France leads in EMR

I thought France was an "old country" that sticks to tradition, an image reinforced by its refusal to let English in, its veneration of rural places like Provence and of its wine and cheese, and how prominent a role agriculture plays in the French economy.

So it came as a total surprise to read that France leads the world in EMR adoption by doctor's offices and hospitals. The assertion made by Ms. Moukheiber, a Forbes blogger, is based on observations made in a book I have to pick up soon titled "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care" by T.R. Reid.

Here's the blog post. And an excerpt:

Reid’s striking observation is that there are no file cabinets; just a desktop computer. Patients conveniently hand their doctor a green plastic card—the size of a credit card, with a chip embedded. It is their portable electronic health record, and contains every visit, diagnosis, lab test, prescription, x-ray, etc. The doctor slides the card into a special reader, and the patient’s medical history pops up on the computer screen. All payments are also recorded—to who, and how much. An insurance fund pays the doctor in as little as three days.

France’s Ministry of Health told Reid there are no privacy breaches, because the medical information is encrypted.

I don't know enough about France's healthcare system (have yet to read the book), but I imagine it is more centralized and government-controlled than ours (where government pays most healthcare costs but do not run most U.S. clinics and hospitals or employ most American healthcare workers).

Diabetes, the most expensive disease in the world?

I heard earlier today that United Healthcare released a report on costs related to diabetes. A reporter on APM's Marketplace called it the most expensive disease in the world.

http://marketplace.publicradio.org/display/web/2010/11/23/pm-diabetes-to-become-most-expensive-disease

Why is it the most expensive disease in the world? Because according to UHC, as reported in Bloomberg, diabetes will cost more than $3 trillion over the next decade.

http://www.bloomberg.com/news/2010-11-23/unitedhealth-says-diabetes-will-cost-3-4-trillion-over-the-next-decade.html

Thus diabetes, the biggest cause of blindness and kidney failure in this country, poses a tremendous opportunity for innovative healthcare to address costs and save lives. Already the FDA is proactively encouraging collaboration to develop an artificial pancreas.

http://www.diabetesmine.com/2010/11/fda-artificial-pancreas-hearing-beating-a-path-to-the-real-world.html

I'm a proponent of lifestyle changes, which prevents development of diabetes, and also helps control blood sugar levels in someone with diabetes. Even here, mobile technology is being investigated that may help people make the necessary changes needed.

http://cwphs.calit2.net/index.php?option=com_content&view=article&id=52&Itemid=61

If the next decade or two will be the decade of diabetes as the world's population gets wealthier and adopts a fat- and calorie-rich diet, it will also be the decade where people invent amazing ways to deal with the disease.

Using a salad spinner to diagnose anemia

Yet another cool low-tech invention in the healthcare space from Rice U., literally in walking distance from where I live: a salad-spinner that's been retrofitted to be a centrifuge that splits blood into plasma and blood cells. It's purpose is to help diagnose anemia in the field among people who live in poor, remote regions of the world. And without electricity, just a bit of muscle power.

The device is called the Sally Centrifuge and you can read about it here and, with more details and a reference to the other cool health-related invention from Rice U. I witnessed last year at a business plan contest, here. (That contest by the way was hosted by the real incubator of these and other low-tech devices, Beyond Traditional Borders.)

Here's a video with a short demonstration of the "centrifuge" and the two inventors. I'm not sure how the resulting separated blood will be interpreted, but I'm curious enough to find out.

From what I understand, it takes about 5 minutes of spinning at 10,000 RPM to get the separation right. I hope the inventors have taken this into account, and that the spinning doesn't tire the user out.

The mHealth movement

mHealth is the name of the concept of promoting or providing healthcare services via mobile phones. Last year, I contacted the chair of UC-San Diego's Center for Wireless and Population Health Systems to ask about projects they had using mobile phones to promote physical activity and weight loss. He gave me the impression that they were just scratching the surface.

I'll write more of UCSD's projects and supporting data later. For now, I want to highlight a couple uses of mobile technology in personal health.

A July 16, 2010 NY Times article covers apps that display calorie information on a large number of foods and beverages (LoseIt is the one featured here) and calculate limits, which people use to help themselves better restrict their calorie consumption and hopefully lose some weight.

I am a big believer in giving people (or consumers in business-speak) more information (like calories in their diet) so that they can better choices for themselves. Not all people will make better choices, but the ones who want to are better enabled (or empowered in the lingo) to do so. People who are motivated to lose weight are more likely to track their consumption, and...

When you track calories closely, you lose more weight, said Dr. Lawrence Cheskin, associate professor of health, behavior and society at Johns Hopkins Bloomberg School of Public Health.

