureau of the Census.

The proportion of women covered by employer-sponsored insurance varies substantially across the 50 United States. The highest percentage of working-aged women covered through employer plans were in the States of Hawaii and New Hampshire, where nearly 8 in 10 women are covered by employers (78%). The lowest penetration of employer-sponsored insurance was found for women living in New Mexico with 55% of women covered by ESI, and Mississippi and Texas where 58% of women receive.

In 14 states, at least 1 in 5 women was uninsured. The table turns to this other side of the coin: the level of uninsurance among women by state. The table presents data for the states where at least 1 in 5 women was uninsured in 2007-2008. These states include Texas (closer to between 1 in 3 or 4 women who lack health insurance), New Mexico, Louisiana, Florida, and Alaska, along with nine others.

Health Populi's Hot Points: The latest and best health plan legislation includes a provision for states to opt out of providing a public option. Since there is high variability, state-by-state, on the proportion of women who lack health insurance, it is easy to forecast that such variability will continue where patchwork health reform allows people (in this case, women) to slip through the cracks left by the over-compromise of certain basic health reform principles: namely, the principle of universal coverage.

Read more about what the opt-out could mean here in The Gov Monitor.

Opening access to primary care, IBM drops copays

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 29 Oct 2009 12:23:00 +0000

IBM is dropping the $20 co-payment for employees' visits to primary care doctors.

The Wall Street Journal covers this story today.

The "no co-pay" scheme will cover employees enrolled in IBM's self-insured health plan -- excluding workers enrolled in HMOs. Overall, IBM has 115,000 employees and spends $1.3 billion on health care.

The WSJ quotes SVP of IBM's human resources Randy MacDonald, who said that emphasizing primary care is part of an overall "wellness" strategy that tries to keep costs low by preventing illness.

Health Populi's Hot Points: The data point of one U.S. company dropping a $20 payment for employees visiting a physician may seem trivial. But in fact the implications of this are huge:

1. Here you have company #14 in the 2009 Fortune 500 list designing a health benefit to nudge people to seek primary care by eliminating one of the main barriers (that is, money) to scheduling that appointment.

2. In the past 12 months, 1 in 3 Americans has postponed getting necessary health care due to cost, according to the latest Kaiser Family Foundation Health Tracking Poll.

3. Employers are "getting" wellness and the crucial role of primary care in keeping employees healthy and productive.

In 1996, the Asheville Project measured the impact of dropping a co-pay for a prescription drug targeting maintenance meds for chronic conditions like diabetes and asthma. By dropping co-pays for drugs in a strategic way, patients' compliance and adherence to prescribed drug regimens improved, thus improving outcomes and increasing peoples' productivity in their daily lives.

David Hom also evangelizes on the top of value-based benefit design where he honed his skills on the topic at Pitney Bowes. His approach is codified in the book, Total Value Total Return which is required reading for new-and-improved health benefit design.

IBM's strategy to drop primary care co-pays is the New Asheville -- watch for primary care visits among IBM's employees to increase and for the company's medical trend to be better managed. This approach also promotes a medical home for every employee, a positive move toward improving access and health management for employees.

Web-based health programs can save money and improve outcomes

jane@think-health.com (Jane Sarasohn-Kahn) — Wed, 28 Oct 2009 13:12:00 +0000

There's more evidence that linking patients online to targeted programs that help them manage chronic conditions not only results in better patient outcomes -- the process results in lowering costs for care.

The DASH for Health program is an online tool that helps health consumers change nutrition and exercise behaviors.

A pilot program to test the cost-effectiveness of DASH was offered by EMC Corporation, an employer based in Massachusetts, to its employees as a free, opt-in benefit. Data generated through employees' use of the program was gathered and analyzed by researchers from Boston University's Schools of Medicine and Public Health.

Among employees diagnosed with heart disease -- including hyperlipidemia, hypertension and diabetes -- use of the Internet-based tool resulted in lower health care costs for those who visited the site at least nine times over the course of a year. Note that visiting the site more than 9x yielded even more impressive results -- representing a possible direct dose-response relationship. The research is published in the Oct/Dec issue of the Journal of Medical Internet Research.

In terms of outcomes, employees who opted into the program lost weight, lowered blood pressure, and improved healthy eating habits.

In terms of money, for people managing cardiovascular conditions, health care costs were $827 lower than for people who did not use the program.

Health Populi's Hot Points: There remains some skepticism among employers who instituted disease management programs during their first generation. Many of these programs didn't demonstrate clear return-on-investment. In the reincarnation of health management, innovators are building on lessons learned from previous failures and are focusing more on patient engagement, usability, and meeting people-patients where they 'live.' This is one building block toward Participatory Health based on greater employee engagement in managing chronic conditions.

Several surveys published from employee benefits firms expect that employers who sponsor health insurance at the workplace are complementing these plans with wellness and population health management programs. Taking a page out of the DASH for Health study at EMC will help health plan sponsor organizations yield positive results for both employee-patients and for the company's bottom line.

This program is another example of how to bend the cost curve of U.S. health finance over the long term. For more on this topic, see my column in the Washington Post's Healthcare Rx panel responding to the question: "Has Congress done enough to constrain long-term health spending growth?"

Health and fast food: calorie labels work

jane@think-health.com (Jane Sarasohn-Kahn) — Tue, 27 Oct 2009 10:53:00 +0000

New Yorkers who frequent Au Bon Pain, KFC, McDonald's and Starbucks who noticed calorie counts on menu labels ordered 106 fewer calories at the point-of-purchase than people who didn't pay attention to the information.

