Healthcare Innovations

Health Care Information Bank

AATP Interactive: National Health Care Network Bill, 2006-Jun-13, by RSK

Legislation, aimed at establishing a nationwide health information technology network was introduced recently by U.S. Rep. Dennis Moore, D-Kansas. According to the proposed legislation, individuals would be able to file their medical information with an accredited health information bank that is registered and regulated through the Federal Trade Commission and the attorney general. Individuals would have complete ownership of their entire medical health record, have the rights to review the contents of the record and have the ability to add personal health information at their discretion.

ASU College of Nursing Introduces first Masters of Health Innovation

The Business Journal of Phoenix: Arizona State University launches Master's in Health Innovation, 2006-Jun-29

"As an industry, health care continues to change at an increasingly rapid pace, integrating complex technology, clinical devices, sophisticated database programs, genomic pharmacology and biotechnology," [Dean Bernadette] Melnyk said.

"Given these dynamics, health care leaders need skills in understanding, managing, creating and evaluating the continually present innovations necessary for progress. While innovation content and coursework are interspersed within many collegiate programs, no program completely dedicated to health care innovation currently exists," she said.

In New Zealand, Innovation in Healthcare Wins Awards

An innovation in support of good decisions--a cheap little spinning chart that helps nurses quickly and reliably figure out how much insulin and food a diabetic patient needs--won the Healthcare Innovation award this year in New Zealand.

OneNews of TVNZ Interactive: Health innovation awards announced, 2006-Jun-30

Intensive care specialist Geoff Shaw leads the winning team and it is the second time Dr Shaw has won at the Health Innovation Awards. In 2005, he led the award-winning Infuse Rite team, with their improved method of providing sedation to critically ill patients.

Shaw says the device has already helped to cut the death rate among his patients, reducing deaths by 30% in patients who spent less than three days in intensive care. Dr Shaw says it could save as many as 150 lives a year and $3 million if used nationwide.

The Health Innovation Awards are a joint initiative by the Ministry of Health and ACC. They promote the sharing of good ideas across the health, disability and rehabilitation sector.

Can We Remove Medical Records from Hospitals and Doctors' Offices?

Given the inertia and conflicting methods in hospitals and doctors' offices, shouldn't we just require that all medical records be remotely hosted? GE Healthcare will be glad to sign them all up for CERS--Centricity Enterprise Remote Servcies. Oh, we know there are still a lot of problems with this idea, but it showing great promise, as this article details.

Wisconsin Technology Network: GE introduces remotely hosted health services, 2006-Jun-26, by Chris Fleissner

The GE service offers a variety of functions to client institutions, including computerized order processing, nursing and physician documentation, electronic medication administration records (MAR), and patient management. These functions could conceivably facilitate hospital operations in numerous institutions. However, providers often must grapple with more fundamental considerations before purchasing a product like CERS.

Robots Can be Part of the Eldercare Solution

Colin Angle, CEO of iRobot, does a great job of explaining how robots can fit into the future of healthcare. He  notes that small specialty robots, such as one's that monitor your health or help out with everyday tasks, quickly become companions which can help reduce social isolation. The point is NOT that robots can replace caregivers but the robots have a role to play beyond that which we currently imagine.

CNET News.com: My friend, the robot - page 2, 2006-May-24, Interview of Colin Angle, CEO of iRobot by Tom Krazit (via Iconowatch)

Where is the greatest future potential for robots?

Angle: Well, I think providing the independence that an aging person requires to remain living independently--meaning, I want to live in my home until I die, and I can't afford a live-in nurse, and even if I could afford a live-in nurse, there aren't any and I don't want to be driven to the doctor's every other day. My robot takes care of me. I'm able to live all my life, I can visit my friends, I could continue my existence even as my physical capabilities diminish.

Is this something you envision as a device that is medically taking care of you, like monitoring your health, or is it something that's doing all the things that you can no longer do because you are too feeble to do so on your own?

Angle: We already sell eldercare robots; they are called Roomba and Scooba.

Overcoming Communications Problems

We all heard the announcement from the Institute for Healthcare Improvement that errors are down. At the Wall St Journal, Laura Landro has some details on how communication and hand-off processes are changing.

WSJ.com - The Informed Patient, 2006-Jun-28, by Laura Landro

John Whittington, patient safety officer at OSF St. Joseph Medical Center, says the SBAR "quick briefing" model can help overcome differing communication styles, such as nurses who give long, descriptive reports and doctors who say, "just give me the headlines," and don't want a nurse's opinion. OSF started training staffers to use the SBAR communication model in 2004, offering pocket cards and laminated "cheat sheets" posted at each phone.

At first, nurses and other staffers were hesitant to provide the "R" -- for recommendation -- to physicians, Dr. Whittington says, but doctors were asked to encourage staff to do so. By last year, the briefing format was used by more than 98% of nurses and the rate of adverse events -- defined as an unexpected medical problem that causes harm -- fell to 39.6 from 89.9 per 1,000 patient days, Dr. Whittington says.

Technology for Home Care

A Wall St Journal reporter dropped in on the White House Conference for the Aging in Washington and reports on a wide variety of tools and technologies for taking care of chronic health problems of an aging population at home. This is one area where Intel has been deploying all the ethnographers they recently hired. Companies large and small are innnovating tools for people to care for themselves and tools for remote monitoring of their health. The costs are very high because most of these tools are based on computerized sensors.

