Even known food allergens dangerous for kids

Even when parents and caregivers are aware of infants' food allergies and have been instructed in avoiding potentially dangerous trigger foods, allergic reactions still occur, the result of both accidental and non-accidental exposures, a study finds.

Accidental exposures from unintentional ingestion, label-reading errors and cross-contamination resulted in 87% of 834 allergic reactions to milk, eggs or peanuts in the study, reported in today's Pediatrics.

Non-accidental exposures resulted in 13% of reactions. It's not clear why caregivers would purposely give a child a known allergen, maybe "to see if (the child) has outgrown an allergy, or how allergic he is," says lead author David Fleischer, a pediatric allergist at National Jewish Health in Denver.

Fleischer and colleagues analyzed data from 512 infants, ages 3 months to 15 months, diagnosed with or at risk for having an allergy to milk, eggs or peanuts. In a 36-month period, 72% had at least one reaction; 53% had more than one.

"This is a high rate of reactions and concerning," says Fleischer, noting that parents were counseled "on a regular basis about food avoidance."

Only 50% of the accidental reactions were from food provided by parents, highlighting the importance of educating all caregivers � grandparents, siblings, babysitters and teachers � about food allergies, he says.

"There is still some misunderstanding in the general public about food allergy and how serious it can be," says Ruchi Gupta, an associate professor of pediatrics at Northwestern University. She led a study published last year that found 8% of U.S. children younger than 18 have a food allergy. About 40% had experienced a life-threatening reaction, such as blocked airways or a drop in blood pressure.

Concerns that skin contact or inhalation might trigger severe reactions were not supported by the new study, Fleischer says. "The vast majority happened from ingestion."

Only 30% of severe allergic reactions were appropriately treated with an epinephrine injection, even when caregivers said they felt that was warranted. Epinephrine helps stop reactions by relaxing muscles in the airways and tightening blood vessels.

There's often a "fear of using epinephrine, a concern that there will be side effects," Fleischer says. "In studies that we've done, parents are surprised how quickly and effectively it works."

Carol-Care and Justin-Care: Extending Coverage on a Parent’s Health Plan

Carol Metcalf�s son, Justin, has a rare genetic lung disease, primary ciliary dyskinesia, but while he needs medical care for it, he hasn�t let the disease define him. He�s thinking about going to law school, or possibly graduate school in international studies. Justin, 23, is able to do so because of the health care law, Carol says.

Because of the Affordable Care Act, young adults like Justin can remain on their parents� health insurance plan until their 26th birthday, even if they move away from home or graduate from school. More than 3 million young adults have gained health insurance because of the health care law.

That has made a tremendous difference in their lives and for their parents� peace of mind.

�As Justin�s Mom, you know every mom wants the best for her child and you want them to have a fair shot � a good shot at life and to be able to make their own way and to be able to pursue their dreams,� Carol says. �The Affordable Care Act gives people like Justin that opportunity.�

Justin explains that if it wasn�t for the health care law, all his energies would have to go into worrying about how to get health care at a cost he could afford. Because of his condition and expensive medical bills, living without coverage isn�t an option. Being able to stay on his parents� plan ensures that Justin is covered and can make his choices based on more than his lung disease.

Without it, Justin says that considering law school wouldn�t even be possible.

�I would have to find medical care right away, because medical care comes first. Without medical care, I�m not here. It�s really that simple,� he says.

And knowing that Justin can stay covered by the family�s health plan for a few more years, Carol says, �is a huge peace of mind.�

Alycia-Care: Peace of Mind in Knowing Sick Child Won’t be Denied Health Coverage

As Alycia Steinberg of Towson, MD, tells us, when a child is seriously ill, a parent shouldn�t have to worry that an insurer would deny coverage due to the child�s pre-existing condition.

That is why she�s grateful that the Affordable Care Act protects her daughter Avey�s health insurance coverage because it bars insurance companies from denying coverage to children based on pre-existing conditions.� �To have a child with cancer, there is so much to worry about, but the Affordable Care Act means that I don�t have to worry that Avey will be denied treatment because of her pre-existing condition,� Alycia says.

At 2-years-old, Avey was diagnosed last year with leukemia, a terrible shock to her parents. Alycia says the prognosis is good and Avey is �doing amazingly well,� following intensive chemotherapy and some initial developmental setbacks due to the treatment. She now faces two years of maintenance chemo. Her treatment is very expensive.

�My first thought, as I was trying to process the fact that my two-year-old has cancer, [was] how am I going to take care of her?� What does this mean if we have our health benefits through my employer? Can I leave my job? Are we going to be able to maintain our coverage?� Alycia says.

The health care law is a �huge relief� for Alycia because insurers won�t be able to deny Avey coverage because of her pre-existing condition now or in the future when she�s an adult and looking for a job.

�As a mother of a child with cancer I have plenty to give me worry. One thing I don�t have to worry about now, thanks to the Affordable Care Act, is having Avey�s treatment denied,� she says. �The Affordable Care Act has given us tremendous peace of mind to know that Avey will be able to get the treatment that she needs. � It allows me to be a mom who can focus on taking care of my little girl with cancer.�

Stimulus package a vote away from becoming a law

WASHINGTON – The House voted Friday afternoon to approve the final version of the $787 billion economic stimulus bill by a 246-183 vote, according to CNN reports.

A final Senate vote was expected by Friday evening, leaving the bill awaiting only President Barack Obama's signature to become law. Obama has said he would like to sign the law in a televised ceremony on Monday.

According to CNN, no House Republicans voted in favor of the bill, and seven Democrats voted against it.

The bill will need three Republican votes to pass in the Senate. Maine Sens. Olympia Snowe and Susan Collins and Sen. Arlen Specter from Pennsylvania are expected to support the bill.

The bill is loaded with money for healthcare reform and the advancement of healthcare IT. It includes $19 billion for healthcare IT and more than $100 billion for healthcare measures including funding to help beef up state Medicaid coffers and subsidies to help unemployed workers afford healthcare coverage through COBRA.

"The economic stimulus package represents a significant step forward for the advancement of healthcare in the United States," said Harry Greenspun, chief medical officer for Perot Systems. "These funds should significantly advance patient safety and care while creating good paying jobs in the health IT sector, especially if we can achieve the goal of developing an electronic health record of every American."

Tele-ICU initiative improves care, increases employee satisfaction

HIGH POINT, NC – High Point Regional Health System has seen big benefits from a three-year tele-ICU pilot with St. Louis-based Advanced ICU Care, officials say – improving care while alleviating clinicians' workload.

High Point's intensivist-led team is based in the Advanced ICU Care Monitoring Center and receives constant information on the patient’s condition through sophisticated software that notifies them of any change in the patient’s health that might require immediate intervention, officials say.

Two-way video in the patient’s room can be activated to conduct a conference between the bedside care team and the Advanced ICU Care team at any time of the day or night. This constant surveillance improves patient safety and health outcomes by avoiding complications and adverse situations with prompt, proactive interventions.

Key to the High Point collaboration is the strong alliance between its staff and the Advanced ICU Care team, officials say. During the three-year partnership, this team has successfully implemented quality care initiatives for better patient management and safety measures to avoid potential complications that can occur in an ICU, such as blood clots, deep vein thrombosis, gastric ulcers and sepsis. A significant achievement is the implementation of an innovative “patient cooling” process for people with cardiac arrest. Patients who have received this treatment have awakened after the arrest with no cognitive impairment.

“Three years ago, we partnered with Advanced ICU Care to bring around-the-clock intensivist care to ICU patients in our community,” said Greg Taylor, MD, High Point's COO. “From a seamless implementation to the quality enhancements we continue to achieve, the collaboration between our hospital staff and Advanced ICU Care has been a success. We are able to offer our patients the highest level of care available in the ICU today and to continue to improve on that level of care every day.”

Research has shown that patients in intensive care do better when they are monitored around-the-clock by intensivists, physicians specially trained in critical care medicine. Constant surveillance by these specialists is now the recommended standard of care for hospital ICUs.

But a severe shortage of intensivists means it’s simply not possible for most hospitals to meet this standard and have intensivists on staff at the hospital at all times. Advanced ICU Care, the nation’s largest independent provider of tele-ICU programs, helps hospitals overcome this barrier and achieve optimal care in the ICU through a tele-ICU program combining sophisticated telemedicine technology, 24-hour-monitoring by Board-certified intensivist physicians and continuous quality improvement initiatives.

In addition to quality patient care initiatives and protocols, staff satisfaction and working conditions have improved since the implementation of the tele-ICU program, and High Point has seen a reduction in nursing turnover, officials say.

“Our nurses have really embraced this program," said Cindy Stewart, RN, director of critical care and cardiovascular services at High Point Regional. "Being able to speak with Advanced ICU Care in the middle of the night has improved employee satisfaction among our nursing staff. We find that when we recruit, many nurses have heard of remote monitoring, and they’re excited to learn something new.”

Physicians at the hospital say they're comforted that their ICU patients have an intensivist-led team available when they are not in the hospital, making sure their care plans are followed and available should any situation arise that needs immediate attention.

“The Advanced ICU Care program relieves the pressure of having to perform around-the-clock ICU coverage by existing staff and avoids burnout,” said intensivist Peter Brath, MD, medical director of High Point’s Intensive Care Unit and Respiratory Therapy. “There are more doctors available to provide weekend and night backup coverage. From a quality of life standpoint, it’s wonderful.”

