The time of change in Healthcare IT.

During the year of 2008 we had companies come and go, however some of these companies had good ideas and others had well what else can you say but bad ideas. Rather than name individual companies, I’d like to highlight categories.

Winners

1. Electronic Health Record vendors, especially web-based applications – The Obama administration has promised  $50 billion for interoperable EHRs.
2. Software as a Service providers – SaaS providers offer lower cost of ownership and faster implementation than traditional software installation approaches.
3. Open Source – I’m embracing Open source operating systems, databases, and applications as long as they can provide the reliability and supportability that I need.
4. Green IT – Winners will be innovative techniques to adjust power draw, such as idle drive management, cpu voltage adjustments, and high efficiency power supplies.
5. Cloud Computing offerings – These are remote infrastructure utilities such as storage and high performance computing. Friday’s Cool Technology of the Week will describe a new technology called Cloud Optimized Storage.

Losers

1. Client Server applications – the cost of deploying, supporting, and maintaining client server applications is no longer affordable.
2. Proprietary operating systems – I’m eliminating Solaris, AIX, HP-UX from my data centers. 
3. High end SAN storage – I find that 90% of my storage needs are met with lower end SAN, NAS, and appliances which use low cost, high density drives (SAS and SATA).
4. Devices that do not offer energy efficient operations.
5. Applications that require a specific operating system or a specific browser on the client side. To be successful in 2009, applications should be operating system neutral, browser neutral, and easily hosted as a service accessible via the web.

I welcome your thoughts on your own winners and losers for 2009.

Google vs. Microsoft the battle continues

Google and Microsoft may eventually become the envy of medical researchers, as the technology behemoths take on the role of hosting health care databases for consumers own personally controlled health records (PCHRs).

The movement toward consumers controlling their own health records and the means that will get them there raises several issues of concern, according to a report in the New England Journal of Medicine.

Under a PCHR, a patient would set up a portal that could authorize their doctors, health care providers, researchers, and family members to provide and share information relating to the patient. Those records and information would be stored in the patient’s PCHR, which would be hosted by Google Health or the Microsoft HealthVault.

Microsoft is working with New York Presbyterian Hospital, and Google is working with Cleveland Clinic to have those institutions provide their patients with an electronic copy of their own records.

Once patients give their approval, companies, government organizations, health-related operators, and others could create applications that would connect to the PCHR platforms.

But the authors of the report, Dr. Kenneth Mandl and Dr. Isaac Kohane, raise a number of key questions concerning the PCHR service providers, such as whether the service providers will have a research mission and whether they would allow secondary use of any aggregated data of their users. And, of course, the issue of privacy was also addressed (PDF). The PCHR service providers are not under the same regulations as the health care industry, which restricts the sharing of patient information to only those people or entities whom the patient designates under the Health Insurance Portability and Accountability Act.

The report says that Google and Microsoft’s databases of patient information may eventually grow to be larger and more up to date than the databases of other well known medical research programs. As a result, researchers may find it easier and cheaper to team up with Microsoft and Google when doing their research, rather than relying on a number of sources for data to do their research.

Challenges in putting PCHRs to use include limitations by some laboratories in releasing medical results to patients, the fact that a substantial number of medical records are still paper based, and that the U.S. currently has no universal patient identification system.

“Despite these challenges, many consumers with PCHRs will soon control a valuable resource an integrated copy of their health care information across sites of care,” the researchers note.

Around the world

The 10 Germiest Jobs in America: Is yours on the list?

We’re getting over the stomach flu in my house (NOT fun), so believe me, I’ve been thinking about germs this week–specifically how to avoid them. So a recent headline caught my eye: The 10 Germiest Jobs in America. Of course, I had to click and learn more. Here’s the scoop …

Dr. Charles Gerba, a microbiologist at the University of Arizona, whose nickname is “Dr. Germ,” spoke to ABC News recently, about the germiest professions in America:

LINK

Obese children have middle-aged arteries

Children who are overweight or obese may have as much atherosclerotic plaque build-up in their arteries as adults in their 40’s, say researchers.

