February 23rd, 2009 by Dr. Val Jones in Audio, Expert Interviews, Health Policy
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Together the Department of Defense and the Department of Veterans Affairs have the largest and most advanced IT infrastructures in US healthcare. As the Obama administration ramps up funding for electronic medical records and other IT initiatives, one might ask what the public and private sectors can learn from the military IT systems (aka AHLTA and VISTA).
I interviewed Dr. Jeff Gruen about the upcoming Military Health Summit at the World Health Care Congress, April 14-16 in Washington, DC. Jeff is Head of the Global Healthcare Practice at PRTM, a management consulting firm and a Chairman of the Military Health Summit.
You may listen to our conversation by clicking the arrow button, or read a summary of our conversation below.
[Audio:http://blog.getbetterhealth.com/wp-content/uploads/2009/02/militaryhealthsummitjeffgruen.mp3]
Dr. Val: To set the stage, tell me a little bit about the World Health Care Congress, and what the Military Health Summit hopes to achieve.
Dr. Gruen: This is the 6th annual World Healthcare Congress (WHC), and the first year for the Military Health Summit. We expect 1500 to 2000 participants – the WHC is the premiere event for healthcare services and the healthcare system at large. It brings together people from across all sectors of healthcare and in addition to the general summit events we have this exciting Military Health Summit track.
Dr. Val: What does the healthcare system at large have to learn from the military health system?
Dr. Gruen: Three things: first, we can use the military health system as a case study for IT initiatives, since they’ve already achieved broad adoption of an EMR. It’s not perfect, but it’s used widely and is getting better. The DOD and the VA are working hard to make their systems interoperable. Second, because the military health system is both a payer and a provider, it serves as a wonderful laboratory for inventing new ways of delivering care. Realigning incentives between inpatient and outpatient care or primary and specialty care can be achieved nicely in the military system, which is like a giant, international Kaiser Permanente. Third, the military has developed very advanced battlefield techniques and devices for saving lives – including telemedicine. So it’s fun to hear about these advances.
Dr. Val: How will healthcare reform impact the Military Health System – do you have any predictions based on what you’ve heard on Capitol Hill?
Dr. Gruen: It’s impossible to know exactly, but let me offer a couple of observations. First, there’s a sense of national patriotic commitment to make sure that our service men and women (and their dependents) get the very best care possible. There’s a real desire to apply the best practices from the commercial sector to the military. PRTM feels very passionate about this, especially since one of our own is currently serving in Iraq right now.
There are a few core problems in healthcare, and they all fall under the rubric of “the right care delivered in the right environment by the right provider at the right time.” These problems may be addressed with interventions including providing point of care decision support, tools that would decrease provider practice variation, and connected convergent care – the idea that we have to move from a system that is designed for acute care to one that is very good at managing chronic care. We also need to move to a system where all the data is present in a very transparent way across environments to allow us to apply the same protocols regardless of whether someone’s in the hospital, or at home, or in a nursing home. The military health system could get these systems in place in a faster and broader way than the general healthcare system.
Dr. Val: Who should attend the Military Health Summit? How do they register?
Dr. Gruen: Those who should attend include: 1) People actively involved in the Military Health system because it offers an opportunity to interact with their luminaries. 2) Anyone on the commercial side of healthcare who’d like to do work with the military 3) Anyone who is interested in health reform 4) People with a particular interest in health IT (disease management and telemedicine in particular) 5) Anyone who wants to hear about the coolest new things coming out of battlefield medicine.
To register, one need only go to the World Health Care Congress website and follow the prompts for the Military Health Summit.
February 22nd, 2009 by Dr. Val Jones in Medblogger Shout Outs
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I thought I’d highlight some interesting posts written by my peers this week. Keep up the great blogging, everyone!
Healthcare Policy
This is what happens when you begin the process of bailing out key stakeholders in our economy: h/t Happy Hospitalist
Britain’s NHS has hired teams of bureaucrats whose sole purpose is to enforce health coverage denials. Dr. Crippen also notes that the NHS will cover sex change operations, but not ear repair from piercings.
The number of Americans without health insurance is increasing by 14,000/day. H/t Shadow Fax.
Just Plain Gross
Thanks to Medgadget for featuring a story on grey nurse sharks. Apparently their young, while still in the womb, cannibalize each other until only one is left in the uterus. They even linked to a video of fetal sharks devouring one another. Eww!