“High Point has been a great partner and we are very excited by the strong results that we have been able to achieve together,” said Mary Jo Gorman, MD, CEO of Advanced ICU Care. “We feel very confident the hospital will continue to see additional benefits stemming from our collaboration, from improved patient care to staff satisfaction.”

Video games help autistic students in classrooms

ASHBURN, Va.�Onscreen, Michael Mendoza's digital avatar stands before a wonderland of cakes and sweets, but his message is all business: "I. Get. Frustrated when people push me and call me � and call me � a teacher's pet!"

In another classroom at Steuart W. Weller Elementary School, nearly an hour's drive west of Washington, D.C., two students stand side-by-side, eyes riveted on a big-screen TV. They jump, duck and swing their arms in unison, working together as they help their digital doppelgangers raft downriver.

In real life, 9-year-old Michael has autism, as do his two classmates. All three have long struggled with the mental, physical and social rigors of school. All three now get help most days from video-game avatars � simplified digital versions of themselves doing things most autistic children don't generally do. In Michael's case, he's recording "social stories" videos that remind him how to act. In his classmates' cases � their parents asked that they not be identified � they're playing games that help with coordination, body awareness and cooperation, all challenges for kids on the autism spectrum.

Can off-the-shelf video games spark a breakthrough in treating autism? That's the question researchers are asking as educators quietly discover the therapeutic uses of motion-controlled sensors. The devices are popular with gamers: Microsoft this week said it had sold more than 19 million Kinect motion-sensor units since introducing it in November 2010.

Now autism researchers, teachers and therapists are installing them in classrooms and clinics, reporting promising results for a fraction of the price of typical equipment. Could a teacher armed with a $300 Xbox and a $10 copy of Double Fine Happy Action Theater do as much good as months of intensive therapy?

"Nobody thought of it as a therapeutic device," said Marc Sirkin of Autism Speaks, a New York-based advocacy group. Earlier this spring, when he first got wind of computer engineering students at the University of Michigan hacking the Kinect to develop autism games, he bought a ticket on a red-eye flight to see for himself. "It turns out you don't have to look very far, you don't have to scratch very deep, to go, 'Wait a minute. There's something really cool here.' "

Microsoft's Radu Burducea stops short of calling the Kinect a therapeutic device, but says he hears every day about teachers and therapists adapting it in new and creative ways: math instruction, book criticism, counseling and physical coordination, for instance.

"We've lost control," he admitted, "and thank God that we have."

The U.S. Centers for Disease Control and Prevention reported in April that about one in 88 children are on the autism spectrum, a 78% rise from 2002 to 2008.

In many cases, researchers have found, autistic children easily interact with an onscreen avatar that mimics their motions � the game world is more predictable and less threatening than real life, said Dan Stachelski of the Lakeside Center for Autism in Issaquah, Wash. As a result, teachers can help even the most isolated child interact with teachers and peers. In one case, Stachelski said, a student playing a Kinect game for a few moments moved his arms up and down in unison for the first time, "something our therapist was trying to do for six months."

Lakeside preschoolers now regularly compete in Dance Central dance-offs, and more recently, eight students shared a tiny classroom space with the help of Happy Action Theater, a sort of rule-free, multiplayer digital sandbox. Tim Schafer, the game's designer, said his team built it with "zero assumptions" about players' abilities. "We were thinking of a birthday party full of toddlers," he said. "The main mantra was, 'No failure.' "

At the University of Michigan, software engineering students this spring designed several Kinect games for children with autism, an assignment from instructor David Chesney. Among the titles in testing: Tickle Monster, in which kids tickle imaginary creatures onscreen and learn about both appropriate touch and facial expressions. "For kids with autism, there's a certain social awkwardness and a lack of ability to recognize emotion, and to respond to emotion and verbal cues in an appropriate manner," he said.

Teachers at Weller had worked for years to help autistic students cope with the everyday demands of school � following directions, staying in a prescribed space, getting along with one another and working together, among others. Even talking to one another is often a challenge, teachers say.

A few weeks ago, Michael's teachers invited him to step in front of an Xbox equipped with a Kinect. He has since recorded four "social stories" that help him cope with social dilemmas as they happen. Teachers create digital QR codes that students access with a smartphone or iPad and up pops the student's video.

One teacher, Adina Popa, recalled that an autistic classmate recently watched Michael's "getting frustrated" video and reminded him of his own prescription: Tell a teacher, don't push, hit or use "inappropriate" words.

"That was a very neat conversation," Popa said.

Patches for pain relief are gaining in popularity

Sometimes the pain from her fibromyalgia gets so bad that Kimberly Smalling can't lift her arms.

She peels open a painkilling patch, puts half on each shoulder, and then crawls into bed. The next morning she can get back to work cutting men's hair.

"It's kind of like a Band-Aid, I guess, but it works," says Smalling, 59, a stylist in Dallas.

She says her prescription lidocaine patch supplements her regular painkiller enough that, 20 years into a disease characterized by chronic pain, she hasn't had to resort to narcotics.

Europeans already get roughly one-quarter of their pain relief from topical treatments, such as patches and creams; the Chinese relieve about half their pain that way, an industry analysis finds. In the USA, where 88% of pain relief comes in a pill, Americans are slowly getting used to the idea of patches, says Patrick Carroll of Hisamitsu America, maker of Salonpas over-the-counter pain patches. The active ingredients are 10% methyl salicylate, a topical analgesic, 3% menthol.

"I think it's just a cultural thing that we've been bred on popping pills," Carroll says.

Baby Boomers are leading the trend, hobbled by the aches of middle age and concerned about the risks of pills.

While patches aren't danger-free � every medication carries some risk � the most common complaint is minor skin irritation around the site. Patches also need to be placed in areas where they'll stick � not a bending elbow or hairy forearm.

The main downside is cost. A five-pack of Salonpas arthritis pain patches is about $9, the same as nearly 100 Advil pills.

Manufacturing a patch is more complicated and therefore more expensive than making a pill, says Phil Nixon of Pfizer's Pharmaceutical Sciences Technology & Innovation division in Groton, Conn.

Patches also must be disposed of out of the reach of pets and children, because they still have medication on them, says Smalling's doctor, Scott Zashin, a clinical professor of medicine at the University of Texas-Southwestern Medical School.

There are two basic types of patches: The first provides a drug locally � for example, over-the-counter pain relievers such as Salonpas. In the second, the medication seeps through the skin into the bloodstream. Nicotine patches, for quitting smoking, work this way, as do patches for attention deficit hyperactivity disorder, menopause symptoms and Alzheimer's.

A few types of medications are particularly well-suited to patches, Nixon and others say. By entering the body through the skin, medications bypass the liver, where they could do damage, or be broken down and made less effective. Robert Shmerling, a rheumatologist at Beth Israel Deaconess Medical Center in Boston, says he occasionally tries patches for arthritis patients who have stomach problems that can be a side effect of over-the-counter pain medications.

Some patients also prefer a patch to a pill because the drug enters the bloodstream slowly and continuously, rather than in a large dose, Nixon says. And for older people with memory problems, a once-a-week patch may be easier to manage than a daily regimen of pills.

For smokers who want to quit or make it through a day of travel or meetings, a patch is more discreet than nicotine gum or lozenges, says Jonathan Winickoff, a pediatrician and tobacco control expert at Massachusetts General Hospital and Harvard Medical School. Nicotine patches deliver the drug 24 hours a day, he says, so people wake up without the intense urge to smoke. Patches double your chance of success vs. going cold-turkey, he adds.

Though patches are used to deliver a wide range of medications to the bloodstream, a lot of newer drugs, called biologics, are too big to pass through the pores of the skin.

Researchers are working on patches that will solve that problem using either ultrasound to open the pores or dozens of "microneedles" so tiny their pricks cannot even be felt. They'll be painless, so they won't carry the fear factor of "real" shots, promises MIT professor Robert Langer, who is working to advance microneedle technology.

Diabetes epidemic brings spike in related eye disease

The nation's rising level of diabetes is driving another health problem: a significant jump in adults with vision problems from a related condition called diabetic retinopathy.

From 2000 and 2010, there was an 89% increase in the number of people with diabetic retinopathy, which affects the tiny blood vessels of the retina. The most severe forms can impair vision if not treated. About 7.7 million people ages 40 and older have diabetic retinopathy, the new estimates say.

The numbers emerge from an analysis, out today, by a group of researchers and sponsored by Prevent Blindness America and the National Eye Institute.

"The number we are most alarmed about is the increase in diabetic retinopathy, which is largely due to the diabetes epidemic," says Jeff Todd, chief operating officer of Prevent Blindness America.

Almost 26 million people in the USA have diabetes, the Centers for Disease Control and Prevention says. In diabetic retinopathy, high blood sugar causes small blood vessels to swell and leak into the retina, blurring vision and sometimes leading to blindness. A government study in 2008 found that about 4.2 million adults had the disease, the leading cause of blindness in adults.

"You can treat and stop progression," says Beatriz Mu�oz, an associate professor of ophthalmology at the Wilmer Eye Institute at Johns Hopkins School of Medicine in Baltimore. But the disease can be "asymptomatic," or without symptoms: "You may not know you have it," she says. "So it's important to have regular eye exams."

