The Week in Review - April 30, 2009

In a report to the SAS Healthcare and Life Science Executive Conference, John Halamka contends that there are many challenges for the implementation and use of the EHR's nationally. "First, there is not a single set of standards for identifying medical information, meaning physicians, insurers, pharmacists and others involved would have trouble communicating with each other electronically... At the same time, technology needs to be developed to maximize ease of use for physicians... 'Putting servers and exchanges into doctors offices is not going to work,' Halamka said, suggesting a better model is using regional health-care information technology centers that use cloud computing systems to work with doctors."

Nothing like the threat of a pandemic... The Senate (finally) confirms Kathleen Sebelius for Secretary of Health and Human Services. The Wall Street Journal reports that "she was sworn in hours later and quickly went to work on the swine-flu outbreak... She'll also guide a health-care overhaul that the White House and Congress are pledging to enact this year."

Joseph Conn reports on the NCVHS hearing on meaningful use. "The NCVHS got a lot more to chew on—a daylong discourse on the ills of the nation’s healthcare system and a broad overview of what role health information technology might play in healthcare reform." Article at Modern Healthcare (subscription required).

NPR's On Point features the push for e-Health records, the concerns about doctor-patient privacy and the costs to implement these systems.

Business Week features the Dubious Promise of Digitial Medicine. Business Week reports that "industry leaders are pushing expensive systems with serious shortcomings, some doctors say. The high cost and questionable quality of products currently on the market are important reasons why barely 1 in 50 hospitals has a comprehensive electronic records system..."

Diagnosis: Inaccuracy - - Boston Globe editorial on the use of billing codes as clinical content in the PHR. And a summary of editorials on electronic health records from the AMA.

Chances for Health Care Reform Rise

The probability that health care reform legislation passes this year just went up.

Earlier in the week, House and Senate leaders came close to a decision to use an arcane procedure called the reconciliation process, that can speed passage and bypass the usual 60 vote majority required to avoid a Senate filibuster. Senate Budget Committee Chairman Kent Conrad one of the negotiators of the budget bill that may include the reconciliation language believes that "the reconciliation process could lead to a health care bill that looks like "Swiss cheese" in that it would be full of holes. In the reconciliation process, provisions of legislation that aren't related to government spending or revenue can be cut out by the Senate parliamentarian."

To avoid the Swiss cheese version of health reform, Democrats will need 60 votes in the Senate. Yesterday, they came one step closer to this goal with the announcement that Arlen Specter is changing parties to become the 59th senator that caucuses with the Democrats. The Wall Street Journal reports that "if, as expected, Democrat Al Franken prevails in the contested Minnesota senatorial election, the president will have a majority large enough to break Republican efforts to impede his agenda without the legislative gamesmanship required to end filibusters. That advantage could give the White House enough votes to move ahead on a national health-care program..."

Technology for a Single-Record System

Technology to deliver a single patient record system and better alignment of incentives for preventive care are two of the provisions cited in the April 27 edition of the Annals of Internal Medicine about The Change We Need in Healthcare.

Drs. David Goff and Philip Greenland highlight the possibilities for a single-payer system to deliver better preventive care. "At present, there is little incentive for private insurers to pay for prevention services when the enrollee (patient) may be covered by another insurer in just a few years. In this example of misaligned incentives, the insurers have little likelihood of realizing a return on their investments in prevention. We have known for several years that risk factors present in middle-aged men and women are predictive of health care costs and disability many years later under Medicare, but Medicare cannot pay for preventive services in middle age because the program is restricted to covering the elderly (and disabled). In a single payer system, the government could cover preventive services and realize the return on that investment, as governments do in many other countries."

