Posted by John Patrick on Jan 29, 2006 in
Healthcare,
IBM 
On February7 we will be discussing Computational Biology at Demo. No doubt we will hear about some potential breakthroughs in healthcare. One thing we know for sure is that new healthcare solutions are costly. How will people afford them? There are many issues associated with this and one of them is the fraud that occurs in today’s system. IBM has been working on this area for years and recently introduced their solution in Rockland County, New York.
The IBM Verify New York Medicaid claims management program has identified $13M in potentially improper Medicaid billing in just 10% of the cases in just one county in just one state. For a modest software and consulting fee, IBM used it’s powerful supercomputers to do a sophisticated statistical analysis of the billing from the top 10% of Medicaid reimbursed pharmacies and general practice doctors in the county during a 21-month period. Seems like a good target since New York’s Medicaid program is the largest in the US, with an annual cost of $44.5 billion — and rising fast.
Rockland County has more than 41,000 residents who use Medicaid and the county spends about $384 million a year on their care. Initial estimates are that as much as $13 million of the billing may be improper. If this turns out to be the case, the nationwide numbers are in the $billions for sure. The IBM system uses thousands of queries to look for anomalies such as suspiciously large numbers of bills for services on a single day, repetitive or duplicate billing or unusually expensive services. Forty-two percent of the ten percent in Rockland County appeared to have discrepancies.
The project doesn’t mean that providers are automatically guilty nor that the money can be quickly recovered but at least it shows the investigators where to look. They have always had the data but with help from IBM they now have the tools. There are obstacles. In New York, the counties are responsible for Medicare but they are not allowed to take action against fraud. Only the state can do that — but they haven’t. The IBM program enables the counties to provide very specific information to the state and press for action to reduce fraud.
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Tags: analytics, fraud, IBM, medicaid, medicare, supercomputers
Posted by John Patrick on Oct 27, 2005 in
Blogging,
Healthcare 
The story about some possible future roles for blogging brought a number of comments from readers. Pito Salas at BlogBridge liked the hospital application I described and took it to the next level. He feels that aggregators (blog readers) do not have to be limited to displaying their results as a time-ordered series of posts. For example, BlogBridge recently introduced "Photo Feeds", where they display the results of a blog feed full of pictures not as posts but as a photo album. Taking this concept into the healthcare arena, Pito envisions the vital signs of a patient being taken every 15 minutes and placed into a blog feed. The aggregator would then display the information as a graph or chart. Seems to me this would have a lot of potential in the area of home healthcare such as the remote monitoring report I wrote about a year ago. Even beyond that, medications could be administered on an automated basis in response to an incoming feed of data from the hospital laboratory which in turn is receiving that data from automated samples taken at bedside.
Earlier this week, I got some hands-on experience with another healthcare solution which points to the future. Intuitive Surgical demonstrated their da Vinci® Surgical System in the Danbury Hospital auditorium. The emerging field of robotic-assisted minimally invasive surgery has great potential to enable surgeons and hospitals to improve clinical outcomes and help patients return to active and productive lives more quickly after surgery. The da Vinci® robot has 10X 3-D vision and four mechanical arms. Those of us in attendance got to spend a few minutes at the console. It was quite an experience to operate the arms and pick up tiny pieces of rubber and move them around. Rather than traditional open surgery, the robot enables the surgeon to operate through four tiny incisions. It doesn’t replace the surgeon — it augments the surgeon’s ability. There is more precision and more flexibility. For the patient there is less bleeding and faster recovery. The surgeon would normally be seated at the console "operating" by manipulating the robot’s arms while looking through binocular-like lenses. Even the shaky hand of a coffee-drinking surgeon can be made steady as a rock. The surgeon could even collaborate with another surgeon who may be thousands of miles away!
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Posted by John Patrick on May 16, 2005 in
Healthcare,
People 
A search at Google for "Wow" yields more than 20 million matches. A visit to the Wiktionary finds that "wow" means "an indication of excitement or surprise. A typical expression, according to the Wiktionary is "Wow! How do they do that?".
If you visit the Danbury Hospital Wellness on Wheels van, I guarantee that you will say "Wow!". I had the privilege to stop by and visit the van late last week. It was quite a sight to behold. Moms and dads and kids lined up for well-child visits, sick visits, physicals for school, sports, or camp, work physicals, TB or lead testing, immunizations, screenings, blood pressure checks, health education, or travel vaccines. WOW is part of the hospital’s Partners in Health program.
The WOW van offers primary care services at no charge, although there may be a fee for some adult immunizations. The minor income and modest budget understate the long term economic and public health benefits. By providing a safety net for some who may not seek care at a doctor’s office or at the hospital, much more costly emergency care may be avoided. Also, by encouraging and providing immunizations, some significant diseases can be avoided. By offering school and camp physicals to many who could not otherwise afford to have them, a broader segment of the local population can participate in activities which help them to be more involved in the community.
