"Canada+Plus": It Leads US in Healthcare IT
The head of Canada's two-year-old Office of the Coordinator of National Health IT (usually shorted in print to OCNIT) recently announced that his federally-supported, non-profit organization -- Canada Health Infoway -- had already invested over $560 million in health information technology projects designed to make paper records obsolete from Newfoundland to British Columbia. The total includes over $150 million for electronic health record systems and approximately $130 million for the development of diagnostic imagining systems.
The federally-invested funds have been matched by equal amounts at the provincial, regional and local levels. Canada Health Infoway estimates all this effort and investment will reduce the country's nationwide health service costs by $6 billion a year in the foreseeable future. A huge amount of investment and projected return when you realize that Canada's population is just a bit more than 10% of our own.
OCNIT's cost-of-operating in 2006 is $111 million. Infoway's reported goal is to provide electronic healthcare services to at least half of the country's population by 2009. As an example of how quickly they are moving, a pilot project is now underway in Alberta, Canada's deep-in-the-snow country's relatively-inaccessible but surprisingly well-populated (a million residents) Northern Lights Health Region.
Initial objective is to connect the town of Fort McMurray with provincial capital Edmonton. Eventual goal is to quickly-as-possible bring electronic health records to every segment of the wide-open province.
Others are doing well, too. Canada's presentation was made at a recent "first world" HIM conference in California in which a number of reports-of-IT-progress were offered. The head of HIM services for the European Union stated their group is moving along quite well…having committed over $1 billion is research and development funds to healthcare IT projects. He stated a surprising 80% of the European Union's primary care physicians are connected to a form of the electronic data interchange system. Several member countries -- France, Germany, the Czech Republic, Austria and Italy -- have adopted "smart cards" which are interoperable in all member-nations.
Great Britain reported its National Health Service has a broadband network up-and-running through sections of England, Scotland, Wales and Northern Island. They boasted it will grow to be "the largest virtual network on the planet" when it is deployed to all 18,000 National Health Services sites throughout the country.
Also presented were the results of a survey of CIOs in U. S. healthcare-related organizations. It concluded that only 18% of American hospitals have installed some form of EHR systems… 42% are in the process of installation … and 22% "plan" to install. Apparently the final 18% still haven't considered any form of IT installation in the immediate future.
"Canada-Minus": The Penalty of Extremism
The increasing downward spiral of the once highly-acclaimed Canadian Healthcare delivery system continues to make much news; most of it bad. Just a bit of necessary background. Today there are basically three operating healthcare models among the industrialized nations. Our own, of course, is pretty much a pay-as-you-go system, making generally excellent healthcare available to those who can either choose their provider as self-pay or who are covered by a health plan that encourages the use of their network providers. The European system is two-tiered: basic service is available to all (but much scanning and surgical procedures call for uncomfortably-long waits) and the option to sign onto one of the many private insurance plans that are available. In England, for example, a patient with a knee problem gets a set of crutches and a place on line for most-likely a year-away scheduled surgery…unless he has an override insurance policy which puts him at the head of line for immediate service at a private hospital, since British doctors are permitted to practice "privately" for a portion of each week.
Canada has the third and most-rigid delivery system. Everyone is equal, no exceptions. Physicians' payment-for-services can only come from the provincial government. Doctors are prohibited from treating ahead-of-the-line "private" patients or more-quickly performing procedures -- from scans to major operations -- except in the case of a severe accident or an immediate life-threatening situation. All these mandated-by-law free services are equally available in public hospitals to all Canadians …though usually far off on too-long waiting lists caused by budget restrictions.
Faced with a problem that no one seems able to solve, quality-care pay-as-you-go hospitals and clinics have started to open all over the country. Now illegal public hospitals are reportedly sending seriously-ill patients to them, simply because they cannot treat these patients in both reasonable and necessary time.
Private diagnostic centers are also opening at a rapid pace. In the face of this, many die-hard provincial officials are threatening major fines and serious battles if this continues, while some seem willing to at least consider some minimum form of a two-tiered system.
Legalization of healthcare insurance is increasingly being presented as an acceptable minimum answer; the courts are starting to agree. Last summer Canada's Supreme Court ruled that the province of Quebec's ban on private health insurance was unconstitutional because people on the waiting list were suffering and dying. And all realize that the affluent-in-trouble merely cross the nearby American border to immediately get quality diagnostic service and surgical care. How's that for unfair?
Meanwhile, Dr. Brian Day -- a leader in the private care rebellion and founder of the "illegal" Vancouver hospital -- has announced plans to open five such hospitals across the country. He is also the next-scheduled president of the Canadian Medical Association.
Newest "New Math"
Little known component of the new Medicare prescription plan is that Congress has authorized the federal government to subsidize the current retiree prescription plans of many large-to-giant corporations…and thereby save the feds huge amounts of money! This according to a new study by Credit Suisse First Boston.
