Beacons lead healthcare quality 'revolution'

"We are really at a tipping point here; providers and patients alike have come to realize that the modernization of healthcare is long overdue and that we all have a role in its broad adoption."

So said Jason Kunzman, project officer for the Office of the National Coordinator for Health Information Technology, as he moderated the "Beacon Communities: Leveraging Health IT to Fuel the Quality Revolution" education event at the recent HIMSS 2012 Virtual Conference and Expo. 

The session featured presentations by officials from two Beacon Communities: Southeastern Minnesota (SE MN) Beacon Community and the Keystone Beacon Community of central Pennsylvania. They grappled with the "tipping point" referenced by Kunzman: how has health IT been fueling the quality revolution? Especially, how has it benefited these spotlighted health systems?

Southeastern Minnesota Beacon Community

Chris Chute, MD,, a principal investigator for the SE MN Beacon Community, discussed the IT running through the Beacon system. 

The unique peer-to-peer HIE integrated throughout the community has been central to the community's infrastructure, he said. "This is distinct from most health information exchanges where the health information is the central hub and people subscribe to it. What's different about Southeastern Minnesota Beacon is that we have open-source software – the ONC-provided NwHIN-connect software – that is deployed in each and every provider," Chute said. 

This diversion from a hub-and-spoke model ensures communication and engagement across providers, and the leveraging of a national model: "When we talk about provision of care in Southeastern Minnesota, we are really talking about an integrated network," he said, "and Beacon is the integrating element where all care providers are coordinating and engaged."

Along that strain, the community's public health providers utilize the Public Health Documentation System (PH-Doc) "that is an electronic medical record of public health services," Chute added. PH-Doc integrates information from public health services into the HIE network to outline "community views of ideal health information."

Running parallel to SE MN Beacon's HIE is a comprehensive CDR, said Lacey Hart, program manager for the SE MN Beacon Program. The depository allows for the tracking of clinical and population metrics in the area. To that end, researchers are able to monitor the community workflow and analyze where impacts are being seen. 

Hart stressed data gaps, too, as a key aspect of area metrics highlighted by the advanced repository. "We looked at our data early on - before the repository - and now the data repository is really an excellent way to hone in on where the data gaps exist."

One timely example: SE MN Beacon has been monitoring asthma and diabetes trends, and outlining the clinical measures used to counter the disease. Using the CDR, however, researchers snagged a data hole; "…One of the things we were missing was the patient data," said Hart. Using metrics from the CDR, the Beacon team developed patient centric data gathering tools. The data exchange is now integrated with information on patient lifestyles

Keystone Beacon Community

Like its sibling in Minnesota, the Keystone Beacon Community of Central-PA is using IT to drive care improvements. 

Geisinger Health System, a Pennsylvania-based health services organization, heads the Keystone HIE. The exchange connects 13 member facilities throughout the area. 

The HIE began as a pilot system with three organizations, said Geisinger Health System IT Director and Keystone HIE Director Jim Younkin. It's now linked between 34 organizations. "The services that are being provided through Keystone Beacon include the EHRs being connected," he said. "EHRs now have the ability to publish and consume documents directly from the health information exchange." 

The HIE includes patient and provider portal applications, and supports three distinct models of health exchange: the "pull model," the "send model," and the "push model," said Younkin. 

"We started with the pull model, which is really just using the portal to do a look-up of information," he said. It hinges on "the idea of having a centralized data repository for access by members of the community."

The direct mode allows messaging between site clinicians and patients. 

The push model will be rolled out this month, said Younkin: it allows clinicians "to subscribe to a patient through the health exchange, and then as activity occurs for that patient we can deliver alerts and notifications to those clinicians to inform them of certain activities."

With these various models and the portal applications supported by the Keystone HIE, Younkin says care capability is expanding in central Pennsylvania. 

Similarly, IT has been catalyzing patient provision in the SE MN Beacon Community through HIE and CDR technology. 

IT critical to achieving quality

The communities highlighted in the HIMSS virtual education event only strengthen the case for IT's critical place in fueling the quality revolution, said Kunzman. It's the essential ingredient, he said, in driving providers over that "tipping point" and in the right direction. 

"We are at the end of year two in a three-year journey. Our Beacon Community grantees have made great achievements," said Kunzman. "They've enhanced the role that safety-net providers play in the overall continuum of care, Beacon communities and technology vendors have formed new collaborations in order to introduce efficiency in bringing the most important functionalities to market…"

VA awards $4.9M contract to support open source tech

WASHINGTON – The Department of Veterans Affairs has awarded Ray Group International of Tampa, Fla., a $4.9 million contract to support the open source community that is contributing software code to the VA and Defense Department integrated electronic health record system.

