By Jane Sarasohn-Kahn. Electronic health records (EHRs) broaden access to patient data and provide the platform for pushing evidence-based decision support to clinicians at the point-of-care. This promotes optimal care for patients, reduces medical errors, optimizes the use of labor, reduces duplication of tests, and by the way, improves patient outcomes. When done in aggregate across all health providers, a team from McKinsey estimates that $40 billion of costs could be saved in the U.S. health system.

Reforming hospitals with IT investment in the McKinsey Quarterly talks about the American Reinvestment and Recovery Act’s (ARRA) $20+ billion worth of stimulus funding under the HITECH Act and estimates that 80% of existing hospital IT applications will be affected by the regulation. Hospitals will be spending about $120 billion to meet the adoption and meaningful use provisions of the Act. This equates to $80,000 to $100,000 per hospital bed. ARRA incentive payments will cover roughly 20% of this cash outlay, meaning that $60-80K won’t to covered.

But McKinsey says, “Hold on!” There are ways to recoup the spending gap between HITECH incentives and cash-out-of-the-hospitals-budget. McKinsey’s research calculates that optimizing labor, reducing adverse drug events and duplicate tests, and adopting revenue cycle management can help the average hospital save $25,000 to $44,000 per bed each year. That gets to the $40 billion in annual savings when multiplied across all hospital beds in the U.S.

In operational terms, the savings accrue through:

• Managing inpatient beds more efficiently using equipment-scheduling software
• Optimizing the use of clinical equipment
• Determining optimal staffing
• Reducing administrative waste
• Reducing adverse drug reactions through computerized-physician-order-entry (CPOE) which cost $8,000 to $15,000 per bed each year (up to $3 million for a 200 bed hospital)
• Managing the revenue cycle by billing unbilled services, equivalent to 0.4% of hospital services, or $4,000 per bed.

Jane’s Hot Points: The McKinsey team rightly points to three critical success factors for maximzing health IT investments that the most wired, effective hospital-adopters have learned: get critical buy-in among clinicians and hospital execs early in the HIT adoption process; ‘radically’ simplify health IT architecture; and, elegantly plan and execute.

It’s the implementation phase in health IT adoption that so often gets short-shrift. McKinsey notes that Canada’s hospital system devoted 30% of its entire budget to change management. That’s a big number, but it’s also where rubber meets road: a capital outlay of $N million is the easy part of HIT adoption. The follow-on implementation resources, both in terms of sheer dollar volume and labor/staffing, along with disruption of clinical workflow, is the hard part. But getting to meaningful use will require no small amount of implementation effort in the form of evangelism, education and training, and ongoing assistance and support.

Originally posted on The Health Care Blog on August 18th.

Did you miss Disruptive Women bloggers Indu Subaiya, Jane Sarasohn-Kahn, Trisha Torrey, and Regina Holliday this week on the Real Women on Health! Radio series? Or did you hear them, but want to listen again? If so, you can listen to the podcasts now available.

By Pamela Cipriano. On July 13, 2010, the clock started running for eligible providers, hospitals, and critical access hospitals, to become meaningful users of certified electronic health records (EHR). Under the direction of the Secretary of Health and Human Services, the Centers for Medicare and Medicaid, together with the Office of the National Coordinator for Health Information Technology (ONC) released the final rules that lay out the first two years of requirements for eligible professionals to qualify for incentive payments included in provisions of the American Recovery and Reinvestment Act of 2009 through the HITECH act (Health Information Technology for Economic and Clinical Health).  View the press conference led by Secretary Sebelius.   (Disruptive Woman Regina Holliday, spoke at the press conference)

Seven months and 2000+ professional and public comments later, the final rules lay out a three phase graduated approach of requirements for demonstrating meaningful use of certified EHRs.  Since not one stakeholder group is wholly enamored with the rules, they are more than likely equitable and balanced.  Listening to the feedback, the ONC made a number of changes from the proposed to the final rules, taking into account concerns about the speed and scope of implementation of criteria to qualify as a meaningful user.  Groups across the industry gave faint praise as they acknowledged the greater flexibility in the final rules and an easing of some of the requirements.  The phased approach lays out the goal for Stage 1 as capture of data in coded format, Stage 2 exchange of information with emphasis on guiding and supporting care processes and coordination, and Stage 3 improving outcomes by focusing on decision support with improved access to comprehensive patient data.