Here's evidence that labeling in fast-food destinations works.

At the annual meeting of the Obesity Society in Washington DC this week, researchers are presenting results on how transparency of calorie information motivates many health citizens to change their choices based on nutritional knowledge.

Reuters reports some details from the study. Researchers in New York polled 10,000 diners at 275 locations of the most popular fast food and coffee chains in the spring of 2007. They repeated the survey in the spring of 2009 among 12,000 consumers, who shared register receipts and survey responses.

New York implemented menu-labeling laws in March 2008. Data on the New York City fast food consumers was delivered at the meeting by Lynn Silver, MD, MPH, assistant commissioner for New York's Bureau of Chronic Disease Prevention and Control. Dr. Silver believes this information will change consumers' food choices over time. She looks to the industry to change portion sizes and offer healthy choices on menus.

Food and health marketers must respond, too, in helping people move toward healthier decisions, several presenters at the conference pointed out. A fifth fast food retailer, Subway, actually had consumers doubling their calories ordered during the study period. This is attributed to the company promoting 12-inch sub sandwiches in a consumer advertising campaign at the time the study was conducted.

Follow the Obesity Society on Twitter at @Obesity2009.

Health Populi's Hot Points: Transparency is the new black in health care. Well, it's not as much 'new' as it is 'standard operating procedure' for building trust and empowerment on the part of health citizens vis-a-vis the health industry. It will take the whole village in health to move Americans toward healthy food and lifestyle choices, akin to a strategic War on Healthy Living. We did it with Brooke Shields, tight jeans, and cigarettes; it can be done for healthy food, too, with engaging and innovative approaches to social marketing.

It's astounding how many calories are consumed in fast food outlets at lunch -- even with transparent labeling information. New Yorkers who heeded the labels purchased on average 754 calories' worth of food for lunch in 2009. Consumers who did not pay attention to the menu labels purchased 860 calories' worth of food.

So portion control, along with more healthy choices, plays a huge role in managing calories. Emerging technologies, such as iPhone apps and proprietary systems like Keas and Sensei, empower consumers on a 24x7 basis to bolster healthy choices.

For the food industry, this means bringing consumers into the information-fold the way health providers, plans, and life science companies have begun to do. It's early days for all stakeholders who touch health citizens with products and services -- including the food industry -- but if all touchpoints provide useful, usable and design-friendly information, then we'll achieve real health reform at the citizen level well beyond whatever comes out of Capitol Hill.

Thanks to Dr. Ted Eytan for his ongoing collegiality and knowledge-sharing. He is the model of a Participatory Provider in this era of Participatory Medicine and Health.

Small business is the working poor in U.S. industry

jane@think-health.com (Jane Sarasohn-Kahn) — Mon, 26 Oct 2009 10:06:00 +0000

Small business is the working poor of American industry when it comes to health insurance access: they simply cannot afford to pay for it.

This means that workers in small businesses -- which is where most new jobs are created -- probably won't have access to health insurance at work.

Workers who don't receive health coverage from employers are unlikely to get coverage on the individual market or from any other source, according to Insurance at Risk: Small Business Employees Risk Losing Coverage.

This report was compiled by a team from the Department of Health and Human Services (DHHS), synthesizing statistics on small business and health insurance coverage between 2000 and 2009.

Three in 4 small businesses that do not offer benefits point to the high cost of premiums as the #1 cause for not offering health insurance at the workplace. The percentage of small businesses offering health insurance dropped from 57% to 46%. Thus, fewer than 1 in 2 small businesses offer health care to employees.

If it's the costs that prevent small businesses from getting into health coverage, why do small businesses face higher health insurance costs than larger companies? First, their relative burden of health plan costs is greater: small biz pays as much as 18% more than big firms for the same policy due to higher broker fees and administrative costs. Administrative costs can be as much as 3 to 4 times greater for small groups than for large groups.

Health Populi's Hot Points: While geography is destiny in health care when it comes to variability in the quality of clinical services, employer size is a determining variable for worker's health coverage. The larger the firm, the more likely health insurance is offered, and offered at a cost that is more manageable than in a small business.

Employees of small business are 50% more likely to lose coverage as a worker in a large business, this report found.

If employers are to continue to be the cornerstone of health insurance financing in the U.S., then health reform must provide small businesses the wherewithal to play this role in a meaningful way. Tax credits and enhanced local competition to keep plan premiums competitive and increase options for businesses of all sizes will translate into a stronger foundation for health coverage nationally.

Can Medicaid absorb the newly-uninsured?

jane@think-health.com (Jane Sarasohn-Kahn) — Fri, 23 Oct 2009 11:04:00 +0000

Over one-quarter of a million jobs were lost in the U.S. in September 2009. Because unemployment quickly morphs into uninsurance, a question for the 263,000 workers and their families is: "Will Medicaid be able to cover me and my family if I cannot afford COBRA?"

There are three pieces of arithmetic that can help us connect the dots to answer this question:

1. On average, the monthly cost of COBRA consumes 84% of the average monthly unemployment payment in the U.S. The ARRA stimulus package included a 65% subsidy to help newly-laid off people pay for COBRA if they elected to do so and earned less than $125,000. This programs covers people laid off to 12/31/09, and covers those who are eligible and opt-in for a period of nine months.

2. For every 1% increase in unemployment, there is a 1.1 million person increase in the uninsured and a 1 million person increase in Medicaid and SCHIP. This metric was calculated by the Kaiser Commission on Medicaid and the Uninsured in April 2008, shown in the graphic.

