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Tag: Data

Decentralizing the Analysis of Health Data

By Harley Geiger

The transition from paper to digital health care records promises a significantly enhanced ability to leverage claims and clinical data for secondary uses – uses beyond that for which the health data was originally collected, such as research, public health surveillance, or fraud prevention. Done properly, these secondary uses of data that were originally collected for treatment or payment can aid the creation of a more effective, information-driven health care system. For example, researchers are using digital claims data to provide the public with comparisons of the quality and cost effectiveness of treatment for particular conditions among plans or health care facilities in a given market.

Patient privacy and data security are among the first considerations of agencies establishing such programs, and many agencies have instituted strong technical controls (such as de-identifying the data) and policy frameworks to protect the confidentiality and integrity of the data. Although a strong policy framework is essential, the technical architecture of information exchange is another important factor. This week, the Center for Democracy & Technology (CDT) released a report challenging the prevailing centralized model of health data analysis and urging Dept. of Health and Human Services (HHS) to explore distributed systems for secondary use programs. The paper comes at the same time that the Centers for Medicare and Medicaid (CMS) issued a final rule for its risk adjustment program – mandated by the Affordable Care Act of 2010 – that would use a distributed system as a default, changing course from the proposed rule, which would have required a centralized model.

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Health Datapalooza 2012: Throw Your Hat Into the Ring!

By Todd Park

It’s a phenomenal time to be an innovator at the intersection of data and health care improvement.  I’m incredibly excited by the rising tide of innovations we’re seeing – new products, services and features being invented by entrepreneurs across the country, fueled by open health data.

And coming soon is the latest opportunity to showcase and learn about many of those innovations: the 2012 Health Data Initiative Forum– aka the Health Datapalooza — being held in DC at the Washington Convention Center on June 5-6, 2012.

For all of you who have been creating value from health and health care data – this is your opportunity to showcase your brilliance for the nation to see!  Led by the amazingly talented folks at Health 2.0, the Health Data Consortium is sponsoring a national competition for the best new apps and services created using health and health care-related data.  Entry applications for the competition are due March 30th.

Innovators will then go through an “American Idol”-style process in which panels of consumers, health care professionals, and community leaders will judge innovations submitted. The innovations that best demonstrate benefit and value for health and care improvement will be featured and demoed at the June Datapalooza.

So if you’ve built or are building something terrific with the aid of health data, throw your hat into the ring! Submit your entry form by March 30th, and may the best innovations win!

Todd Park is the CTO of HHS and has just been appointed CTO of the Federal Government.

(Full disclosure: as is obvious from the article Health 2.0 which is a sister company to THCB is involved as a sub-contractor helping with Health Datapalooza 2012)

How Much Will a Data Breach Cost You?

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By DAVID HARLOW

The going rate for a compromised medical record seems to be $1000 (well, at least that’s the asking price) as seen in papers filed in the eleven class action lawsuits against Sutter Health following the theft of a desktop computer last fall.  The computer contained unencrypted protected health information on about 4.24 million members.  The eleven class action suits are likely to be consolidated for ease of handling by the courts.

For an outfit whose most recently reported year-end financials show just under $900 million in income on just over $9 billion in revenue, a $4.24 billion claim certainly qualifies as a big deal.  The data breach claims against Sutter Health were filed last year following its self-reporting of the computer theft, and are in the news again due to the potential consolidation.

The company had reportedly begun to encrypt its data last year, starting with more vulnerable mobile devices, and moving on to desktop computers, but had not gotten to the desktop in question by the time of the breach.  It remains to be seen how these facts end up affecting the final damages awarded in this case.

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Welcome to the DMV. Your Clerk Will Be With You Shortly.

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By David Whelan


Have you ever tried to use Medicare data to research a hospital? If so, I bet you’ve been disappointed.

Let’s say you live in Las Vegas and you have heart problems. There are three hospitals nearby. You’d like to know the answer to a simple question. “If I ever have a heart attack where should I tell the ambulance to take me?”

Medicare’s Web site that holds this information is called Hospital Compare. If you visit and search for Las Vegas heart attack care, above is what you’ll find.

Is that helpful?

As you can see the three hospitals within your search are all rated “No Different than U.S. National Rate.” In other words, they are all average. Do the same search in every other city that has more than one hospital and you’re likely to find the same thing. Or you might find that there was not even enough data to calculate an average result.

