The holidays are upon us, and we all know what that means for health issues — besides higher sugar and alcohol intake. That’s right, healthcare reform house parties! Check out the message from HHS Secretary nominee Tom Daschle below, and learn more about hosting or attending a healthcare community discussion over the holidays.

Meanwhile, four issues dominating discussions around the web this week are the future of the FDA, the new Nursing Home Compare rating system and web site, physicians and health IT, and of course, healthcare reform issues.

At the Center for Medicine in the Public Interest DrugWonks blog, Peter Pitts shared his recommendations for reforming the Food and Drug Administration:

I was honored when the Obama FDA transition team called and asked for my advice on how the incoming administration could make the agency a more robust and forward-looking regulatory instrument.
…
My suggested areas of focus are

1. A strong, science-based FDA
2. The Reagan/Udall Foundation — a Partnership of Unequals
3. Clarity vs. Ambiguity
4. Information Management
5. Food Safety and Security
6. Risk Communications
7. The Drug Label and the “Safe Use” of Drugs

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There are, obviously, many, many other important issues … and I look forward to working with the transition team to ensure that the new commissioner can hit the ground running… And kudos to the Obama transition team for reaching out to a wide variety of groups.

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When I was at Pfizer, I worked with colleagues at NHGRI and FNIH to form the Genetic Association Information Network (GAIN) — a public-private partnership that encourages industry and academic collaboration to better understand the genetic basis of common disease.

At the final GAIN analysis workshop earlier this month, we were given the chance to review data generated over the last two years, including disease studies of psoriasis, depression, schizophrenia, diabetic nephropathy, and bipolar disorder. It was exciting to see that each study identified important regions of the genome associated with these diseases. Unfortunately we also learned that neuropsychiatric diseases remain a challenge as the search for genetic variation and diseases is hampered by the complexity of the phenotypes involved, as well as the apparent diversity in genes which contribute to the diseases.

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We have all seen the disturbing headlines of economic failures, bailouts, corporate bankruptcies, and massive layoffs. Economies around the world are slowing down. We also see the continued and raging debates over health care costs, delivery and quality as healthcare organizations and providers fight to reduce or control costs while delivering quality health care and attracting a qualified workforce. Whatever the reasons, there is a growing shortage of clinical, health, and allied health workers. Factors cited as contributing to the shortage include an aging workforce; high retirement eligibility; difficulty in recruiting and retaining workers; lack of educational, training, and retraining opportunities; high vacancy rates; high turnover rates; lack of opportunities for career advancement; low pay; and/or increased work load demand.

Recently, increased attention (and resources) has been placed on deploying new clinical technologies, devices, and treatments. Initiatives and advances include automated solutions for electronic health and medical records, bio-surveillance and disease reporting, public health monitoring, electronic prescribing, clinical decision support, personal health records, home health monitoring, and remote consultations. As the demand for and ability of these technologies to improve patient safety and quality grows their adoption will (hopefully) be more widespread. Yet, these technical advances also contribute to the workforce shortage because of the growing need for educated and trained personnel to develop, maintain and use these applications, products, and systems. (more…)

Dear President-Elect Obama,

Congratulations on your historic win. As we emerge from the first decade of the 21st century, I agree with your campaign message that there is great opportunity for change and the ability to harness new ways of looking at existing problems to propel us forward as never before. As President, you will have many complicated issues to address and manage, both foreign and domestic, more so than perhaps any incoming President in the history of this great nation.

Despite a lengthy campaign that covered so many issues, I am still left with this huge question, “How will we manage healthcare going into the 21st century?” Having practiced emergency medicine for 17 years, I know the shortcomings of our employer-based healthcare insurance system and our inability to address the under-insured.

Having also been in the health IT field for many years as a CMIO, I have also know the challenges of implementation cost and difficulties with EMR adoption from an organizational and clinician perspective. In my more recent role as a vendor, I speak daily with customers who have spent millions deploying transactional systems yet cannot get the data they need for quality improvement, cost analysis and business intelligence. (more…)

Last week, the Better Health Care Together coalition held a briefing at the National Press Club to unveil a new study written by economist Dr. Robert Litan.

The study, entitled Vital Signs Via Broadband: Remote Health Monitoring Transmits Savings, Enhances Lives, found that the United States could cut $197 billion from its health care bill over the next 25 years by the widespread use of remote monitoring to track the vital signs of patients with chronic diseases such as congestive heart failure and diabetes.