The vision analysis found that overall, the number of people over 40 with vision impairment and blindness has increased 23% in the past decade, partly because of more people with eye conditions such as cataracts.

Vision impairment is defined as having worse than 20/40 vision in the better eye even with glasses. In the USA, people are typically considered blind with vision of 20/200 or worse in their best eye.

If the trend remains the same, about 13 million in the USA will have visual impairment or be blind by 2050, the report says. "The increase we're seeing in eye diseases mirrors the increase in the aging population," Todd says.

Estimates for eye conditions:

�24.4 million people 40 and older have cataracts, a 19% jump from 2000. A cataract is a clouding of the eye's clear lens that appears with age. Surgery is effective in restoring vision, Mu�oz says, but "there is no clear way to prevent it."

�2.7 million people ages 40 and older have open-angle glaucoma, the most common form of the disease, up 22%. Glaucoma causes damage to the optic nerve. Treatments can slow progression, she says.

�2.1 million people ages 50 and older have late age-related macular degeneration, a 25% increase from 2000. Late AMD is the most severe form, and treatments can slow progression and prevent vision loss for some of the forms, Mu�oz says.

Greenway integrates patient data with Microsoft HealthVault

CARROLLTON, GA – With an eye toward driving patient engagement, Greenway Medical Technologies is piloting a project by which its EHR and practice management technology, PrimeSUITE, will link with Microsoft's personal health record.

Through PrimeSUITE's secure online portal, PrimePATIENT, patients can create and access a HealthVault account to gather, store and manage centralized and sharable health information.

The integration will provide patients with digital health history forms to establish the HealthVault clinical record. Following each patient visit, entire clinical summaries or chosen elements can be sent from PrimeSUITE into HealthVault through standards-based continuity-of-care document (CCD) transport. Patients can merge the discrete data with compatible medical device, home healthcare and mobile application data to create a broader or tailored clinical picture, officials say.

"Mobile, accessible and liquid data are prerequisites for today's care coordination," said Greenway President and CEO Tee Green, who noted that "it's time to recognize patients as consumers of healthcare best practices. They are demanding it, and payers are increasingly linking patient engagement and empowerment into quality reporting and data exchange criteria in meaningful use and accountable care programs. We are committed to providing these innovations, and are proud to announce this collaboration with Microsoft."

Greenway officials say the combined data is sharable with other providers regardless of which EHR system they use if HealthVault integration is also present, or through permissible PrimeSUITE data exchange directly into EHRs and health information exchanges.

"With more than three hundred live applications across the Web and mobile devices, HealthVault can be a truly transformational tool to create more informed and engaged patients, but it only works when people have access to their clinical information," said Sean Nolan, Microsoft HealthVault distinguished engineer. "Greenway has made it easy for their providers to deliver exactly that."

Regardless Of High Court, No Return To Old Days For Parts Of Health System

Carolyn Kaster/AP

Attorney Paul Clement argued against the heath care overhaul at the Supreme Court in March. The decision on the law's constitutionality is expected any day.

Will recent changes to the way health care is delivered and paid for last even if the Supreme Court strikes down the Affordable Health Act?

It's far from unanimous, but many believe Newton's law of inertia will kick in even if the statute that launched the changes drops away.

If the federal law is thrown out, "will you have to go back and recalculate? Of course," says Brad Wilson, CEO of Blue Cross and Blue Shield of North Carolina, which is experimenting with bonuses for doctors who improve efficiency. "But the genie is out of the bottle. We're far enough into the revolution now that I don't see how the political leadership can completely sweep it away."

  Related NPR Stories Insurers Wait For Verdict On Health Care Law And Their Bottom Line June 15, 2012 UnitedHealthcare Pledges To Keep Popular Coverage, Regardless Of Supreme Court June 11, 2012

Efforts to stop paying doctors for procedures and start rewarding them for keeping people healthy began even before the 2010 law. The act's so-called accountable care organizations of Medicare providers, designed to deliver better health for less money, inspired similar attempts involving commercial insurers and hospitals. Such enterprises will continue even if the court whacks the entire ACA, many argue.

"There are now something like 50-plus ACOs in Medicare alone," said Dr. Mark McClellan, who ran Medicare under President George W. Bush. "There are probably 250 nationwide � not just public but private. No question the Medicare legislation on this issue has led to more adoption of these payment reforms."

True, but didn't we try something like this in the 1990s? It was called managed care. It was supposed to control ruinous health care inflation. It didn't. Why should ACOs be any more successful, even if the health law is upheld?

"I'm very skeptical" that accountable care groups will save money, said Glenn Melnick, a health economist at the University of Southern California. "The ACO may in fact be able to manage care more efficiently, but that doesn't mean those savings are going to be passed on.... You may have consumers getting less service at higher prices."

Here's why this time may be different. The health crisis is worse. Costs are higher than ever. A poor economy makes society less able to afford them. Caring for aging baby boomers is expected to suck up more than a fifth of the nation's income in a few years.

"Whatever else the Supreme Court does, they can't overturn the aging process, and they're not going to strike down chronic disease," says Chas Roades, chief research officer with the Advisory Board Co. "Those are factors that are at the root of our health care crisis, and we're going to have to continue to figure out ways to address them."

Perhaps the authority to invoke is not Newton but Herb Stein, who was an economist in the Nixon and Ford administrations. Stein's Law is: "If something cannot go on forever, it will stop."

Survey aims to 'amplify the conversation' on aging

There's no cure for growing old, but your attitude about what's important and how you feel about aging can depend in part on how old you are, a new survey finds.

The survey of 1,017 people over 18 finds, for instance, that 24% admit they have lied about their age. But of those 50-64, it's just 21%, and for those over 65, it's 18%.

The survey, out today, was commissioned by the drug company Pfizer in conjunction with about a dozen health advocacy organizations to help encourage dialogue about aging in America. In addition to the survey, the group plans to launch a website, GetOld.com, which invites users to share perspectives on aging.

Asked how they feel about getting old, the top choice was "optimistic" (39%). But not far behind was "uneasy" (36%). About 42% of those 50 to 64 are optimistic, the highest percentage of any age group.

Experts say findings are not surprising. Many adults spend more years in good health, says Nancy Perry Graham, editor in chief of AARP The Magazine.

People also enjoy more freedom as they age and stop having to prove themselves at work or in relationships, Graham says.

The survey also aimed to shed light on people's fears. Only 7% over 65 said their biggest fear was dying; 64% said they were most afraid of losing independence or living in pain.

More than half (51%) of those 18 to 65 would accept having a parent live with them, but just 25% over 65 would want to live with a younger relative if unable to care for themselves.

Freda Lewis-Hall, Pfizer's chief medical officer, says the company and partners did the survey to "shake things up."

"We think a good way to do that is to start by listening and then amplifying the conversation and learning how Americans are really tackling aging � and that's Americans of all ages."

The findings suggest that adults' priorities shift as they age: presented with a list of lifetime achievements, 45% of 18- to 34-year-olds most aspire to have $1 million, but 48% of those over 65 say they would rather see their grandchild graduate.

Linda Fried of the International Longevity Center at Columbia University says it's crucial that people deal with the realities of aging, not just the downsides. "We have such a human aversion to getting old; it's associated with death, and death is scary. But as a society, we have not had the conversations we need to have. There's huge opportunities there."

64%

over age 65 say their biggest fear is losing independence or living in pain

Women doctors paid less: reluctant to push for raises?

CHICAGO(AP)�Women physician-scientists are paid much less than their male counterparts, researchers found, with a salary difference that over the course of a career could pay for a college education, a spacious house, or a retirement nest egg.

To get the fairest comparison, the study authors took into account work hours, academic titles, medical specialties, age and other factors that influence salaries. They included only doctors who were involved in research at U.S. medical schools and teaching hospitals, all at the same stage in their careers. And they still found men's average yearly salaries were at least $12,000 higher than women's.

Over a 30-year career, that adds up to more than $350,000.

The results are sobering and "disappointing. I think we have much work to do," said lead author Dr. Reshma Jagsi, a breast cancer radiation specialist and researcher at the University of Michigan.

Why the big disparity?

Two women who have been prominent in medical research say this: Men tend to be more aggressive at self-promoting and asking for pay raises than women.

"Male faculty members are willing to negotiate more aggressively. It may be social and cultural. It seems to be fairly deep-rooted," said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital and a professor at Harvard Medical School.

Manson, who as a division chief helps makes salary decisions, says men much more frequently than women ask her for salary increases and promotions.

Dr. Julie Gerberding, former head of the federal Centers for Disease Control and Prevention, agrees.

Gerberding did infectious disease research at the University of California at San Francisco before joining the CDC and says early in her career she was bothered that relatively few women held high-paying leadership positions in academic medicine.

"There were some moments when I was angry, but that was motivating. I thought it was an intolerable situation and it just motivated me to work harder," said Gerberding, who left CDC in 2009 and now heads Merck & Co.'s vaccine unit.

She and Manson declined to say if they think they've been paid less than male counterparts.

While previous studies have found that female doctors are frequently paid less than male doctors, many observers have assumed that's often related to having children � working fewer hours, or choosing less time-consuming, lower-paying specialties to allow time for child-rearing.

The new study did find more women in less lucrative specialties, including pediatrics and family medicine, and more men in the highest-paying fields, including heart surgery and radiology. But it still found salary inequities even among women and men without parental responsibilities, in similar jobs.