Focusing in on healthcare technology, Goff and Greenland advocate for the creation of a single patient record system. "The government should insist on, and assist with, implementation of electronic health records with decision support and other informatics capabilities that enhance quality. Perhaps even more than a single-payer system, we need a single-record system (as in banking). It is striking that bank customers can access their bank accounts across the nation at different financial institutions, yet patients have unnecessary and wasteful repeated tests in different locations owing to our inability to share medical records in an efficient manner. Care is fragmented, which impairs quality and cost, when records cannot be shared. Government incentives are likely to be the only way to accomplish this critically important innovation in health care across multiple, unconnected providers."

News Analysis

The importance of a single-record system cannot be overstated. However, the analogy to the banking system understates the challenge in healthcare. Unlike banking whose ATMs deliver anywhere access to customer information from a single institution's records, the healthcare single-record system implies anywhere access to patient information from diverse organizations with the attendant issues of person identification and selective security. The healthcare single-record system must also overcome a tower of babel across organizations to deliver on semantic interoperability.

Chronic Care: Reducing Socioeconomic Differences in Outcomes

On April 21, the Commonwealth Fund released its report on "Universal Health Care as a Health Disparity Intervention." The study found that universal health insurance and improved access to care helps to reduce socioeconomic differences in chronic disease control.

The report finds that "ensuring that adults under age 65 have health coverage may reduce racial, ethnic, and socioeconomic differences in health outcomes for cardiovascular disease and diabetes."


While overall control of control of diabetes and cardiovascular disease has improved from 1999 to 2006, there are continuing disparities between racial, ethnic and socioeconomic groups. The study found that these disparities were reduced in Medicare-eligible populations. "With near-universal Medicare coverage after age 65 years, differences in systolic blood pressure, hemoglobin A1c levels, or total cholesterol levels reduced substantially. These reductions may substantially decrease racial and socioeconomic differences in mortality as well."

The Week in Review - April 23, 2009

Fox News medical contributor and NYU Professor of Medicine Marc Siegel delivers a thumbs down to universal health insurance in a Wall Street Journal Op-ed. He contends that universal health coverage won't necessarily deliver health care. Siegel cites the Medicare Payment Advisory Commission finding that an increasing percentage (28%) of Medicare patients couldn't find a primary care doc. Siegel considers dropping Aetna and Blue Cross following the lead of 11% of his fellow NYU physicians due to the increasing paperwork and decreasing payments. When Doctors Opt Out suggests that this vicious cycle means physicians left behind will have even worse workloads for less money - all to the detriment of the patients. Editor's Note: For an alternative view, see the seventh paragraph of the Hippocratic Oath.

New England Journal of Medicine reports on the struggle for health care reform. "The result might be a phasing in of a less comprehensive reform plan with more modest benefits than many liberal Democrats favor and tighter controls on costs. But given the party's current power, public majorities favoring government intervention to ensure coverage, and private interests that recognize the system's unsustainability, the odds remain with Obama and his allies. If their reform affects the entire medical economy, it will represent a paradigm shift away from the incrementalism that has long dominated U.S. health policymaking."


The Economist's special report on "Medicine Goes Digital" looks at the deployment of healthcare technology in the US, the impact of EHR's on medical care, a "new Moore's law" for personalized medicine (genomics), mobile health technology for the developing world, portable personal health technology, and Health 2.0.

A good piece from Software Advice on the "odd couple" - - Sam's Club and eClnicalWorks. "Competing EMR companies ... will enter the fray one way or another, and the economics of software will allow them to match the Wal-Mart price."

It's the penalites that will drive the investments in Health IT, not the incentives. For a 500 bed hospital these penalties can rise to as much as $3 million per year by 2017, while total incentives are $6 million. PWC's report is one of the few articles correctly reporting the $36 billion in incentives that will be doled out between 2011 and 2015. (It's the benefits that push the net to $20 billion.)

