Archive for: 2010

Extending the Cure Helps CDC Kick-Off Its 'Get Smart for Healthcare' Campaign

Nov 19, 2010, 10:58 AM, Posted by RWJF Blog Team

To bring attention to the growing global problem of antibiotic resistance, the Centers for Disease Control and Prevention (CDC) observed its Get Smart About Antibiotics Week Nov. 15-21. This national campaign highlighted the coordinated efforts of the agency, states, non-profit partners, and for-profit partners to educate the public about antibiotic resistance and the importance of appropriate antibiotic use in both community and health care settings.

Extending the Cure, a Pioneer -sponsored project that examines policy solutions for antibiotic resistance, collaborated with the CDC and other partners as part of this awareness campaign.  Get Smart About Antibiotics Week helped launch CDC’s Get Smart for Healthcare program, which urges health care providers to curb the unnecessary use of antibiotics, a practice that significantly contributes to antibiotic resistance.

A guest blog post about the campaign ran Wednesday in The Health Care Blog. In it, co-authors Arjun Srinivasan, Medical Director for CDC’s “Get Smart for Healthcare” campaign, and Ramanan Laxminarayan, Director of Extending the Cure called on hospitals, healthcare facilities, and pharmaceutical companies to engage in better stewardship of these drugs.

An op-ed also ran in The Boston Globe this week, with its authors proposing an innovative solution to one aspect of the problem: compensation to the developers of new antibiotics should be connected to avoiding the overuse and overselling of these drugs. Authors Aaron Kesselheim of Harvard Medical School and Kevin Outterson of Boston University, both of whom have been studying this topic with support from the RWJF Public Health Law Research program, argued this will “preserve the power of antibiotics so that these drugs will still work in the future.” They suggest pricing new antibiotics at a higher level that better reflects their value and implementing incentive-based policies that ensure that antibiotics are not oversold.

Let us know your thoughts by leaving a comment a below.

Patricia Flatley Brennan Discusses Project HealthDesign at TEDMED

Nov 19, 2010, 1:07 AM, Posted by RWJF Blog Team

We had the good fortune of catching-up with Project HealthDesign Director Patricia Flatley Brennan while at TEDMED this year. In this video Q&A, Patti discusses how Project HealthDesign is redefining the way we fundamentally perceive Personal Health Records (PHRs), away from a repository for health information and towards a “platform for action.” This includes enabling patients to track their “Observations of Daily Living” (ODLs) to better understand the state of their health and create an impetus to action.

Check out our interview with Patti and let us know your thoughts on ODLs and the work Project HealthDesign is doing.

It's Starting to Add Up - A Few Observations from AMIA 2010

Nov 18, 2010, 11:16 AM, Posted by Steve Downs

I’ve just finished three days at AMIA’s Annual Symposium – the geekfest gathering of informaticians (or informaticists, if you prefer).  It’s a big conference, with many themes and tracks, so it’s hard to draw general conclusions as any observations are largely functions of which sessions one chooses to attend.  So I’ll try not to generalize (too much) but offer a few thoughts on what I saw and heard.

Meaningful Use policy is a really delicate business.  As provider organizations are starting to translate Meaningful Use requirements into operational plans, the details are getting really tricky.  I saw a panel representing some real EHR pioneers (e.g. Intermountain Health Care, Marshfield Clinic) that showed how even for them, who’ve been using EHRs rather meaningfully for years, they will have to make substantial changes to their systems in order to qualify for the subsidies.  Meaningful Use is a great concept because it uses large scale EHR implementation as a vehicle to shift practice in the direction of better quality (good) and more prevention (good again), but doing so without being over-prescriptive is much harder than it looks.  Finding that balance of rewarding the principles while maintaining a fair degree of flexibility on the implementation details seems to be the key (and, to be fair, easier said than done).

Health IT raises interesting questions about roles.  Dan Masys, in his perennially fascinating review of the past year’s research findings and key developments, pointed out that now study after study about clinical decision support shows the same finding:  that decision alerts always have more impact if they are sent to anyone on the care team but the physician.  He also noted that the teachable moment of an order entry system is at the moment of entry (when, for example, a drug-drug interaction or contraindication alert is triggered) and that physicians don’t learn from these opportunities if they delegate the order entry task, as is common.  Dryly, he observed that studies also show that decision support is most effective when it’s not ignored.  On a serious note, he commented that if the trend of these findings continues, disintermediation of physicians will become inevitable.  Ouch.

Rapid Learning is really starting to happen.  I attended a terrific presentation by Nirav Shah, a researcher based at NYU and Geisinger.  He’s been mining Geisinger’s EHR data, which goes back many years now, and doing just the kind of studies one would hope to see when we can start to tap large clinical datasets.  After a preliminary rundown of the pros and cons of mining EHR data vs. running prospective clinical trials, he showed how he was able to compare the effectiveness (not a sanitized clinical trial of efficacy, but actual effectiveness in terms of real-world experience) of a next-generation brand-name drug against a generic (no difference except in cost).  He also showed that he could predict, in 50 percent of cases, which patients would develop congestive heart failure six to 24 months ahead of time.  Wow.  While it would be great to see the 50 percent number climb, that kind of result opens the door for preventive interventions that could save many lives.