3. Governors have to balance their state budgets under the law and cannot run deficits. The recession has decimated most state budgets due to lower tax receipts accompanied by increasing demand for services -- like health, education, and social services as citizens lose jobs. The Washington Post discussed the painful burdens of governors earlier this month, noting that the National Governors Association is lobbying hard against any additional unfunded mandates for health and other programs.

Health Populi's Hot Points: Time for the Kaiser team to update their metric on 1% = 1.1 + 1. The "1 million people" expected to be absorbed by Medicaid is now unsustainable given the depth and length of the recession. The U.S. has lost about 6,582,000 jobs since January 2008. The rate of job losses in the past six months hasn't dramatically slowed -- we lost 467,000 jobs in July, 466,000 jobs in August, and 263,000 jobs in September -- so over 1 million jobs lost in just the past 3 months.

One job that's dealing with this intensely is the Governor's -- having to dial down services when more are being demanded. Expect Medicaid to foist off prospective enrollees to the uninsured rolls in this so-called "jobless recovery."

The state of U.S. health care quality is flat - and varies across America

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 22 Oct 2009 11:39:00 +0000

Managing health care costs and achieving a high quality health system aren't parallel goals - they're inter-related and two sides of one coin. Adding more enrollees to existing poorly integrated health delivery organizations will simply increase costs while delivering sub-optimal outcomes to patients.

In its 13th annual report card on the U.S. health system, the National Committee for Quality Assurance (NCQA)'s The State of Health Care Quality 2009 adds more statistical evidence to the argument for health reform in America. 2009 has seen "meager progress" according to the President of NCQA, Margaret O'Kane. In her introduction to the report, O'Kane argues for five key elements in health reform that will directly improve quality:

1. Hold all health plans accountable, through accreditation, data reporting of HEDIS and CAHPS measures, and demonstrating quality improvement.

2. Reform payment and delivery systems, by paying for performance.

3. Create a framework for quality measurement, setting priorities for measurement, and aligning public and private markets by using similar measures for comparison.

4. Focus on Medicare and Medicaid quality, which NCQA has found slipping in the past 3 years.

The report analyzes quality of care data for 116 million Americans enrolled in health plans.

NCQA found that there is high variability in quality of care for a broad range of conditions. A key example is diabetes, which has reached epidemic proportions in the U.S. When well-managed,

diabetics can gain five or more years of life. NCQA found that the highest quality of care for diabetics is achieved in New England; the lowest, in the South Central region including Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee, and Texas).

There is some good news in the report:

Improvement in the use of beta-blockers administered to Medicare patients who had a heart attack within the previous 6 months.

Near universal high-quality care for Americans with asthma.

Gains in helping Medicaid beneficiaries to stop smoking (important because 1 in 3 Medicaid beneficiaries smokes).

The back of the report contains a plethora of quality measures on health conditions and lifestyle behaviors that provide the backstory to NCQA's conclusions and recommendations. One of the best parts of this report is the 13-page appendix containing a long list of reference articles on health care quality, organized by theme. This will be useful for anyone looking for vetted evidence on various aspects of health quality.

Health Populi's Hot Points: If all health plans performed at the 90th percentile level demonstrated by the top 10% of plans in the U.S., between 49,400 adn 115,300 deaths could be prevented every year in the U.S. Furthermore, billions of dollars would be saved in the U.S. health system that could be deployed elsewhere -- say, to cover the uninsured in better-performing plans.

"The status quo is dangerous and costly," NCQA concludes. NCQA data prove that by spending more, you don't get more. We learned this from Shannon Brownlee's important book, Overtreated, we've learned it from the Dartmouth Health Atlas, and now we have the 13th annual NCQA State of Health Care Quality report to further bolster that fact.

We must reform payment to reform clinical workflow and nudge all players to do right by patients. Paying wrong can kill in health care.

The New Era of Participatory Medicine and Connected Health: building the evidence base

jane@think-health.com (Jane Sarasohn-Kahn) — Wed, 21 Oct 2009 10:15:00 +0000

Today marks the launch of the Journal of Participatory Medicine. The inaugural issue coincides with the kickoff of the Connected Health symposium today in Boston.

In the first issue of the Journal, Esther Dyson asks and answers the question, "Why Participatory Medicine?" She talks about the need for evidence that demonstrates what works in collaborative health care. "We are just at the beginning," Esther says, "not of a brave new experiment that could end in disaster, but of multiple experiments, by thousands and ultimately millions of people, with variations in every parameter imaginable."

Thoughtful perspectives are offered through the lenses of patients, providers, purchasers, nurses, technology developers and clinical researchers.

Finally, a bold research agenda is offered by Dr. David Kibbe and Dr. Joseph Kvedar focused on how to build the evidence base for participatory medicine:

1. What does participation in health mean?
2. How does a patient's participation in medicine challenge the traditional role(s) of physicians?
3. How can technology be strategically, appropriate deployed in participatory medicine?
4. How can participatory medicine play a role in quality and new payment systems based on outcomes and performance?
5. What are the personal and societal "rules of the game" in the context of participatory medicine? Just how much responsibility should individuals bear? What's the role of genes vs. individual responsibility for lifestyle choices? How much can we nudge people toward participation?

The Journal welcomes participation from all comers -- which is what participatory health is all about. They're collecting via crowdsourcing research papers from that demonstrate or reflect participatory medicine. See this link for instructions on how to be part of this growing crowd.

Health Populi's Hot Points: What's driving this emerging era of collaborative and participatory health? Kibbe and Kvedar see, "A confluence of factors...including an overburdened health care system and inexpensive, fast consumer access to targeted information, technologies, and peer support."