The most impressive part of the WOW van is the people who work there. Headed by Dr. Jack Fong, chairman of the hospital’s pediatrics department, the staff includes a physician, nurse, immunization outreach worker, medical case manager, and a driver. The entire team is compassionate toward their patients while dedicated and enthusiastic about their work. As I left from the visit, there was only word I could think of. Wow! We are so fortunate to have this resource at work in the community.
Posted by John Patrick on Jun 23, 2004 in
Healthcare 
Today was the day for the annual physical examination. There are certain aspects of the "physical" that are not pleasant for anyone, but the thing I enjoy the least is filling out the paperwork. Step one at the doctor’s office is to be presented with a clipboard and forms with fields that are too small and questions that I don’t know the answer to — like the address of my healthcare provider. I said that I had been a patient of the doctor for years and nothing had changed since the last time I filled out the paperwork. "Yes, but we have a new billing service and they require that all patients fill out the paperwork again". It seems like at every visit there is some reason that I have to write down my name, address, phone number, date of birth, etc. After I wrote down the health insurance information from my insurance card, the office assistant asked for my insurance card and then made a photocopy of the front and back of it to put in the manila folder. This is the 21st century?
Before I continue this story I should say that I feel extremely fortunate to have healthcare coverage. It is very unfortunate that many millions of people have no coverage at all. There are multiple reasons for this, but the biggest is the cost. Healthcare costs are spiraling out of control. One of the reasons for that is the paperwork. Not just the forms at the doctor’s office but also prescriptions that the pharmacy can’t read. Another big cost factor is human error. In part because the various processes and sources of data are on paper and are not integrated, there is an increased administrative cost. When medical errors occur, patients (mainly their attorneys) decide to take legal action. This adds tremendously to the cost of healthcare. It is not uncommon for some doctors to incur a cost of hundreds of thousands of dollars per year for malpractice insurance. I believe the glass is half full, not half empty. (read more)
Posted by John Patrick on Jun 4, 2004 in
Healthcare 
Today was the final planning meeting for the first annual golf outing of the Housatonic Habitat for Humanity. The meeting finished at 1 p.m. and there were two choices: head back home and work on some board meeting preparations and committed writing projects or take the long way home on the Fatboy. The blue sky and 75 degree temperature made this an easy choice. The meeting was in Stony Hill, Connecticut on Route 6, just off of Interstate 84. I headed east on Route 6 and merged onto route 25 and then headed south to Bridgeport. According to Microsoft MapPoint, the 24 mile trip should take thirty-five minutes. That would be true if there were no trucks, traffic lights, construction, nor congestion. On a Friday afternoon or in bad weather, the trip can easily take double what the mapping programs suggest.
For a Friday afternoon motorcycle ride, it really doesn’t matter how long it takes, but if you happen to be in an ambulance on the way from Danbury Hospital to the hospital in Bridgeport, the travel time can be a matter of life or death. The State of Connecticut regulates which hospital is able to perform which procedures. On the surface this appears to be a very political and financial process, as opposed to a quality of care process like most people expect. If you have a heart attack in the western part of Fairfield County, an ambulance will take you to Danbury hospital. The outstanding emergency department team would apply numerous techniques to bring you back to normal. An attending cardiologist would utilize some of the latest drugs known to be effective for certain heart conditions. However, if the treatments are not adequate and it is determined that you need angioplasty, you would then be put back in an ambulance to make the trip to Bridgeport. (read more)
Posted by John Patrick on Jan 25, 2004 in
Healthcare 
It is a privilege to be able to participate and contribute to various boards and committees. It is also a way to learn a lot, meet great people and gain new perspectives. That has certainly been the case with my involvement at Danbury Hospital. For the past year I have been participating on the policy and technology committees of the board and as of this week I have been elected to the board of Danbury Health Systems, Inc. and Danbury Hospital. At a recent meeting of the policy committee, Ann Faraguna, executive director of the Danbury Visiting Nurses Association, made a presentation about the good work they are doing and mentioned that they are using technology to remotely monitor the condition of patients in their home. This really got my attention and I could not wait to learn more. (read more)
Tags: danbury hospital, monitoring, nurse, nursing, oximetry, van
Posted by John Patrick on Jan 22, 2004 in
Healthcare 
Many long term runners have developed arthritic conditions in their knee joints that eventually prevent them from running. Even with the best MRI scans available, it is often hard to get an accurate description of exactly what is going on. The result is a diagnosis of “you have a bum knee” and a prescription of “try swimming”. I suspect many runners like me are frustrated with the imprecision and long for better diagnostics and cures. The Mayo Clinic has just made a large stride in this direction with new technology developed jointly with IBM.