The findings are from a mailed 2009-10 survey of 800 doctors who had received prestigious federal research grants in 2000-03. The findings appear in Wednesday's Journal of the American Medical Association.

Women's yearly salaries averaged almost $168,000, compared with $200,400 for men � a difference of more than $32,000. Taking into account academic rank, choice of medical specialties and other factors that could affect salary, the difference wound up being $12,194.

Dr. Peter Ubel, the study's senior author and a Duke University professor, said there's no formula for pay increases; doctor-researchers don't automatically get a raise every time one of their studies is published. That makes the decision-making process more subjective, he said.

About equal numbers of men and women attend and graduate from medical school. But women make up a tiny portion of leadership positions at medical schools. And Jagsi said people in hiring positions may be biased, perhaps unconsciously, toward hiring men.

Ann Bonham, chief scientific officer at the American Association of Medical Colleges, a national group that represents U.S. medical schools and teaching hospitals, said medicine isn't the only field with gender differences in salaries. Medical schools are aware of the problem and are moving to ensure that decision-making on salaries "is a fair process and transparent. Nobody intends to be unfair in distributing resources," Bonham said.

Gerberding praised the study for raising awareness.

"Institutions need to take this information seriously and take a hard and closer look at their own salary parity issues," she said. Career advancement often depends on having a strong mentor and sponsor, so women and men in leadership positions at medical schools and teaching hospitals should make sure they're actively advocating for qualified women and suggesting them for promotions, Gerberding said.

Health Wonk Review

This week, Maggie Mahar edits the Health Wonk Review, a biweekly compendium of the best of the health policy blogs.

Voices from the Blogosphere, May 21-June 6

I've decided to let the "Voices" of healthcare bloggers become the theme of this edition of Health Wonk Review. Some are passionate; others are dispassionate; some are disarmingly candid; others are angry.

I'm not going to try to "rate" the posts, or tell you which ones I like. Instead, I want to let you hear those voices, as directly as possible, and decide for yourself.� To that end, I'm quoting liberally from the posts submitted to HWR.

A right to health care?

One of the most provocative entries that I received comes from the Center for Objective Health Policy (COHP), a group that reaches out to medical students while arguing that health care reform violates individual rights.

Nathan Fatal explains: "The problem with [the] assumption" that everyone has a "right to health care … is that a right to a good or service would require that somebody provide it, i.e., that somebody be forced to provide it."

He objects to the individual mandate: "Just as one cannot kick down a neighbor's door and hold a family hostage until all members pay a small fee toward his healthcare costs, a large number of citizens cannot properly hand the role of hostage-taker to the … government in order to exact indirect but forced payments from all fellow citizens … all such actions are the same since they violate freedom of action by initiating force against innocent people in order to provide ‘basic security' to those who ‘need' it."

Fatal also defends the rights of insurers and doctors:

"As Richard Salsman explains in Forbes, health insurance is�'a valuable service provided by intelligent, hard-working professionals . . . people who, like other Americans, … have a right to their own life, liberty, property and the pursuit of their own happiness. Doctors, nurses, hospitals, drug-makers, and health insurers are no more servants of the masses, or even of those in need of health care, than are businessmen, bankers, teachers, journalists, or truck drivers …'"

Supreme Court's ruling on health reform law

Here, on healthinsurance.org, Linda Bergthold also considers the mandate, and suggests that it's "worth reviewing again what's at stake" if the Supremes strike down the entire ACA. She writes:

"We could lose things that have already been implemented" including "free preventive services; children's access to coverage regardless of pre-existing conditions; tax credits for small businesses; and the provision that lets "children under 26 stay on their parents' plan." Meanwhile, "lifetime limits on your insurance plan would probably be reinstated."

If just the individual mandate is overturned, "Most economists and business analysts predict that health care costs would increase, because the uninsured would continue to use the system as a last resort, shifting the costs to those of us who are covered."�But, she notes, "There are a number of ways to get around the overturning of the individual mandate."

Over at the Health Affairs Blog, Alan Weil and Sonya Schwartz each review the impact the Court's decision could have on the states:

Weil writes that "the States' responses" to the ACA "have unfolded in three acts." When the Court issues its decision, "we will see the opening of Act IV. "He offers a "visual representation" of those four acts.

"It is unclear how long Act IV will run," Weil adds. "If significant aspects of the law are struck down, states may have to wait a very long time before it is clear how Congress and the President will respond. States in search of a stable, unambiguous federal statutory and legal environment will almost certainly be frustrated."

Meanwhile, Schwartz grades the possible Supreme Court rulings on a "Richter Scale" of disruption, as she looks at "what each possible ruling would mean for the states that have been most active in implementing the ACA."

"If the Supreme Court invalidates components of the Affordable Care Act, active states will try to adapt to the shifting ground by designing new policies to mitigate adverse selection and cover the uninsured," she concludes. "However, their success in doing so will depend in part on how much the ground shifts."

On Colorado Health Insurance Insider,� Louise explains why Governor Hickenlooper Says Reform Can Succeed Without an Individual Mandate. She agrees that "that if you can make health insurance attractive enough and affordable enough, people will buy it without a mandate." She believes that the generous subsidy program" included in the ACA "should be a significant help."

But if the mandate is struck down, and the provision holds that insurers cannot turn down applicants because of a pre-existing condition, "this could quickly lead to out-of-reach premiums" because healthy people would wait until they were sick before joining the pool. If that happens, she says "the states will have to be creative, and get to work hammering out some sort of carrot and stick program to incentivize people to purchase insurance."

The business of medicine

Over at the Prepared Patient Forum, Jessie Gruman turns from the politics of healthcare to the business of medicine.

Her post begins:

"On Monday morning at 8:30 a.m. the pianist was playing Chopin in the beautiful but deserted four-story lobby of the new hospital where my father was being cared for … the contrast between that lovely lobby and the minimal attention my dad received over the weekend, combined with a report about the architectural ‘whimsy' of a new hospital at Johns Hopkins ("a football-field-size front entrance" with ‘manicured gardens and a rectangular water feature') make me cranky."

Why do hospitals indulge in "conspicuous spending" on amenities that the truly sick cannot possibly appreciate, while accepting "staff shortages" (nurses checked her father just once each shift) and "dangerous medical errors"? Gruman:

"We should probably just grow up and recognize that our na�ve notions of the beneficence of health care generally and hospital care specifically are outdated … Health care is big business" and "these new fabulous facilities and all this advertising constitute the cost of … competing for private payers."

Cancer, too, has become a big business. On Health News Review, Gary Schwitzer critiques the media hype surrounding news of an experimental cancer drug.

"When the New York Times reports something, the TV networks are soon to follow," Schwitzer observes. "So when the Times reported ‘A new class of cancer drugs may be less toxic,' featuring a single patient's experience with T-DM1 ��NBC followed closely – featuring the exact same patient in the exact same setting."

"One woman out of 1,000 in the trial. Who chose her?" asks Schwitzer. "The drug company PR people? "

By contrast, Schwitzer calls USA Today's piece "refreshing."�He offers "Excerpts:

2nd sentence: ‘The experimental drug, T-DM1, doesn't cure anyone.'"Later: ‘… statistically, it's possible that those findings could be due to chance, Horning says.'"

Roy Poses, founder of Health Care Renewal� also questions how the quest for earnings affects healthcare, zeroing in on the for-profit hospice industry:

"Remarkable public comments by some for-profit hospice marketers show their focus on increasing patient volumes, even if that means recruiting patients who are not really at the end of life."

Poses explains that this means that some patients suffering from "acute illnesses and injuries may not receive … treatment" they need, while profit-driven hospice care "ends up shortening their lives."

"It's funny that the people who were so alarmed by ‘death panels' do not seem so alarmed by this pathway to denying care for profit," Poses observes.

Rising costs of Medicare and Medicaid

Meanwhile, on Managed Care Matters, Joe Paduda compares how fast the costs of Medicare, Medicaid and commercial insurance have been growing.

"Medicare and Medicaid trends are looking better these days" he writes. "And this trend looks like it will continue. Note this is per-capita growth, which is more accurate when comparing different payer types."�But he reports, "employers' health care costs are up 5.9% this year, and would have increased more if not for a significant increase in cost-shifting to employees (up over 19% from 2011 – 2012)"

Giving physicians a check-up

But money does not drive all of the problems in our health care system � at least not among doctors � writes Brad Flamsbaum in Why We Lie�on the The Hospitalist Leader.)

Doctors sometimes fib, Flamsbaum acknowledges, to insurers, in order "to obtain pre-certification for patient testing perceived as necessary"���and, yes, they lie to patients: "We are humble folk and he says, physicians have the same foibles as the flock we oversee."�Yet, "it's not about the money," he explains, "but a host of other factors ���surprisingly more potent than financial rewards."

Flamsbaum points to research on why humans lie that begins with our "ability to rationalize," followed by "conflicts of interest," "creativity," "previous immoral acts," and "being depleted," all illustrated here.

On�Health Business Blog, David Williams expresses his own�concerns about physicians. �He quotes a doctor advising that�doctors should be candid with families�and "raise the issue of a grim prognosis early on," giving them "an opportunity to deal with it." Otherwise families may fall victim to "optimism bias."

