ZDNet Healthcare

April 4th, 2008

Fat is a market on fire

Posted by Dana Blankenhorn @ 11:33 am

Categories: General, Hospital Equipment, Home Health Care, Research, Rehabilitation, Wellness

Tags: Obesity, Productivity, Marketing Research, Marketing, Dana Blankenhorn

Obesity has gotten so big, and so many people are now getting surgery to fight it, that Frost & Sullivan has broken out its first marketing report on the subject. (Picture from Medicalook.com)

The “U.S. Obesity Surgery Devices Markets” further divides this market into four pieces:

1. Laparoscopic gastric bypass, what you might call the full Roker 
2. Laparoscopic gastric banding, which put the skinny on Brian Dennehy. )
3. Endoluminal technologies, pioneered by, among others, Dr. Shawn Garber of New York, and
4. Other emerging techniques (you don’t want to know).

Someone is getting phat on your fat. Does the rising price of flour spell opportunity for you? You don’t want your neighbors looking to milk you for a pint so they can drive to the store, do you?

How about we take a walk this weekend?

April 4th, 2008

We’re number 43!

Posted by Dana Blankenhorn @ 6:34 am

Categories: General, Curioisities, Wellness

Tags: Fish, Business Ethics, Productivity, Blogging, Vertical Industries, Development Tools, Handhelds, Leadership, Management, Internet

The late, great Douglas Adams once wrote that the secret to the universe is 42, so we’re pretty close.

But 43 in this case is our ranking in Laura Milligan’s list of “The Top 100 Academic Medical Blogs.”

Looking over the list, it seems this doesn’t mean we’re the 43rd best medical blog out there.

Instead Laura created categories — research, news, ethics, neuroscience, pediatrics, technology, cancer, libraries, alternative medicine, etc. – then poured her bookmarks into them.

We’re in the technology section, naturally, alongside medGadget, the Healthcare IT guy, and Medical Nerds. Still pretty good company.

Lists like this represent a form of spring cleaning for the author and a rummage sale for the reader. It can be fun to see what someone else thinks is important.

Take Medical Nerds, which I’m sorry to say had not been on this blogroll before. Chris Pearson offers short, snappy, gadgety takes on using tools lots of doctors have, like Blackberries – it’s obvious he’s a fine programmer.

The word “fish” is sometimes defined as the newcomer in a college or prison, as in new fish. So the best way to conclude this piece is with Adams’ own words, “So long and thanks for all the fish.”

April 3rd, 2008

Burden of uninsured now closing non-profit hospitals

Posted by Dana Blankenhorn @ 11:18 am

Categories: General, Government, state government, Ethics, Finance

Tags: Hospital, Healthcare, Dana Blankenhorn

In all the flurry and fury concerning Grady Hospital in Atlanta the threat of its closing, while real, has seldom been taken seriously.

Grady recently appointed a non-profit board to stave off bankruptcy. The hope is that charitable fundraising and a small statewide car tag tax will save the state’s only Level One trauma facility.

But the fact is that the burden of uninsured patients is closing hospitals, around the country. State-supported charity hospitals, like Grady, have been among the first to go, but this is now extending into the non-profit sector, with the closing of St. Francis Hospital south of Chicago.

As these hospitals close two things may happen. The burden which closed the hospitals shifts to other hospitals, to any hospital which follows its Hippocratic Oath and serves people first, then asks about money.

Second, of course, uninsured people die.

Both these things are happening right now. A lack of routine care makes sick people sicker. A fear of costs causes sick patients to be shuttled about. Doctors, as well as patients, put off care and people die.

Maybe that’s OK. If you lack resources maybe you deserve to die.

But that’s not the way doctors operate. It’s against their professional code.

So, should the doctor’s code be changed? Right now it’s being changed in practice, as more-and-more doctors turn away from the burden, and others undergo burnout.

If you think poor or uninsured people should die and not be given care, say so. That’s all I ask. Although I should add we’re all one lay-off notice away from being in that position, and this recession has just begun.

April 3rd, 2008

A HIX tax moves ahead in Vermont

Posted by Dana Blankenhorn @ 7:26 am

Categories: General, Medical Office IT, Government, state government, Networking, Medical Records, Finance

Tags: Fee, Electronic Health Record, Doctor, E-health, Healthcare, Taxes, Financial Planning, Finance, Dana Blankenhorn

The Vermont House voted 119-19 last night to keep a tax on medical claims aimed at paying for computing systems in doctors’ offices and an online network to trade the records.

The fee would raise $33 million over the next 10 years and would allow all doctors to create Electronic Medical Records (EMRs) which would link to a Health Information Exchange (HIX).

The state’s governor, Republican Jim Douglas, opposed the fee but it passed on a bipartisan vote.

The fee was pushed by  Vermont Information Technology Leaders, which was formed in 2005 to push information technology into the state’s medical establishment.

The argument for the fee is that insurers are the primary beneficiaries of a HIX network, but that doctors are being pushed to buy the necessary EMR software.