Power to the Patients!  One panel brought together some of the true pioneers of patient engagement.  (Okay, I’m a bit biased as RWJF/Pioneer funds two of them currently) Warner Slack, who’s a great-grandmentor of some of the students in the audience (he trained the students that trained the current generation of faculty), gave a hilarious talk about just how strange his colleagues thought him when he was advocating for greater patient participation in clinical decisions 40 years ago.  Tom Delbanco discussed the OpenNotes project , and Patti Brennan discussed Project HealthDesign and the value of tracking observations of daily living (“ODLs,” also a frequent topic on this blog).  Patti gave a very clear explanation of the value of each: OpenNotes, she said, gives a window into what the clinician is thinking; ODLs give the clinician a window into the day-to-day life that a patient is living.  Both, she said, are necessary to improving care.  Charlie Safran made some important observations about the need to drop often stereotypic assumptions about how groups of patients will behave and e-Patient Dave was both passionate and entertaining as he spoke about the value of engaging patients in reviewing their records (not only will they be better informed, they will inevitably fins mistakes – some serious). Dave’s comments raised for me a key point, which is that clinicians should make sure that patients know what’s in their records – not for any moral or philosophical reasons – but for the simple practical reason that it can improve care and safety. 

Those were a few things I noticed.  You can check out the Twitter stream for many perspectives.   I’d love to hear from others who were there and get their take.  And for those who weren’t, are these observations consistent with what you’re seeing?

Genes, John Wayne and Population Health

Nov 12, 2010, 1:26 AM, Posted by RWJF Blog Team

Pioneer Team Leader Paul Tarini posted his take on TEDMED and the broader issue of the movement towards personalized medicine on the Huffington Post today. According to Paul, it's time to start changing the way we percieve the impact of genetic data, away from a focus on the individual and towards how we can harness that knowledge to create change on a broad scale:

There’s another path, one that assumes and embraces a dynamic tension between the drive to personalized medicine and our national interest in population health.  Yes, our exploration of our genomes will produce knowledge that enables targeted, personalized care.  But aggregated, it can also produce knowledge that will advance our understanding of population-level health problems and present new opportunities to address them.

Read the full post here and let us know your thoughts by leaving a comment.

Time to Accelerate Innovation: Takeaways from this Year's mHealth Summit

Nov 10, 2010, 6:03 AM, Posted by Al Shar

I just returned from the mHealth Summit in Washington, D.C. We’ve been sponsors of the event for 2009 and 2010 – both years it’s been held. Last year there were about 400 people who attended. This year there were about 2,500, including prominent guest speakers like Francis Collins, Bill Gates and Aneesh Chopra, among others. There was also a large hall with lots of exhibitors and an extensive poster session. I guess this means that means mobile health is coming of age.

I liked it a lot, but not for the reason you might think. At most of these types of events the presentations tend to expand on the great things that are going on in the field. Here there was a good, healthy dose of skepticism. And there’s a lot to be skeptical about. There are the “show me” skeptics, the ones that ask for evidence that it actually works. There are the regulation skeptics, the ones who know the problems in getting devices approved by the responsible government agencies. There are the “disruptive innovation won’t work here” skeptics. There are the “who will pay for it?” skeptics, not to mention the standards, open source, proprietary, silo, etc. skeptics. It makes my head spin and wonder how we’ll ever get there.

There are two reasons I’m still optimistic. First, in spite of all this, the field is growing and there are big players in the field. Second, many of the issues are starting to be formally addressed at what seems to be appropriate levels. That’s good. There is an area where I think more can be done, and that’s in developing better methods for validation and evidence. There’s still a huge emphasis on the traditional clinical trials model, which sets up a fixed and structured experiment, collects data over a period of time, consolidates and analyzes the data at the end of the trial, and, after a long period of time (maybe five years), reports the outcome.

The field shouldn’t have to wait five years to understand the effects of what by then will be an obsolete intervention. In addition, this is a field where there should be continuous improvement, where tinkerers thrive, where prototypes are the rule. It makes little sense to freeze development when you learn something that will make it better. One solution might be the type of adaptive trial that pharmaceutical companies are investigating. This is one where results at various stages in a trial can effect changes in the trial model. You might change the sample size, the target population, the delivery method, the formulation, etc., based upon analyzing data internal or external to the experiment. Analysis of this model is complex but can be manageable. In the end you should be able to deliver a safer, more effective product sooner.

That’s the germ of one idea for being able to develop an evidence base for mHealth quicker and better than today. These are my thoughts. I’m sure that there are smart and thoughtful people who have others.