In December, 2003 the world renowned Mayo Clinic in Rochester, Minnesota announced it has developed a series of magnetic resonance imaging devices that make it easier to diagnose injuries and diseases affecting wrists, forearms, elbows, hands, and fingers. I don’t know if knees were left out accidentally or if they are not included. If they are not included, I am confident that they will included at some point. The devices will be sold to other medical centers nationwide. Named Mayo Clinic BC-10 MRI Coils, the sophisticated new devices will be able to take detailed pictures of a particular part of the body, producing high resolution images.
The images will improve a physician’s ability to see small structures such as tiny ligaments and nerves in the hand. Seeing the fine details makes possible more accurate diagnosis of injuries and diseases, and in some cases, eliminating the need for invasive diagnostic procedures such as arthroscopy, which is often used to gain a visual examination of the interior of a joint with a specialized surgical instrument.
Mayo has been using the new coils clinically for some time to diagnose cartilage degeneration, nerve compression, ligament injuries, tendon abnormalities, tumor detection, bone injuries and scarring within the wrist. “Accurate diagnosis is the critical forerunner to effective medical treatment, which is why Mayo focused on improving the diagnostic capabilities of magnetic imaging,” says Kimberly Amrami, M.D., a radiologist at Mayo Clinic in Rochester. This is the first of a series of MRI coils Mayo is developing to improve the accuracy and thoroughness of imaging diagnoses.
Mayo’s partner in the project is IBM Corporation. IBM industrial design engineers helped to optimize the functionality of the new devices. For example, the IBM engineering team suggested adding windows to the sides of the device that enable technicians to better view and align patient anatomy within the coil. “This effort represents years of medical research and a great collaboration between a team of Mayo clinicians and IBM engineers,” says Samuel Prabhakar, director of system solutions, IBM Engineering & Technology Services. “We look forward to a continued collaboration, including developing more designs with the goal of improving patient care.” IBM will also be manufacturing the coils at it’s plant in Rochester, Minnesota. Revenue Mayo receives from this device will be used to support Mayo’s clinical practice, medical research, and educational activities.
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Tags: arthroscopy, IBM, knee, mayo clinic, mri
Posted by John Patrick on Jan 6, 2004 in
Gadgets,
Healthcare The Body Fat Scale has prompted as much feedback as the future of the Internet! This will be the last story about it though. Perhaps it is holiday gadget gift giving that is behind the interest or perhaps it is a desire that many people have to focus on their physical condition at the beginning of a new year. One reader reports that he has had a body fat scale for some time and found it to be "reasonably accurate, consistent, and reliable". He pointed out that the key with body fat measurements is the trend line, not the absolute number. More importantly, the reader related the measurement of body fat to the much larger issue of measuring other things about our bodies using personal medical technology. Being a member of the technology committee of a hospital board, I immediately related to his comments. (read more)
Tags: body fat, diabetes, Healthcare, home healthcare, hospital
Posted by John Patrick on Nov 29, 2003 in
Healthcare,
Public Policy 
There have been
many emails about the PepperBall, but perhaps the most emotional feedback has been about my short stories on healthcare.
The cry for more efficient, effective, and affordable healthcare is universal. One reader said,
"I was happy to see your take on healthcare in your recent blog. This is a field where
some good IT could solve redundancy quagmires, but one of the basic problems is privacy. I think people reject the idea of their healthcare info being in a database for fear unauthorized people would be able to get at it to find out what their ‘weaknesses’ are".
Of all the issues which will affect the future of the Internet, the safeguarding of our personal information when it travels on or over the Net is likely the most important because it is at the heart of Trust — and without Trust the Net will not be able to realize its full potential. This means that information about an individual needs to be handled in a way that is consistent with the privacy and security expectations of the individual — if not, there will be no trust. I am planning a series of stories about trust. There may be other stories along the way, but this is Part 1. (read more)
Tags: authentication, authorization, ca, certificate authority, digital id, encyption, integrity, key, non-repudiation, passphrase, privacy, security, smart card, trust, usb
Posted by John Patrick on Nov 23, 2003 in
Healthcare There has been a lot of feedback about the "Accident" story. It was all of the nature of "I can top that one!". Here is what one reader had to say…
"AMEN!!! Having just had to choose a new health plan and wade through the details of co-pays and deductibles, I have come to the conclusion that our health insurance system is fatally flawed (and rigged against the patient). I would love to see a calculation of what percentage of policy holders’ legitimate health costs are actually properly reimbursed. I for one only fill out the paperwork for a fraction of the expenses I should claim. And when I do, there is a 20-25% chance that they will be rejected, so that I have to call and complain, after which I get the money".
He went on to say, "The bottom line is Americans spend almost twice as much money on health care as other countries and yet people are getting fatter, more sedentary, and less and less healthy–and more and more of my friends are undergoing invasive medical procedures which turn out to have been unnecessary or, even worse, harmful".
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patrickWeb stories about healthcare