With quality at stake, the meaningful use incentives tie payments to achieving advances in health care processes and outcomes.  The payments are intended to help accelerate use of HIT. Fortunately there is already broad agreement that populating data into EHRs, using electronic prescribing, reviewing and sharing data across providers and settings, and reporting on quality measures has a positive effect on care.  Dr. Don Berwick, newly appointed Administrator of the Centers for Medicare and Medicaid, emphasized that the new rules define the use of EHRs that is “meaningful to care and to people,” emphasizing the direct improvement in patient safety, transparency, and access to data resulting in better, safer, and more reliable care for everyone.  Certified EHRs help providers know more about their patients, make better informed decisions, and reduce costs of care.  Electronic systems can reduce potential for errors, and enable consumers to work with their providers to coordinate and manage their care.     (more…)

By Robin Strongin. It didn’t receive much attention in the context of oil wells being capped and financial services legislation being passed, but the Federal Communications Commission (FCC) took a step last week that could make a profound difference for Americans who live in rural parts of the country.

The FCC voted unanimously to have the federal government pay a greater share of broadband Internet costs for rural health care providers, and the commission also expressed its intent to subsidize the construction of broadband networks.

Why is this important?  Over the past 25 years, according to the Center for Health Transformation, over 500 rural hospitals have shuttered their facilities.  And, while 25 percent of the U.S. population lives in rural areas, only about one in ten doctors base their practices in sparsely populated areas, creating a serious physician shortage.  For many, it’s an economic hardship to drive a few hundred miles to see a specialist.  Broadband access can bridge those distances and help physicians and rural patients share vital information.

The FCC has a $400 million annual spending cap for rural health care telecommunications programs, but it wasn’t spending all of that money.  So, now it will pay 50 percent of monthly broadband charges for eligible health providers, instead of 25 percent.

It’s not a lot of dollars in the grand scheme of federal outlays, but if it can help bring quality health care closer to those living in America’s wide open spaces, it’s one of our nation’s better investments.

By Mary Grealy.  An organization of health industry chief executives today applauded federal regulators for being responsive to the concerns of hospitals and physicians in constructing the final “meaningful use” regulations that will determine the allocation of health information technology (HIT) incentive funds.  But, said the president of the Healthcare Leadership Council (HLC), the newly-released rules leave some critical issues still unaddressed.

HLC president Mary R. Grealy said that, even though her organization was still analyzing the regulations, “it’s clear that federal regulators paid close attention to the more than 2,000 comments they received on the proposed rule, and that they have been responsive to concerns that the initial regulations placed the “meaningful use” bar so unrealistically high that the health technology revolution would have been slowed instead of accelerated.”

The “meaningful use” regulations establish standards that health providers must meet in order to qualify for a share of the more than $27 billion authorized by Congress in last year’s economic stimulus legislation.

The Healthcare Leadership Council is a coalition of chief executives from all sectors of American healthcare.

Ms. Grealy said, “An example of this responsiveness is seen in the fact that the rules no longer require that, in the initial stage of implementation, all of a health provider’s administrative transactions must be included in an electronic health record.  That simply wasn’t realistic.  Those requirements are now in Phase 2 of implementation, which is achievable.”

She said, though, that legitimate concerns remain.  For example, the regulations should consider each campus of a multi-campus hospital system as a separate entity in qualifying for HIT incentive payments.  And, she said, health providers who have built and succeeded with their own information technology systems should be grandfathered into the universe of successful “meaningful use” qualifiers, but that doesn’t appear to be the case based on an initial review of the rules released today.