RGI, a service-disabled veteran-owned small business that provides software engineering support services, will perform operations to continue the development and establishment of the Open Source Electronic Health Record Agent (OSEHRA) over the next six months, according to a June 21 announcement  in Federal Business Opportunities.

[See also: VA a good model for EHR systems and implementation]

With the contract in place, OSEHRA will be able to recruit necessary staff and deploy accounting capability and other business systems to ultimately make the OSEHRA software development community operationally self-sufficient, according to the notice. RGI will provide project management, analysis, configuration management and testing services. 

OSEHRA will enable federal agencies, industry and academia to contribute software code to create applications and tools for the iEHR, to improve and modernize VA's VistA electronic health record system, and eventually to certify code through testing.

DOD recently said thatit has contributed the software code of the theater version of its AHLTA clinical information system into the open source community. OSEHRA started with the VistA code.

[See also: VA and DoD interoperability program needs better management, GAO says]

The custodial agent for the open source community must approve software code for integration into the evolving VistA code base and interoperability of complimentary software.

Xerox to build health insurance marketplace in Florida

DALLAS – Florida Health Choices, a corporation established by the state to improve access to care, has selected Xerox to administer its insurance marketplace.

According to Xerox officials, the program is designed to give small business and eligible individuals more flexibility in finding affordable health insurance and other services. The nine-year contract is valued at $68 million.

With partner CHOICE Administrators Exchange Solutions, Xerox will provide a cloud-based Web portal and online plan selection tool to give consumers and employers more information when making health insurance selections. The solution preserves the benefits of employer-sponsored insurance and eases the administrative burden for small businesses, officials said.

“We’re designing and supporting programs that increase access to health coverage for consumers,” said Will Saunders, group president, Government Healthcare Solutions, Xerox. “The solution we create in Florida will serve citizens and small business owners and help position the state as a leader in establishing a competitive and voluntary health insurance marketplace for small employers.”

Xerox will also provide eligibility determination and enrollment management services for the program, and operate a customer contact center to share information on marketplace offerings. These services will help Florida Health Choices handle the massive amounts of information involved with the marketplace quickly, efficiently and securely.

“We need a partner who can get a fully functional marketplace setup that is designed to serve Floridians now and into the future – delivering on both our short and long-term goals,” said Aaron Bean, chairman, board of directors, Florida Health Choices. “We’re confident Xerox will support us in establishing our marketplace quickly, while helping us to increase healthcare access to small business employees – one of our key priorities.”

Cerner revenues up 18 percent in 4th quarter

KANSAS CITY, MO – The economy may be in crisis, but Cerner Corp. has a rosy outlook. The Kansas City-based healthcare IT company posted a better-than-expected fourth quarter result on Tuesday, with revenues up 18 percent.

Executives credited the company's broad global client base for its success.

"The large size and geographic diversity of our client base and the deep strategic relationships with those clients contributed to our ability to deliver solid results in a difficult environment," said Cerner founder and CEO Neal Patterson.

"We are pleased with our fourth quarter and full-year 2008 results, which reflect good execution in a challenging economic environment," Patterson said. "We delivered solid bookings, revenue and earnings and record levels of cash flow."

"We are cautiously optimistic that we will continue to generate solid results," he said, adding that Cerner is well positioned to take advantage of the Obama administration's focus on healthcare IT as a necessary piece of healthcare reform.

Sean Weil, an analyst with Piper Jaffrey, concurs that Cerner is well positioned for the stimulus package making its way through Congress.

"Cerner is one of a handful of companies that can benefit from both the hospital and physician stimulus incentives," he said in an analysis issued Wednesday.

In addition, Weiland said Cerner's size and scale likely afford it the capital it needs to execute.

Cerner's bookings in the fourth quarter of 2008 were $404.9 million, near the record level of $406.6 million recorded in the fourth quarter of 2007. Fourth quarter revenue increased 18 percent, to $465.7 million, over the same period a year ago.

Net earnings were $71.5 million compared with fourth quarter 2007 net earnings of $41.3 million.

Other fourth-quarter highlights:

Cash collections of $441 million and record operating cash flow of $98 million.Days sales outstanding of 92 days compared to 93 days in the third quarter of 2008 and 90 days during the same quarter last year.Total revenue backlog of $3.5 billion, up 7 percent over the same quarter a year ago. This is composed of $2.9 billion of contract backlog and $0.6 billion of support and maintenance backlog.

Why Has the Press Failed Us In Reporting on Health Care Reform?