Today, pioneering physicians, providers and patients are meeting in Boston at Connected Health to continue to gain insights and learnings into how participatory health can work to benefit patients, providers, and the public's health. The most effective way to bend the cost curve in health is to get health citizens more engaged in their own health to manage the $1.7 trillion component of health spending that's spent on chronic disease. We'll need to realign incentives for both providers and patients to change the workflow in health care delivery and get the participants on the same page.

Participatory medicine is an integral part of spending smart in health care.

Poverty is a major health risk

jane@think-health.com (Jane Sarasohn-Kahn) — Tue, 20 Oct 2009 09:21:00 +0000

Poverty is a problem for all of us…and it reaches across the generations.

The health effects of poverty begin in early childhood and persist through a person’s lifetime. Poor children have a higher rate of asthma and lower rates of cognitive development. By middle age, diabetes and heart disease hit the poor harder than more affluent Americans. Among older Americans, those living below the poverty line are far more likely to have three or more chronic conditions than those whose incomes are four times greater than the poverty line.

Poverty costs not only the poor, but the overall U.S. economy as well. Based on a subset of the potential quantifiable consequences of poverty, the economic costs of sustained childhood poverty alone amount to $500 billion per year -- nearly 4% of the U.S. GDP of the U.S.

A new study from the Robert Wood Johnson Foundation, The Poor Pay More: Poverty’s High Cost to Health, by Dr. George Kaplan of the University of Michigan School of Public Health (my alma mater).

Poor environments in childhood set the stage for ill health later in life. Environmental factors that negatively impact kids' health include exposure to hazardous waste and bad air, as well as crime and disorder. Furthermore, lack of access to healthy foods – fresh fruit and vegetables – leads to higher incidence of obesity and heart un-healthy food habits. The report cites the impactful statistic that within walking distance of schools in lower income neighborhoods there are one-third more fast food restaurants and 50% percent more convenience stores than near schools in higher income neighborhoods. Citing a 2008 study by Zenk and Powell, curbing the obesity epidemic among adolescents requires addressing the food environment surrounding schools.

Because poorer Americans often lack health insurance benefits from employers, many poor and near-poor families don't have adequate access to health care. This translates into less access to preventive care, diagnostic services and treatment. Of over 53 million people without health insurance some time in 2007, nearly two-thirds of 18 to 64 year old almost two-thirds of poor 18 to 64 year olds had no health insurance.38

Health Populi’s Hot Points: How to break the cycle of poverty and ill health in the United States? The diagram illustrates five strategic pillars that, together, would ameliorate the underlying negative forces that shape poor health among the poor. These challenges are:

To raise the economic status of the poor
To reinforce the safety net
To provide affordable health care
To improve where the poor live
To invest in early childhood and in education.

All five of these areas are, in fact, investments in the future health of Americans. Beyond the health of the individuals who would directly benefit in this investment strategy is the larger nation and its citizens. If we break the poverty cycle in early childhood, the lifelong benefits of healthy, hard-working taxpayers would accrue to the macroeconomy. And, wouldn't it be nice for the health status of America to be raised from the position at #37 in the World Health Organization's rankings of health systems.

Internet use among the elderly reduces depression

jane@think-health.com (Jane Sarasohn-Kahn) — Mon, 19 Oct 2009 12:09:00 +0000

Use of the Internet by older Americans leads to a reduction in the prevalence of depression, according to a study published by the Phoenix Center for Advanced Legal & Economic Public Policy Studies. This research highlights the macro-benefit of deploying broadband to all health citizens.

Internet Use and Depression Among the Elderly analyzed a data sample of 7,000 Americans age 55 and older from the University of Michigan's Health and Retirement Study household survey. This survey instrument polls over 22,000 older Americans every two years. The data used by Dr. George S. Ford and Dr. Sherry G. Ford in the study was from the latest available data from 2006.

The researchers conclude that expanding Internet use among the elderly may have "significant economic payoffs."

The study methodology analyzed two variables: Internet use and the measure of depression. Internet use is based on the question of whether the respondent uses the Internet for the purpose of "sending or receiving e-mail or for any other purpose" (yes or no). The depression variable was based on the eight-item depression scale developed by the Center for Epidemiologic Studies (known as the CES-D scale). This is a common screening test for people to use in assessing the state of their personal mental health. The scale synthesizes eight response to questions that ask the person to reflect on their mental wellbeing.

The sample was limited to non-working people over 55.

Health Populi's Hot Points: Getting broadband connections to the homes of older health citizens has a direct positive impact on the mental health of seniors, based on the data analyzed by the Phoenix Center team. Dr. George Ford intuits that, "Increased Internet access and use by senior citizens enables them to connect with sources of social support when face-to-face interaction becomes more difficult."

The latest findings from The Pew Internet & American Life Project estimated that 45% of people over 65 use the Internet. The largest percentage increase in Internet use since 2005 has been in the 70 to 75 age group.

However, broadband penetration to households among the oldest age cohort severely lags younger homes; only 16% of people 76 years of age and older have broadband.

Public health policy would argue for broadband to be part of the prescription for senior health and wellness.

From Here to Maternity: How to Effectively Market Health Services Online

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 15 Oct 2009 21:41:00 +0000

The proliferation of health care report cards has not seen an uptake by the majority of health citizens in the U.S. In fact, there are more than 200 health quality ratings programs accounted for by the Agency for Healthcare Research and Quality (AHRQ), yet few consumers use them to make choices about providers or health services.