Nonetheless, Ms. Grealy said, “we’re seeing important progress with these regulations.  Clearly, the administration saw there was a gap between the theoretical standards they initially wanted to apply and the real-world challenges that physicians and hospitals face in achieving HIT advancement.   We all want the benefits that come from information technology – enhanced patient safety, more cost-efficient operations, greater use of evidence-based medicine – but to make strides forward, regulators and providers need to be moving at a coordinated pace.”

Orignially posted on Prognosis: A Healthcare Blog on July 13th

Disruptive Woman Regina Holliday’s testimony at the release of the final rules on meaningful use on Tuesday.

Straight from AHRQ….

This week HHS announced final rules to help improve Americans’ health, increase safety and reduce health care costs through expanded use of electronic health records (EHR).  The announcement marks the completion of multiple steps laying the groundwork for the incentive payments program.  One of the two regulations announced today defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other regulation identifies the technical capabilities required for certified EHR technology. Select to access the announcement.

By Glenna Crooks. Rittenhouse Square in Philly, a holiday weekend and great weather made for the perfect place for light reading this weekend. I got magazines with the intention of doing just that – and did. It was great to be outside on warm, breezy days.

However, my mood soured about half way into Spirituality&Health, reading an article about a possible new cancer therapy.

It describes the observations of Mamdooh Ghoneum, PhD: cancer cells are attracted to, ‘eat’ heat-killed baker’s yeast and then die. That’s good news. It happens in labs and in mice, who apparently suffer no side effects. That’s good news, too. Approval for testing in other animals is pending. I hope he gets it. We need progress in the healing of people with cancer.

Why the sour mood? Dr. Ghoneum is hero enough for making the observation and following through with studies. He’ll be all the more heroic if he continues and learns from whatever comes next.

The article does not stop with the ‘scientist vs disease’ heroic tale, however. It goes further to paint an unfortunate and ill-informed, biased contrast – between an altruistic pioneer using his personal savings and fund raising efforts to find a cure vs a greedy, patent-dependent industry hungry to return to shareholders the $800M – $2B quoted as the cost of developing a medicine. It asserts that industry would never develop a ‘natural’ product, saying: “Nowadays, a cancer cure that is all natural, non-toxic, simple to administer and inexpensive to produce has become an economic non-starter.”

Drug Development and Approval. Dr. Ghoneum is currently at the drug ‘research’ phase. This is the easy part. Get past animal research and the ‘development’ phase begins. Move into humans and the costs pile up fast – so do the failures. He’ll face institutional review boards, numerous negotiations with FDA over appropriate surrogate markers and end points, challenges of getting patients into clinical trials, careful management of clinical research sites and exquisite documentation at every stage. This is the phase that washes out all but 1-2 of every 10,000 drugs discovered.

Add to that, this is a yeast product – a biological – which means he’ll have to satisfy FDA that there is ‘batch to batch’ consistency in the product as he scales up for clinical studies and, if the product succeeds, eventual market use.

Since he intends to develop a treatment safe, effective and affordable enough for poor people around the world, he will also face regulatory requirements, and perhaps clinical trials, in those nations as well.   (more…)

By Joy Burwell. On Monday, June 7th Health 2.0 took over Washington DC and yesterday the excitement continued with a Disruptive Women in Health Care breakfast. The breakfast would not have been possible without the generous sponsorship of Manatt and the support of The Hill. A huge thank you to this morning’s engaging panelists: Fran McMahon, Publisher of The Hill; Indu Subaiya, Co-Founder Health 2.0; Julie Murchinson, Manatt Health Solutions; Alexandra Drane, Founder and President, Eliza; Marlene Beggelman, Founder, Enhanced Medical Decisions and Linda Von Schweber, Co-Founder Surveyor Health. Robin Strongin, Creator of the Disruptive Women in Health Care blog moderated the program. Below is a very brief summary of the discussions; video and photographs of the breakfast will be posted soon.