If you want to find a hospital that’s exceptional, there’s no way to search for it. You can also can’t search for a dud.

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Now you have healthcare data. So where does it go?

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By Paul Grundy, MD


In the next 10 years, data and the ability to analyze the data will do for the doctor’s mind what x-ray and medical imaging have done for their vision. How? By turning data into actionable information.

For instance, take Watson, IBM’s intelligent supercomputer. Watson can analyze the meaning and context of human language, and quickly process vast amounts of information. With this information, it can suggest options targeted to a patient’s circumstances. This is an example of technology that can help physicians and nurses identify the most effective courses of treatment for their patients. And fast: in less than 3 seconds Watson can sift through the equivalent of about 200 million pages, evaluate the information, and provide precise responses. With medical information doubling every 5 years, advanced health analytic systems technologies can help improve patient care through the delivery of up- to-date, evidence-based health care.

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Why Getting to a Digital Health Care System Is Going to Be Harder Than We Thought Ten Years Ago

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By David Shaywitz, MD and Tory Wolff

A leading scientist once claimed that, with the relevant data and a large enough computer, he could “compute the organism” – meaning completely describe its anatomy, physiology, and behavior. Another legendary researcher asserted that, following capture of the relevant data, “we will know what it is to be human.” The breathless excitement of Sydney Brenner and Walter Gilbert —voiced more than a decade ago and captured by the skeptical Harvard geneticist Richard Lewontin [1]– was sparked by the sequencing of the human genome. Its echoes can be heard in the bold promises made for digital health today.

The human genome project, while an extraordinary technological accomplishment, has not translated easily into improved medicine nor unleashed a torrent of new cures. Perhaps the most successful “genomics” company, Millennium Pharmaceuticals, achieved lasting success not by virtue of the molecular cures they organically discovered, but by the more traditional pipeline they shrewdly acquired (notably via the purchase of LeukoSite, which ultimately yielded Campath and Velcade).

The enduring lesson of the genomics frenzy was succinctly captured by Brown and Goldstein, when they observed, “a gene sequence is not a drug.”

Flash forward to today: technologists, investors, providers, and policy makers all exalt the potential of digital health [2]. Like genomics, the big idea – or leap of faith — is that through the more complete collection and analysis of data, we’ll be able to essentially “compute” healthcare – to the point, some envision, where computers will become the care providers, and doctors will at best be customer service personnel, like the attendants at PepBoys, interfacing with libraries of software driven algorithms.

A measure of humility is in order. Just as a gene sequence is not a drug, information is not a cure. Getting there will take patience, persistence, money and aligned interests. The most successful innovators in digital health will see the promise of the technology, but also accept, embrace, and ideally leverage the ambiguity of disease, the variability of patients, and the complexities of clinical care.
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Digitizing Human Beings

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By Eric J. Topol, MD

Our day-to-day lives were reformatted when the consumer mobile wireless device era, beyond cell phones, was ushered in by iPods in 2001 and followed in short order by Blackberries, smartphones, e-readers, and tablets. Nurturing our peripatetic existence, we could immediately and virtually anywhere download music, books, videos, periodical, games and movies. Television is soon to follow. But these forms of digital communication and entertainment are a far cry from digitizing people.

This decade will be marked by the intersection of the digital world with the medical cocoon, which until now have been largely circulating in separate orbits. The remarkable digital infrastructure that has been built—which includes broadband Internet, cloud and supercomputing, pluripotent mobile devices and social networking― is ripe to provide the framework for a most extraordinary upgrade and rebooting of medicine.

When I was finishing my internal medicine training in 1982 the term “digital” in medicine referred exclusively to the rectal examination. Now, 3 decades later, there are 4 domains of what comprises digital medicine―genomics, wireless sensors and devices, imaging and health information systems. Each of these digital medical technologies are on exceptionally accelerated growth curves. In 2012, complete DNA sequencing of all 6 billion bases of a diploid human genome will be accomplished in 2 hours at a price well under $4000. Already DNA sequencing is having an impact in medicine for specific gene-drug interactions, targeting of cancer therapy by defining tumor driver mutations (comparing somatic versus germ-line DNA), and demystifying life-threatening idiopathic diseases. Just a few years ago wireless sensors got their start for consumers in the health and fitness space, with wearable accelerometers in running shoes, bracelets, necklaces or clips. Now a brain wave sensor can be used to continuously monitor one’s phases of sleep and wakefulness.Continue reading…