But, and here’s the catch: Dr. Litan warned that adoption of remote monitoring and other telemedicine opportunities will be slowed and benefits reduced unless the United States does a better job of reimbursing health care organizations for remote care and encouraging continued investment in broadband infrastructure that can be tailored to meet the privacy, security, and reliability requirements for telemedicine applications.

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“Drugs don’t work in patients who don’t take them.” This quote, by the former Surgeon General, C. Everett Koop, M.D, appeared in a New England Journal of Medicine article on drug therapy and adherence.

There are many reasons (cost, inconvenience, forgetfulness, unpleasant side effects) why patients don’t take their medicine. Medication adherence has become an issue of great concern within the health community, especially as we get older as a nation. So in this spirit, Verizon recently launched what it refers to as the Pill Phone — a new technology that allows people to make sure they keep to their medication regimens and help family members keep to theirs.

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It’s ironic to me that while Congress was busy twisting itself into a political pretzel over privacy, which ultimately—once again—caused the defeat of a much needed piece of legislation ushering in electronic medical records, 10 brave souls volunteered to let it all hang out at Harvard, and on the Internet.

I’m talking, of course, about the groundbreaking new venture known as the Personal Genome Project, led by Harvard genetics professor Dr. George Church. The project, which launched this week with 10 volunteers calling themselves the PGP-10 (including technology VC extraordinaire, Esther Dyson), is looking to speed medical research by doing away with traditional privacy precautions.

For the participants, the quid pro quo of having their DNA decoded involves putting their information on the project’s website—for all the world to see.

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If you don’t, you may want to seriously think about creating one. I am. I’ll admit it, at first I was skeptical, but the more I see the benefits of virtual worlds, the greater the value and potential I can see for health care.

An Avatar, as Wikipedia notes, is “a computer user’s representation of himself/herself or alter ego.” (Hmmm, wonder what Joe the Plumber’s avatar might look like)…

Avatars are used in virtual worlds like Second Life and Whyville. (more…)

When asked if she had a choice, if she would rather be deaf or blind, Helen Keller chose blindness. She answered “blindness separates you from things but deafness separates you from people”. Communication is the foundation of all human interactions. 30 million Americans, or 1 in 10 suffer from hearing loss yet only about 20% of those who could benefit from amplification choose to wear hearing aids. It is a statistic that has stymied me for many years. Most adults have hearing loss that occurs gradually over time. They don’t typically wake up one day and suddenly say “I don’t hear too well anymore”. In fact, the process occurs slowly over years. Many people aren’t even aware; family, co-workers or friends may be the first to realize what is happening. The TV may be a little louder, the person asks for repetitions, struggles in a crowd. The problem is, once made aware; resistance has historically been truly amazing. My grandmother, until nearly the age of 90 stated, “I don’t need a hearing aid…they are for old people”.

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Guest post from Alexandra Carmichael

Open source has emerged as a powerful set of principles for solving complex problems in fields as diverse as education and physical security. With roughly 60 million Americans suffering from a chronic health condition, traditional research progressing slowly, and personalized medicine on the horizon, the time is right to apply open source to health research. Advances in technology enabling cheap, massive data collection combined with the emerging phenomena of self quantification and crowdsourcing make this plan feasible today. We can all work together to cure disease, and here’s how. (more…)

With the election around the corner, everyone is hammering about the economy, healthcare reform and the war. Given the critical time in our election history, I found it amusing that I attended the Stanford Healthcare Policy Conference, “Can Innovation Save Healthcare Reform” last week and found the speakers debating the same problems they were talking about 10 years ago. Don’t get me wrong. I bow to the legends at Stanford, like Alan Garber and Alain Enthoven. Those were the giant minds in graduate school that got me interested in healthcare in the first place. But seriously, someone could have peeled me off the floor, I was so bored.

It was like nothing had changed since I left my dorm room in Escondido Village in 1998. It was the same academics muttering about “access, affordability, and quality.” And it dribbled on…“rising healthcare expenditures, cost containment, rationing resources,” …blah, blah, blah. This is why I loved it when Mark Smith, M.D., CEO and President of the California Healthcare Foundation, took the stage and opened his talk with the slightly irreverent comment. He said, “Here we all are talking about healthcare reform, and not one of you has mentioned the patient yet.” I wanted to stand up and applaud (and in full disclosure Mark serves on the Google Health Advisory Council).

I do not pretend to have the magic bullet for healthcare reform in the U.S but here is what I do know about the average “Joe” on the street and what I have learned working on the Google Health team for the past 2 years.

When it comes to healthcare, we are all in denial!

• No one cares about their health until they or a family member gets sick.
• The average consumer (over 52% surveyed) does not understand their health insurance benefits. (Deloitte Center for Health Solutions, 2008 Survey of Healthcare Consumers).