An Open Letter to Bill Keller, Executive Editor, New York Times, and Clark Hoyt, Public Editor, New York Times

by Benjamin Day–

Dear Bill Keller and Clark Hoyt,

For the first time in the span of a generation, national health care reform is back on the horizon, and I’m writing to you to step back for a moment into the history of the Times’s reporting on health care reform. Last year I began a research project with two researchers from Harvard Medical School, Drs. David Himmelstein and Steffie Woolhandler, to look at the history of major state health reforms such as TennCare, the Oregon Health Plan, MinnesotaCare, and many others. A sweeping health reform bill had been passed into law in Massachusetts in 2006 that was being hailed as a unique, first-of-its-kind bipartisan strategy to achieve universal or near-universal health coverage without raising taxes or adding new regulations on the health care industry. We initially set out to find how unique the Massachusetts health reform law really was compared to previous state efforts, and to see if by analyzing the outcomes of those earlier reform efforts we could learn some lessons about what to expect in Massachusetts.

What we found surprised us, and a summary write up of our findings was published in the International Journal of Health Services. We found that, aside from the “individual mandate” in Massachusetts requiring many of the uninsured to purchase their own private health plan or face tax penalties, many reforms in other states – indeed, even in our own state in the recent past – were almost identical to the Mass plan in their goals and structure. They also all failed to achieve their stated goals of reducing the uninsured population in their respective states and/or of controlling rising health care costs. The most ambitious of these, TennCare in 1994 and a large Medicaid expansion in Massachusetts also in the mid-1990s, were able to reduce the uninsured in their respective states for a period of several years. However, the financing of these plans all proved unsustainable over time, enrollment was often capped or benefits eroded, and a few short years after passage every state found itself back where it started: with high and rising health care costs and a large and growing uninsured population. We titled our article “State Health Reform Flatlines.

What we found even more surprising than this history of failed reform efforts, though, was media coverage of the legislation. Articles by our most respected news organizations hailed state reform after state reform as pioneering, likely to serve as models for the nation, and designed to control costs and extend health coverage to the uninsured. No reasonable reader of the news available at the time these laws were passed would expect that they might fail entirely to reduce the uninsured over time, or that they might not succeed in controlling costs at all.

Florida in April 1993 launched the first of what would be many “managed competition” plans for controlling costs and extending health coverage, a scheme that would serve as virtually the only cost control component of Bill Clinton’s proposed health reform bill of 1994. The New York Times wrote “The Florida Legislature approved a sweeping overhaul of the state’s overburdened health-care system early today, making Florida the first state in the nation to combine free market competition and government regulation in a way similar to the Clinton Administration’s plans for controlling soaring medical costs… Florida’s plan, which will try to cover most people eventually and at the same time to control health costs, is taking place on a larger scale than anything seen elsewhere.” Managed competition did not control costs in Florida or anywhere else, nor was the uninsured population reduced.

Exactly one year previous in April of 1992 Minnesota passed its “HealthRight” plan – later renamed “MinnesotaCare.” USA Today wrote of it: “Minnesota is about to embark on a plan to solve the health-insurance crisis that could hold lessons for other states and the nation… HealthRight… will begin signing up families with children in the fall and will be fully open to Minnesota’s estimated 370,000 eligible uninsured by 1994.” The Associated Press wire coverage of the law repeated state estimates that almost 40 percent of those uninsured should be covered by 1997, and quoted the head of the National Conference of State Legislatures calling the bill “the first complete reform proposal in the United States.” MinnesotaCare did not reduce the percentage of uninsured in Minnesota even in the short-term.

A few other quotes should be enough to convey the sense that there is a recurring problem in the news we receive on health reform in America. A Vermont bill also passed in 1992 elicited this opening description in the New York Times: “Gov. Howard Dean, the only governor who is a physician, signed a law Monday in Bennington that sets in motion a plan to give Vermont universal health care by 1995.” The Oregon Health Plan of 1992, which attempted to reduce benefits for Medicaid beneficiaries in order to expand coverage to the uninsured, was described in a Washington Post article as “The most far-reaching health care reform in the nation.” The New York Times began its coverage by stating that “The Clinton Administration today approved Oregon’s proposal to guarantee health services for poor people by rationing care.” Neither Vermont’s reform nor Oregon’s reduced the percentage of uninsured in the state, and the poor in Oregon were not covered.

These are selective quotes: the broader coverage has often provided good descriptions of what the laws are intended to accomplish. Moreover, they have included extremely effective reporting on the politics of the health reform process – particularly when the process is contentious, or where well-organized groups have mobilized opposition. However, in the United States we have a long history of reforms that have survived the political process only to fail economically, and it is clear in retrospect that the media sources – both local and national – with large market share have not done their due-diligence in reporting on the economic viability of health reform efforts. I believe this would be borne out by analyzing coverage of many other significant reforms in Washington, Tennessee, Massachusetts, Hawaii, Maine, California, Utah, and nationally.