Improving Medication Use and Outcomes with Clinical Decision Support (CDS) is published. It documents the five rights for CDS. "The CDS Five Rights model states that we can achieve CDS-supported improvements in desired healthcare outcomes if we communicate:

1. The right information: evidence-based, suitable to guide action, pertinent to the circumstance
2. To the right person: considering all members of the care team, including clinicians, patients, and their caretakers
3. In the right CDS intervention format: such as an alert, order set, or reference information to answer a clinical question
4. Through the right channel: for example, a clinical information system (CIS) such as an electronic medical record (EMR), personal health record (PHR), or a more general channel such as the Internet or a mobile device
5. At the right time in workflow: for example, at time of decision/action/need"

Soon-to-be-confirmed HHS Secretary Kathleen Sebelius in written testimony to the Senate Finance Committee says that “a nationwide interoperable health IT infrastructure is a fundamental building block for broader health reform" and that the systems should be "interoperable and that patient privacy ... assured.” When asked about management of chronically ill patients, she referred to Health IT as a part of the solution for provider communication and care coordination.

New position announcements from the White House targeting government efficiency and effectiveness include Jeffrey Zients, Chief Performance Officer and Aneesh Chopra, Chief Technology Officer. They join new Chief Information Officer Vivek Kundra.

Telemedicine improves treatment and outcomes for stroke victims. The hub at Millard Fillmore hospital's stroke center connects to 10 other hospitals. "Early evidence from Buffalo and elsewhere suggests that telemedicine links improve the chances that patients will survive a stroke and avoid paralysis and other major problems."

Wall Street Journal reports on the big challenges facing David Blumenthal as he guides the transition to electronic health records.

HHS Issues Guidelines to Secure PHI

On April 17, HHS announced guidance on the technologies for securing protected health information (PHI). The technologies are used to render PHI "unusable, unreadable or indecipherable to unauthorized individuals." Properly used, these technologies also protect health care covered entities, business associates and vendors of PHR's from pending breach notification requirements.

It's all documented under this snappy title: Guidance Specifying the Technologies and Methodologies That Render Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals for Purposes of the Breach Notification Requirements under Section 13402 of Title XIII (Health Information Technology for Economic and Clinical Health Act) of the American Recovery and Reinvestment Act of 2009; Request for Information.

The guidance will apply to breaches occurring 30 days after the forthcoming release of the final regulations.

Encryption methods that are deemed acceptable include:

• "Valid encryption processes for data at rest are consistent with NIST Special Publication 800-111, Guide to Storage Encryption Technologies for End User Devices.
• Valid encryption processes for data in motion are those that comply with the requirements of Federal Information Processing Standards (FIPS) 140-2. These include, as appropriate, standards described in NIST Special Publications 800-52, Guidelines for the Selection and Use of Transport Layer Security (TLS) Implementations; 800-77, Guide to IPsec VPNs; or 800-113, Guide to SSL VPNs, and may include others which are FIPS 140-2 validated."

Acceptable methods to destroy PHI include:

• "Paper, film, or other hard copy media have been shredded or destroyed such that the PHI cannot be read or otherwise cannot be reconstructed.
• Electronic media have been cleared, purged, or destroyed consistent with NIST Special Publication 800-88, Guidelines for Media Sanitization,19 such that the PHI cannot be retrieved."

Comments on this guidance will be accepted through May 21.

Red Flags Rule Takes Effect May 1

Editor's Note: Since this article was published, the date for enforcement has been moved to August 1, 2009.

New Red Flags rule regarding identity theft goes into effect May 1. While still being challenged, the rule is interpreted to apply to most health care organizations.

Health care organizations that accept insurance or provide payment plans are considered creditors subject to the red flags requirements.

Red Flag - Painting by Ana Bikic

Red Flags Rule requires that creditors must have identity theft prevention programs to identify, detect, and respond to patterns, practices, or specific activities that could indicate identity theft. Information including Protected Health Information (PHI), social security numbers, credit card info, claims data and other sensitive information are covered by the rule.