Since maternity services are among the most consumer-facing health services that people might use in the course of their lifetime, the California HealthCare Foundation (CHCF) wondered how to "nudge" people to use quality ratings to inform their choices. The Issue Brief, From Here to Maternity: Birth of an Online Marketing Campaign, describes how CHCF increased California health consumers use of the online quality website, CalHospitalCompare.org, and what the team learned in the course of implementing a promotional campaign to educate consumers about the website.

To put the project in context, we should first ask: what makes an effective health care "consumer?"

For purposes of this brief, a workable definition of "consumer" is someone who can make the decision whether or not to purchase an item at the store, and someone who can be influenced by marketing and advertisements.

This definition comes from Investorwords.com and I especially like the second half of the definition that speaks to the reality of shopping in the 21st century: that consumers can be influenced by marketing and ads.

CHCF undertook a multi-pronged marketing campaign to promote CalHospitalCompare.org's maternity service ratings. Promotional channels included display and text ads online, search words, branded emails, and finally an 'offline" event in the form of the San Francisco Birth & Baby Fair.

CHCF quickly learned that the online ad campaign had an immediate impact and drove up visits to CalHospitalCompare.org by eleven-fold in seven months.

As in any good pilot, the team measured progress and took away several key learnings:

Match the medium and the message to the audience.
Target group diversity.
Pay attention to placement of online investments and measure ROI.
Cost-effectiveness varies by strategy and audience, so pay attention to these details.
Be flexible throughout a campaign and adjust as needed.
Words matter: ads should have a call to action and be meaningful to the consumer.

Health Populi's Hot Points: Questions remain which CHCF's study raised: for example, Yahoo and Google yielded positive results, but would AOL and/or MSN do the same? Is maternity unique compared to other health conditions; would an online campaign to drive traffic for mental health services, for example, fare as well? This campaign was for health services; would a similar campaign for physicians produce the same cost-effective outcomes?

Manhattan Research published its 9th Cybercitizen Health survey this month, finding that most Americans are now ePatients: the number of Americans seeking health information online reached 157.5 million people in 2009, 1.6 times the number of online health seekers found in 2005. As more health citizens come online to seek health information, they'll be looking for quality data to inform health decisions. Among those 200 quality health info sites AHRQ has inventoried will be a few trusted brands that health citizens will come to trust. The trick will be to meet health consumers using the language, channels, and other qualitative factors they'll demand that are highly relevant and meaningful to their own lives.

We're #1: now, let's behave like it

jane@think-health.com (Jane Sarasohn-Kahn) — Wed, 14 Oct 2009 12:57:00 +0000

Once again, the U.S. has earned a cup of goodwill from the world - and we can, once again, blow it, big time.

The 2009 Anholt-GfK Roper Nation Brands Index(NBI), which measures the brand equity of the world's nations akin to product brand value, found that the U.S. is now #1 -- rising to the top after languishing at #7 in 2008.

Behind us are France, Germany, the U.K, Japan, Italy, and our sister to the north, Canada.

Commenting on the study, Simon Anholt who founded the study observed, "What’s really remarkable is that in all my years studying national reputation, I have never seen any country experience such a dramatic change in its standing as we see for the United States in 2009. ...The results suggest that the new U.S. administration has been well received abroad and the American electorate’s decision to vote in President Obama has given the United States the status of the world’s most admired country.”

Health Populi's Hot Points: After 9/11, the collective heart of the world embraced the United States and poured out sympathy and empathy to us. The great majority of nations who had experienced terrorist acts before the U.S. had knew the feeling, and their generous displays of caring filled a cup of goodwill.

In the years that followed, that asset of goodwill dramatically eroded. Foreign policy, business practices, and growing distrust of America set in, especially during President Bush's second term.

The fact today is, notwithstanding the protestations of those who deny globalization and the flattening world, that we are all global citizens now. Media and social networks are ubiquitous, from the poorest nations to the most developed.

My personal experience in working with clients overseas starting in about 2003 through October 2008 inform my perspective on "being #1." More often than not, before a meeting outside of the U.S., I was asked about U.S. politics, The War in Iraq, and other aspects of U.S. life. While many individuals could distinguish between the U.S. government and the U.S. people, the bottom line was that America, like Rodney Dangerfield, got no respect.

Today, we've an opportunity in the Land of Obama to hold on to the promise that the world sees. But we're not only Rodney D. in this instance: we are also Pogo, who met the enemy and saw it as "us."

The health reform 'debate' over the past few months illustrates some of the worst aspects of American culture in 2010: disrespect, lack of thoughtful discourse, collective ADD, vitriol, demonization, racism. Let's live up to the promise that global citizens see in the U.S.: our potential to lead once again in the ways that really count.

Revisiting NPR's story on "Modern Patients" driving up health costs; time for the Journal of Participatory Medicine

jane@think-health.com (Jane Sarasohn-Kahn) — Tue, 13 Oct 2009 13:35:00 +0000

NPR featured a story called, "How the Modern Patient Drives Up Health Care Costs" on October 12, 2009. The theme connected dots between so-called consumer-driven health care and patients who demand the latest in health technology which may not be appropriate or even useful, thus driving up costs unnecessarily.

NPR attributes three driving forces in building The Modern Patient:

1. Direct-to-consumer advertising for prescription drugs, beginning in the middle-1980s; this exposed health citizens to medication names and conditions which motivated some consumers to ask for specific medications and question physicians' choice of other meds.

2. The adoption of the Internet, which expanded access to boundless health information online for virtually free.

3. Health consumers with more 'skin in the game,' meaning more financial responsibility in paying for health plans, visits to providers, and treatments.