This becomes particularly clear by comparing coverage of health care reform with medical reporting in virtually any paper. The Christian Science Monitor on April 8, for example, carried a story that is typical of this approach to health politics reporting entitled “Healthcare battle brewing: political groups gear up: A public insurance alternative is likely to be the most contentious of the reform proposals.” The story states that the Obama administration hopes to introduce a Medicare-like public buy-in plan available to individuals and businesses as an alternative to private health coverage. It goes on to cite the Heritage Foundation’s opposition to the plan, the support of groups such as MoveOn.Org and Democracy for America, and public polling from Harvard Professor Robert Blendon. The article follows a “he-said/she-said” format, with the Heritage Foundation contending that such a plan would not allow private insurance to compete on a level playing field, advocates urging that it will bring down costs and hold the private insurance industry accountable, and the CEO of Families USA urging that both sides attempt to find a common ground.

What is missing from this narrative of contending arguments is a discussion of evidence about the likely impacts of a public plan option. There have been forms of public-private health insurance competition implemented under Medicare for a number of years, and there are many other countries that allow competition between public and private health insurers. Peer-reviewed studies of public-private competition are not hard to find, nor are experts with varying opinions. Compare the CSM discussion with almost any medical news story in the New York Times Health Section on the same day: there is a report on a new study by two Stanford professors assessing the impact of George W. Bush’s AIDS Relief program in Africa; two studies about the impact of light exercise for heart failure patients; three reports on the role of “brown fat” in burning calories; and others. In short, medical reporting and the coverage of public disagreements revolve around evidence, there are standards for credible sources, and it is common to read about the limitations of available evidence. Although I am personally an advocate and an organizer coming from a single-payer health care perspective, what strikes me most after reading hundreds of news reports on health reform is the lack of academic perspectives, held to academic standards, concerned with basic questions of the economic efficacy and sustainability of health policy proposals.

At the state level this has often been exacerbated by bi-partisan legislation. Many of the reforms that have failed to achieve or even approach their stated goals have been passed with support from the Democrats and Republicans holding one or both legislative houses or the governor’s office. This has a particularly chilling effect on politics-based health reform coverage. Reporting on the Oregon Health Plan, for example, focused almost exclusively on the attempt to ration services for Medicaid enrollees – would this plan harm the disabled or the poor, was it just? – while the basic question of whether the law, even taking rationing for granted, would succeed in reducing the uninsured in the state, went unasked. In Tennessee, similarly, the spectacle of almost one million Medicaid enrollees being moved into managed care plans occluded the basic question of whether the proposal to extend coverage to another half a million uninsured residents was economically viable, or if it would succeed in reducing the state’s uninsured over time – these latter goals being the entire point of moving Medicaid recipients into managed care plans in the first place.

This shortcoming has also been exacerbated by the subject material. Increasing access to health care is what makes health reform morally compelling for most people, but financing and cost controls are what make efforts to expand access sustainable or unsustainable. These are topics not well-suited to personal interest stories, and they are often bewilderingly complex. In Massachusetts alone, residents have been promised universal health care or dramatic reductions in the uninsured at least four times in the last twenty years. A few years after each reform passes, the dry logic of costs and financing has left residents back where they started, and yet when the politics of health reform begin again we are provided with very little information in the public sphere to sort out the snake-oil from the genuine, sustainable reform proposals.

I write to you not because I believe the New York Times is particularly at-fault in leaving its reading public unprepared to determine the viability of different health reform proposals, but because the scope of the Times’s coverage has meant that it has reported on a wide range of state and national efforts, which gives us a good window on the history of health reform coverage in the United States. This year, many national commentators are measuring the ongoing process of health policy development against the failed Health Security Act of the Clinton era. This has led many advocates to be particularly concerned with crafting politically viable proposals. I believe this makes the burden on reporters to effectively assess whether the proposals are likely to achieve their stated goals sustainably all the more important.

I would urge the Times not to report health policy disputes in a he-said/she-said format divorced from evidence-based standards. Reporters should challenge interviewees to source their economic claims, include those sources in their write-ups, and not shy away from evaluating the quality of evidence offered from different perspectives. Furthermore, we have learned time and again that where there is political harmony, there is not necessarily economic rationality. The burden of evidence-based evaluation of health policy cannot stop at the borders of political skirmishes.

I thank you for your consideration of this open letter,

Sincerely,

Benjamin Day
Executive Director
Mass-Care: The Massachusetts Campaign for Single Payer Health Care

Ohio runner with cerebral palsy, 11, becomes YouTube hit

COLUMBUS, Ohio(AP)�When John Blaine realized 11-year-old Matt Woodrum was struggling through his 400-meter race at school in central Ohio, the physical education teacher felt compelled to walk over and check on the boy.

"Matt, you're not going to stop, are you?" he encouragingly asked Woodrum, who has cerebral palsy.