L to R: Julie Murchinson, Robin Strongin, Indu Subaiya, Fran McMahon

You may be asking what the term Health 2.0 means and luckily for you Indu Subaiya Co-Founder of Health 2.0 provided us with an answer. Health 2.0 applies the same social networks and user-generated focus as Web 2.0 (which has been around since 2003) to the world of health care. It began as a consumer-driven movement with providers becoming involved a bit later. More recently the concept has grown as a result of its partnership with health care reform. Another noteworthy aspect is its ability to foster data-driven decision-making. Currently, there are about 1000 companies actively engaged in Health 2.0.

Bottom Line: Health 2.0 gives you (the patient, caregiver, provider, payer) the tools to be able to get the information to make better decisions.

To better illustrate Health 2.0, the panelists discussed their companies’ developments. Dr. Marlene Beggelman founded Enhanced Medical Decisions which developed an online medical solution that uses “natural language” search technology, to enable users to quickly and easily find accurate information on drug interactions and reactions.. Linda Von Schweber the Co-Founder of Surveyor Health discussed their software’s ability to create an online medicine cabinet for consumers where they can learn the various side effects and interactions of the drugs they are taking. Eliza Founder and President Alexandra Drane detailed the personalized voice-based service they developed that helps consumers make better health care decisions. All of these technologies are innovative, put consumers in the driver’s seat and support efficient, safe and quality health care.

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By Sheryl Flynn.  Earlier this week, the American Heart Association (AHA) announced a new partnership with Nintendo of America.  According to their website (www.activeplaynow.com), the AHA and Nintendo are working together to promote physically active play as a part of a healthy lifestyle. This is the first time that the AHA has partnered with the video game industry to help consumers discover how video games that incorporate movement can be beneficial to health.  According to their “Healthy Lifestyle Tips” they encourage everyone in the house to enjoy active-play video games together and when the weather prevents outdoor activities- they encourage hosting an active-play video game tournament in your living room. 

 Today, according to AHA’s press release- They are not supporting playing all video games in an effort to promote a healthy lifestyle- only the Nintendo games such as WiiFit™ Plus and Wii Sports Resort™ software for the Wii are supported by the AHA.  The AHA’s logo will be found on these products beginning this summer. 

 The AHA is “trying to reach people where they are.”  They suggest that if you don’t move at all- move some.  If you move a little, move a little more.  In essence, if you go outside and play sports or are already active- they are not suggesting that you come inside and play video games- rather, they are trying to get those people who play video games (or are otherwise) mostly inactive- to start doing something active.  They figure, if you like playing video games and typically play video games with your thumbs while surfing the couch- perhaps you could get a little exercise by playing active video games. They are targeting the “no physical activity” group and trying to get them to move!

So, as one would expect- there is controversy over the two companies working together.  Some people believe that both Nintendo and the AHA see a significant return on their partnership investment.  But the AHA has suggested that this is not the case.  Nintendo has contributed $1.5million to AHA to fund a prevention platform aimed at informing Americans about heart disease and stroke prevention.  Another important consideration to keep in mind is that Nintendo is not the only “active-play” video game company out there.  Sony PlayStation released the “EyeToy” years before the Wii and it offers many hours of fun, active gaming as well.  The EyeToy is fun because you can see a video projection of yourself in the game, rather than controlling an avatar as with the Wii games. Microsoft plans to release Project Natal later this year- these games will also offer hours of active gaming fun! There are a number of other off-the-shelf gaming devices that promote active gaming- the consumer should be encouraged to seek the game that would be most fun for them. 

Perhaps most exciting, however, is the Innovation Summit that the AHA intends to host.  With $350,000 support from Nintendo, the AHA will bring together “Thought Leaders” in the area of health care, research, physical activity, fitness and video gaming to look at the synergies and potential benefits of active-play video games and physically active lifestyles.  Now that is exciting!  Finally!  The game industry, researchers and health care industry all together in one room to envision the future!  Wow!