According to NPR's research, it's hard for doctors to say 'no' to demanding health consumer-patients.

Health Populi's Hot Points: Do demanding health consumers lead to increased costs in the U.S. health system? Perhaps. There's anecdotal data and stories shared on Sermo, but there's not been a well-vetted study to prove this.

The ideal scenario is an engaged patients who is well-informed with the right information at the right time, shared in collaboration with a smart, effective and efficient health provider-coach. The right information at the right time will be available when we have data liquidity: good data gathered (and gather-able) from the range of clinical sites the patient encounters: the lab, the physician's office, the pharmacy, the clinic, and the home where a patient might be monitoring her numbers.

U.S. health citizens can't seem to win in media stories on health consumerism: we're either painted as lazy couch potatoes who don't engage in our health, or we're cyberchondriacs who force physicians to prescribe ineffective tests and inappropriate drugs.

The reality is the scenario of The Modern Patient isn't so bipolar. No better time, then, to welcome the new Journal of Participatory Medicine. On Twitter, we'll be using the hashtag #WhyPM (for "participatory medicine") to discuss the journal's launch and to track ongoing dialogue on this emerging movement. See Gilles Frydman's post on "Why PM?" on e-patients.net to learn more about the launch of the Journal and the rationale for launching it at this point in health citizen history.

Geography is health insurance destiny

jane@think-health.com (Jane Sarasohn-Kahn) — Mon, 12 Oct 2009 10:11:00 +0000

Where you live is a determining factor in whether you have health insurance.

The darker green on the map illustrates states with the highest percentage penetration of people with private health insurance among people under 65. Note the concentration in the Upper Midwest, scattered Midwest, and bits of the northeast. It's also helpful to live in Utah when it comes to health insurance coverage.

The lowest proportions of privately insured Americans are in much of the south, from Florida west to Texas and into southern New Mexico, Arizona and much of California.

The Urban Institute has studied health insurance coverage across Congressional districts and concludes that, indeed, geography is destiny. The Institute's report, Variation in Insurance Coverage Across Congressional Districts, analyzes data from the 2008 American Community Survey, part of the U.S. Bureau of the Census data collection activities.

The bottom line is that private health insurance coverage is lowest in districts that have higher poverty rates.

Health Populi's Hot Points: This second map illustrates the rate of uninsurance in each state. The darkest red represents the highest levels of uninsurance among people under 65. It's clear these areas of highest uininsurance bleed from the south westward all the way up to the Canadian border.

The Institute punctuates its report with the conclusion that certain Congressional districts "would have the most to gain from health reforms that are designed to increase health insurance coverage toward a higher and more uniform national standard."

This is one of the arguments for universal coverage: that Americans, regardless of geography or socioeconomic status, should have access to at minimum, a basic market basket of health services.

Americans like mobile health, especially for exams, wellness, and monitoring

jane@think-health.com (Jane Sarasohn-Kahn) — Sat, 10 Oct 2009 11:45:00 +0000

If mobile medical services were available to Americans today, 40% would use the service in addition to seeing their doctors.

23% of people would replace the doctor with mobile medical services.

1 in 3 people wouldn't use the service at all.

Welcome to the era of "m"-everything -- mobile-everything, 24x7. And health is a natural partner for "m."

These stats come from a survey released by CTIA-The Wireless Association, in conjunction with The Harris Poll. The poll was conducted among American adults in September 2009.

The 23% of health citizens who would use mobile health services instead of going to the doctor's office are the leading edge of patients who are interested in mobile exams and clinical consultations, wellness support, monitoring, and medical reminders.

As detailed in the chart, not every medical application is of interest to American health consumers. Less interesting applications for mobile health are infant monitoring, mobile skin screening, and mobile medicine administration (i.e., support for medication/Rx adherence).

Health Populi's Hot Points: What health citizens stand to benefit most from mHealth? The answer is everyone. In particular, the survey found that people in remote areas, people with chronic diseases, retirees, and caregivers are seen as the big beneficiaries of mHealth.

Looking at the second chart on the most appealing aspects of mHealth applications, one that slips through the demand side is mobile medication administration. Yet this relates directly to sound chronic care management, wellness and monitoring -- categories that consumers highly value in mHealth apps. There is important education to be done for this strategic health issue. Safe administration and consumption of prescription drugs leads to higher efficacy, better outcomes and mitigation of medical risks. That means fewer accidents and emergency room admissions, and better health for the masses.

It's encouraging to see Americans embracing the promise of mobile health. People like the idea of care delivered at home, the security of being 'watched' by a health coach or caregiver, peace of mind, and freedom 24x7. In fact 19% of Americans surveyed said they'd upgrade their existing wireless plan to include mobile health services. Verizon, AT&T, et. al.: take heed!

Beyond the promise, there's adoption -- and that can be bolstered through giving patients incentives and nudges toward using mobile health services, especially for wellness, monitoring, and meeting with physicians.

Americans are spending more for health care and getting less, says Consumers Union

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 08 Oct 2009 14:39:00 +0000

More consumers are cutting back on health care, according to a survey from Consumers Union.

CU is the organization that helps Americans seek the best buys in cars, computers, and home theatres. They're also growinug their opinion base in the health care market, oping on everything from "Best Buy Drugs" to health plan quality.

Now, CU is the latest organization coming out in favor of a health care overhaul. In a poll conducted by the Consumer Reports National Research Center, CU concludes that, "Americans are paying more for less health care."

