csiblog

Electronic Medical Records: Google and Cleveland Clinic Pair Up

I remember when my wife Kim and I were first searching for a diagnosis for our daughter.  We went from doctor to doctor – Geneticists, Neurologists, Pediatricians, GI’s, etc.  Living in the Boston area we had broad access to a number of doctors who specialized in specific areas – which at first glance seemed great.   And, at some level it is.  However, the fragmentation of the healthcare system in Boston also created a big issue around sharing information between specialists, and accessing medical records.  I can’t even tell you how many times we had doctors cutting and pasting information out of their hospital systems into emails so we could share prior tests with professionals at other hospitals.  You would think that doctors have better things to do with their time.

We oscillated across three separate hospitals in search of a diagnosis -- Mass General, Boston Childrens, and Tufts New England Medical Center.  We found ourselves answering the same questions over and over again.  Finally, Kim put the family tree/ genetic map into a PowerPoint slide and started pulling it out-- the medical professionals looked at her like she was the next coming of Bill Gates.  It saved us about 10 - 15 minutes at the start of every meeting.

Today, we still use doctors at all three hospitals for our daughter.  The medical records are still spread across all of them.  We still spend time transferring information from one hospital to the other.   In fact, I find a bit of irony that with all the money spent on electronic medical records (EMRs) -- which figures into our healthcare costs -- the most comprehensive medical record we have on our daughter happens to be a three ring binder that sits in our home.  Every doctors’ letter is in it, every blood test, and much more – including Kim’s original PowerPoint slide.

For caregivers and patients, not having quick access to their records can be disastrous. For doctors and medical staff, it can be frustrating, time-consuming, and lead to major mistakes in care options.

So the focus these days is on management of electronic medical records, who owns them, where they reside, how to make them portable, how to protect privacy along the way. Both Google and Microsoft have pilot programs to house personal medical records in large databases so that any doctor anywhere can access information about any patient. Of course, there is controversy.

But for us, the larger issue is that there is movement away from the concept that individual hospitals own your information, and toward a more open architecture that favors the patient and not the hospital.

While the important debate about privacy and security goes on, Kim and I are thrilled to see that one hospital, the prestigious Cleveland Clinic, is engaging in a pilot program with Google to store medical records in a central database built by Google. We applaud the Cleveland Clinic’s efforts toward portability and accessibility, and look forward to the results of the pilot.

Brian Costello
carespace.com

For more on this:
techdirt.com
cnn.com
wsj health blog

Should Doctors Be Paid to Prescribe Generic Drugs?

Regarding yesterday’s article in the Wall Street Journal entitled "Doctor's Paid to Prescribe Generic Pills" by Vanessa Fuhrman:

We have a very real crisis in America and it is our healthcare system.  It is downright scary the direction it is headed.  And no one has more experience with the broken system than patients with serious illnesses and their caregivers.

The journal article is about health insurance companies paying doctors financial incentives to move their patients over to generic drugs. Many of us caregivers deal with managing multiple medications. It doesn’t matter if a prescription is directly aimed at an area of illness or it is to manage some of the symptoms that present themselves – they are an important part of life in this world.

My daughter Meg has a number of prescriptions she requires on a regular basis – CoQ10, Synthroid, Carnetene, Neocate Junior, Bactrim, and Zyrtec.  At least one of these has a generic version coming available at the end of this month.  For us, the decision to move to a generic version of one of Meg’s meds will be front and center in early February. My wife Kim and I will look at moving to generics because they will most likely incur a lower insurance co-payment.

Insurance companies push people over to the generic version of a drug by significantly increasing your co-pay on the non-generic version.This is usually how people find out - their co-payment goes up on the generic and they ask the pharmacist why. Do not depend on your doctor to tell you that a generic version of a drug is available – our own did not tell us.

So we’ll talk to our doctor and our pharmacist, do a little research on the web about the new generic, and then collectively make a decision if we should move Meg over to it. Kim and I make sure we are part of all the decisions related to Meghan's care and work with all the professionals involved in her care.

But what upsets me about the Wall Street Journal article is that, more and more, insurance companies are attempting to get doctors to move to generics through financial incentives. We know Meg’s doctors fairly well and we're quite sure that none of them would change our daughter's meds based solely on a financial incentive from an insurance company. A doctor’s responsibility is to provide the best care available to their patients, not to help insurance companies and the generic pharmaceutical industry make profits. And our experience with doctors bears that out.

So how do we know when we’re being steered to a generic drug because of a kickback? How do we get the assistance we need throughout the decision-making process of moving to generics?

I would love to hear people’s thoughts on this one as it hits very close to home for all caregivers and their loved ones.

Brian Costello
carespace.com

More to read:

http://epablog.wordpress.com/2007/11/26/kickbacks-doctors-pharma-insurance-and-surprise-patients-caught-in-the-middle/

http://www.thebostonchannel.com/news/13800173/detail.html

Medical Clinics in Convenience Stores

Would you really want to put your health in the hands of convenience stores selling cigarettes, candy, and magazines? This question hovers behind the recent controversy over whether Boston-area retail convenience stores should be allowed to offer limited healthcare clinics (e.g., CVS’s Minute Clinics) to handle sore throats, ear infections, and the like.

Boston Mayor Thomas Menino weighed in against the move, the Massachusetts Public Health Council seems to be for it, and much of the discussion is relentlessly focused on potential quality of care and safety issues. Let’s face it -- the market (and plenty of regulation – this is Massachusetts, after all) will quickly address quality of care. For caregivers, access to care is the more pertinent issue—and the real benefit for us.

Enabling low-priority issues to be handled at these convenient, walk-in clinics will free up the schedules of swamped General Practitioners (GP’s) to handle more complex, challenging, chronic medical conditions—the kind that caregivers struggle to get for their loved ones every day. As caregivers, we spend a fair amount of time in waiting rooms and hospital lobbies. Removing even a little of the considerable burden from GPs would help streamline access to specialized attention when it’s needed.

Plus, these clinics will give caregivers fast, as-needed access to routine diagnostic tests (throat cultures, etc.) when the problem is less serious. In short, getting your Alzheimer’s-afflicted mother’s blood pressure taken in 10 minutes at a convenience store beats waiting around the lobby of your doctor’s office for an hour or two.

With the right approvals, monitoring, and expectations, these new types of clinics seem to bring a simple and sensible addition to the healthcare mix. If convenience stores manage to make money offering these services, more power to them. If only our healthcare system was so responsive to the needs of the marketplace.

Should we rely on convenience-store clinics as frontline identifiers of more serious conditions, such as diabetes or cancer? Of course not. But can caregivers look to these walk-in clinics as a new, convenient resource? Absolutely.

Stona Fitch
carespace.com