Bad Science Of The Week
Thanks to Mark Hoofnagle for deconstructing the laughable PLoS article suggesting that cell phone exposure increases migraine risk but decreases Alzheimer’s and epilepsy risk. The study was a statistical fishing expedition that proposes random cause and effect.
Good Doctor
Dr. Theresa Chan coaxed a 90 year old man out of somnolent delirium by singing to him.
“Bad Doctor”
By not caving in to a 16 year old’s request for a medical excuse from school or admitting a patient to the hospital for walker training and observation, this doctor won no brownie points with his patients.
Funny Patient
Nurse Gina witnesses a post-op patient give a doctor a math lesson.
Tragedy
A physician mother struggles with the immanent death of her 4-year-old with brain cancer.
February 21st, 2009 by Dr. Val Jones in Health Policy
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The FDA is grossly underfunded, resulting in spotty oversight and slow drug approval processes, leading some to speculate that America might be better served by two agencies instead: one for food safety and another for drug oversight.
But today industry insiders* downplayed the idea of carving up the FDA. Their reasoning? First of all, it would be too complicated to untether the two areas of oversight. Secondly, America is redoubling its preventive health efforts, including healthy eating and regular exercise as a means to reduce the chronic disease burden. Billy Tauzin, CEO of PhRMA, commented, “We are what we eat. We should keep food and drug oversight closely aligned.”
Other industry concerns voiced on the conference call included:
1. A wish for the FDA to enter the 21st century by accepting digital filing and analysis of clinical trial data. Currently, they accept paper copies only.
2. A call for an experienced executive leader to become the new FDA Commissioner. One conference participant stated that “The FDA has been a rudderless ship for too long. We need someone who has the courage to say that there’s no such thing as a risk-free drug, and then speed up the approval process based on the best science available. The FDA is the world’s leading regulatory agency but is losing respect on the international stage, while Europe’s FDA equivalent is increasing in prestige.”
3. A desire for the new FDA Commissioner to be “above politics” and objective about science. A fixed term for the position was proposed.
4. A request for transparency in the drug approval process. One call participant said, “The FDA’s decision-making process is a black box. That really slows down our ability to get effective drugs to market.”
5. A cautious approach to approving biosimilar (or follow-on biologics) treatments. “At least 14 years are needed to demonstrate the interchangeability of biologic therapies,” said one biotech industry leader. “There’s a big difference between creating generic molecules of a common drug, and reproducing safe and effective treatments derived from living organisms.”
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*The conference call was called, “The Obama administration and the new congress: good medicine for the pharma, biotech, and medtech industries?” sponsored by Ernst and Young. Recordings of the conference are not yet available to the public. Participants included:
Billy Tauzin, President and CEO of PhRMA
Jim Greenwood, President and CEO of the Biotechnology Industry Organization
Brett Loper, Executive Vice President, Government Affairs from AdvaMed
Special guest:
Mark B. Hassenplug, Global Pharmaceutical Markets Leader, Ernst & Young LLP
Moderators:
Anne Phelps, Prinicpal, Washington Council Ernst & Young LLP
Carolyn Buck Luce, Global Pharmaceutical Sector Leader, Ernst & Young LLP
February 20th, 2009 by Dr. Val Jones in Health Policy
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In a provocative analysis of a 30-year old Medicare coverage loophole, John Schall explained the following (at the Medicare Policy Summit event):
1. Medicare covers kidney transplants for patients with end stage renal disease (ESRD). Transplant patients, of course, require life-long immunosupressive drugs to keep their bodies from rejecting the new kidney.
2. Medicare only covers immunosupressive drugs for 36 months total. These drugs are too expensive for most patients to afford out-of-pocket.
3. Many kidney transplant patients covered by Medicare are unable to continue their immunosupression regimen after 36 months, and slowly go into organ rejection.
4. Once they have rejected their transplanted kidney, they are eligible to receive a new one, fully covered by Medicare, with (you guessed it) 36 months of immunosuppresive drug coverage to follow.
Wouldn’t it just be cheaper to cover immunosuppresive drugs for the lifetime of the patient who receives an organ transplant? Yes, and that’s what lobbyists have been arguing for 30 years now, without a change in the rules.
Government-run healthcare can have its challenges… and this is only the beginning.
Together the Department of Defense and the Department of Veterans Affairs have the largest and most advanced IT infrastructures in US healthcare. As the Obama administration ramps up funding for electronic medical records and other IT initiatives, one might ask what the public and private sectors can learn from the military IT systems (aka AHLTA and VISTA).