Williams is "wary." The Physician may be "wrong, or unduly certain." He realizes that doctors "must find ways to deal with death" or "they can't practice medicine. But … I don't want a physician to make peace with my relative's death … while he's still alive."

By contrast, Michael Gavin and Mark Pew, executives at Prium, a worker's comp utilization company, worry that�doctors are too quick to give injured workers a heavy dose of pain-killers. �Writing on Evidence-Based, they point to "A new ruling from Texas … that finds payers liable for a range of opioid-related side effects ranging from addiction to death. Prediction: This is just the beginning."

Finally, over at�The New Health Dialogue, Joe Colucci and Shannon Brownlee turn to�how television depicts physicians. "The Fox show House ended last week," they write. "It was entertaining, but as far as health policy is concerned, we're not sorry to see it go … Dr. House exemplified the "cowboy doctor" as "hero" who is in fact a "hazard" … practicing "reckless, unscientific, non-evidence based medicine."

Just "one point in House's favor: he works with a team" and they "actually talk to each other … Unfortunately, that's as unrealistic as the rest of the show."

Thoughts on obesity

In another post,�The New Health Dialogue's�Colucci examines New York Mayor Mike Bloomberg's most recent public health proposal,�banning sugary beverages�"gigantic enough for a small marine mammal to do laps in." Bloomberg would limit sodas served in restaurants to 16 ounces.

"The reaction has included furious opposition from �people claiming this is the nanny state run amok," Colucci reports, but in fact, "There is extensive evidence from psychology and behavioral economics that people respond to larger portions by eating more."

Over at 365 Days of Wellness, Kat Haselkorn focuses on a different profit-driven problem. In Unstoppable Obesity Epidemic, she acknowledges that "obesity is a bigger issue in low-income communities and is more likely to affect minorities." But "marketing and advertising play a significant role in childhood obesity, nudging children towards processed foods and sugar. Government subsidies allow Big Agriculture and top manufacturers to aggressively market products to children … 77% of obese children become obese adults."

Uninsured veterans

The government might better be spending that money on Veterans. On the Healthcare Economist, Jason Shafrin's Memorial Day post�reports that "About 10 percent of U.S. veterans under the age of 65 lack health insurance and are not being taken care of by the VA."�Eligibility for VA services "is based on veteran status, service-related disabilities, income level, and other factors," Shafrin explains. "Proximity to VA facilities and cost-sharing requirements" also affect access.

High anxiety

On Workers' Comp Insider, Julie Ferguson reports on another group at risk. The "boom in cell phones has spawned" a huge demand for radio towers, and "brutal" schedules are leading to more fatalities among tower workers. �(See this video from a prior post.)�"Tower work is carried out by" layer after layer of subcontractors, she explains allowing large companies to "deflect responsibility for on-the-jobwork practices." In an era of sub-contracting, "this layering makes OSHA enforcement almost impossible."

Electronic health records

Jann Sidorov focuses his concern on Electronic Health Records (EHRs)�and "The Need for Legal Framework." Writing on Disease Management Blog�about a piece in the Economist that examines the need for legal reform for military drones and driverless cars, �Sidorov argues that "since robot-like artificial intelligence is involved in electronic health records, the same legal protections may be necessary there."

Age rating

Although I'm a fan of health reform, I too, have my worries. Under the Affordable Care Act, insurers can charge older Baby-boomers (in their 50s and early 60s) premiums three times higher than they would charge a 20-year-old for exactly the same coverage.

I explore the issue here, on HealthInsurance.org, where I've recently begun posting. (Soon, I�ll be re-launching HealthBeat thanks to technical assistance from HealthInsurance.org. In the future, I�ll be writing on both web sites.)

HHS gives 81 innovation awards in second round

WASHINGTON – Health and Human Services Secretary Kathleen Sebelius on Friday announced the recipients of 81 new Health Care Innovation Awardsmade possible by Affordable Care Act. The awards will support innovative projects nationwide designed to deliver high-quality medical care, enhance the health care workforce, and save money.

Combined with the 26 awards announced last month, HHS has distributed money to 107 projects that plan  to save the healthcare system an estimated $1.9 billion over the next three years.?

[See also: HHS gives innovation awards to 26 organizations]

“Thanks to the healthcare law, we are giving people in local communities the resources they need to make our healthcare system stronger,” said Sebelius.
The projects are located in urban and rural areas, all 50 states, the District of Columbia and Puerto Rico. 

Two examples of projects include:
Sepsis Early Recognition and Response Initiative in Texas:  Led by the Methodist Hospital Research Institute in Houston, the program takes a novel approach to identify and treat sepsis before it progresses. Sepsis is the sixth most common reason for hospitalization and typically requires double the average time in the hospital. It leads to complications such as renal failure and cognitive decline. One out of 20 patients with sepsis die within 30 days. Methodist Hospital’s initiative is designed  to reduce the cases of organ failure, improve patient outcomes, lead to shorter hospital stay and lower costs.
Regional Emergency Medical Services in Nevada – along with the Renown Medical Group, the University of Nevada, the Reno School of Community Health Sciences, the Wahoe County Health District, and Nevada‘s Office of Emergency Medical Services – is establishing a new non-emergency phone number for Community Health Early Intervention Teams that will help people get fast and appropriate care, reduce unnecessary hospitalizations, and lower costs.

Awardees were chosen for their innovative solutions to the healthcare challenges facing their communities and for their focus on creating a well-trained healthcare workforce that is equipped to meet the need for new jobs in the 21st century health care system.

[See also: CMS' Tavenner spotlights innovation]

The Centers for Medicare & Medicaid Services (CMS) at HHS contracted with an external organization with extensive experience in managing independent grant review processes to administer the award review process to ensure an objective review of each application. The Center for Medicare and Medicaid Innovation within CMS will administer the awards through cooperative agreements over three years.

 

Healthcare IT slated for $19B in proposed stimulus package

WASHINGTON – Congress is expected to approve $19 billion toward health information technology, with $17 billion allotted to incentives and $2 billion to jump-start healthcare IT adoption, according to a Wednesday night draft of the stimulus package.

The original House version of the bill designated $20 billion for healthcare IT, with the Senate setting aside $22 billion.

The $789 billion conference agreement between the House and Senate versions of the American Recovery and Reinvestment Act (H.R. 1) still faces potential amendments before a final vote, and some healthcare provisions of the bill were not scored as of Wednesday night.

Speaker of the House Nancy Pelosi (D-Calif.) said a final vote is expected before Saturday.

The conference agreement includes measures to codify the Office of the National Coordinator for Health Information Technology (ONC) and establish an open and transparent process led by the national coordinator to develop standards by 2010 that allow for secure nationwide electronic exchange of health information.

It also would improve and expand current federal privacy and security protections for health information, such as requiring that an individual be notified if there is an unauthorized disclosure or use of his or her health information and requiring a patient's permission to use his or her personal health information for marketing purposes.

Medicare and Medicaid HIT provisions in the bill include funding for the adoption and use of health IT, such as electronic health records by providers who serve Medicare and Medicaid patients. It would provide temporary bonus payments ranging from $44,000 to $64,000 for physicians and up to $11 million for hospitals that meaningfully use electronic health records.

The bill supports Medicare and Medicaid incentive payments for critical access hospitals, federally qualified health centers, rural health clinics, children's hospitals and others and phases in Medicare payment penalties for physicians and hospitals not using electronic health records starting in 2014. It seeks a 90 percent HIT adoption rate for physicians and 70 percent for hospitals for using electronic health records and would generate savings of more than $12 billion through improvements in quality of care and care coordination and reductions in medical errors and duplicative care.

Microsoft CEO Steve Ballmer sent a letter to Congress urging quick passage of the bill.

"We believe information technology can help create a connected health system that delivers predictive, preventive and personalized care – a system that will improve the health of Americans and help control healthcare spending," he said. "Government support for rapid adoption of information technology is essential and measurable outcomes are needed to help the Administration and Congress achieve the goals of increased access, lower healthcare costs and improved quality of care."

5 basics of big data

At the recent HIMSS Virtual Conference and Expo, Chris Gough, solutions architect at Intel Healthcare Information Technology and Alan Stein, MD, vice president of healthcare technology Autonomy, an HP company, presented a webinar titled, "Big Data and Analytics in Healthcare."

Gough and Stein outlined five basics of big data. 

1.The main problem is the fragmentation of data. The separation of data among labs, hospital systems, and even clinical components, like financial IT and EHRs, serves as the main issue with leveraging the data, said Stein. "All of these are separate repositories for information," he said. "Their single use in nature is to provide clinical care or provide scheduling information or operational information, and this is a problem if we want systems to talk to each other." Sometimes, he added, an organization can also end up with redundant information due to a legacy system. "So we also have this normalization problem," he said. "And this is where we want to go: we want to improve quality of care and lower costs…we need a shift from best practices to a culture of best practices – if we have them available – but also best experiences and using data from various components of health IT to improve care and lower costs in a holistic way."

2.Big data is all about real or near-real time. Traditional analytics, said Gough, use ETL processes that upload data nightly or weekly to a data warehouse. Processing takes place in the warehouse, yet, the trend of big data is moving toward real or near-real time. "It's not waiting for batch processes but is driving value from data more immediately," he said. "In healthcare, it's clinical decision support, so at the point of care, being able to understand data to make a decision." With traditional analytics, Gough said, reporting focuses on the past, but with big data, "it's more predictive, and it looks forward to what may happen in the future."