There really is an almost-logical fiscal plan behind the apparent oddity. Many major corporations are struggling with mountainous retiree healthcare costs, which have become a major financial drag on their "bottom lines". Often most-visible are their prescription plans, all of which carry modest co-pays.
Corporate figures can therefore improve if they can convince retirees to individually shift -- at company expense -- from their present company-sponsored prescription plan to a "new-and-better" Medicare prescription plan. Enabling these corporations to thereby reduce a portion of their overall retiree healthcare costs, while pointing out to retirees that they are getting even better overall benefits. All this in turn would cost the government huge amounts of unplanned-for additional dollars, since the Medicare drug plans are federally-subsidized.
More than 330 of America's top 500 corporations offer some level of retiree prescription plans. The government has said to them: prove to us that your level of co-pay is less than the new Medicare plan and we will in-part subsidize your plan rather than face the added problem of having too many already-covered retirees shift to the new Medicare plan… which we will then have to subsidize even more heavily!
To date, employers with a total of 6.5 million retirees in their various plans have signed on for the government's subsidiary, enabling them -- with little or no cost -- to increase their retiree's prescription plan to the level of the new Medicare plan.
The feds point out that they are also helping protect individual retirees from getting their benefits reduced by cash-strapped former employers. The high-profile company in most dire straits in this area is General Motors, which is apparently scheduled to receive just over a billion dollars in these CMS subsidies over the next four years in order to keep their retiree prescription plan benefits at its current level. Another such struggling-for-survival company is Delta Airlines, whose current finances have stripped them of much of their corporate reserves. But others, such as Bell South -- now in the midst of a possible takeover -- are a lot healthier. Apparently this type of subsidy is being offered to state and local governments, most of which currently offer similar retires prescription plans.
HHS Moves to Set HIT Standards
Making the point that the federal government pays 46% of the healthcare bills in America, HHS Secretary Michael Levitt says it is therefore the duty of the feds to prod patients and caregivers into a more-efficient, more practical and less-costly healthcare system. At the top of his list is quicker adoption of electronic medical records. HHS has therefore launched a program that is sure to generate quite a bit of "heat". Its stated goal is to codify and evaluate current operating procedures…across the board. In the coming months, his people will analyze fifty metro markets and then request that the largest employers in each area to voluntarily join the government in a combined effort to establish four significant initiatives.
Cooperating employers will be requested to only work with insurers that provide both clearly-established price and quality standards for common medical procedures…and even more-importantly, also offer privacy-protected electronic medical records. Finally, these companies will be asked to offer their employees the option of switching to health savings accounts rather than their standard coverage.
The need for such an initiative seems to coincide with a several-year-old study, recently reported in the New England Journal of Medicine, which effectively derided our fragmented healthcare system that the researchers found to be unfair to a huge number of Americans, most of whom had "good coverage". The authors of the article reported a telephone interview study of 6,700 patients in twelve major metro areas that received care between 1996 and 2000. Quality of care was evaluated according to 439 indicators for 30 acute and chronic conditions.
Conclusion was that only 54.9% of the care normally recommended for their conditions was received. Quality of care generally decreased as people got older. Higher-income people got only slightly-better care than those with lower incomes. Insurance status had little or no effect on quality of care. Blacks and Hispanics surprisingly got a slightly better level of care than did whites.
The fact that the numbers were so low and the results so unexpected was largely blamed on the lack of Information Technology that even then could have offered caregivers and insurers the kind of feedback that leads to action.
Feeling is, this technology is here and must be used to its maximum advantage if Americans are to be given the care they expect and deserve.
State-of-the-Art IT
Wi-Fi has started to replace many internal hospital phone calls and, with the help of a voice-over "instant messaging" system, also effectively eliminate those often-annoying hospital-broadcast pager systems.
It's all done using a send-receive "badge"; a button that can be clipped to a pocket or uniform. The sender accesses the recipient's code to discuss plans or orders as necessary. That varies from surgeons quickly lining up a trauma team, to administrators looking for vacant beds, to doctors asking for consult, to nurses requesting adjustment of a patient's meds. Those using it say the system's virtual instant-access often leads to saving patients' pain, discomfort… or even their lives.
And eliminating all those phone lines apparently can result in the system paying for itself in quick-time, too.
User Fees for Generic Drugs
The FDA is asking for help, in the form of "user fees", from the growing generic drug industry. User fees are currently charged and paid by the makers of brand-name drugs, medical devices and even animal drugs; all in an effort to offset a major portion of the FDA's cost of analyzing and reviewing these products before releasing them to the public. The agency claims that it is currently both under-funded and overwhelmed by a review backlog of more than 800 generic-drug applications.