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I believe that broadband technology is transformative, to quote my CEO Ivan Seidenberg. While in the U. S., almost 60 million homes have broadband connections and tens of millions of Americans use mobile wireless broadband networks operating at speeds similar to DSL connections, we still have only scratched the service regarding what broadband can do to help improve access to health care, the efficiency of our health care system, and the effectiveness of patient care regimens.

As the American Telemedicine Association has noted, twenty years ago, only large hospitals were connected with high speed lines. Under the Telecom Act of 1996, rural hospitals and clinics, using the rural health care program created by the Act, began to connect to each other and to larger, regional hospitals. A second phase of connectivity began when doctors, specialists and hospitals began to connect directly to homes monitoring vital signs and other patient information, but often at relatively slow speeds. Today, broadband and wireless connections can move beyond the hospital, clinic and even the home. New software based applications, video devices and HD screens and sophisticated analysis devices mean that today’s much faster broadband connections can offer more access to needed information and services than ever before.

But the health care system needs to catch up. While broadband is increasingly connecting Americans to the Internet, the health care system is not yet updated so that important patient health care records can be readily accessed by doctors wherever patients happen to be electronically. Savings in health care administrative costs could top $80 billion annually if we could transform paper records for patients into electronic files. Mistakes in treatment regimens could be reduced too as electronic records, connected with automated systems for dispensing needed pharmaceuticals, could help ensure that only the right type and amount of drugs was dispensed.

Beyond more effective management and treatment using electronic records, the constant improvements in broadband speeds that are occurring could mean major advances in access to needed health care and the effectiveness of treatment. Two-way, very high capacity networks based on the latest fiber technologies could help make it possible for doctors to assess patient progress, instruct patients on treatment programs, and check on patient vital signs and general appearance all from the convenience of home. Studies show that home treatment and care can be very effective, especially for elderly patients. Almost a million and a half people are cared for at home, disproportionately by women. High speed two-way networks like the FiOS system being deployed by Verizon mean better access to consultation services, monitoring and diagnosis than ever before. More and more Americans who are being treated at home are over 65 years of age and it is very difficult for many of them to move to a hospital. Good two-way connections, HD terminals and sophisticated digital analysis tools can dramatically improve care giving in the home.

Home health care is not the only part of the health care system that can advance and improve due to broadband networks and advanced health care records and administrative systems. But it is one area where women are often on the frontline and where high capacity two-way networks can do a lot of good.

In thinking about what to preserve, to encourage, to replicate in the current health care system, I kept coming back to the same thought. With a system so fundamentally in need of repair, how is it that we still have outstanding success stories? In a system in which nearly all incentives are misaligned, and the lack of information necessary to make informed decisions is pervasive, how is it that the system works at all?

The answer is that we are a nation of innovative problem solvers, and we have brought that skill to health care. So even in the face of the seemingly intractable problems created by our health care system, problems are solved every day, and solved well. There are many examples – ones that will show up on this blog no doubt - of employers, which continue to cover over 170 million people in this country, successfully implementing changes in benefit design that both improve care and lower costs; of introduction and adoption of new technologies that improve care and decrease costs; of doctors and health care institutions who move beyond the challenges inherent in the fee-for-service environment to provide excellent and efficient care; of systems developed to provide people with full and complete information on cost and quality.

As a provider of technology we see it everyday. We see it in the AT&T Labs where we are working to develop ZigBee networks - named for the zigzagging path data takes to reach its destination like that of a bee zigzagging from flower to flower – to weave together data from short range, low power wireless devices to make independent living a reality. We see it in innovative applications of surprisingly simple technology such as one being developed by our technology partner, Confidant, which uses a teenager’s cellphone to track and improve treatment for Type 1 diabetes. This application wirelessly sends blood sugar readings these teenagers must take multiple times a day to the doctor’s office via a Bluetooth enabled cell phone with a touch of a button. Text message reminders are sent if a reading is missed and encouraging messages sent if readings are regular.

We also see it in the progress that has been made in both the private and public sectors on introducing a continuous stream of new technology based products and developing the standards for interoperability, security and privacy that are necessary for the full scale adoption of information technology in the health sector. And we see it in the resources technology companies like AT&T, with their expansive expertise in building networks, managing information and harnessing the power of computing, have dedicated to development of the necessary standards and products.

We need to encourage this kind of innovative problem-solving in all aspects of the financing and delivery system. We need to recognize that the ability of any and all stakeholders in the ecosystem to develop and implement new ways of doing things will be central to the success of any effort at reform.