According to the Federal Trade Commission (FTC), Red Flags rule requires a "a written program that identifies and detects the relevant warning signs – or “red flags” – of identity theft. These may include, for example, unusual account activity, fraud alerts on a consumer report, or attempted use of suspicious account application documents. The program must also describe appropriate responses that would prevent and mitigate the crime and detail a plan to update the program. The program must be managed by the Board of Directors or senior employees ... include appropriate staff training, and provide for oversight of any service providers."

The AMA's Practice Management Center has published a sample policy for Red Flags compliance and a good overview document on what physician practices should do to prepare for Red Flags compliance.

The Week in Review - April 16, 2009

National Association of Community Health Centers (NACHC) reports that 60 million lack access to care. NACHC links the "growth of the 'medically disenfranchised' population to a host of factors that include a worsening shortage of primary care doctors in needy communities and a growing scarcity of providers willing to treat the uninsured or publicly insured."

Blue Cross Blue Shield of Minnesota initiates a pilot virtual clinic - 10 minute consultations with a doctor over the web.

Ownership of electronic health information is not clear, as the nation gears up to put this information on-line nationally by 2014.

Using genomics to assess risk of various diseases will improve over the next several years. While it's premature to test for many diseases today, "the situation may be very different in just 2 or 3 years. Appropriate guidelines are urgently needed to help physicians advise patients who are considering this form of genetic testing as to how to interpret, and when to act on, the results as they become more stable."

Health Research Insights sends letters to a physician threatening to turn him over to the feds, if he doesn't pay $347 for up-coding on 4 occasions, the earliest dating back to 2005. American Medical News reports that companies operating under ERISA are not time limited in making such claims.

The Preident and CEO of Catholic IPA Western New York argues that the national "investment in health information technology has the great potential to improve the functioning of our health care system."

Medicare's Transitions Project aims to reduce hospital re-admissions and fragmentation of care in a pilot running in 14 communities.

Washington Hospital Center in Washington DC are piloting an ethical checklist, which includes the following items to progress notes and reports:

• "Patient's wishes unclear/refusal of treatment
• Questionable capacity to consent to, or refuse, treatment
• Disagreement involving relatives/surrogates/caregivers
• End-of-life (advance directive/power of attorney, do not resuscitate/allow natural death, withdraw/withhold Rx)
• Confidentiality/disclosure issue
• Resource or fairness issue
• Other (please note)
• No notable ethical issues"

According to the New England Journal of Medicine, "only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with electronic-records systems were less likely to cite these barriers than hospitals without such systems."

The AMA launches an e-prescribing learning center for physicians.

The State Health Access Data Assistance Center and the Robert Wood Johnson Foundation "At the Brink" reports on the demographics of the uninsured broken down by state.

Obama at Georgetown: A New Foundation

Barack Obama delivered a major economic speech at Georgetown today. A large part of his focus was on healthcare. Excerpts from the prepared remarks follow.


"The fourth pillar of the new foundation is a 21st century health care system where families, businesses, and government budgets aren't dragged down by skyrocketing insurance premiums.

One and a half million Americans could lose their homes this year just because of a medical crisis. Major American corporations are struggling to compete with their foreign counterparts, and small businesses are closing their doors. We cannot allow the cost of health care to strangle our economy any longer.

That's why our Recovery Act will invest in electronic health records with strict privacy standards that will save money and lives. We've also made the largest investment ever in preventive care, because that is one of the best ways to keep costs under control. And included in the budgets that just passed Congress is an historic commitment to reform that will finally make quality health care affordable for every American. So I look forward to working with both parties in Congress to make this reform a reality in the coming months.

Fixing our health care system will certainly require resources, but in my budget, we've made a commitment to fully pay for reform without increasing the deficit, and we've identified specific savings that will make the health care system more efficient and reduce costs for us all...

We will end education programs that don't work, and root out waste, fraud, and abuse in our Medicare program...

Along with defense and interest on the national debt, the biggest costs in our budget are entitlement programs like Medicare, Medicaid, and Social Security that get more and more expensive every year. So if we want to get serious about fiscal discipline – and I do – then we are going to not only have to trim waste out of our discretionary budget, a process we have already begun – but we will also have to get serious about entitlement reform.