Here are a few of their findings that deonstrate a declining value-for-money proposition for Americans and their health care:

Putting off a doctor’s visit (28 percent)
Inability to pay for medical bills or medications (25 percent)
Putting off a medical procedure (22 percent)
Declining a medical test (20 percent)
Not filling a prescription (20 percent)
Using expired medications (15 percent)
Skipping a scheduled dose (15 percent)
Splitting pills (13 percent)
Sharing a prescription with someone else (9 percent).

Health Populi's Hot Points: CU has launched its first ad in its history that supports health reform. It makes sense: this is the organization that helps people manage family budgets. Health care in the U.S. has become a major line item in that budget.

CU's survey found that 51% of Americans, 1 in 2 health citizens, faced "tough health choices" in the past year due to the cost of care. The organization rightly says, "the high cost of health care impacts all of us." The 1 in 2 Americans facing tough health choices will continue to grow without systemic health reform for covering the uninsured and stemming health cost inflation.

Consumers and online health information aggregators: whose missing from this picture?

jane@think-health.com (Jane Sarasohn-Kahn) — Wed, 07 Oct 2009 14:10:00 +0000

Today I'm at the Health 2.0 Conference in San Francisco, where I'll be moderating a panel of the "consumer aggregators" in health care. "Say what?" those of you who don't speak Health 2.0? Consumer aggregators are the places online where lots of health citizens go en masse for health information, support, advice, and tools.

Today's panel brings Google Health, Microsoft and WebMD together to talk about trends in health care consumers online. I'll set the context describing the "N" of health citizens going online using data from the 9th Cybercitizen Health Study from Manhattan Research coupled with Susannah Fox's data from her seminal report, The Social Life of Health Information. Furthemore, the September version of the Kaiser Health Tracking Poll which found that 56% of Americans are changing their health behaviors in response to health costs. Within that cadre of "DIY"ing health citizens are those who go online for health management, both clinical and financial-related issues.

What's different at this time as Health 2.0 matures is the nature of consumer aggregation. Increasingly, while consumers are going online to long-time players like Google, Microsoft and WebMD, health citizens are also finding their way to other names, some with consumer-facing identities such as MayoClinic.com and true consumer brands under the EverydayHealth/Waterfront Media banner of media outlets.

Health Populi's Hot Points: In one year, will Google Health, Microsoft and WebMD be the key consumer health aggregators once again? They are certainly financial behemoths in the space, with about $400 billion in market cap as of this week. A fragile media and advertising market could limit business model potential for some of the newer entrants. Stay tuned for the new hungry players to grow with the organic growth of U.S. health citizenry going from 150 million people upward, seeking meaningful relationships and helpful, actionable information through networks and groups -- both mature and greener.

Kicking off the Health 2.0 Conference: Keas Makes the New York Times

jane@think-health.com (Jane Sarasohn-Kahn) — Tue, 06 Oct 2009 13:44:00 +0000

A New Tool to Take Care of Your Life is an article in today's New York Times written by Steve Lohr. The article features Keas, Adam Bosworth's start-up that empowers people to intimately, actively participate in managing their own health.

This is significant because (1) a start-up Health 2.0 company is prominently featured on the front page of the NYT's Business Day section, and (2) Keas is off the ground.

Welcome to The Health 2.0 Conference, version 3.0, number 5. The initial conference (known on Twitter as #health2con) was held in San Francisco in October 2007. Two years later, at this fifth meeting of the group, there are some differences we'll observe today and tomorrow:

1. We'll see the consumer aggregators, Google, Microsoft, and WebMD, demonstrating new applications that are on their way to integration health citizens' personal health information from data silos. We won't achieve perfect data liquidity, but we'll be on the way.

1a. We'll learn about newer consumer aggregators where consumers are aggregating themselves, not through organizations like health plans and providers, but on their own. The earliest pioneer in this space, PatientsLikeMe, has spawned a new generation of similar

2. More applications will be available for physicians and other health providers that help to both streamline workflow and achieve economic efficiencies as well as move them closer to engaging in participatory health with patients.

3. New health trackers and mobile health apps will continue to proliferate and arm those patients who want to be full participants in their own care.

4. The search for meaningful use using open source and Health 2.0 tools will play out in debates on the center stage between Dogs and Cats -- different interests in health stakeholder groups.

5. While health care is delivered locally, there's an increasing global bent to health app development so we'll learn about emerging health management applications being developed outside of the U.S. And riffing on the global team, we'll hear more about next Spring's Health 2.0 Conference to be held in Paris.

Health Populi's Hot Points: Stay tuned to Health Populi each day this week to hear more details on who's who in Health 2.0 and what they're doing. And watch the tweets on Twitter using the hashtag #health20con.

Most American adults are ePatients

jane@think-health.com (Jane Sarasohn-Kahn) — Mon, 05 Oct 2009 21:39:00 +0000

The number of Americans seeking health information online reached 157.5 million people -- 1.6 times the number of online health seekers found in 2005.

The number of Americans seeking online information about prescription drugs grew to 102.3 million people -- double the number of Americans researching Rx's online in 2005.

Manhattan Research's 9th and latest Cybercitizen Health survey, released on October 2, 2009, firmly establishes the fact that mainstream Americans are becoming ePatients. These findings support what Susannah Fox found earlier this year in her Pew Internet & American Life survey, The Social Life of Health Information. That poll estimated that 61% of American adults go online for health information.

Health Populi's Hot Points: Mark Bard, president of Manhattan Research, is quick (and right) to point out that health information search isn't just about the 'e' -- that is, the online search. People find health engagement through trusted relationships, online and offline. This includes health providers such as trusted relationships with doctors, friends and family, media outlets of personal choice (broadcast TV and cable, the dwindling supply of newspapers), and favorite magazines (again, dwindling in supply with today's news of Conde Nast's sad shutdown of Gourmet and Cookie, among others).