[See also: Big data: opportunity and challenge.]

3.Processing is moving to the data. Another trend Gough pointed out is the processing coming to the data, instead of the other way around. "So traditionally, you move data out of a production database to a warehouse, and you pull from different repositories." At the rate data is increasing in healthcare though, he said, whether it's from medical imaging, EHRs, etc., moving this data around is becoming more of a challenge. "So the trend we're seeing is moving processing to the data," said Gough. "That's a large job, that's split up into a number of parts and split across a system. The infrastructure knows where the data resides, and processing happens as close to it as possible to improve performance."

4."Scale-up" is shifting to "scale-out." Typically, said Gough, the industry leans toward a "scale-up" mentality.  "So, [they say] 'Get me a bigger server, a more powerful server,' but instead, the trend is 'scale-out,'" he said. "So don't leave behind or get rid of older hardware nodes – just add them over time and improve performance and scalability of a system by adding nodes." The same notion is true from a storage point of view, he added. "So being able to much more easily scale with the architecture, where you can add another node to the solution and it adds to the system more memory." This makes systems more easy to manage, he said, and are," the kinds of solutions the industry is moving toward, instead of a 'rip and replace' mentality."

[See also: 6 keys to the future of analytics and big data in healthcare.]

5.For smaller organizations, it's all about software-as-a-service (SaaS.) Most of the trends Gough said he's seeing are for smaller hospitals that are leaning toward SaaS. "So an EHR vendor basically posting the solution on behalf of clients and customers, and something we're seeing is, many of those vendors are looking to add services alongside EHRs and other types of applications, more specifically, analytics," he said. A lot of those analytics solutions, he continued, focus on meaningful use and quality metrics. "I expect that trend to accelerate over time toward SaaS, especially for smaller organizations," he said. "It makes sense [for them] to look at hosted analytics solutions and hosted services." 

CMS pays $5.58B in EHR incentives to date

WASHINGTON – Another milestone: The Medicare and Medicaid electronic health record program has paid out $5.58 billion to 110,650 physicians and hospitals in total program estimates through May 2012.

Final figures will be available later this month once the Centers for Medicare and Medicaid Services completes its May monthly data collection.

In May, CMS paid $346 million to Medicare physicians and hospitals and $205 million to Medicaid providers for a total of $551 million to 16,400 providers in preliminary estimates, said Robert Anthony, specialist in CMS’ Office of eHealth Standards and Services.

“We are reaching an even keel as to how much we are paying each month in incentive payments,” he said in his program status report at the June 6 meeting of the Health IT Policy Committee, which advises the Office of the National Coordinator for Health IT.

Through April, CMS paid $5.03 billion to 94,097 Medicare and Medicaid physicians and hospitals in incentive payments since the program’s inception. In April alone, 12,205 Medicare providers received $276 million, while 3,977 Medicaid providers received $195.5 million for adoption, implementation and update of EHRs and 37 Medicaid providers got $3.17 million for demonstrating meaningful use.

It was the first month that Medicaid professionals could be paid as meaningful users, but not all of the states have their systems up and running yet for meaningful use attestations, he said.

Most states have initiated their Medicaid EHR incentive programs, but Hawaii, Minnesota, New Hampshire, Nevada and Virginia are preparing to start within the next few months. Nebraska was the latest state to launch its Medicaid EHR program in May.

Registration among providers for the program is “consistently high,” with 12,374 in April and a total of 238,139 Medicare and Medicaid registrants as of the end of April.

“About 71 percent of hospitals that are eligible to participate in the program have registered, and we are fast closing in on 50 percent of eligible professionals being registered at this point,” Anthony said.

While provider registrations show they have reached a plateau, there were predictable bumps in January and February so those providers could be included in the count for 2011 meaningful use.

The preliminary estimates for May show “a little downtick” for the number of Medicare providers receiving payments. Many came in at the end of the year.

“We won’t see people coming back for 2012 until 2013 because they will have to do meaningful use for an entire year,” he said. But May also included payments for eligible physicians in Medicare Advantage organizations.

A snapshot from 2011 meaningful use data is beginning to emerge. “It does appear that those coming in at the end were performing significantly lower in a way from those who came in the beginning. We’re unsure whether that means that once you’re a meaningful user, you’re a meaningful user, or whether these are the folks in 2011 who were most situated to come in and incorporate it in the workflow. We’ll want to look at whether the folks who came in 2012 differ in any significant way,” Anthony said.

As of April, about 45 percent of all eligible hospitals have received an incentive payment, while 1 of every 7 eligible Medicare physicians is a meaningful user of EHRs, moving steadily higher from the previous month’s 1 in every 9 Medicare physicians, he said.

And nearly 1 of every 5 Medicare and Medicaid eligible provider have received payment whether it’s for meaningful use or to adopt, implement or update EHR systems.

German hospital interfaces angiography with image IT

ERLANGEN, Germany – The Peine Clinic in Lower Saxony has become the first hospital in Germany to interface its angiography systems with an image management and reporting system.

All data generated prior to or during an intervention in the cardiac cath lab is now automatically transferred to the new IT system.

The advantage of this is that while the examination is still in progress, operating personnel can use important examination data to prepare a report for wards or referring physicians in just a matter of minutes. Previously, this took several hours, because the data was transferred from forms to the reporting system manually and the images were also stored manually.

For this innovative IT solution in the catheter laboratory in Peine, Siemens interfaced its image archiving system syngo Dynamics with the angiographic system Axiom Artis FC and the hemodynamic measuring station Axiom Sensis XP.

In May 2008, the former community hospital in Peine opened a cardiac catheter laboratory.

To begin with the most efficient environments possible, the Peine Clinic chose Siemens's syngo Dynamics cardiology image management and reporting system.

In the past, one of the most time-consuming tasks in the clinical routine for cardiac cath has been the preparation of reports.

The large amount of data that had to be transferred manually from different forms, or from external data media, to the electronic reporting systems caused long delays in report availability.

The Peine Clinic chose Siemens to install a solution that would significantly reduce the amount of time and effort for report preparation following cardiac catheterization.

To achieve this objective, Siemens interfaced its multi-modality image archiving system syngo Dynamics with the angiographic system Axiom Artis FC and the hemodynamic measurement station Axiom Sensis XP. An interface to the clinic's ultrasound systems will be added in the future.

Axiom Sensis XP, a state-of-the art recording procedure for interventional cardiology and electrophysiology, even transmits measurement data automatically to syngo Dynamics via real-time data transfer.

Directly at their syngo Dynamics workstations, the reporting physicians are now provided with all data required to prepare the necessary reports as soon as catheterization is completed. This considerably accelerates the workflow in the cardiology department and allows for more precise reporting than in conventional catheter labs.

Wilfried Schröter, Head of Medical Systems of the Peine Clinic, said, "With this scalable solution, we are best equipped to face the technical challenges of the future. Networking will make the data exchange even faster and offer further advantages, for example in long-term archiving. This will certainly expand the existing cooperation of our hospitals."

Vendor Notebook - SRS delivers hybrid EMR to Calif. cardiology group

SRS, based in Montvale, N.J., has announced that Regional Cardiology Associates Medical Group has selected the SRS hybrid electronic medical record (EMR) for its six-office, 22-provider practice covering the greater Sacramento, Calif. area.

Affiliated Computer Services, Inc. of Dallas has announced that the Alabama Medicaid Agency has implemented ACS' QTool to develop an electronic health information exchange that links Medicaid, state health agencies, providers and private payers.

The Informatics Corporation of America, based in Nashville, Tenn., has announced that Northwest Healthcare of Kalispell, Mont., part of the Health Information Exchange of Montana, is now using the company's software to aggregate data from core clinical systems.

EDS, a subsidiary of Palo Alto, Calif.-based HP, has been certified by Germany-based SAP AG to provide solution implementation and solution operations for clients using the Run SAP methodology.

The Eclipsys Corporation of Atlanta has announced that the Genesis Physicians Group, a Dallas-based independent practice association, will endorse the PeakPractice solution as its electronic medical record system of choice for more than 1,450 physician members. In addition, the company has announced that Greenwood Pediatrics, a 10-physician group practice based in Denver, has also selected PeakPractice for its three offices.

The MRO Corp., a King of Prussia, Pa.-based provider of release-of-information solutions for healthcare providers, has added Remote Services and Staffed Services as options to its traditional Shared Services model for ROI processing.

IBM has announced a partnership with UnitedHealthcare to develop a patient-centered medical home program with selected primary-care physicians in Arizona.

Tribridge has entered into an agreement with Medical Connections Holdings, Inc. to provide software to the Boca Raton, Fla.-based healthcare staffing company.

SAP AG has announced that the Marshfield Clinic in Marshfield, Wis. has selected the company's Business Objects XI intelligence platform to replace its existing BI system.

Greenway Medical Technologies, a Carrollton, Ga.-based provider of integrated electronic health records, practice management and interoperability solutions, is partnering with Navicure, an Atlanta-based medical claims clearinghouse, to streamline the claims management process through an integration of their services.

Microsoft and GE Healthcare get regulatory approval to form Caradigm

REDMOND, WA – General Electric and Microsoft announced Wednesday they have completed the formation of Caradigm, the 50/50 joint health IT venture first announced this past December.