Nothing will be more important to this goal than passing health care reform that brings down costs across the system, including in Medicare and Medicaid. Make no mistake: health care reform is entitlement reform. That's not just my opinion – that was the conclusion of a wide range of participants at the Fiscal Responsibility Summit we held at the White House in February, and that's one of the reasons why I firmly believe we need to get health care reform done this year...

All of these efforts will require tough choices and compromises. But the difficulties can't serve as an excuse for inaction. Not anymore."

Chronic Care: Afflictions of Health and Money

The health trends and the financial impacts on the chronically ill are worsening at a significant rate. This is the recurring theme of the Center for Studying Health System Change's April 2009 tracking report, Financial and Health Burdens of Chronic Conditions Grow.

The study focused on the working-age population in the US. Key findings include:

• Increases in chronic conditions: 72 million people have at least one chronic condition, representing an increase from 34 to 39 percent of the working-age population since 2001.
• Increases in obesity: Obesity (body mass of 30+) has risen from 25 to 29 percent. 55 percent of the obese have at least one chronic condition, much greater than the 36 percent of those who are 'only' overweight.
• Decreases in private coverage: Private health insurance for those with chronic conditions has shrunk from 71 percent (2001) to 65 percent.
• Increasing problems with medical bills: An increasing number (20 million) of the chronically ill had difficulty paying their medical bills. Even controlling for the increasing financial challenges for everyone, the chronically ill were twice as likely to have families with medical bill problems.
  
• Challenges for the insured as well: "Among those who are privately insured and low income, 37 percent—more than 2 million people—reported family medical bill problems, underscoring the limitations of private insurance alone in protecting people from the high costs of treating chronic conditions..."
• Limited access to care linked to trouble with medical bills: Of the chronically ill patients in families with problems paying medical bills, 25% didn't receive needed care and 50% delayed needed care.

The report concludes that most recent economic collapse is sure to have made these statistics even worse (study results were based on 2007 data).

Health Affairs recently reported that 75% of the $2.2 trillion in U.S. healthcare costs "goes to paying the bills for chronic illness". For more on chronic care and the technology implications, see Chronic Care: Wagner's Chronic Care Model.

Latest News - April 13, 2009

A physician contends that the EHR is "the final stage in the forced metamorphism of physicians from thoughtful professionals to clerk-typists from the Katherine Gibbs School of Medicine."

The Boston Globe tags Google Health with service inaccuracies due to the use of inaccurate or imprecise billing code data.

McKinsey reports that "health care costs, health care coverage, and household income have contributed to growing disparities between different income groups in the United States."

Obama signs order creating White House Office of Health Reform headed by Nancy-Ann DeParle and announces joint DOD/VA initiative on lifetime medical records.

Opponents of public health insurance get ready for battle.

Kaiser CEO calls for health reform.

Brian Klepper recaps the progress on the Continuity of Care Record (CCR) standard.

NewYork Presbyterian Hospital provides patient/consumer-controlled Personal Health Records.

Chicago's Daily Herald reports on the the benefits of the electronic health record and the concerns regarding privacy.

A rural doctor switches to electronic medical records and the New York Times reports that she will never go back.

The Week in Review - April 9, 2009

A look back at some of the best news stories (and some entertaining diversions) from the week in health care.

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Florida Times-Union reports on slow costly transition to electronic medical records.

New York Times editorial weighs in on the "miles to go on e-health records".

iHealthBeat reports on remote patient monitoring and its use for chronic diseases (see above).

Time Magazine contributor Dr. Scott Haig challenges Electronic Medical Records, calling them the "wrong prescription" to reduce health-care costs.

"Two-thirds of U.S. hospitals have made significant progress toward implementing comprehensive electronic health records, HIMSS Analytics contends. The assertion comes in reaction to a recent report in the New England Journal of Medicine that claimed only 1.5% of hospitals have a comprehensive EHR in place."