"No way," said the panting, yet determined, fifth-grader.

Almost spontaneously, dozens of Woodrum's classmates � many who had participated earlier in the school's field day � converged alongside him, running and cheering on Woodrum as he completed his final lap under the hot sun.

The race on May 16, captured on video by Woodrum's mother, is now capturing the attention of strangers on the Internet, many who call the boy and his classmates an inspiration to be more compassionate toward each other. A nearly five-minute YouTube video posted this week by the boy's uncle has received more than 680,000 views.

Woodrum, who has spastic cerebral palsy that greatly affects his muscle movement, said he had a few moments where he struggled.

"I knew I would finish it," said the soft-spoken Woodrum, who attends Colonial Hills Elementary School in suburban Worthington. "But there were a couple of parts of the race where I really felt like giving up."

It was his fourth race of the day, and one he didn't have to run. Only a handful of students opted to give it a try, said Anne Curran, Woodrum's mother. She said her son doesn't exclude himself from anything, playing football and baseball with friends and his two brothers.

"He pushes through everything. He pushes through the pain, and he pushes through however long it may take to complete a task," she said. "He wants to go big or go home."

The sometimes shaky footage shows Woodrum beginning the race on a steady pace with his classmates, though he quickly lags. As several students pass him on their second lap around the grassy course, Blaine walks over to make sure Woodrum is OK.

"The kids will tell you that Matt never gives up on anything that he sets out to do," said Blaine, who has been Woodrum's teacher since kindergarten. "They knew he would cross that finish line, and they wanted to be a part of that."

During his second lap and with Blaine by his side, Woodrum is suddenly joined by classmates encouraging him to keep going. Clapping and running by his side, the group begins to yell in unison, "Let's go, Matt! Let's go!"

Woodrum said he was surprised by his classmates' kindness.

"It was really cool and encouraging," he said.

As Woodrum reaches the finish line, the video shows the dozens of students bursting into applause, some throwing their arms and fists into the air before giving him a round of high-fives. Some congratulate him, and at least one kid is heard in the video proudly telling another that Woodrum is his friend.

"They treat him like every other kid," Curran said. "They're very great with him and they're like a second family to him."

Curran said her son doesn't dwell on his condition.

"He's been a fighter since day one, and I didn't expect anything less."

Blaine said no one knew a video camera was recording the race that day.

"It was so fitting that we were all together," he said. "Matt was a huge part of that race, his classmates were a huge part of that race. It was a magic moment."

Learn all you can about health care alternatives

The following editorial is from www.Courier-Journal.com.

The challenge is for citizens to get involved. the public must do its part by educating itself about the various alternatives, and letting their representatives in Washington know what they conclude.

How broken is our current system?

Some 47 million Americans are uninsured; another 50 million are underinsured (not fully covered).

About 8.7 million children are uninsured.

Most bankruptcies have a health reason as a major cause, and 68 percent of those people who have gone belly up do have health insurance policies.

The World Health Organization ranks the level of U.S. health care at 37th in the world.

Private health insurance companies, which have doubled the premiums since 2000, have a bureaucratic overhead of 28-31 percent while Medicare operates at 3 percent efficiency. Therein lies a large part of the problem. These companies have an incentive to reduce benefits to patients.

The most persistent solution on the grassroots level is a single-payer system, the single payer being the federal government. This program involves a Medicare-type approach for everyone, but it would be expanded to include dental care, vision care and preventive programs. Overall, it would cost about the same — maybe a little more, maybe a little less — as the present 15 percent of the Gross National Product (GNP). All other industrialized nations with full coverage for all citizens average about half the costs in total medical care.

A single-payer system is best outlined in congressional bill HR676, which would set up the National Health Insurance (NHI) program. What it is not is “socialized medicine.” England and Spain have socialized medicine, wherein the doctors and hospitals are all employees of the federal government. Under HR676 the present system would stay; doctors would remain private vendors and would submit their bills to one payer, the U.S. government, not to the 1,500 private health insurance companies. Patients would still choose their doctors. (More about HR676 later)

Is a single-payer system just the blue-sky proposal of some Washington, D.C., think tank? Not by a long shot. It is the work product of Rep. John Conyers and has 90 other congressmen as co-sponsors. This is about one in five House members. Also endorsing HR676 are the U.S. Conference of Mayors (a nonpartisan group of 1,100 members), Physicians for National Health Care Program (more than 10,000 doctors), League of Independent Voters, the United Church of Christ and the United Methodist Board of Church and Society, 32 city councils (including Louisville, Indianapolis, Baltimore, Detroit and Boston), 14 national and international labor organizations, the American Medical Students’ Association, the National Family Farm Coalition and more.