One of the essential duties of the FDA's Office of Generic Pharmaceuticals is to analyze the proposed generics to ascertain whether they are equivalent to the "name brand" and to continue monitoring these replacements as long as they are on the market.
In response, several spokespeople for the Generic Pharmaceuticals Association claim that the current problems need more than just users fees to solve the backlog. Stating that the FDA has, for many years, been following a planned underfunding of the Office of Generic Drugs… thus allowing the brand-name producers to effectively extend their patent periods, as procedural gimmicks block the earliest-possible introduction of many generics. Which seems to say that they would be willing to pay those fees if it led to the elimination of what they see as regulatory and legal obstacles which continually work to keep generics off the market, sometimes for years.
Odd point is that both sides are talking about relatively small amounts in terms of government budgets and spending. The spokesperson for the GPA claims that Congress needs to appropriate an additional $15 million to solve the generic-backlog problem. On the other hand, that represents almost a 50% budget increase to the Office of Generic Drugs. The generics' spokespeople point out that the FDA's Office of New Drugs has a budget of $400 million for analysis and oversight. Any funding increase would have to be approved by Congress.
Chips In, Somewhat Fearfully
Microchips implanted under a patient's skin which are able to provide instant emergency access to his or her medical records are starting to earn basic acceptance from some patients, but lots of privacy worries from many more. Approximately 80 emergency rooms across the country - including Hackensack University Medical Center in Northern New Jersey -- now routinely scan emergency-care patients when added facts are needed. Estimates are 200 hospitals will do the same by end of year.
But it is a slow process, Hackensack reports that perhaps a dozen residents in the north Jersey area are now carrying the chip. Estimate is perhaps 100 are implanted nationwide. According to the manufacturer, about 2,500 chips have been sold worldwide; perhaps 15% have actually been implanted, though a number of hospitals - at least three in the nation's capital -- have received scanners and reportedly are training ER staffs in their use.
The basic devices, incidentally, were originally developed to track wandering and stolen cattle. They have also been implanted in more than six million dogs and cats that may have been stolen, or merely wandered off.
When used for humans, the microchip, plus a copper antenna, locked in a glass capsule about the size of a grain of rice is quickly inserted under the skin on the back of a patient's arm using a "relatively painless" large bore needle. It then transmits a special 16-digit number than can be read by a nurse or doctor using a handheld scanner.
The number electronically seeks out the patient's medical records which have been stored on a secure web site. The site provides the vital information that a comatose patient is not able to deliver: ID, blood type, allergies, current meds and much more, including next of kin in most cases.
Better Back Repair
Spinal fusion has always been a painful and difficult operation, requiring a large incision to implant long screws and a metal connecting bar in the back. Up to a five day stay in the hospital and of pain control for the patient.
Much of the pain and suffering may be alleviated if the FDA approves a less-invasive treatment which uses a disposable "gun" that requires a small incision and drives stabilizing screws into the vertebrae. Quick operation, shorter hospital stay, much less pain; all of this is promised by U. S. Spine, a privately held Florida start-up company.
The completely-new surgical concept was developed by a University of Michigan surgeon-researcher. His "gun" is two-triggered; the first trigger-pull pushes an inner metal tube forward; its job is to compress and better align the bolt that is then fired into a locknut which effectively fuses two vertebrae.
Currently two "giants", J&J and Medtronics, control the spinal device market.
Transcription Tips
Two clotting disorders have sound-alike names. "Leiden" refers to a blood clotting factor V deficiency causing Owren disease, a rare hemorrhagic tendency or parahemophilia which varies in severity. "Leyden" refers to deficiency of factor IX, causing Christmas disease, which is similar to classic hemophilia, but the bleeding tendency abates after puberty. If the name is not spelled by the dictator and no 'clue' is given, you should leave a blank with a notation regarding question of Leiden versus Leyden.
Lung Cancer: First and Worst
The early death of Dana Reeve in March led many medical sources - including WHO and the American Cancer Society - to re-issue some numbers that we have all seen before, but too-often ignore.
Worldwide, lung cancer is both the most-common and the most-killing form of the disease. One million deaths a year; one million new cases a year. In the face of great medical advances across the entire breadth of cancers, approximately 60% of people die within a year of being diagnosed with lung cancer. Smoking causes 80% of these cases; this includes smokers and those merely exposed to tobacco smoke. Currently 20% of women stricken with lung cancer never smoked.
The good news, if there is any, is only about 3% of people under 45 are afflicted with the disease. Non-smoker Dana Reeve was 44 when she died.
Medical Minutia
Taking patients' temperatures at arm's length, at the click of a button on a camera-equipped cell phone, is apparently in final development stage. Making it all possible is the infrared technology developed to enable soldiers to "see" in the dark. The phones will also help campers find friends who may have wandered off …or help homeowners locate a hot water pipe in the wall. Just point, click and the exact warmth of the patient, friend or device will register on the cell-phone's screen. The "temperature phones" hopefully will be available in a year or so.
