July 14th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
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I had the chance to speak with John Rother, Executive Vice President of Policy and Strategy for the AARP about the intersection of online health, information technology (IT), and the baby boomer generation. Find out what America’s most powerful boomer organization thinks about the future of healthcare in this country.
*Listen to the podcast*
Dr. Val: Recent studies suggest that Americans age 50 and older are more Internet savvy than ever before. How are AARP members using the Internet to manage their health?
Rother: People over the age of 50 are the fastest growing set of online users, and healthcare is the major reason why they’re going online. They’re looking for health related news, help with diagnosis, and finding appropriate healthcare providers.
Dr. Val: What role can online community play in encouraging people to engage in healthy lifestyles that may prevent chronic disease?
Rother: Our experience is that online communities can be extremely helpful in several ways. First, it provides emotional support for people who have a shared experience, whether it’s as a caregiver, or being recently diagnosed with a disease or condition. Second, people seem to feel more comfortable asking questions of others with their condition than they do their own physicians. And third, online communities can reinforce needed behavior change. Whether it’s weight loss, exercise, or quitting smoking – online communities can be just as effective in encouraging behavior change as a face-to-face community.
Dr. Val: Tell me a little bit about the communities on the AARP website.
Rother: Currently our communities are organized around medical topics, but in the future I think the communities will become more geographical. An online community designed to serve the needs of people in a given location can facilitate information sharing about how to navigate a particular hospital system, for example, instead of just general information about coping with a disease or condition.
Dr. Val: Intel just announced that it has FDA approval for its “Intel Health Guide.” The unit enables caregivers to provide their patients with more-personalized care at home, while also empowering patients to take a more-active role in their own care. What do you think of this technology?
Rother: I think information technology is going to have all kinds of beneficial applications for people with health challenges. Personal health records and this Intel Health Guide are very well suited to the needs of individuals with chronic health conditions, and I expect to see more Internet based tools developed to help people to make appropriate decisions and change their behavior.
General information is helpful, but personalized information is the key. The more these technologies allow you to have your own individual information at your fingertips and allow that to be the basis for recommendations and decision support, the more powerful it’s going to be. This is all very promising technology – the next question is, can people afford it and will the people who need it be able to use it?
Dr. Val: In your opinion, what role does health IT have in reducing healthcare costs and improving access to care?
Rother: Health IT can support almost every aspect of healthcare. It can decrease costs by reducing duplication. Many people with chronic conditions see different doctors – and if you have to go through the same set of X-rays or CT scans every time you see a different doctor, that can get very expensive. A good, common medical record system is critical in reducing costs and improving care.
IT can also reduce the cost of health insurance, in the way that online car insurance has reduced car insurance premiums. If we reform our health insurance market, this could offer substantial savings to individuals.
People often use the Emergency Department inappropriately – for minor issues instead of true emergencies. A good decision support system that helps people to figure out when they need to go the ER could be helpful in reducing costs.
Dr. Val: What are the AARP’s major health-oriented initiatives?
Rother: The AARP is very focused on healthcare because our members tell us that it’s their top priority. The cost, quality, safety and accessibility of healthcare are important to us, so we are involved in a broad spectrum of initiatives.
First of all, extending coverage to all Americans, regardless of their age or health condition, is a top priority for the AARP. Second, In terms of health quality, it varies quite broadly among hospitals in the US. If we could get everyone to copy the best hospital practices, we’d have a much more manageable problem.
Dr. Val: What needs to happen to America’s healthcare system in order for it to serve the needs of baby boomers on its limited budget?
Rother: We spend almost 2.5 trillion dollars for healthcare in the United States, so I don’t think of it as a limited budget, but quite an expansive budget. There is enough money in the system to fully respond to the needs of the population. It’s just that we’re not organized very well and the system has become fragmented.
The healthcare system needs to be organized in a more person-centered way, and we need it to shift from a focus on acute care to a chronic care model. We need a different system of health delivery – one that relies more on nurses and other physician extenders. People need to join support groups to modify their behaviors and risk factors and rely on IT to help them make appropriate decisions.
So you put that all together and you have a pretty big agenda for change. I don’t know if we can achieve this all at once, or if it will occupy us for several years. The upcoming election gives us the opportunity to do this at the Federal level, though there are many private sector initiatives that are currently making important contributions.
Dr. Val: Can you give me an example of someone in the private sector who’s making an important contribution to improving healthcare?
Rother: The AARP just met with the leadership of the Mayo Clinic, one of the most outstanding medical institutions in the country. They provide excellent care at a cost that is less than most other parts of the healthcare system – and with improved outcomes. We asked them about their secret to success.
Mayo has an electronic medical record and all their patients have their information online. The physicians are on salary, so there’s no incentive to order unnecessary tests or procedures, and Mayo has an ethic of patient-centered care, with a long history of attracting the best people and rewarding them.
