Just an occasional post when I come upon a few interesting reports and resources that are worth a download or browse. This week we have a few.
First we have:
A Better Model for Health Care
An innovative experiment in Florida shows the potential for more systemic collaboration as the catalyst for lower costs and improved quality.
by Gary D. Ahlquist, Minoo Javanmardian, and Sanjay B. Saxena
In 2009, U.S. health-care reform moved rapidly to the front burner, and it will stay there. President Barack Obama and his advisors have made it clear that reducing health-care costs is a necessary prerequisite to achieving their broader economic goals.
The levers that the new administration plans to pull will address the obvious issues: treatment variability (standardized procedures tend to be more cost-effective), value-in-use analysis (evaluating costs and benefits), chronic disease management, enhanced information technology, and utilization rates. (Utilization rates measure the amount of health care delivered and received per capita. Preventive medicine and other means of reducing long-term utilization while maintaining overall public health thus represent a major cost-saving opportunity.) The reforms are all expected to involve both public and private initiatives, reassuring voters that “if you have insurance you like, you can keep it.”
But it isn’t yet obvious how the government’s changes will actually work in the current industry structure of health-care delivery and finance. Today’s health-care system in the U.S. is set up to optimize everyone’s interests except the consumer’s. Unlike other industries, in which products and processes tend to be about 80 percent standardized, and a purchaser has a reasonable sense of what to expect, the U.S. health-care industry is full of fragmentation, friction, unnecessary customization, and excessive costs. Reducing those costs would require holistic change in the practices and structures of the industry. It would mean reshaping everything from the patient care experience to the methods of gathering and sharing data.
In short, even if the new government health-care policies are well designed and effective, the U.S. will still be a long way from having a health-care finance and delivery system that can offer the right combination of incentives and relationships among sponsors (such as employers and associations), payors (health-care insurance companies and reimbursement plans), providers (including hospitals and physicians), and consumers. The federal government alone has the scope and authority to mandate top-down change across the United States, but only the industry can implement it. The challenge facing the U.S. health-care industry is thus significant: Its many varied components must cooperate to rebuild their programs and structures from the bottom up.
To use an analogy to American football, the government “kicking team” is getting ready for the game to begin. But will the “receiving team” of employers, plans, providers, and consumers be ready?
Fortunately, there are some models that the industry can draw on to answer that question. One of the most promising is an innovative experiment just getting under way in Florida. The model, dubbed Healthcare of the Future (HOF), addresses health-care reform from the ground up and engages plans, providers, and consumers. Although it has started modestly with three initial services (involving cardiac care, lung cancer treatment, and hip and knee surgery), the program is expected to expand to as many as 25 offerings, covering the great majority of services and costs.
Compared with other health-care reform efforts, HOF is distinctive because it is both comprehensive (involving multiple participants in potentially broad-scale reform) and organic (evolving from current efforts and priorities). That makes it a relevant model for any country or health-care system. Different countries have their own approaches to the way health care is funded, but they are all wrestling with the same cost and effectiveness issues, and they must all figure out how to embrace technological innovation and best-quality science. In addition, many nations face the challenge of an aging population that will have an increasing need for care and thus raise utilization rates.
If the United States is fortunate, and if models like HOF prove influential, there is a genuine possibility that the receiving team members will not just accept the ball from the government; they will change the very nature of how the game is played.
Much, much more here:
http://www.strategy-business.com/article/09301?gko=09f34-27802017-27863320
This is an interesting and sophisticated article on a possible re-design of Healthcare delivery. Experiments such as described here are vital.
Second we have:
Australian Health Issues Centre.
eHealth
Australian Government – Department of Health and Ageing eHealth Incentive Guidelines (PIP)
The PIP eHealth Incentive aims to encourage practices to keep up-to-date with the latest development in eHealth
E-Health: Empowering clinicians and consumers
This is a power point presentation by Marion J.Ball Ed.D, while its is set in an American context some of the points are relevant to the eHealth debate in Australia. In this power point eHealth is also used to mean not only personal electronic health records but also the vast amount of information that is now available on the internet which is used by consumers to make decisions about their health care.
Electronic Health Records: An International Perspective
Development of electronically linked patient records or Electronic Health Record schemes (EHRs) is a priority for governments in many countries, including Australia, as part of a vision for future health care services using call centres, web-based patient information and telehealth. This article discusses the privacy framework needed for EHRs and the role of Privacy Commissioners. It reviews nationally significant EHR schemes in Canada, England, Germany, France and Ireland and the privacy frameworks they operate within.
Electronic health records – People centred or technology centred
The National Health and Hospitals Reform Commission say that electronic health records which can be accessed by health professionals and across all settings, with the persons agreement, is arguable the most important enabler of truly person centred care.