Opponents noted that 13% of the state’s doctors already have an EMR system and 30% have plans to buy them.

While Gov. Douglas strongly opposed the fee, a spokesman said he would be unlikely to veto the state budget if it’s in there.

April 2nd, 2008

Concierge medicine

Posted by Dana Blankenhorn @ 8:06 am

Categories: General, Aging, Home Health Care, Medical Records, Wellness

Tags: Patient, Dr., Dana Blankenhorn

Ever envy those rich guys with their own personal doctors? Now you can get one of your own.

Well, part of one.

Concierge medicine is a bit like those share a corporate jet programs, and now it’s coming complete with a franchise.

The franchisor in this case could be Dr. Lorne Stitsky of Jupiter, Florida (center in the picture above), the “House Call Doc”, now doing business as Personal Choice Family Practice.

Instead of charging a per-visit fee, Stitsky has 400 patients pay him a yearly fee. He figures he can do just as well with 400 paying regularly as he did serving over 3,000 patients at his old office, seeing 30 per day and charging per-visit.

And now he can make house calls.

Here’s where it gets interesting. Dr. Stitsky has teamed up with Medefile, an EMR company in Cedar Knolls, NJ, to get his patients’ personal health records onto its stick drives.

Now he not only has a business model, he has on that scales. With a technology platform in place, which also scales, plus a brand name, Dr. Stitsky may soon not have to see patients at all.

April 2nd, 2008

Pennsylvania joins Health Information Exchange movement

Posted by Dana Blankenhorn @ 7:05 am

Categories: General, Government, state government, Networking, Medical IT, Medical Records, Finance

Tags: Pennsylvania, Health Care, HIE, Healthbridge, eHealth Initiative, Vertical Industries, Healthcare, Benefits, Enterprise Software, Software

Pennsylvania has become the latest state to join the rush toward Health Information Exchanges (HIX), through an executive order signed by Gov. Ed Rendell.

An HIE provides a framework for sharing medical records among doctors and hospitals. Often, as in the Pennsylvania case, it’s pushed by industry groups like HIMSS.

It’s also pushed specifically by vendors. The framework of the Pennsylvania HIX was detailed last week by the man in charge, Philip Magistro, during a speech at Siemens Medical’s corporate office in Malvern (above).

The next hurdle is money. New York’s HIX recently secured a $4.6 million grant from the state health department. Massachusetts and Indiana also have active HIX programs.

Not all HIX systems are statewide. Healthbridge covers the Cincinnati metro area. Mendocino HRE covers a part of northern California. The non-profit eHealth Initiative offers a full list of them.

What we’re getting is a quilt of systems, driven by different types of groups, that will be a bear to integrate. It’s progress that we’re seeing anything at all.

April 2nd, 2008

Solving the loose laptop problem

Posted by Dana Blankenhorn @ 6:29 am

Categories: General, Medical Office IT, Gadgets, Networking

Tags: Software, Patient, Laptop Computer, Notebooks, Hardware, Notebooks & Tablets, Dana Blankenhorn

The stories come out in dribs and drabs, and each one gives doctors another excuse to avoid electronic medical records:

• A man is arrested in Indiana with laptops containing patient data from a local VA hospital.
• Thieves in Grand Rapids, Mich. steal 14 laptops from a medical office, and workers are trying to see if records were compromised.

Check your local paper and you’ll find stories like this nearly every day. Because laptops are light they are easy to steal. This makes patient data easy to steal.

A solution may come from an unlikely source — secretaries.

Philips has announced what it calls a USB Smart Key to protect its dictation software.

We’re basically talking about a stick drive with a lengthy license key and software. Plug it in from any laptop and you’re good to go. (Shown is the iLok version of this device — note it has an extra chip with the software key.)

You can protect medical records the same way. Such a drive would allow access to a central storage system, and software, from anywhere.

But if the laptop you were using were stolen, no access. And if you tried to use the stick without a password, same thing. A thief would have to kidnap the key owner, or be an insider.

The problem of securing medical records in a mobile world is a serious one. Fortunately it’s not an insoluble one.

April 1st, 2008

Who kicked up the cell phone scare?

Posted by Dana Blankenhorn @ 7:09 am

Categories: General, Internet, Consumer Information, Curioisities, Research

Tags: Phone, Dr., Cell Phone, Telecom & Utilities, Dana Blankenhorn

His name is Vini Khurana (right). Doctor Khurana to you.

Best known (until now) for having performed the first brain keyhole surgery (with the patient awake), he has now compiled a review of all the data he could find on cell phones and brain cancer. (The last link is to a PDF version of Dr. Khrana’s report.)

His conclusion: this is no April Fool’s joke.

Given how much young people use phones, and how close the antenna is to the ear, he calls it “an emerging global health concern” with “far broader public health ramifications than asbestos and smoking.”

Since this is a review of literature, and much of his evidence is anecdotal, the concerns have proven easy to dismiss.

The good news, Dr. Khurana writes (but few report it), is that these risks can be minimized, if designers get serious now about shielding the antenna. If not, he says, the link will be proven in 5-10 years and the resulting lawsuits will bankrupt the industry.