Why don't the HIPAA rules apply to Google and Microsoft?

Open-source gateway software for the nationwide health information network released by the Office of the National Coordinator for Health IT.

PHR's and portals are up and comers - - but just not quite yet.

How Hard Can It Be To Coordinate Care?

There's one patient, one primary care physician and a couple other providers, right?

Not from the perspective of the physician who has to coordinate with 229 providers across 114 practices. A recent article in the Annals of Internal Medicine spells out the challenge.

Dr. Mai Pham is the Senior Health Researcher and Co-Director for Quantitative Research at the Center for Studying Health System Change. She was the principal investigator for "Primary Care Physicians' Links to Other Physicians Through Medicare Patients: The Scope of Coordination of Care".

Mai recently sat down with Healthcare Technology News to talk about the study and its implications for healthcare reform.

HTN: Please tell us about the Center for Studying Health System Change. With all the work on health care reform, what will this next year bring?

Mai Pham: HSC is a non-partisan, health policy research organization in Washington that focuses on understanding how health policy decisions affect people and health care markets. The coming months obviously will generate a lot of debate on the issues we’re interested in. I think it will be interesting to see how policymakers balance the desire to broaden insurance coverage versus the need to rein in costs and at least begin to tackle re-design of the health care delivery system.

HTN: You just completed a study which found that the typical primary care doctor may need to coordinate care with 229 doctors across 117 different practices. That’s an eye-popping statistic.

Mai Pham: It really is very daunting. We worked hard to keep our estimates on the conservative side – we focused only on Medicare patients and only physicians. If you consider younger patients and important providers like nurse practitioners, those numbers would be even larger. We imagine that a primary care doctor wouldn’t necessarily be able to name all the other doctors in his or her “peer network.”

HTN: The reality is that doctors can’t stay meaningfully in touch with this many providers, right?

Mai Pham: It is possible that physicians manage to exchange some clinical information most of the time, with the peers that they know about. But it seems far less likely either (1) that they know who all their peers are since Medicare patients can self-refer to any physician and don’t necessarily tell their primary care doctor about all their other providers; or (2) that all these physician peers can really engage in meaningful, shared decision-making, which I think is one of the tougher tasks in coordinating care.

HTN: So what happens today? And what should be happening?

Mai Pham: My guess about what’s happening today is that both patients and physicians feel overwhelmed by the fragmented nature of care and care relationships. Often it will seem to them that it’s not possible for anyone to really steer the ship in a way that is consistent with a patient’s needs and preferences. I think a more ideal situation might be one in which a patient identifies a single practice as their “medical home,” and is honest with that practice about care that they seek elsewhere. Then the medical home would have a reciprocal responsibility to choose their peers carefully based on those peers’ demonstrated willingness to communicate and coordinate with them, explain to patients why they prefer some peers to others, and not least – get paid to do that coordination work, which they don’t have under fee-for-service structures.

HTN: Since your study was limited to fee-for-service Medicare patients and didn’t consider non-physician providers, it’s likely that the actual number of provider links is greater than the median 229. Care to guess how much greater?

Mai Pham: I don’t think it would be as large as double, because Medicare patients will tend to be sicker and require more different physicians than will other patients, but I think it would be noticeably larger, especially for family practitioners who also need pediatric consultants. Let’s just say I pale at the thought….

HTN: You suggest that this fragmentation of care might be effectively addressed by formalizing relationships and tying payment to “peer webs”. Can you explain the peer web concept?

Mai Pham: Other terms that try to capture the same concept include “medical neighborhood” and “peer networks.” The concept is that no physician has sole influence over their patients’ care. Even if I am the main provider for my patient, their “medical home” if you will, I need to coordinate shared decision-making with all the other providers who also treat my patient. If you extend that one “web” for one patient to all of my core patients, you start to see the complexity of my total “peer web.” It’s really about shouldering the burden of care coordination as a primary care doctor.