Health Information on the Internet: Retrieval and Assessment Strategies for Consumers
The Internet is the fastest growing source of health information with over five million websites worldwide, of which 100,000 are health related. There is a need for a consumer guide on how to find health information on the Internet and evaluate its quality and the quality of the website providing the information. This article attempts to meet this need by describing a systematic approach for an Internet search where the consumer is encouraged to: identify the type of information being sought; identify the most appropriate search software; and discover tools for assessing the quality of the information retrieved and technical quality of websites.
Healthcare identifiers and privacy
All Australian governments recognise the potential benefits of changing how information is accessed and shared across the healthcare system through the use of electronic communication and information technology to ensure that information is available when it is needed to provide patient care.
The adoption of this technology, commonly described as e-health, is expected to transform the way in which healthcare providers practise and consumers interact with the health system and improve the safety and quality of healthcare and patient outcomes.
Legislative Developments in Privacy of Health Information
Electronic communication and management of information is receiving increasing attention in the Australian health sector. With this comes increasing concern about how to manage the risks to privacy generated by these developments. This article explores recent legislative responses to health privacy concerns in Australia, comparing the Commonwealth and Victorian approaches in detail.
NEHTA - National E-Health Transition Authority
Across Australia there is a groundswell of support for a better, more connected healthcare system. More than 80 percent of Australians are in favour of electronic health records and are increasingly aware of the safety and quality benefits that e-health can deliver. NEHTA has been tasked by the governments of Australia to identify and foster the development of the right technology necessary to deliver the best e-health system.
New Frontiers Old Cowboys: A Consumer Perspective on eHealth Initiatives
The move to an efficient, patient-focused health system could be greatly assisted by an integrated electronic health record. However, examination of the recent uses of technology within the health system has raised concern. This article focuses on two areas of concern, ePrescribing and the patenting of health software, and the sorts of protections that need to be instituted to ensure that any new system of electronic record keeping serves the needs of the health system and consumers.
New Resources added for September 2009-eHealth
Electronic Health Records resources and links
Privacy and Public Confidence in an eHealth Era
Australian Health Ministers have approved the development of HealthConnect, a comprehensive national scheme linking health records. Media statements emphasise participation is voluntary but public confidence in the scheme will depend on rigorous privacy protection. At the same time, amendments to the Commonwealth Privacy Act are winding their way through federal Parliament. This article looks at the adequacy of the proposed privacy legislation drawing on the concerns raised by consumers.
Privacy of Health: The Consumer’s Perspective
Privacy issues remain at the top of the political agenda in Australian health care and globally. This and the increasing push towards electronic health records make understanding consumer views about handling their health information essential. This article analyses data gathered from interviews and a survey that investigated consumers’ views about sharing their health information.
The Australian eHealth research centre
A joint venture between CSIRO and the Queensland Government, the Australian e-Health Research Centre is a leading national research facility in ICT for healthcare innovations.
More here:
http://www.healthissuescentre.org.au/subjects/list-library-subject.chtml?subject=7
This is an interesting collection of resources.
Third we have:
SCR evaluation data shows added value
08 Sep 2009
Data from the evaluation of the Summary Care Record shows the SCR sometimes adds value in out-of-hours consultations but so far has made a limited contribution in secondary care, according to a report presented to Connecting for Health.
The SCR evaluation team from University College, London, have collected data from 108 consecutive medical encounters where they examined use of the SCR and its added value, both in the view of the UCL team and the clinician using the record.
Prof Trisha Greenhalgh, who leads the independent evaluation team, told EHI Primary Care that it was impossible to draw conclusions from the data at this stage with much more data to be collected and analysed before the final report in published in May 2010.
She added: “These are not findings it is just data and the final report will not say either the SCR is of no use or it’s the best thing since sliced bread. It will be a nuanced report on what is a very complex area.”
The evaluation team presented its provisional conclusions from the data so far to an extraordinary meeting of the Summary Care Record Advisory Group at the end of June and minutes of the meeting have been published by CfH this week.
Dr Gillian Braunold, clinical lead for the SCR project, said the SCRAG was clear that there was a big difference between use of the summary record in A&E at the moment and in out-of-hours centres where the SCR was integrated into the out-of-hours software.
She added: “We had a lot of discussion with Prof Greenhalgh on the emerging benefits in primary care where there is increasing evidence that the SCR is providing benefits in terms of clinician confidence in decision making and changes in therapeutic decisions which echoes our own findings.”
More here:
http://www.ehiprimarycare.com/news/5185/scr_evaluation_data_shows_added_value
It is worth browsing these notes as they show the US Summary Care Record is starting to show some benefits.