By Hygeia. Several Disruptive Women in Health Care are very involved in the high tech or biotech space.  We thought it was important to let you know about this exciting program—one that is taking place in our backyard.  We encourage as many of you ladies out there with an interest in health, science, innovation and business to attend—we need to spread the estrogen around – there are many women in and out of the I-270 corridor who are making enormous contributions to these fields. Don’t let the men do all the talking—join the conversation and join us on June 1st.

Click here to see the full announcement. If the image in your browser appears small, click to enlarge.

By Stephanie Mensh. House and Senate Appropriations health subcommittees are in full swing this month. On May 5, the National Institutes of Health Director testified to the Senate subcommittee.

I follow NIH funding because they have a leadership role in understanding and treating cardiovascular and neurological diseases. For example, NIH sponsored the recently-reported landmark CREST study comparing surgery to stenting for patients with carotid artery disease related to stroke, conducted in 117 centers over 9 years.

NIH also sponsored historic research on the clot-buster tPA treatment that reduces morbidity and mortality in acute stroke patients when initiated within three hours of onset.  Stroke is the third leading cause of death and the leading cause of disability in adults. So, I assumed that a lot of privately-supported research was underway.

I was shocked and dismayed to hear Story Landis, Ph.D, Director of NIH’s National Institute of Neurological Disorders and Stroke (NINDS), tell the American Heart Association’s lobby-day lunch attendees that pharmaceutical and biotech companies are abandoning research into acute stroke and neuroprotective drugs that could extend the window for tPA treatment beyond three hours.

This means that NIH will be left to develop new treatments. Unfortunately, only 1% of the federal NIH budget goes to stroke.  President Obama’s proposed 2011 budget for NIH is $32 billion. I’m advocating for the American Heart Association/American Stroke Association’s recommendation that Congress appropriate $35 billion for NIH, so more grants can be made for stroke research.

My husband, Paul Berger, had a stroke 20 years ago at age 36.  Paul wouldn’t have qualified for tPA even if it was available back then because his stroke was the result of a ruptured aneurysm dumping blood in his brain, instead of a clot (80% of strokes are caused by clots).  I am very  encouraged to see NINDS support research into other treatments for the acute phase as well as post-stroke rehabilitation.

May is National Stroke Awareness Month. You can find information on stroke warning signs and risks posted to the NINDS website: http://stroke.nih.gov/ .

Even with emergency medical treatment, many stroke survivors will require rehabilitation and suffer chronic health problems—weakness or paralysis in arms and legs, difficulty with speech/language, and problems with everyday living skills.

Strokes affect people of all ages, including younger people who may lose their jobs due to stroke-related disabilities. The sudden, life-changing nature of a stroke impacts the survivor’s spouse and family as well.

To help make everyday better, my husband and I have written 3 new E-Books on stroke recovery just launched by Positive Power Publishing and  StrokeSurvivor.com:  (1) “Conquering Aphasia & Stroke TODAY!”; (2) “Conquering Aphasia & Stroke for Caregivers”; and (3) “Articles to Take With You.”  Excerpts and details are posted at: http://www.strokesurvivor.com/e-books.html.

Yesterday we encouraged our readers to take part in the live video chat presented by the White House, during which HHS Secretary Kathleen Sebelius and Health Reform Director Nancy-Ann DeParle took questions about President Obama‘s recent health care reform proposal.

Did you watch yesterday’s live chat? If so, what are your thoughts and reactions on what was said? What additional questions do you have for the President as well as the HHS Secretary and the Health Reform Director?

Chairman Wu, Congresswomen Edwards and Biggert, and Committee Members. Thank you for this opportunity to testify at this hearing on the National Institute of Standards and Technology.

I ask that my written testimony be accepted into the record.

Today you will hear from accomplished researchers and leaders in their fields of study from Duke University and Stanford. These individuals are scientists, entrepreneurs and biotechnology innovators.