Geetha Raghuveer and colleagues studied 70 children aged 6 to 19. All of the children involved in the study were at high risk of future cardiovascular disease because they had a high cholesterol level and/or were obese, or they had familial hypercholesterolemia. The thickness of the inner wall of each child’s carotid artery (carotid intima-media thickness, or CIMT) was measured by ultrasound scan. A high CIMT reading indicates that there is a build-up of plaque in the carotid artery, and is associated with an increased risk of heart attack and stroke.

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‘Pregnant man’ is pregnant again

Thomas Beatie, who was born a woman but lives as a man in Oregon after surgery and hormone treatment, is expecting a second child, Beatie has told Barbara Walters in an interview set to air on television on Friday.

Beatie, 34, who is legally a man but kept female reproductive organs when he had a sex-change operation 10 years ago, is in his first trimester of pregnancy, he told celebrity interviewer Walters for the ABC news program “20/20″ that will air on Nov. 14. Walters highlighted the interview on her daytime chat show, “The View,” on Thursday.

LINK

Can a Bone-Marrow Transplant Halt HIV?

The human immunodeficiency virus (HIV) is a pathogen so wily and protean that researchers rarely talk about curing infected patients, focusing instead on treatment and prevention. But in an announcement that caused a flutter of excitement and a wave of prudent skepticism, Berlin-based hematologist Gero Huetter claimed on Thursday that he has cured an HIV infection in a 42-year-old man through a bone-marrow transplant.

LINK

Intel Corp. releases home medical monitor

Intel Corp. is taking its next step in building a business in health care, introducing technology to help homebound patients with chronic medical problems.

Intel has designed products to help patients monitor conditions.

The Silicon Valley company, at a medical conference in New Orleans, announced a series of trials with health-care organizations of specialized hardware and software developed by the chip maker. The tests are designed to show whether the new tools bring improved results in treating conditions such as diabetes, hypertension and heart disease.

Intel and other computer-related companies see big opportunities in health care, hoping to address inefficiencies that will become more costly as patients and caregivers get older. Allowing more people to receive care at home can save billions of dollars, the companies say.

Intel’s offerings collectively called the Intel Health Guide include a simplified computer and software that are designed to help elderly people and other patients monitor and manage their conditions at home. It connects to medical devices such as scales, blood-pressure monitors and glucose readers, recording information that can be shared with health professionals over the Internet.

Intel also has developed software to help staff at medical call centers to remotely monitor patients’ conditions and manage their treatment; it will manage patient-monitoring systems for customers as well. “We are going to do end-to-end services,” said Louis Burns, vice president and general manager of the Intel Digital Health Group.

That’s a new approach for Intel, which has been studying medical issues since 1999 and kicked health-care efforts into a higher gear in 2005.

The company ordinarily makes components that other companies assemble into systems. In other cases, Intel makes prototype designs that it offers to hardware companies — including a tablet-style computer for nurses.

In managing home care, however, Mr. Burns said health-care organizations want a complete system that can be customized for their needs. Intel is discussing pricing for its latest offerings, in part because each deployment may differ greatly in size and scope.

But there are many obstacles. Intel’s Health Guide, for example, had to be approved by the U.S. Food and Drug Administration, a process that took several months.

The company also hopes to deliver its software to patients on conventional laptop and desktop computers and cellphones, but each combination of hardware and software would have to go through FDA approval processes, said Eric Dishman, Intel’s director of product research and innovation.

Who pays for such advances is another issue. Medicare, which covers many elderly patients, hasn’t yet been willing to reimburse patients or caregivers using remote monitoring systems, said Marc Holland, research director at Health Industry Insights, a unit of research firm IDC. “Unless and until Medicare gets on the bus, it will be slow going,” he said.