Officials say Caradigm will draw on both companies' strengths to develop an open intelligence platform and new clinical applications aimed at enabling better population health management.

In addition, GE and Microsoft on Wednesday announced the appointment of Lauren Salata as chief financial officer and Michael Willingham as quality assurance and regulatory affairs executive for Caradigm.

Salata previously served as the chief financial officer and compliance officer of Care Innovations, an Intel and GE company based in Roseville, Calif. Willingham joins Caradigm from Philips Healthcare in Bothell, Wash., where he served as senior director of quality and regulatory affairs.

“The combination of people and technology from GE Healthcare and Microsoft will allow us to drive the dramatic change that is needed in healthcare,” said Simpson. “By forming Caradigm, we can offer innovative healthcare solutions, including an open platform and tools that enable software developers around the world to address the complexities of population health today.”

[See also: Newsmaker Interview: Michael J. Simpson - Caradigm CEO.]

Caradigm will be headquartered in Bellevue, Wash., with offices in Salt Lake City; Andover, Mass.; Chevy Chase, Md.; and other cities around the world.

To Count As A Young Scientist, Anything Less Than 52 Will Do

iStockphoto.com

You're not getting older, you're getting better.

I always suspected that the pursuit of science could keep a person young � or at least young at heart.

Now I have evidence. Sort of.

The Foundation for the National Institutes of Health, a charity that helps raise money to support the NIH, today announced the Lurie Prize. A $100,000 check awaits a "promising young scientist in biomedical research" with the right stuff.

The awardee will be selected by a jury of six eminent researchers in recognition of outstanding scientific achievement. Nominations (and you can't nominate yourself) are due Aug. 15.

 

So what's the cutoff age?

"Nominations are to be for an outstanding young biomedical investigator, who shall not have passed his/her 52nd birthday on April 12, 2013."

Fifty-two still qualifies as being a young scientist? Really? I thought there must be a mistake.

I called the foundation, and spokeswoman Kimberly O'Sullivan confirmed that it was correct. "It was a board decision," she said. "Most awardees of this nature seem to be older."

Criteria for some other grants and awards define young a different way, pegging it to how long ago researchers completed their terminal academic degree or medical residency.

Ten years, for instance, closes the window for some NIH grants earmarked for new investigators. And it's true that the average age for researchers getting their first career-making R01 grant from NIH is now north of 42.

Back when I was young, or at least younger, I wrote my journalism master's project on the problems young biomedical researchers were having landing enough grant money to get their careers on track. That was back in the '90s, and most of the youngsters I talked to were 30-somethings. The graybeard in the group was 41 at the time.

But it apparently takes even longer for people to get traction in the world of science these days, and we're living longer, too. So maybe 50 is the new 30, if you're a promising scientist.

To Count As A Young Scientist, Anything Less Than 52 Will Do

iStockphoto.com

You're not getting older, you're getting better.

I always suspected that the pursuit of science could keep a person young � or at least young at heart.

Now I have evidence. Sort of.

The Foundation for the National Institutes of Health, a charity that helps raise money to support the NIH, today announced the Lurie Prize. A $100,000 check awaits a "promising young scientist in biomedical research" with the right stuff.

The awardee will be selected by a jury of six eminent researchers in recognition of outstanding scientific achievement. Nominations (and you can't nominate yourself) are due Aug. 15.

 

So what's the cutoff age?

"Nominations are to be for an outstanding young biomedical investigator, who shall not have passed his/her 52nd birthday on April 12, 2013."

Fifty-two still qualifies as being a young scientist? Really? I thought there must be a mistake.

I called the foundation, and spokeswoman Kimberly O'Sullivan confirmed that it was correct. "It was a board decision," she said. "Most awardees of this nature seem to be older."

Criteria for some other grants and awards define young a different way, pegging it to how long ago researchers completed their terminal academic degree or medical residency.

Ten years, for instance, closes the window for some NIH grants earmarked for new investigators. And it's true that the average age for researchers getting their first career-making R01 grant from NIH is now north of 42.

Back when I was young, or at least younger, I wrote my journalism master's project on the problems young biomedical researchers were having landing enough grant money to get their careers on track. That was back in the '90s, and most of the youngsters I talked to were 30-somethings. The graybeard in the group was 41 at the time.

But it apparently takes even longer for people to get traction in the world of science these days, and we're living longer, too. So maybe 50 is the new 30, if you're a promising scientist.

Obesity app takes first place in D.C. competition

WASHINGTON – The winners of the Washington D.C. Health Data & Innovation Week Code-a-Thon were announced Tuesday. School Fit was awarded first place for developing an application that utilizes physical fitness data to monitor the health of children in public schools.

The app will allow communities to recognize and collaboratively address obesity problems in California public schools. School Fit earned $4,000 and two passes to the Health Data Initiative Forum III and the 2012 Health 2.0 Annual Fall Conference. 

The Health 2.0 Code-a-Thon, sponsored by the Office of the National Coordinator for Health Information Technology (ONC) and Kaiser Permanente, attracted thousands of healthcare providers, policymakers and innovators from across the U.S.  

Teams comprising students, software developers and researchers participated in the two-day event, which required contestants to use publicly available data to create online tools and applications to enhance quality of care and prevent obesity.

"The judges had an especially difficult time choosing a winner and extended passes to the Health 2.0 fall conference to the second place team to encourage further development of its app," said Indu Subaiya, co-chair and CEO of Health 2.0.

Healthy Plate placed second by creating a mobile app that educates and improves nutritional literacy by displaying the nutritional information about the user's food they intend to purchase by portion, recipe or grocery list. It won $3,000 and two passes to Health 2.0's annual conference.

The LessBadd and SMS2Live teams tied for third place. Both teams received $1,000.

Independent Grades For Hospitals Show Quality Could Be Better

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Hospitals that muff patient safety avoided F's for now, but a new independent grading system will hand those out before long.

The cities of New York and Los Angeles grade their restaurants on cleanliness and the precautions they take to avoid making customers sick.

Now hospitals are getting similar assessments for their patient safety records from the Leapfrog Group, a nonprofit that's looking to improve the quality and safety of health care.

For 2,651 hospitals, Leapfrog created a single letter grade from 26 different measures collected by Leapfrog or Medicare. They included hospitals' adherence to safe practices, such as entering physician orders into computer records to avoid penmanship errors and removing catheters promptly to minimize the risk of infections. The grade was also based on hospitals' records of mishaps, such as bed sores, infections and punctured lungs.

Leapfrog gave 729 hospitals an A grade, 679 hospitals a B and 1,111 hospitals a C. Another 132 hospitals were scored "Grade Pending," Leapfrog's euphemism for below a C.

 

Leapfrog plans to introduce D's and F's when it updates the ratings in six months, but didn't want to be too harsh in its first report, said Leah Binder, Leapfrog's executive director.

"We designed this to capture the attention of the public," Binder said. "No one has ever given one individual score to most of the general hospitals in the country, including those that didn't perform well." Ratings can be found at Hospitalsafetyscore.org, but the site was hard to access Wednesday morning, apparently everyone wanted to see it at once.

The American Hospital Association disputed Leapfrog's ratings, saying in a statement that it "has supported several good quality measures but many of the measures Leapfrog uses to grade hospitals are flawed, and they do not accurately portray a picture of the safety efforts made by hospitals."

Among the mediocre performers in Leapfrog's study are some well-respected names. New York-Presbyterian Hospital in Manhattan and the Cleveland Clinic Hospital both got C's. UCLA Ronald Reagan in Los Angeles got a "Grade Pending." Leapfrog gave A's to some other well-known places such as the Mayo Clinic in Rochester, Minn., and Cedars-Sinai Medical Center in Los Angeles, and also to a host of obscure community hospitals.

"The hospitals that achieved an A came from all walks of life, across the gamut of hospital types and people they serve," Binder said. "Safety appears to be something that all hospitals can choose."

Massachusetts, Maine and Vermont were the only three states where half of the hospitals or more got a grade of A. In 24 states and the District of Columbia, half or more of the hospitals got a C or "Grade Pending." The worst performers were the District, Oregon and New York , where at least two-thirds of the hospitals got a C or lower. Kaiser Health News has a sortable chart of the grades by state here.

Hospital officials raised a number of objections. Dr. Michael Henderson, chief quality officer at the Cleveland Clinic, noted that much of the data was a year or two old, and many hospitals have made significant strides since then. "The question the public needs to be asking is, 'Are you working on this? Are you getting better?' " he said.

Leapfrog's information comes from two sources: its own surveys of hospitals that agree to participate, and data the Centers for Medicare & Medicaid Services culls from its billing records and posts on its Hospital Compare website.

Dr. Shannon Phillips, a quality and safety officer at the Cleveland Clinic, said that the way Leapfrog calculated its grades, "you are automatically at a deficit if you did not participate in their survey." The clinic, like some other hospitals, dropped out of Leapfrog's surveys in recent years as the government began requiring more and more information to be provided to it for publication.

Binder, however, said that the way the scores were calculated wouldn't disadvantage hospitals that didn't partake in Leapfrog's survey.

Leapfrog, which is based in Washington, said it consulted with nine nationally known experts, including Dr. Peter Pronovost of Johns Hopkins, Dr. Patrick Romano of University of California, Davis and Dr. Ashish Jha of the Harvard School of Public Health, in designing the letter grade scoring methods.