That wave of lawsuits has already begun, he writes, with Sharesa Price of California the first “winner.”

There are also companies now emerging to make money off the problem, like Aegis Corp. of Lafayette, Colo.,which already claims to have produced shielding equipment.

It’s easy to call this scaremongering, but the timelines add up. That is, Dr. Khurana writes, tumors are starting to be found in countries like Sweden which developed mobile mass markets early, and in the Australian outback, where signal strengths must be high to reach large distances.

On CNN this morning, Dr. Sanjay Gupta was bragging about his wired earpiece, but Dr. Khurana’s report says these are not safe without shielding, since they essentially turn your head into an antenna.

The safest alternative, he writes, is actually to use a phone’s speaker option, but most phones (like my Razr) have horrible speakers.

Having covered this area for many years now, I can tell you that this cell phone-brain cancer scare comes up every few years, and in the past it has always been dismissed. But even if the risk is minimal, why is the industry taking it?

That’s a question their liability insurers should start asking.

March 31st, 2008

Go with the generic

Posted by Dana Blankenhorn @ 7:01 am

Categories: General, Aging, Ethics, Finance, Research, genetics, Drugs, Wellness

Tags: Generic, Zetia, Insurance, Branding, Operational Accounting, Business Operations, Corporate Insurance, Marketing, Finance, Dana Blankenhorn

It was fun this morning, watching the contortions of the morning anchors as they tried to spin the bad news about Zetia without admitting the plain, simple truth.

If your cholesterol is high go with the generic.

While Zetia and Vytorin, which combines Zetia with Zocor (the name brand for a generic statin) did reduce “the numbers” your doctor looks to as markers for heart disease, they don’t cut plaque, the fatty deposit that clogs arteries and causes an attack.

The generic name for Zetia is ezetimibe. The generic name for Zocor is simvastatin.

The specific study in question dealt with folks who have super-high cholesterol levels due to a genetic defect. The numbers went down but there was no impact on heart attack rates.

Insurers’ criticism was more direct. The U.S. wasted $1.5 billion on Zetia over the last five years.

This number was calculated by comparing total payments for cholesterol-lowering drugs over the last six years, $19.5 billion, with what would have happened if we followed the Canadian example. They never approved Vytorin and have long banned direct-to-consumer drug advertising.

Of course, there’s another potential implication, one which is much more frightening to drug companies and, face it, to heart patients like me.

That is, managing to the number, those LDL and triglyceride numbers your doctor checks ever six months (once you go on statins), may be meaningless.

My opinion is that once the plaque is there, dropping fat levels in the blood won’t get rid of it. And it’s possible that plaque attracts plaque.

I go back to something I wrote in December, from the Emory Predictive Health conference. Keeping plaque from forming is key. Low-dose statins at younger ages may make sense, to prevent it, based on western diets which are high in fat.

But once you have plaque, we don’t know how to get rid of it. Lowering cholesterol may slow its growth, but LDL cholesterol and triglycerides are just a gross indication of other things going on, enzymatic processes we have yet to fully understand.

“Lowering cholesterol does not necessarily reduce heart attacks, strokes and deaths,” Dr. Steven Nissen of the Cleveland Clinic told CNBC this morning.

This “scandal,” in other words, is an opportunity to dig deeper into the question.

March 28th, 2008

Golden age for hydrogels?

Posted by Dana Blankenhorn @ 9:14 am

Categories: General, Hospital Equipment, Medical Office Equipment, Research, Drugs, Rehabilitation

Tags: Patent, Hydrogels, Dana Blankenhorn

Hydrogels are familiar to anyone in medicine.

My daughter wears hydrogel contact lenses. They’re also used in breast implants, for dressing wounds, even as miniature glucose sensors.

But they are only just coming into their own, as drug delivery mechanisms.

Covalon Technologies Ltd. of Canada holds the patent on this, granted in 2001 under its previous name of UroTeq. This week, it won the Canadian patent as well. (The illustration is from Covalon, showing hydrogels applied as wound dressings.)

Covalon is still run by one of the patent holders, Valerio DiTizio, who holds the title of chief scientific officer. The board was recently bulked-up with an experienced entrepreneur and a former government official.

The company’s present products involve wound dressings and for coating things like urinary catheters with antibiotics.

The stock price shot up in early 2007, from just over 50 cents to $3, but it hasn’t fallen much since.

Why the sudden excitement? Nanotechnology. Hydrogels can be engineered to deliver what you want, where you want it, at the rate you want it.

Once you start thinking about producing nano-scale hydrogels, with nano-scale drug loads, you’ve got a whole new ballgame.

Suddenly you can use them against cancer, delivering radiation, or chemotherapy. By gaining a patent now in Canada, Covalon gives itself protection which lasts even after the U.S. patent expires late in the next decade.

Whether Covalon’s patent rights will make it the big winner here isn’t the issue. The issue is that the materials you now see in contact lenses have far more importance than you realize.

And that may be true for other chemical substances as well.