EDITH Goes to Work
Time was when an EMR installation was a very special and unique event. Today they are getting common and user-friendly enough to enter the sphere of name-that-systems contests.
Midland Memorial Hospital in West Texas plans to have an electronic patient record system up and running by year's end. But first came a hospital-wide contest to give it a bit of a personality, starting with a name. The winner was EDITH: Electronic Data Information Team for Healthcare…which stands for a marriage between the hospital's current system and the proven-effective Veterans Administration's VistA software, parts of which were already used in Midland's pharmacy and labs.
The getting-to-know- you period started at the end of January with the first group of doctors and nurses assembled for hands-on training. It is projected that, by year's end, about 1,000 people will be trained on the system.
A small, first-stage segment was put to work at a single surgical nursing unit in February. From here on, EDITH will be introduced in stages throughout the hospital; throughout the year. It will eventually cover all physician's order entries, nursing documentation, patient medical history, lab tests, social services, patient progress reports and assessments…as well as possible clinical alerts. EDITH should be quite the popular West Texan by this time next year!
Auditing the News
Complaints are rampant that various states aren't investing enough money in the anti-smoking campaigns…an important promised benefit in their $246 billion settlement with the tobacco companies. However, Americans smoked fewer cigarettes in 2005 than any year since 1951 and per capita consumption fell to levels not seen since the early days of the Great Depression.
The facts were presented by the association of state attorneys general, who went on to say of the original target that only 15% of youths and 12% of adults will still smoke by 2010 was achievable. Long way to go, though. Current federal studies show that 21.7% of high school students now smoke, as do 20.9% of adults.
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In an interesting crossover, early testing of Viagra (sildenafil) shows it just might prove to be an effective treatment for a number of heart, lung and circulatory diseases…by mildly decreasing blood pressure, increasing circulation, effectively protecting heart and lungs from stress. Doctors warn, however, that there is much need for more clinical trials before its widespread use in these areas.
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A non-profit consortium of public health groups in Louisville, Ky. is hoping to develop a HIM system that will move quickly ahead and hopefully even become a national model. Key element is that it provides incentives for all participants… physicians, hospitals, employers and patients.
Researchers at the U. of Louisville School of Public Health initiated the program about two years ago. They project that, in just several years, the network could achieve annual cost-of-care savings of over 7%.
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According to the American Heart Association, it seems that stroke victims can regain use of an impaired arm as much as five years after the original incident. Previously the recovery "window" was considered to be about six month maximum.
Doctors and physical therapists at the University of Alabama accomplished their results in a short, intensive program of immobilizing the full-functioning arm and thereby forcing the patient to use -- and strengthen -- the weak one. Purpose is to encourage the brain to send more signals to the impaired area. The degree of recovery varied, but some patients could again use their stroke-weakened arm and hand to write their name.
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The FDA apparently is worried by the fact that the introduction of new drugs is at a twenty-year low, even though pharmaceutical research spending is at an all-time high.
This in part because 90% of experimental drugs fail when tested on humans.
Plan is to develop a "critical path" program that will measure, at earliest stages, the possible toxicity and efficacy of developmental drugs, thereby separating drugs with greatest potential from those of more-questionable merit. The FDA has formerly requested $6 million to fund the proposed program.
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New drugs are still coming through the pipeline. The FDA reportedly is leaning-towards approval of some four potential blockbusters later this year. Two are sleep-related: Pfizer's Indiplon to make sleep easier and Cephalon's Nuvigil to improve wakefulness. Wythe's Bifeprunox & J&J's Paliperidone ER, both easier-to-live with antipsychotics are also forthcoming.
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The plan to slim down youngsters by cutting the calories in their junk food seems to be struggling. The Center for Science in the Public Interest is doggedly trying to get a better-nutrition approach across to Coke, Pepsi for both their sugared soft-drinks and many snack foods. Legal action is being threatened against these companies and several major "junk food" marketers.
The basis for these threats is a report from the Robert Wood Johnson Foundation that found obesity in the six to eleven age bracket has tripled since 1975. In addition to working to ban soft drink machines and monitoring the snack food offered in school cafeterias, CSPI would like to limit advertising of such products at children's prime viewing time on the Nickelodeon channel.
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So-called "Alternative" remedies are a $20 billion dollar a year industry that needs lots more oversight according to continuing government-funded research efforts. In the past several years St. John's wort was found ineffective when used to treat major bouts of depression…saw palmetto was unable to lessen prostate problems …Echinacea could not markedly ease the ravages of the common cold…and powdered shark cartilage was found was virtually useless when used to battle several types of cancer.
Latest addition to that list are two extremely-popular arthritis pills...glucosamine and chondroitin. Recent government studies concluded that they fared no better than placebos.
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