There is also likely to be plenty of competition some of it aided by an Intel-spearheaded consortium called Continua that has been developing standards to help medical devices exchange information, he added.

Still, Mr. Holland said he is “very excited” about Intel’s new offerings and the involvement of companies that will test them, which include Aetna Inc., Erickson Retirement Communities LLC and SCAN Health Plan. Another company, Advanced Warning Systems Inc., said it plans to use the Intel technology in services to monitor patients such as retired football players and war veterans.

Links in Article

AETNA: www.aetna.com

INTEL: http://www.intel.com/pressroom/archive/releases/20081110corp.htm?iid=pr1_releasepri_20081110r

IT outsourcing could benefit rural hospitals, researchers find

Patients expect the most up-to-date equipment and technology at hospitals, regardless of the institution’s size or budget. Providing that technology, however, can be difficult for small, rural hospitals that often lack the budget and staffing to make it possible.

A case study conducted by researchers in Penn State’s College of Information Sciences and Technology (IST) shows that smaller hospitals may be able to benefit by sharing an IT infrastructure with larger hospitals in the same geographic area.

Madhu Reddy, assistant professor of IST, Sandeep Purao, associate professor of IST, and Mary Kelly, a graduate student, conducted interviews with administrators at a regional hospital and three small, rural hospitals in central Pennsylvania. The three smaller hospitals relied on the regional hospital to manage such things as software, laboratory information and technical support.

The researchers found that the smaller hospitals saw financial savings from the partnership and also benefitted from the shared IT staff and its experience. The group reported their results of the study in a recent issue of the Journal of the American Medical Informatics Association.

“The most prominent financial benefit for the rural hospitals was the ability to afford a comprehensive IT infrastructure at a relatively low price,” Reddy said. “For instance, the rural hospitals only pay a percentage of the hardware dedicated to their needs … if the regional hospital buys a new hard drive, the rural hospitals will only be charged for the percentage of the hard drive they use.”

The regional hospital did not profit from sharing its services, but the smaller hospitals did take on costs involved with the partnership and helped pay for the additional staffing required to make the relationship possible.

One of the challenges to this outsourcing system, the researchers found, was a perception among the small hospitals that their customer service requests were sometimes not a high priority for the regional hospital’s IT staff.

“They believed a traditional vendor would want to meet their needs in order to retain their business, but that was not always the case in the partnership,” Reddy said. “However, as the partnership evolved over time, they were able to overcome this challenge.”

Reddy said he hopes to continue this research by organizing a larger case study examining rural/regional hospital IT relationships throughout Pennsylvania to determine whether this type of relationship can have long-term benefits for rural hospitals across the state and the country.

Links within article:

Journal of American Medical Informatics Association: http://www.jamia.org/

Download PDF of Article: LINK

Around the World

America’s Best Health Plans Honor Roll

The Honor Roll recognizes the very best of the hundreds of commercial, Medicare, and Medicaid managed-care plans reviewed for this year’s U.S. News health plan rankings. Plans were scored from 0 to 100 based on data collected and analyzed by the National Committee for Quality Assurance, managed care’s major accrediting and standards-setting body.

LINK

Four Ways to Trade a Presidential Election

With the U.S. presidential election finally behind us, you might be wondering how to manage your portfolio these days.  Let’s see what we can learn from the S&P 500, which I use as a stock market proxy.

LINK

Determined Texas woman, 92, votes in ambulance

Betty Owen is 92 and after a stroke four years ago, needs a feeding tube and can’t walk. But she was determined not to miss Tuesday’s election. She arrived at her polling place on a gurney in an ambulance, where an election judge and support worker climbed aboard with an electronic voting machine and let her cast her ballot.

LINK

Study: Women lead men in bacteria, hands down

Wash your hands, folks, especially you ladies. A new study found that women have a greater variety of bacteria on their hands than men do. And everybody has more types of bacteria than the researchers expected to find.