In another passage, modest gains (or as it were, loses in weight and average blood sugar) are reported by a healthcare provider:

Dana Green, a diabetes specialist at St. Joseph Healthcare Diabetes Institute of Behavioral Medicine in Bangor, Me., has been testing the LoseIt program with a small group of his patients, including the Dodges. Since April, almost all of the 17 patients, ranging in age from 48 to 76, have lost weight and lowered their blood sugar. One man lost six pounds; two of the women in the program were able to reduce their insulin intake by 20 percent, Mr. Green said.

“Patients begin to see their patterns and habits and so make better decisions,” he said. “I’m extremely optimistic.”

There's a companion piece with four recommended apps for losing weight.

Another interesting app keeps one's immunization records together. I like the idea of this app. I was going through my old files and found I have immunization records from elementary school, high school, medical school and from the city health department when I got vaccinated before trips.

It would be awesome to have all those papers collated into one record of vaccine shots. Why? Well, say I step on a rusty nail. And I go to the doctor and ask for a tetanus shot. I'll be asked when was the last time I had a booster shot, and I'd have to say I have no idea. It would be useful to have an idea.

Interestingly, there are apps out there that do that for adults and for children's immunizations. So there you have it. One kind of mobile app that promotes healthy behavior. A second kind that keeps all of your health info organized and easily accessible.

Forcing the hospital's hand

Medicare recently announced it would not pay for 'hospital errors' or preventable illnesses, like hospital-acquired infections, according to the NYT article "Medicare Says It Won’t Cover Hospital Errors".

Interestingly, Michigan has been ahead of the curve in terms of forcing changes in hospitals there, which has saved lives and money. And the hospitals there improved their rates without employing new technology.

Michigan hospitals have been extremely successful in reducing bloodstream infections related to such catheters, researchers reported recently in The New England Journal of Medicine. The hospitals did not use expensive new technology, but systematically followed well-established infection-control practices, like covering doctors and patients from head to toe with sterile gowns and sheets while the catheters were inserted.

Hospital executives said these techniques had saved 1,700 lives and $246 million by reducing infection rates in intensive care units since 2004.

Some of the complications for which Medicare will not pay, under the new policy, are caused by common strains of staphylococcus bacteria.

Titans of Information Age aiming to transform healthcare

The NYT article "Google and Microsoft Look to Change Health Care," run in the 14 August 2007 issue, talks about how the two giants are trying to integrate info technologies into healthcare. The key difference is that Google is approaching the consumer exclusively while Microsoft seems to be offering something to both sides of the fence, providers (e.g., hospitals and physicians) and consumers.

Some interesting tidbits from the article.

“What’s behind this is the mass consumerization of health information,” said Dr. David J. Brailer, the former health information technology coordinator in the Bush administration, who now heads a firm that invests in health ventures.

"A Harris poll, published last month [July 2007], found that 52 percent of adults sometimes or frequently go to the Web for health information, up from 29 percent in 2001." Furthermore, "58 percent of people who look online for health information discussed what they found with their doctors in the last year."

“The doctor is becoming a knowledge navigator,” [John D. Halamka, a doctor and the chief information officer of the Harvard Medical School] said. “In the future, health care will be a much more collaborative process between patients and doctors.”

"There are plenty of competitors these days in online health records and information from start-ups like Revolution Health, headed by AOL’s founder, Stephen M. Case, and thriving profit-makers led by WebMD."

"Indeed, it is the market reach and deep pockets that Google and Microsoft can bring to consumer health information that intrigues medical experts, and has lured recruits. Dr. Roni Zeiger, a graduate of Stanford’s School of Medicine, a medical informatics researcher and a former primary care doctor, joined Google last year. The 36-year-old, who still sees patients some evenings and weekends at a nearby clinic, said, 'At Google, I can use my expertise and knowledge to potentially help millions of people each day.'"

I have written about Microsoft's forays into healthcare here and here.

Google Health has been fleshed out apparently. Here are some screen shots. And here's how the article described it:

"A presentation of screen images from the prototype — which two people who received it showed to a reporter — then has 17 other Web pages including a “health profile” for medications, conditions and allergies; a personalized “health guide” for suggested treatments, drug interactions and diet and exercise regimens; pages for receiving reminder messages to get prescription refills or visit a doctor; and directories of nearby doctors."

CDC: number of doctors visits jump

The CDC reported this past week that the number of patient visits to primary care medicine and surgical doctors' offices jumped by 20% between 1995 and 2005.

From the Reuters' article 'Survey finds U.S. hospital, doctor visits balloon':

"It was only a few years ago that we released that the total number of visits had reached 1 billion. And now we are up to 1.2 billion," Catharine Burt of the CDC's National Center for Health Statistics said in a telephone interview.

"That's a 20 percent increase in the just the last five years -- a huge number," said Burt. "I can tell you that the number of hospitals and physicians has not increased 20 percent."

The reason is clear -- Americans are getting older. "When you reach 50 things start going wrong, just little by little, and you keep going back to the doctors," Burt said.