Fourth we have:
Participatory Health: Online and Mobile Tools Help Chronically Ill Manage Their Care
Jane Sarasohn-Kahn, THINK-Health
September 2009
Of the $2.2 trillion in total U.S. health care spending in 2007, 75% ($1.7 trillion) went to care for patients with chronic conditions. Despite this staggering expenditure, there are pervasive problems with the quality of chronic disease care.
Chronic disease is most effectively managed through frequent, near continuous monitoring. Yet many patients spend only a few minutes a year with their clinicians. According to the National Council on Aging, a third of all chronically ill people say they leave a doctor's office or hospital feeling confused about what they should do to manage their disease, and 57% report that their providers have not asked whether they have anyone to help implement a care plan at home. New technology tools are emerging to bridge these gaps. This report describes some of the online and mobile platforms and applications that can assist patients in managing their health care -- not only at home, but almost anywhere else outside their clinician's office. Sources include extensive interviews with stakeholders in the field, whose experiences and views are presented throughout the report.
More here:
http://www.chcf.org/topics/chronicdisease/index.cfm?itemID=134063
Document Downloads
Participatory Health: Online and Mobile Tools Help Chronically Ill Manage Their Care (821K)
This is a very interesting report. There are certainly some in Australia pushing similar lines.
Fifth we have:
JAMA - Vol. 302 No. 10, pp. 1033-1130, September 9, 2009 - Commentaries 
Electronic Medical Records at a Crossroads: Impetus for Change or Missed Opportunity?
Leonard W. D’Avolio
JAMA. 2009;302(10):1109-1111.
Eight Rights of Safe Electronic Health Record Use
Dean F. Sittig; Hardeep Singh
JAMA. 2009;302(10):1111-1113.
More here:
Links above in text. The second article especially is worth chasing down.
Further coverage is here (with links):
'JAMA' series attempts to bring EHRs back into reform discussion
September 10, 2009 — 11:57am ET | By Neil Versel
It can't be said enough: EHRs alone won't fix healthcare. We got some more peer-reviewed ammunition behind this statement with a pair of articles in this week's Journal of the American Medical Association, and the authors even managed to put their arguments in the context of health reform, despite the politicians' seemingly singular focus on the insurance market.
Sixth we have:
Implementing a Successful Health Care Pilot Project
Regional focus aligns constituents and leads to success.
By Emad Rizk, MD
It is difficult to have a conversation about health care these days without discussing the national topics of reform and change. But it is important to remember that the most effective changes in health care occur on a regional basis with pilot projects. Within a single region, we have the greatest opportunity to learn what works and what doesn't, and how to align constituents and achieve success. After all, each region has its own practice patterns, insurers, government structures and population characteristics. In this article, I will draw upon my 25 years of industry experience to share some important strategies for developing a meaningful and successful pilot program that can then be deployed on a larger scale.
Much more here:
http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=206110
This is an interesting article and given its scope the book on which it is based looks to be well worth a read.
Dr. Rizk is president of McKesson Health Solutions. This article is based on material from his latest book, The New Era of Healthcare: Practical Strategies for Providers and Payers.
Second last we have:
Medical automation market expected to grow to $23.2B by 2014
September 08, 2009 | Bernie Monegain, Editor
WELLESLEY, MA – The market for medical automation technology is forecast to grow from $13.1 billion this year to $23.2 billion in 2014, according to BCC Research.
The report, Medical Automation Technologies, Products and Markets, pegs the compound annual growth rate (CAGR) at 12.2 percent.
The market is broken down into segments for therapy, diagnostic and monitoring and logistics and training. The therapy segment currently has the largest share of the market, worth an estimated $9.5 billion in 2009. This should increase at a CAGR of 11.9 percent to $16.7 billion in 2014.
The diagnostic and monitoring segment has the second-largest share of the market, worth an estimated $3.3 billion in 2009. This segment is expected to generate nearly $5.9 billion in 2014, for a CAGR of 12.4 percent.
The logistic and training market is expected to be worth $272 million in 2009 and increase to nearly $652 million in 2014, for a CAGR of 19.1 percent.
More here:
http://www.healthcareitnews.com/news/medical-automation-market-expected-grow-232b-2014
Report etc here:
Lastly we have:
Database Lists Device Standards
HDM Breaking News, September 8, 2009
Four standards development organizations have jointly launched a database listing standards for more than 1,300 medical devices.
Founders of the Medical Device Standards Portal include the Association for the Advancement of Medical Instrumentation, American National Standards Institute, ASTM International and the German Institute for Standardization. The site includes documents from the organizations as well as the Food and Drug Administration, International Electrotechnical Commission, International Organization for Standardization and various European regulations.
More here:
More information is available at medicaldevicestandards.com.
Enjoy!
David.
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