LINK

ND pantries to accept only archery-killed deer

A North Dakota program that distributes venison to the needy will accept only deer killed with arrows, fearing that firearm-shot meat may contain lead fragments.

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Cataract Surgery Statistics

How does your OR staff and ophthalmologist rank in comparison to others?

One way to judge your center is to look at information provided by Surgical Outcomes Information Exchange and AAAHC Institute. Here is what centers through the US reported in terms of their averages:

Operating Room:

Surgical time – 15 to 20 minutes
OR time – 25 to 30 minutes
Recovery time – 25 to 30 minutes

Anesthesia Used:

76% MAC anesthesia for cataracts.
42% intraoperative anesthetic techniques included topical
24% peribulbar block
26% retrobulbar block

High tech IOLs Usage

15% Medicare patients
28% non-Medicare patients

Taking time out of your busy day to access where your center stands in comparison to your peers is time well spent. If your OR stats fare well, congratulations!!! If not, then use this as an opportunity to improve those areas which aren’t doing so well.

Around the World

Medical Grind Hurts Healing Art

Did you feel healed the last time you went to the doctor?

My bet is no. If you were lucky, maybe you got 10 minutes with the doctor. In not much more time than you might have spent in a fast food drive-thru, the doctor wrote a prescription, ordered a battery of lab tests and sent you off for a thousand dollars worth of imaging studies.

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‘Killer’ dye to combat both MRSA and C-diff

Killer dyes and paints, activated by switching on a light, could be used to fight superbugs in patient wounds after operations and across hospital surfaces, scientists at a meeting in Trinity College Dublin have been told.

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Google patches Android security flaw

Google has begun distributing a patch to its Android mobile phone operating system, an early test for how nimbly the company can respond and how well the infrastructure works to distribute and install updates.

LINK

Where Are We Heading with Color Coding?

That seems to be the unanswered question in today’s healthcare world?  For some, the debate is whether or not to standardize the color chart for patient condition alerts. For others, it is over whether or not this violates the patient privacy act, HIPAA.

There is a national movement afoot to standardize the color coding of hospital wristbands, e.g. purple for do not resuscitate, red for allergies; yellow for fall risk; white or clear for patient identification and green for those receiving blood products. The benefit for uniformity would be for those allied health professionals who move between hospitals and health organizations.  Without standardization, confusion could result and the goal of preventing dangerous mistakes would be compromised.  While a color coding system has been supported by at least 20 states, as well as embraced by the American Hospital Association, the final color code continues to be scrutinized. However, if standardization fails to prevail, we could end up with an infinite array of colors and alerts.  As the Ohio Patient Safety Institute reported in 2007, there are 19 different colors with 28 different meanings in the state. The Greater New York Association reported nine different colors to denote D.N.R. orders and five different ones to highlight allergies.  

On the other hand, there are healthcare authorities who feel strongly that hospitals need to make sure that patient privacy and sensitivity for patients need to take precedence over the need for patient safety and accuracy. Their argument is that standardized color-coded wristbands brand patients’ health status and as the result, broadcast such matters to family and friends who have not been consulted.

Given these on-going debates, color-coded wristbands may never be fully implemented. My prediction is that bar coded hospital ID bracelets will be fully developed long before we can agree on the standardization of color coded wristbands.

Around the World

Greenspan – I was wrong about the economy. Sort of

The former Federal Reserve chairman, Alan Greenspan, has conceded that the global financial crisis has exposed a “mistake” in the free market ideology which guided his 18-year stewardship of US monetary policy.

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Warm Hands Warm Your Heart

Holding a warm cup of coffee gives you a warm feeling about the person across the table, new research reveals.

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Scientists try to stop hunger with retooled foods

Want to lose weight? Try eating. That’s one of the strategies being developed by scientists experimenting with foods that trick the body into feeling full.

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