There was a time when the doctors would (and did) kill any national health care plan in the womb. Today a solid 59 percent of U.S. physicians now support national health insurance. Particularly strong on the issue are psychiatrists (83 percent), pediatric sub-specialists (71 percent), emergency medicine physicians (69 percent), general internists (64 percent) and family physicians (60 percent). Doctors and hospitals have to employ huge staffs just to process insurance claims from a multiplicity of insurance firms. About 20 percent of private doctors’ income goes to pay for this staff.

Businesses are now leaning toward a national program. The Business Coalition for Single Payer Healthcare in New York (www.BusinessCoalition.net) poses this scenario: “If you own a small business with a $100,000-per-month payroll, your health care costs can be reduced from typically $15,000 per month to just $3,300 — from 15 percent to 3.3 percent of wages, a savings of $140,400 per year.”

General Motors, which says health care adds at least $1,500 to each car, is paying people to leave their jobs so they can hire replacements at 50 cents on the dollar with reduced health benefits. This may help the bottom line and the company can compete better, but it is a sad commentary on the state of American health care, especially for the newest of workers.

Neither of the two major presidential candidates favored a single-payer program. Democrat Barack Obama comes up with a halfway reform that includes the insurance companies in the mix. His plan would offer help to nearly half of the uninsured people and would cover all children. Republican John McCain’s plan was only a small reform that features a tax credit plan of $5,000 for a family. This wouldn’t come close to paying a normal $12,000 premium for family health care. And the McCain plan, from some analysts’ viewpoint, would offer help to only about 4 to 5 million uninsured people.

Neither Republican nor Democrat solutions take advantage of the tremendous savings realized from eliminating the waste in the private health insurance industry. This waste alone, by the estimates of several studies, would pay for health coverage for all of the uninsured. More than several states have tried systems of mandating and subsidizing policies from insurance companies. Minnesota, Tennessee, Vermont, Washington and Massachusetts have learned the hard way in failing to fix the system by including the health insurance industry.

Where else would the money come from to support a national program? HR676 calls for a modest payroll tax on all employers and employees of 3.3 percent each, in addition to a 1.45 percent tax that they are already paying for a total of 4.75 percent each. Also there would be a 5 percent health tax on the top 5 percent of income earners and a 10 percent tax on the richest 1 percent . A small tax on stock and bond transfers is also envisioned along with the closing of corporate tax loopholes and repealing the Bush tax cut for the highest 1 percent of income earners.

When you subtract the cost of insurance premiums, the deductibles and the co-pays, most businesses and most people would pay less for national health care than they do today. Even if the cost did go up some, the coverage would be much broader and medical needs would be met much more easily.

What we are learning is that the United States is all alone among its peers in the whole world. This is the only country that treats health care as a commodity distributed according to ability to pay, rather than as a social service distributed according to medical need.

The challenge is to get fully informed citizens involved in changing things for the better.

DAVID ROSS STEVENS
Borden, Ind.

Mr. Stevens is a member of the Southern Indiana branch of Hoosiers for a Commonsense Health Plan (whose Kentucky counterpart can be reached at www.kyhealthcare.org).

Obama and Daschle should opt for single-payer

Barack Obama needs to make good on his campaign pledge to reform health care. It is not enough to throw the issue off to former Senator Tom Daschle, Obama�s choice to head the Department of Health and Human Services.

Daschle says he wants to hear from us, the American people, on this issue. So we should oblige him.

Obama and Daschle have a choice: Rely on a private insurance-based plan that does little to mitigate the escalating health care crisis, or solve the problem once and for all and adopt universal, single-payer health care.

Many in Congress, the media, conservative think tanks and some advocacy groups � led by the Service Employees International Union and its business allies � are stumping for piecemeal changes.

Such a path would perpetuate the crisis and deal a cruel blow to the hopes of Americans for real reform. Those in Congress and liberal policy organizations who are embracing caution or promoting more insurance, not more care, are playing a risky game. It could jeopardize the health security of tens of millions of Americans and, in the process, fatally erode public support for the Obama administration.

Hardly a day passes without fresh signs of the health-care implosion.

Just days after the election, the New York Times reported a sharp increase in cost-shifting in employer-paid health plans, with more employers pushing high deductible plans that typically cost workers thousands of dollars in out-of-pocket payments.

Similarly, the Wall Street Journal reported a huge spike in health care premiums for small businesses, which prompted many to raise deductibles or cut coverage.

The consequences are chillingly apparent. In October, the Washington Post cited a study that found one-fourth of Americans are skipping doctors� visits, and 10 percent could not take their child to the doctor because of cost.

That same month, USA Today reported that one in eight patients with advanced cancer turn down recommended treatment because of the bills.

America is falling embarrassingly behind.