If Mayo can do it, why can’t everyone else? The AARP believes that the potential is there for most communities to have excellent care – we must emulate the care delivery of institutions like the Mayo Clinic, and put in place payment and information systems that will coordinate care management better. It’s a big job and will take some investment, but we have many opportunities to do a better job than we’re doing today.
*Listen to the podcast*
*Learn more about preventing chronic disease*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 11th, 2008 by Dr. Val Jones in News
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Intel just received FDA approval for their new in-home monitoring devices. The press release notes:
The Intel Health Guide enables caregivers to provide their patients with more personalized care at home, while also engaging and empowering patients to take a more active and positive role in their own care.
Intel said the interactive guide integrates vital sign collection, patient reminders, multimedia educational content and feedback and communications tools such as videoconferencing and e-mail. It can connect to specific models of wired and wireless medical devices, including blood pressure monitors, glucose meters, pulse oximeters, peak flow meters and weight scales.
Now this is a good idea – imagine how much pain and suffering we can alleviate by intervening in illnesses before they become acute? For example, when a patient with CHF begins to decompensate, physicians can intervene before the patient experiences severe shortness of breath and requires a hospital admission via the ER. What about catching a hyperglycemic episode early on? What about a hypertensive emergency that has no symptoms until very late in the game?
Avoiding the hospital can reduce exposure to infections, medical errors, insomnia, stress, and disorientation. Early intervention in disease keeps people out of the ER, and saves money and resources – while improving quality of life for the patients. The data gathering tools not only empower patients to be as independent as possible for as long as possible, but they empower physicians to care for their patients more effectively.
Unlike services that are aimed at replacing physicians, this one is designed to make them more efficient and effective. One day I imagine that a primary care physician will be able to keep an eye on her patients on one web page – with input from all the terminals combined into a dashboard. Alerts can be set at customized levels for different patients, and with a glance of an eye the physician will be able to see which patients may need help.
This is a brave new world of real-time health communication, and with technologies like this one, we may be able to bridge the gap between growing care needs and decreasing care resources while actually improving quality to boot.
Personal, affordable, telemedicine for the chronically ill. Bravo, Intel.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 3rd, 2008 by Dr. Val Jones in Expert Interviews
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The following interview with Alzheimer’s researcher, Dr. Jeffrey Cummings, is a continuation of part 1…
Dr. Val: Tell me about the comorbidities associated with Alzheimer’s and how caregivers can prepare for them.
Dr. Cummings: Being a caregiver is a real challenge. It’s so difficult to take care of someone who may be incontinent, agitated, psychotic or depressed. All of these symptoms occur with increasing frequency as the disease progresses, and can challenge even the most devoted caregiver.
There are educational programs that can help to explain to caregivers where these behaviors are coming from, and can teach them how not to exacerbate the symptoms. For example, it’s important to avoid confrontation with the patient. If he or she doesn’t want to take a shower in the morning, then it’s better just to let it go.
Reducing friction between the caregiver and the patient has been shown to delay the time to nursing home placement, so there are behavioral interventions on the part of the caregiver that can be very beneficial.
Dr. Val: What can online companies like Revolution Health do to support patients with Alzheimer’s disease and their caregivers?
Dr. Cummings: We’ve learned that there are things that people can do to protect themselves against getting Alzheimer’s disease. This includes physical exercise (at least 30 minutes per day 3 times per week), active engagement in leisure time activities, eating a diet high in anti-oxidants (such as salmon, green leafy vegetables, and blueberries), avoiding head trauma (e.g. wear helmets while cycling), controlling high blood pressure, and controlling cholesterol.
It would be great if Revolution Health included all of these healthy lifestyle strategies in a comprehensive Alzheimer’s prevention agenda.
Dr. Val: Is there a role for the “brain games” movement in Alzheimer’s disease?
Dr. Cummings: That’s an interesting question – though I’ve seen very little data supporting brain games in particular. We do know that active intellectual engagement reduces the risk of Alzheimer’s disease, but once one has the disease, it’s less clear whether these kinds of programs can actually reduce progression. At the very least they may reduce agitation by active engagement of the patient, leaving less time for them to be unoccupied. I’d really encourage the people who are developing brain games to test them in well controlled trials. The games could be tested in the same way that drugs are tested.
*Listen to the full interview here*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 29th, 2008 by Dr. Val Jones in Health Policy
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I attended an excellent brown bag lunch with Dr. Greg Downing today. He’s the program director for the U.S. Department of Health and Human Services’ (HHS) Personalized Health Care Initiative. He spoke about some of the challenges associated with incorporating genetic test results into a personalized health record, and how consumer demand is fueling biotech companies to offer tests long before their clinical significance has been determined.