HTN: You found that patients are seeing “7 different physicians from 4 different practices in a given year, and care of patients with multiple chronic illnesses is even more fragmented.” What does this fragmentation of care mean to the patient? Will peer webs help?

Mai Pham: For patients, I think it means a lot of mental energy goes into navigating the system, having potentially redundant conversations with different physicians, and in the end, not necessarily getting the care you need or want because details fall through the cracks. I think rationalizing peer webs can help, if there is an explicit understanding between different physicians and between physicians and patients that “this is what you can expect of me when you send me a referral” or “this is what we will do together when we consult you.”

HTN: What are the implications of your study on the requirements for the Advanced Medical Home?

Mai Pham: I think there is interest in broadening the medical home concept to incorporate this notion of a “medical neighborhood” in a way that sets realistic expectations for how physicians outside of the medical home will behave, and how each physician will be paid to support shared decision-making and effective coordination.

HTN: What other implications does your study have for the health care reform debate now underway?

Mai Pham: I think it is very tempting for reformers to focus on creating “winners,” for example by offering greater access to insurance coverage. The flip side of that is ensuring that once someone has insurance, they can actually get good care. Whether or not they take it as one of the early steps in reform, policymakers will eventually have to confront the need to re-design the care delivery system, or the money we spend on increasing access may not be worth it.

Mayo Clinic, IBM Launch Open-Source NLP Initiative

On March 31, Mayo Clinic and IBM biomedical informatics researchers announced the formation of the Open Health Natural Language Processing Consortium and donated their systems for natural language processing (NLP) to this open source initiative.

Clinical natural language processing is ideally suited for the large amounts of unstructured text found in clinical notes and reports. NLP systems "categorize and structure it according to standard nomenclature – in this case focusing on terms used in a range of medical specialties – that will ultimately speed data searches for both diagnoses and medical research. These NLP platforms or “pipelines” aid indexing and searching electronic medical records within institutions to quickly find similar cases or conditions, so physicians are not reliant solely on their own clinical experience in analyzing a problem. Researchers may also use these tools to aid retrospective epidemiological studies or do groundwork for new clinical trials."

Dr. Christopher Chute from Mayo Clinic said that up to now "much of information has languished in clinical records in a way that has made it difficult to analyze, interpret or understand across populations of patients. "

The two NLP solutions include clinical notes and pathology reports.

The teams developed methods for extracting information from over 20 million unstructured clinical notes. Physicians can "mine the text for references of specific conditions, drugs, diseases, signs and symptoms; anatomical areas or organs; or treatment procedures."

In addition, they focused on unstructured pathology reports to be able to mine cancer disease characteristics. "The system extracts tumor characteristics, lymph node status and metastatic disease information enabling the automatic computation of cancer stage, which is critical to determine optimal treatment."

Mayo reporting realizing the following benefits:

• "Physicians can research past records to examine earlier cases of rare conditions, thereby “conferring” with their colleagues across time to aid diagnosis and treatment decisions.
• Retrospective studies of tissue samples can propel new research findings, as happened with a major breast cancer finding at Mayo in 2008.
• Enhanced ability to mine data and determine potential study factors or participants has already enabled individualized medicine treatments in psychiatric care."

The Clinical Genomics Collaborative prepared this demonstration.

The Week in Review - April 2, 2009

A look back at some of the best news stories (and some entertaining diversions) from the week in health care.
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All Things Considered reports on Governor Kathleen Sebelius as her HHS nomination faces Senate questioning. Is it a preview to the "looming debate" over health care reform?

The Struggle for Reform - Challenges and Hopes for Comprehensive Health Care Legislation.

The "Right Hospital for You" reports on the top 125 hospitals, with comparative data by region with information on death rate for high risk cases, rate of major complications in cases, % of cases with proper tests and procedures, and ratings by consumers and physicians.