A study by the Commonwealth Fund in November compared adults with chronic conditions, such as high blood pressure, diabetes, or heart disease, in seven major industrialized countries. A stunning 54 percent of the American respondents said they were likely to go without recommended care, compared to just 7 percent of chronically ill patients in the Netherlands. Over 40 percent of the Americans spent more than $1,000 on medical bills, compared to just 4 percent of British and 5 percent of French patients.

If we adopted a universal, single-payer system like these European countries, or if we simply expanded Medicare to all Americans, we would rectify this problem.

The need is urgent. Today 46 million Americans are without health care.

Millions more are at risk of losing it during this recession. And huge numbers of Americans with insurance can�t afford the cost hikes.

At some point, our government must stop subsidizing these private companies and start investing in the American people.

The time to do so is now.

The best way to get it done is to guarantee all Americans health care in a single-payer system.

Tell Obama and Daschle to support improved Medicare for all.

Rose Ann DeMoro is executive director of the 85,000-member California Nurses Association/National Nurses Organizing Committee.

This article is from the Progressive.

Mizzou researchers use sensors for remote monitoring of seniors

COLUMBIA, MO – The University of Missouri announced its development of new technologies that could help aging adults stay in their own homes longer while still being monitored by healthcare providers.

Marjorie Skubic, a professor of electrical and computer engineering in the MU College of Engineering, and Marilyn Rantz, a curator’s professor of Nursing in the MU Sinclair School of Nursing, have used motion-sensing technology to monitor changes in residents’ health for several years at TigerPlace, an eldercare facility in Columbia. 

Now they've received a grant from the National Science Foundation to expand their work to a facility in Cedar Falls, Iowa.

Fiber networking in Columbia and Cedar Falls will provide the infrastructure necessary for health care providers in Missouri to remotely monitor the health of elderly residents in Iowa. High-speed video conferencing capabilities will allow communication between staff and residents at the two locations.

“Using what we’re already doing at TigerPlace and deploying it at the facility in Cedar Falls will allow us to further test the concept of remote healthcare,” said Rantz. “Monitoring individuals with in-home sensors allows us to unobtrusively monitor their health changes based on their individual activity patterns and baseline health conditions.”

Rantz says the in-home monitoring systems use proactive, rather than reactive, ways of monitoring seniors’ health. The systems provide automated data that alert health providers when patients need assistance or medical interventions. The sensors will include video gaming technology for measuring residents’ movements in the home, and the researchers will integrate new hydraulic bed sensors that will monitor an individual’s pulse, respiration and restlessness.

“We’re using high-speed networks to solve real-world problems,” Skubic said. “Implementing the health alert system in Cedar Falls will tell us how the approach we use at TigerPlace compares to other settings. It will be an important step toward facilitating independent housing, which is where most seniors want to be.”

Skubic and Rantz said in-home sensors, such as the ones in their study, can help identify early changes in health. Identifying issues early is the key to maintaining health, independence and function for older adults, the researchers said.

“The sensors help identify the small problems – before they become big problems,” Rantz said. “Based on the data collected by the sensors, health providers can offer timely interventions designed to change the trajectory in individuals’ functional decline.”

The research is funded by US Ignite, an endeavor financed by the National Science Foundation and the White House Office of Science and Technology Policy that supports health care technology development.

 

Technology at forefront of NHS treatment in Scotland

EDINBURGH – Online scanning to allow remote diagnosis for island patients and Scotland's biggest telehealth system are among a raft of hi-tech projects to help more patients be treated quicker and closer to home.

EHealth investment totalling £1.6million - including funding from the NHS's major IT partner - has been announced today by Scottish Health Secretary Nicola Sturgeon.

Speaking at the first annual Scottish Telehealth and Telecare conference, Sturgeon unveiled details of projects extending the use of electronic technology in the NHS, including:

 

Touch screens in the homes of hundreds of patients with chronic conditions in Lothian, allowing them to be monitored from home;

 

 

Online scanning allowing patients in Orkney to be diagnosed remotely, avoiding lengthy trips to hospital;

 

 

New software in Glasgow transmitting patients' records directly to consulting rooms.

 

"Telehealthcare technologies and eHealth have huge potential to benefit patients, by harnessing all that technology can offer to make care quicker, safer and closer to home. It also allows more efficient working and better support for our health and care staff," Sturgeon said.

"In eHealth, our joint investment in 16 pilot projects will help patients in hospital and at home. At the West of Scotland Heart and Lung Centre, for example, they're replacing cardiac databases with the latest systems to improve patient safety.

"Together with NHS Lothian, we're also rolling out Scotland's biggest telehome monitoring system. Four hundred people living with conditions like heart failure or chronic lung disease will have touch screens to monitor their vital signs from home, helping them avoid repeated hospital visits."