Here are some interesting statistics that Dr. Downing mentioned:
Only 15% of Americans have their medical records in an electronic format that they can access
About 30% of clinical decisions are based upon evidence from quality research
At least 70% of genetic tests are requested by patients, rather than clinicians
At the same time, HSS Secretary Mike Leavitt has issued this vision statement about personalized health care:
“Personalized health care is providing the right treatment, for the right patient, for the first time, every time.”
So what we have here is an incredible gap between our aspirations and reality. While we want to leverage genetic information for disease prevention purposes, subjecting the entire population to a “needle in a haystack” search for disease predictors is extremely expensive. In addition, genes rarely provide black and white answers regarding disease risk. Sure there’s the Huntington’s Disease gene (which really does have a nearly 100% correlation with the development of the disease), but the vast majority of genes have much more gray significance, with shades of predisposition and uncertainty.
Biotech companies sense America’s eagerness to peer into its health future, and are actively engaged in direct to consumer advertising. With tests ranging in price from $300-$3000 dollars, and wealthier clients willing to pay for the tests, they stand to make a good profit without clear improvements in health outcomes, or patients even knowing how to interpret their results.
Connecticut Attorney General Richard Blumenthal (D) recently said his office is investigating the accuracy of claims Myriad makes about the test in the ads, including issuing a subpoena for information about the ads. Blumenthal said his office has received complaints from professional caregivers, clinicians and scientists who believe the test has a “very high potential for misinterpretation and overreaction.”
In a rather extreme case of putting the cart before the horse, a potential susceptibility to suicidality (while on particular anti-depressants) was linked to a certain gene sequence. The day after the publication of this preliminary research one company was offering the genetic test directly to patients for $500/test.
So ultimately I agree with Dr. Downing’s cautionary message: let evidence based medicine be the foundation upon which personalized medicine is built. Mad dashes for genetic enlightenment don’t mean much if we don’t know how to interpret the test results. And let’s not forget the role of environmental factors in our health. You may have longevity genes, but if you’re engaged in risky behaviors, what good are they?
I do believe that the study of genetics is critical to our understanding of health and disease, but we need to do the research to learn how to leverage what we learn. Research is costly and slow, but the rewards are worth the investment. If you are going to undergo genetic testing online, make sure that you do so with a reputable company like DNA Direct that offers evidence-based tests with genetic counseling as part of the package, so that you will know what your test(s) mean. Of course, the best plan is to discuss genetic testing with your doctor.
And as for Secretary Leavitt, I applaud his vision and look forward to the day when we’ll all have access to our health information online, and we’ll receive the right treatments at the right time, every time… Let’s just say we’re not there yet.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 16th, 2007 by Dr. Val Jones in Announcements
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Because Washington DC is the national headquarters for many heathcare professional organizations and advocacy groups, we host more than our fair share of medical conferences. Just a few weeks ago I attended Digestive Disease Week, where 16 thousand gastroenterologists descended upon our fair city from all over the globe. Sporting purple gift totes and oversized name tags, these docs moved like a great school of fish through the reefs of our convention center. At one point I was standing in the wrong place at the wrong time – a lecture let out just before lunch, and I was almost flattened by the wave of hungry purple people on a frantic quest to be first in line at the refreshment counters (the song, “one eyed, one horned flying purple people eater” kept dancing in my head as I ran for cover).
And I started thinking – gee wouldn’t it be easier to have a virtual conference where you could attend from the comfort of your own home? You could navigate to the information booths that interest you, you could attend lectures via telecast, and you could even opt in for goodie bags that could be mailed to you. No need to be stressed out and jostled by well meaning, but frantic colleagues. You could sit in your PJs with kitty or puppy nearby and click your way through a much calmer version of the educational experience.
And so the Revolution Health team discussed this idea and came up with the Online Health Fair. We invited a small group of advocacy groups to set up booths on our website to show others all the exciting programs they have going, and to spark interest in getting involved. The fair just opened and I think it’s a pretty neat idea – Revolution Health is donating money to the groups, based on page clicks. So the more people who go to learn about their favorite advocacy groups, the more they benefit.
So I would encourage you to check this out and let us know what you think – do you like this online health fair concept, or are you more of a “flying purple people eater” kind of person?
Here are the advocacy group “booths” at the fair:
Autism Speaks
American Kidney Fund
National Alliance on Mental Illness
IBS Self Help and Support Group
National Family Caregivers Association
The Wellness Community
National Foundation for Celiac Awareness
Asthma and Allergy Foundation of America
National Sleep Foundation
Society for Women’s Health Research
If this online fair is popular, we can create many more of them in the future. I think it’s great to support these noble groups, and the Wall Street Journal agrees. Tell a friend. 🙂This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