"A new study casts doubt on a hospital safety rating conducted by the Leapfrog Group, a nonprofit business coalition."

Drs. Mandl and Kohane argue that health care information systems should be modular, platform-based and interoperable, rather than monolithic.

In the third such suit against payers, the AMA and state medical associations allege that WellPoint "colluded with database firm Ingenix to fix prices in a multistate scheme to underpay doctors for so-called out-of-network medical care."

Kaiser reports reducing cardiac deaths by 73 percent using an integrated clinical team "connected by technology tools that help them deliver care proven to improve health outcomes. Activities such as lifestyle modification, medication management, patient education, laboratory results monitoring, and management of adverse events."

Wireless technology is used to "remotely monitor heart arrhythmia through personal mobile devices."

Study finds that 1/3 of patient bad debt should have been classified as charity care. "With self-pay portfolio balances rising, regulatory authorities are scrutinizing hospitals’ charity care practices and provisions of community benefit in exchange for tax exemptions. "

An ASQ study finds that "53 percent of hospitals report some level ("minor," "moderate" or "full") of lean deployment, and 42 percent of hospitals report some level of Six Sigma deployment".

DOD and VA partnering on lifetime longitudinal medical record.


Geisinger introduces warranties on heart surgery and "reduces bypass surgery costs by 15%".

The Save $4 Billion campaign is launched using benchmarking to improve visibility of hospitals' relative performance.

Would you pay $60 per year to e-mail your physician?

Budgeting for Change - Obama's Down Payment on Health Care Reform.

HHS Makes the Case for Health Reform: The Costs of Inaction

On Monday March 30, the Department of Health and Human Services released their report on The Costs of Inaction - the Urgent Need for Health Reform.

The report lays out the the challenge of controlling health care costs.

• "Employer-sponsored health insurance premiums have more than doubled in the last 9 years, a rate 6 times faster than cumulative wage increases.¹
• The United States spent approximately $2.2 trillion on health care in 2007, or $7,421 per person.² This comes to 16.2% of GDP, nearly twice the average of other developed nations.³
• Health care costs doubled from 1996 to 2006, and are projected to rise to 25% of GDP in 2025 and 49% in 2082.⁴
• The proportion of spending attributable to Medicare and Medicaid in the health system is expected to rise from 4 percent of GDP in 2007 to 19 percent of GDP in 2082, making it the principle driving force behind rising federal spending in the decades to come.⁵
• Health care costs add $1,525 to the price of every General Motors vehicle. The company spent $4.6 billion on health care in 2007, more than the cost of steel.⁶
• As a result of these crushing health care costs, American businesses are losing their ability to compete in the global marketplace. Health care at General Motors puts the company at a $5 billion disadvantage against Toyota, which spends $1,400 less on health care per vehicle.^7,8
• The average cost of an employer-based family insurance policy in 2008 was $12,680, which was nearly the annual earnings of a full-time minimum wage job.⁹
• From 2000 to 2008, the percentage of employees with an annual deductible greater than $1000 increased from 1% to 18%. Among small businesses, more than one in three workers must spend at least $1000 out of pocket before their health benefits kick in.¹⁰
• Half of all personal bankruptcies are at least partly the result of medical expenses.¹¹
• The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone.¹²
• Eight in ten Americans are dissatisfied with the total cost of health care,¹³ and over half report paying for the cost of a major illness as a major problem.^14"

The report cites the "persistent gaps in quality, in spite of the vast resources invested." The US scored a 65 out of 100 on the most recent National Scorecard for Health System Performance reviewing 37 indicators of health system performance.


Rebecca Adelman of HHS, in a companion piece, desribes the increasing problems with health care access. According to the report, "health care costs doubled from 1996 to 2006, and more Americans are being left out of the health care system than ever before. An estimated 87 million people -- one in every three Americans under the age of 65 -- were uninsured at some point in 2007 and 2008."