Health engagement will be optimally realized when health citizens meet up with trusted health content and tools where they want to be engaged: at home, on the move, at the workplace, in the gym, or the grocery store. Those nodes of health information and communication who seek health consumers' attention need to touch these various points to curry favor, trust and ongoing engagement with their customers and patients. The growing numbers of people going online to manage health on and ongoing basis will expect nothing less.

The importance of data liquidity - PwC's report on transforming health through data

jane@think-health.com (Jane Sarasohn-Kahn) — Fri, 02 Oct 2009 10:23:00 +0000

It's not the data, stupid; it's what you do with it. That's the value of investing in health information technology. The end-game is data liquidity.

Or, put more elegantly by Dr. Charles Kennedy of Wellpoint, "Taking data from a system – a piece of data from system A to system B – is very analogous to a transaction, and that’s really not where we need to go. Where we need to go is to repurpose raw clinical transactional data into an electronic understanding of the patient that easily and quickly allows doctors and patients to make ideal care management decisions.”

PricewaterhouseCoopers' report, Transforming healthcare through secondary use of health data, dives deeply into the opportunity of accessing, mining and analyzing data to best inform medical decisions and empower providers and patients.

This Holy Grail is clear; but so are the barriers and obstacles to getting there. Consider the list of issues to consider on this journey:

Cooperation and connectivity -- including personal health management and wellness
Technology -- such as interoperability and data architecture
Quality and value -- both clinical and data quality
Governance, standards and compliance -- "Standards" -- need I say more?
Privacy and security -- the big enchilada, regarding access control and breach disclosure.

On this road, different stakeholder organizations will create new models along the way: for example, providers will improve disease, care and case management for patients managing chronic conditions; pharmaceutical manufacturers will better target treatment efficacy and streamline sales and marketing processes; and public health agencies can better anticipate epidemics.

Ultimately, empowering the patient is the focus of secondary use of health data. PwC rightly points out that the patient is actually the most vital collection source, living daily making decisions and taking actions that impact their health. This is known as observations of daily living and they need to be captured as a key data source in ongoing monitoring.

Health Populi's Hot Points: As Dr. Kennedy points out in the highlighted quote, the health industry en masse needs to shift the focus of data from transactions to quality and outcomes. This will require - surprise, surprise - incentives to, as PwC puts it, "induce all stakeholders to collect, report and use the data."

This is how we get to rewarding providers and suppliers for quality and value. But getting there is very heavy lifting. For example, according to a PwC survey, only 20% of providers have fully implemented computerized provider order entry, and 37% are in the pre-implementation stage. Going up the EHR complexity scale, only 15% of providers use clinical decision support, with 30% in the pre-implementation phase.

And the privacy issue is common concern among well over 80% of health stakeholders that PwC surveyed: privacy implications, public relations ramifications, and legal implications are several of the challenges that lawyers in these organizations are firmly focused on. This effort goes way beyond HIPAA: MedMining, one of the stakeholders that PwC focuses on in the report, says they have gone over and above HIPAA requirements to develop, "a belt, suspenders, Velcro and glue approach" to privacy and security of personal health information. They are focused on transparency and many Chinese Walls between the patient data and users of that data.

Read this report for a sober analysis of what stands between transactions and raw data, and the ultimate goal of using that information: clinical transformation that benefits people.

Americans believe in health information technology

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 01 Oct 2009 10:45:00 +0000

Health information technology (HIT) will prove positive for health quality and expanded access to health care, according to 3 in 4 American adults. 64% of Americans believe HIT implementation will help to reduce health care costs.

A poll supported by the Career College Association and TechAmerica found broad-based support for HIT. While many health reform alternatives appear to be splitting American sentiment, HIT seems to be a unifying force for health improvement in the U.S.

The positive sentiment toward HIT crosses age, gender, and socioeconomic status.

Most health citizens see HIT as a personal health enabler, as well: 3 in 5 Americans (61%) believe that people would adopt healthier behaviors if, "IT systems and well-trained personnel to help them use the technology were more widely available in venues such as drug stores, health clubs, recreation centers, school and other places readily accessible to the public."

35% of Americans are worried about the impact of HIT on privacy; 25% believe there are adequate protections in place to ensure confidentiality of personal health information.

The survey was conducted online by Harris Interactive among 2,175 U.S. adults between August 28 and September 1, 2009.

Health Populi's Hot Points: It's encouraging to see Americans largely agreeing about something in the health sphere these days; HIT has been a rallying objective among legislators on both sides of the aisle for some time, and this is translating to the larger health citizenry.

It's even more encouraging that most Americans see the potential for HIT to be a health-enabler -- and that means the recognition of the role that people can be empowered and engaged in their own health through the use of health information tools. This finding echoes a survey done earlier this year by Deloitte, who found that 2 in 3 Americans like the idea of home health monitoring, as well as communicating "my numbers" back to my health provider for more continuous monitoring and support.

That this poll was sponsored by the Career College Association (CCA) is fascinating. CCA represents educators -- colleges and universities that provide career-specific educational programs. Part of the survey analyzed whether America's intellectual capital is sufficiently trained to manage the impending era of health information technology implementation. There remain gaps in training, according to consumers, who, based on the survey results, lack confidence the current state of HIT knowledge among health workers. This is an opportunity for the educational system to fill that gap asap, and an area where job growth can be expected -- if funding is available for such positions.