WSJ.com: The Future of Health Care?, 2006-Jun-26, by Sarah Lueck

"Right now I think everyone is trying to prove these things work," says Gregg Malkary, managing director of Spyglass Consulting Group, a Menlo Park, Calif., provider of market research for technology companies. That's a crucial hurdle if companies want government programs or health insurers to begin reimbursing for care provided electronically or by robots.

Perhaps the biggest issue is to get the nation, including the government, to think seriously about how to deal with the aging population.

"Our crisis is going to hit in the next 10 or 15 years," says Mr. Bodoff in Washington. "We're generally not preparing for it."

Politics of Innovation

For an excellent picture of a broken health care system which has its hands tied when it comes to helping people, see this WSJ article (paid subscription required) about heart failure and Medicaid. Doctors know how to manage its course but Medicaid won't reimburse them for it. Mt. Sinai finally swallowed hard and accepted the risk of making a change.

WSJ.com: How a Hospital Stumbled Across An Rx for Medicaid, 2006-Jun-22, by John Carreyrou

At a strategy meeting with hospital administrators, Dr. Chassin proposed using the heart-failure program as a bargaining chip. By turning it into a permanent program, Mount Sinai would reduce hospitalization rates of heart-failure patients, saving the state money. At the same time, the higher Medicaid reimbursements Mount Sinai's clinic would enjoy as a DTC would cut its annual losses by several million dollars a year. Part of those savings would fund the heart-failure program and the rest would flow to Mount Sinai's bottom line.

One Unknown

One unknown in the financial equation was how much revenue Mount Sinai would lose by improving its patients' health. Dr. Davis says he didn't worry; with Mount Sinai's occupancy rate around 95%, he figured the hospital could replace heart-failure admissions with more lucrative, non-Medicaid patients, such as those getting hip replacements. "Having fewer heart-failure hospitalizations is actually very good for Mount Sinai," he says.

The state agreed, hoping that the increase in reimbursements would be outweighed by the reduction in hospital bills. The heart-failure program resumed as a permanent program in September 2005 and so far about 40 East Harlem residents have been enrolled.

Why Healthcare Can't Innovate

Actually, if it makes Tim Gee feel any better, most innovations everywhere fail, but healthcare innovations do face more complex and opaque problems than most. The May issue of the Harvard Business Review included an article Why Innovation in Health Care Is So Hard by Regina E. Herzlinger (that'll cost you). At his blog, Tim reviews the main six issues (players, money, timing, regulations, customers, and proof) and adds his observations. Regulation seems like it would be the biggest issue, but I suspect that the difficulty of figuring out who the real paying customer for the innovation will be is the trickiest challenge, decision-making and funding being so divorced.

Medical Connectivity Consulting: Why Most Health Care Innovations Fail, 2006-Jun-9, by Tim Gee

Most who have been in health care for any length of time experience a crisis of confidence when they've had enough of the seemingly arbitrary way in which some deserving innovations fail while others succeed. This is the point where many of us leave health care for more "rational" markets.

Mounting Collaboration

Physicians are starting to catch up with the rest of professionals when it comes to using online collaborative tools. Businesses have been making document sharing and editing tools available, even to their contractors, for years. Now research physicians, who collaborate more than the institutions who employ them, are delighted to join us by using the free tools from Google.

Clinical Cases and Images - Blog: How Can Academic Physicians Benefit From "Google Office"?, 2006-Jun-6, by Ves Dimov, MD

We already use Writely.com to collaborate on articles at our section at the Cleveland Clinic and several members of the group (including me) are very happy with it. No more emailing back and forth different versions of one document and you can see all the revisions.

For example, KidneyNotes and me are currently working on an abstract together. He is in New York and I am in Cleveland but if he edits the document at the same time as me, I can see the changes in real time....

Online Spreadsheet

Google Spreadsheets, which is released today, is the logical next step -- now you can combine the data online and share it with other researchers. .... HIPAA compliance is a must -- no patient-identifiable information can be stored on Google servers.

Blogging Through Illness

San Francisco Chronicle: 'Sick blogs' help afflicted share news, seek comfort, 2006-Jun-14, by Justin Berton

"At first it was just to clear my head," he recalled. "Your mind gets cloudy when you get diagnosed, so you don't want to forget all the things you're hearing -- and so you start to write them down. ... But then it turned into something more."

Rahenkamp, who now attracts a readership of 40,000, is part of a growing subgroup of bloggers who write about their illnesses. The reasons for creating such blogs vary -- from the need to efficiently update family and friends about one's health to the desire to share stories about medical treatments with fellow sufferers. But for many so-called sick bloggers, a primary aim is to achieve an emotional catharsis by writing and disseminating their thoughts online.

Arthur W. Frank, a sociology professor at University of Calgary who has studied the history of "illness narratives" and has written a book titled "Wounded Storytellers," says the instinct to share one's sickness is an age-old tradition but one that is being recast because of the Internet.

No Demand for Personal Health Records

Consumers Reveal Personal Health Records (PHRs) Are Barely on Their Radar, press release from Health Industry Insights, May 26, 2006

A survey of 1,095 consumers, conducted by IDC's Health Industry Insights research and advisory services firm, reveals the majority of respondents (83%) have never used personal health records (PHRs) in either electronic or paper form. The primary reason for not using a PHR, according to the survey results, is lack of awareness. Fifty-two percent (52%) of respondents indicate they are simply unaware of the concept, with nearly one in five (18%) noting they would consider using PHRs if recommended by a physician. When asked of their plans for future use of a PHR, consumers are decidedly ambivalent, with 82% "uncertain;" another 8% stating "never."