Mind the Gap

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By Stephen J. Downs

It’s a simple idea – show patients the notes that doctors write about them– but it’s also a dangerous idea … in the best sense of the word. It’s dangerous because the very idea forces a conversation and in the course of that conversation, some uncomfortable tensions surface. Jan Walker and Tom Delbanco, co-directors of OpenNotes, a project supported by the Robert Wood Johnson Foundation’s Pioneer Portfolio that enables patients to see their doctors’ notes via secure e-mail after a visit, published a preliminary set of results from their first study. Actually, it’s just a pre-study: they surveyed doctors and patients about their expectations of how the OpenNotes idea would play out. And what they found is fascinating – and uncomfortable.

Doctors and patients are clearly divided about the expected benefits and consequences of the OpenNotes intervention. On a wide range of possible benefits, ranging from a greater sense of control to increased medication adherence, doctors are more skeptical than patients. But what really jumps out are the responses to questions of whether patients would find the notes more confusing than useful, and whether the notes would make them worry more. The gap is dramatic. In each case, most doctors said “yes” while less than one in six patients agreed. Ouch. That’s a big gap and my sense is that we should be talking about what it means. From my perspective, it appears that many doctors are underestimating their patients and that this underestimation could lead to less patient engagement and ultimately poorer care. Call it a hunch.

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What Keeps Me Up at Night

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By John Halamka, MD

Every year I write about the projects and trends which keep me up at night.   Here’s my list for FY12:

1. Workforce recruitment/retention – $27 billion in stimulus funds from HITECH have increased demand for experienced IT staff to implement and support electronic health records.   In many ways, it’s a mini “dot com” boom for healthcare IT experts.    This makes recruiting and retaining qualified staff even harder.  Tomorrow, I’m meeting with a consulting team to formulate an FY12 workforce strategy.

2. 5010/ICD10 –  5010 describes a set of X12 standards used for administrative transactions (benefits/authorization. referral authorization, claims).   Payers and providers must support 5010 by January 1, 2012 or risk disruption of the revenue cycle.   BIDMC completed all its 5010 work and is now in final testing with every payer.   Most payer and provider stakeholders will meet the deadline, but significant resources have been pulled from other projects.   ICD-10 implementation is required by October 1, 2013 and I’ve written about those challenges.  Billions will be spent, many healthcare IT projects will be deferred for the next 2 years, and the end result will be no cost savings (coding costs are likely to increase 50%), no quality improvement, no increased safety, and no efficiency gains.  If we complete the ICD-10 project on time, no one will notice, but customers will all be angry at the IT department (and the CIO) for the work on other projects that was deferred.

3. Vendor Product Quality – over the past year, I’ve had several bad experiences with infrastructure and application vendors which delivered products that did not have the reliability, security, or performance promised.   Why?

* the pace of innovation is so fast, that time for quality assurance is diminished

* the economy has stressed companies and they are focused on making as many sales as fast as they can while controlling development  and support costs

* the end result is less satisfied customers

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Reforming the NPDB: An Open Letter

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Kathleen Sebelius, Secretary
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201

Mary K. Wakefield, Administrator
Health Resources and Services Administration
5600 Fishers Lane
Rockville, MD 20857

Re: Public Use File of the National Practitioner Data Bank

Dear Secretary Sebelius and Administrator Wakefield:

The undersigned are academic researchers who work in the areas of public health, health care quality/patient safety, medical liability, and related fields. (Signatories are listed alphabetically by last name. Academic affiliations are provided for purposes of identification only.)

We write to condemn, in the strongest possible terms, HRSA’s recent decision to make the Public Use File (PUF) of the National Practitioner Data Bank (NPDB) unavailable. We also request that HRSA restore the PUF’s availability immediately.

The NPDB is the only nationwide database of closed medical malpractice claims that is publicly available to researchers. Academics use it extensively. A search on “National Practitioner Data Bank” in Google Scholar’s “articles and patents” database returned a multitude of hits. The same search run in WESTLAW’s “journals and law reviews” database returned 576 articles. In PubMed, the search generated 399 articles. Not all of these articles contain new empirical findings, but many do, and the sheer number of publications attests to the NPDB’s importance.  The NPDB is an indispensable resource for academic researchers.

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