I come here primarily as a mom. I am here today to address the critical link between my experience as a mother striving for treatments, for my kids and millions of others, and the question before this Committee — How our National Institute of Standards and Technology can more effectively influence innovation in life sciences.

I begin with a plain statement about NIST and its activities — it can appear to be boring, non-interesting, and terribly esoteric. NIST suffers from being hidden, embedded into the foundational infrastructure of the scientific and early commercial enterprise of innovation, as well as having the thankless task of creating measurement standards for a whole array of scientific disciplines. However, it is precisely because of these elements that this Committee needs to champion a more active role for NIST in the life sciences.

Some have argued quite convincingly that the next century of scientific and technological innovations will be most profound in the life sciences. NIST is critical to a robust biomedical enterprise and must contribute high quality materials, methods, and expertise for the field to advance on a platform of certainty and high quality measurements.

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Human beings have a fundamental right to health, which must be equally distributed to all. To be able to provide the prevention, care, treatment and rehabilitative services needed for its population, Rwanda has embarked on an ambitious journey to transform its socio-economic situation by changing its economy from an agriculture-based to a knowledge-based economy. In this context, Rwanda has identified the use of science and technology as a key tool for achieving our socio-economic transformation and reaching the MGDs. Although a high tech strategy may appear inappropriate for the health system of a developing country, this is is not applicable to Rwanda because our health sector ICT plan is integrated into two master plans: our health sector strategic plan and our national ICT plan. We know that e-Health is vital in order to create an effective and sustainable health system, as it will help us solve challenges in our health system, such as the lack of infrastructure and the shortage of professionals (since roads are still a problem in some remote areas, sending information, plans, and reports by ICT saves time and money).

Another reason why ICT for E-Health should be developed is because the right to health cannot be separated from the right to information, and the use of new information and communication technologies is the most accurate and timely way to provide information.

A good flow of information concerns four categories in the health sector: the patients, the policy makers, the care providers and the program managers. When it comes to patients, they need to be educated on their health needs and on how, when, and where to seek proper care. Also, once on treatment, patients should know why it is important to go for timely medical follow up appointments and be compliant to treatment, since it not only aids their recovery, but also helps to avoid dangerous resistances to epidemic diseases like HIV. Patients would be informed of these things by making ICT tools available to health professional at all level: community health workers would use phones, while central and district managers, health centres, district hospitals and referral hospitals would use web-based tools. For policy makers and program managers, ICT is important because it helps to design health policies and programs that are informed by evidence and based on accurate information. In general, the use of ICT has proven to be the more effective, secure, rapid and accurate way to serve patients and program managers. This is why the Government of Rwanda has put ICT as a top priority for its health development and recognizes that there is an urgent need to build e-Health capacity.

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The following guest post by Dr. Peggy Polaneczky, a New York-based physician, was recently featured on the Better Health blog.The original post can be found on Dr. Polaneczky’s The Blog that Ate Manhattan: Food, Considerations & Second Opinions blog.

First off, I need to address those who think they’re being brilliantly funny comparing Apple’s new product name to a feminine hygiene product – making comments like “Does it come with wings?” and “It’s light and easy to use, but can you swim with it?” (these are the cleaner comments I’ve seen), or calling for the next generation ITampon.

Since when did the word “Pad” become unusable in public discourse? And where were these folks when IBM came out with their Think Pad? It’s stupid, 12-year old funny and just plain dumb. Grow up, ladies and gents.

Now, on to more serious matters.

Is the IPad, as some are suggesting, the next big thing in Medicine? Dana Blakenhorn at ZDNet thinks so, calling medicine the IPad’s “Sweet Spot”-

It’s what your doctor has been dreaming of ever ince the PC revolution began. Imagine this in a flip-up case, in every examination room at your clinic. The nurse sets up the chart, the doctor walks in with a stylus and examines you, and when he’s done the chart goes into the file and the prescription is waiting at the desk for you, printed clearly, along with your Coordination of Care Record. Hand the nurse your credit card and you’re off.