Jha called Leapfrog's grades "a really important step forward," because they simplify complex measurements into things that consumers can easily understand and digest. Numerous studies have found that consumers rarely use complex quality measurements when choosing hospitals, blunting the potential influence of resources like Hospital Compare.

"As better data comes along and as time goes by, my hope is this grading will get refined," Jha said.

Unlike a city public health department, Leapfrog can't post its grades on the front doors of a hospital. Binder said Leapfrog hopes that groups of employers that purchase insurance will disseminate the ratings to workers and use them when selecting health care providers.

Obesity app takes first place in D.C. competition

WASHINGTON – The winners of the Washington D.C. Health Data & Innovation Week Code-a-Thon were announced Tuesday. School Fit was awarded first place for developing an application that utilizes physical fitness data to monitor the health of children in public schools.

The app will allow communities to recognize and collaboratively address obesity problems in California public schools. School Fit earned $4,000 and two passes to the Health Data Initiative Forum III and the 2012 Health 2.0 Annual Fall Conference. 

The Health 2.0 Code-a-Thon, sponsored by the Office of the National Coordinator for Health Information Technology (ONC) and Kaiser Permanente, attracted thousands of healthcare providers, policymakers and innovators from across the U.S.  

Teams comprising students, software developers and researchers participated in the two-day event, which required contestants to use publicly available data to create online tools and applications to enhance quality of care and prevent obesity.

"The judges had an especially difficult time choosing a winner and extended passes to the Health 2.0 fall conference to the second place team to encourage further development of its app," said Indu Subaiya, co-chair and CEO of Health 2.0.

Healthy Plate placed second by creating a mobile app that educates and improves nutritional literacy by displaying the nutritional information about the user's food they intend to purchase by portion, recipe or grocery list. It won $3,000 and two passes to Health 2.0's annual conference.

The LessBadd and SMS2Live teams tied for third place. Both teams received $1,000.

Crisis = Opportunity for Single-Payer

Fiscal crises may force Obama to save costs via a single-payer plan.

By Roger Bybee for Dollars and Sense–

President Obama seems ready to proceed full-throttle toward a health care reform plan, but one that will keep private insurers at the center of the system. The plan, termed �guaranteed affordable choice,� would allow workers to �keep the insurance they like,� find a rival private insurer, or opt into a Medicare-style public plan.

To date, Obama has sensibly insisted that quick action on health care is imperative. �It�s not something that we can put off because of the [financial] emergency,� Obama declared in December. �This is part of the emergency.� Questioned about the wisdom of launching a $100 billion health care program at a time of mounting government deficits, �I ask a different question,� Obama countered. �How can we afford not to?�

He�s right: economic meltdown is making health care reform more urgent by the day. Hospitals are hurting; while �the number of paying patients and profitable elective procedures is down . . . ,� the LA Times reported recently, �the number of uninsured patients whom hospitals treat is rising.� At the same time, escalating health care costs are squeezing private employers and governments alike. �The new Congressional Budget Office report shows that rising health care costs are the largest driver of the nation�s long-term budget problems,� budget watchdog Robert Greenstein of the Center on Budget and Policy Priorities told Congress last fall.

But Obama�s hybrid, public-private plan is likely to hit a fiscal wall as federal spending balloons, and along with it the deficit. In the end, both popular sentiment and fiscal barriers may force him to follow a different course.

The administration�s plan subsidizes lower-income Americans to enable them to buy private health insurance. Contrary to Obama�s statements during the campaign, his plan will �need to require� all individuals to have health insurance, concludes the respected Commonwealth Fund. Such a mandate would be crucial to securing industry concessions necessary to move toward universal coverage, particularly a ban on excluding people with pre-existing conditions from coverage.

If so, the plan would eventually deliver tens of millions of new enrollees �the number of uninsured is about 47 million�to the insurance companies. Some 31% of their premiums, in many cases government-subsidized, will go into overhead and insurance company profits�an estimated $400 billion annual burden weighing down the health care system.

But this plan is on a collision course with the fiscal realities. On top of the budget wreckage left by the Bush years, the federal government�s fiscal demands are exploding. Health care reform faces daunting competition from a $787 billion stimulus package; the president�s $72 billion decision to delay repealing the Bush tax cuts for high earners; a Wall Street, bank, and insurance company bailout at $700 billion to date and likely to grow; and the ongoing Iraq and Afghanistan wars, together costing $170 billion in �extra� defense spending in FY2009.

Still, a leading advocate of the Obama plan, political scientist Jacob Hacker, argues that it can be billed as an important economic stimulus and thus escape the fierce budgetary competition. In December, Hacker cheerfully declared in The New Republic that the Obama plan offers nothing less than a �magic bullet� that will yield �short-term spending and long-term saving��a perfect combination as the economy moves deeper into recession.

However, it is likely that Hacker seriously overstates the long-term savings while underestimating the clash of government priorities that lies just ahead. First, Obama-style individual mandate plans have run aground in at least six states that have tried them. With no mechanism to control the premiums charged by private insurers, the ever-higher cost of subsidizing low-income residents� premiums soon exhausts available funds. Nor will sufficient savings be derived from Obama�s plan for electronic recordkeeping and more treatment of chronic illness, recent studies by the Congressional Budget Office and others suggest.

To many, a single-payer plan is the obvious way to ensure universal health coverage while containing costs. In addition to the dramatic reduction in administrative costs, single-payer plans offer other opportunities for controlling costs. For instance, they allow government�the �single payer� �to negotiate for lower costs with providers like doctors, hospitals, and pharmaceutical companies.

Unfortunately, Obama�s statements and key appointments suggest he has already disqualified single-payer as a serious option.

Tom Daschle, tapped for Health and Human Services secretary and �point man� on the health care reform effort until tax problems forced him to withdraw his name in February, appeared unwilling to let the private insurance industry go. His basic policy direction emerged in an interview last May. In a remark that seems staggering in hindsight, Daschle said, �And I would ask the question, if you think our banking system today is reasonably regulated, why not try the same model for our health-care system?�

Obama�s initial pick for surgeon general was TV health expert Dr. Sanjay Gupta. Gupta was trounced by Michael Moore in a televised debate over Moore�s documentary �Sicko,� and was then forced to retract some of the factually inaccurate criticisms of single-payer he had offered.

Another key player is Senate Finance Chair Max Baucus, author of a plan similar to Obama�s. Baucus recently dismissed the single-payer option on this basis: �We are Americans; we�re different from Canada, we�re different from the United Kingdom.� Baucus was probably not referring to the United States� poorer health outcomes at vastly higher costs when he spoke of the American �difference.�

Promoted by this kind of team, Obama�s health-care plan could prove to be the most vulnerable component of his domestic program. The Republicans feel confident about their ability to brand Obama�s plan as overly complex and a threat to consumer choice in medical care, as they did so successfully with the Clinton plan in the 1990s.

The Obama plan�s �pay or play� component, giving employers a choice between insuring their employees or paying a tax to help finance the government plan, will no doubt open it up to conservative criticism as a coercive, big-government program. This line may also strike a chord among moderate-income citizens who earn too much to qualify for a subsidy and consequently lose enthusiasm for reform once they start to pay mandatory health premiums.

The single-payer approach, on the other hand, would disarm many of the most explosive Republican arguments. It is far less costly to both employers and individuals�nearly 50% lower per person in Canada than the United States, for instance�and there is no billing of patients or other complexity. Every citizen enjoys the right to health care and a free choice of doctors and hospitals. Start-up costs would be minimal, especially if Medicare were simply expanded to cover the entire public.

Back in 2003, Barack Obama told the Illinois AFL-CIO: �I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14% of its Gross National Product on health care, cannot provide basic health insurance to everybody . . . a single-payer health care plan, a universal health care plan. And that�s what I�d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.�

Now that Obama himself occupies the White House and health care costs consume nearly 17% of GNP, the new president may rediscover that single-payer is the truly pragmatic course on health care reform. Hemmed in on all sides by the enormous costs facing the federal government, Obama may find�despite his misgivings�that pursuing a single-payer reform plan is the sole means of creating a low-cost and appealing alternative to the health-care status quo.

Roger Bybee is the former editor of the union weekly Racine Labor and is now a consultant and freelance writer whose work has appeared in Z Magazine, The Progressive, Extra!, The Progressive Populist, In These Times, commondreams.org, and other national publications and websites. Visit his webpage at www.zmag.org/zspace/rogerdbybee.

SOURCES: Jacob S. Hacker, �A Healthy Economy,� The New Republic, Dec. 31, 2008; S. Woolhandler, T. Campbell, and D. Himmelstein, �Costs of Health Care Administration in the United States and Canada,� New England Journal of Medicine, Aug. 21, 2003; Physicians for a National Health Program, �Barack Obama on single payer in 2003,� posted June 4, 2008; Maggie Mahar, �On Healthcare Reform Stimulating the Economy: the Massachusetts Example,� Health Beat blog (Century Foundation, Dec. 12, 2008); Sara Collins et al., �An Analysis of Leading Congressional Health Care Bills, 2007-2008: Part I, Insurance Coverage,� Commonwealth Fund, Jan. 9, 2009; Kevin Freking, �Health secretary pick seeks health care overhaul,� Associated Press, Jan. 10, 2009.