The overall eHealth funding announcements made by the Cabinet Secretary totalled £1.6million - £564,000 of which comes from the Atos Origin Alliance, an innovation fund from the NHS's main IT partner.

The Atos Origin Alliance comprises Atos Origin, BT, IBM and Sopra Group.

The roll-out of the £700,000 telehealth project for long term-condition patients is funded equally between the Scottish Government and NHS Lothian.

6 opportunities to keep hospital supply chain in line

This past March, Texas Children's Hospital in Houston opened its Texas Children's Hospital Pavilion for Women after recently expanding a new West Campus in an effort to meet growing needs and a shift in population base. And with this growth, said Rick McFee, director of supply chain management at Texas Children's, there came an excellent opportunity to streamline the system's supply chain.

"Due to both of those projects as new projects, we had the ability to look at supply chain and how we were managing all that activity," he said. "It gave us the opportunity to look at new ways of doing that."

[See also: Premier's supply chain program boosts bottom line]

McFee, based on his experiences, outlines six keys to supply chain management. 

1. IT systems should support maximum flexibility. When deciding on an IT system, said McFee, the organization chose to look, first and foremost, for one that gave them maximum flexibility. "We were making sure we could manage multiple types of items," he said. "For example, not every item can fit into the same box or container, so we needed to make sure we had maximum flexibility." Having a close-cabinet system, he added, results in more limitations than an open-cabinet system, putting the emphasis on barcoding to streamline processes. "So as long as you can grab that item and scan its barcode, or have the barcode label close to the item's location, the system works," he said. "That was one of the things we were looking for: the flexibility to manage multiple different types and sizes of projects without limitations to the physical constraint."

[See also: VA deploys robotic systems across healthcare facilities]

2. Try to manage utilization at the floor level. Within Texas Children's facilities, said McFee, a nurse can pick up an item and see barcoding from both the manufacturer and the facility itself, allowing them to scan either code and document the inventory. "From a nursing perspective, they can scan it when they're pulling it off the shelf, or when they have it in their hand," said McFee. "In all of these systems that we used, the key concept is to try to manage the utilization at the floor level to the point where the user – the nurse, the technician, whoever – is basically documenting their use of that item." And, in the background, McFee continued, the system manages the generation of, say, a replenishment request automatically, "without someone having to go up and count every shelf," he said.

3. Include nurses on compliance efforts. McFee said they both train and monitor nurses on their compliance efforts, while identifying folks who may be having issues maintaining compliance. "We're talking down to the individual level or groups of folks," he said. "So if we find an item that's consistently not being captured, we work with nursing on how we can improve that, and how [we] can handle [this] in a different way." McFee added nurses also took a hard look at their own utilization patterns, which allowed the organization to dramatically reduce numbers when shifting to a new system. "We reduced the numbers for what [nurses] thought they'd be using," he said. "In some cases, they had a 10- to 12-day supply sitting on the shelves, and they were down to three to five a day for most items. That was a dramatic reduction."

4. Be aware of utilization patterns. An advantage of using a system to help streamline supply chain efforts is having the ability to key in your "true utilization patterns," he said. "All of these systems manage those utilization numbers, and they allow you to tweak those numbers to fit the true utilization patterns," he said. Communication with nurses and this function, McFee said, played a large part in the overall reduction in the inventory sitting on the floor. "That was through a multiple step process," he said. "We went through to right-size our inventory for the right volume of activity they were expecting."

5. Review your standardization and have a strong value analysis process. This is an "old stand-by" point, said McFee, and includes making sure you don't duplicate products in your supply chains. "And that means a pretty robust value analysis process, and one that's looking for opportunities, especially where we may be using a different manufacturer for achieving the same functional requirements," he said.  "It's also looking at what you can do to reduce those number of overall lines." The value analysis process, he added, should look at any addition to the supply chain from a value perspective, while comparing it to what an organization currently has in stock. "We're always looking to use the best, most efficient and most effective product," he said. "[For example,] if you have a product and you're getting a great price on it, but in reality, you're using two or three of them when one should be working – finding these issues and those items and working closely with the clinical staff to identify those opportunities for change. It's part of what our value analysis does."

6. Don't forget about the data. Lastly, said McFee, you can't forget about the data. "Data, data, data," he said. "If you're not tracking it and you don't have your utilization activity through your ERP system or your point-of-sales system, you need that utilization data on everything." He added that purchasing systems should be linked to a point-of-sales system, allowing for a "single item master," he said. "So if someone goes to order something, if it's an item that's already out there, we may prevent them from creating a PO if they could get it from our warehouse," he said. "Or, we may have a contract established for an item with a vendor. We may not stock it, but the pricing has been established, which cuts out a significant amount of time within our purchasing function."

Technology at forefront of NHS treatment in Scotland

EDINBURGH – Online scanning to allow remote diagnosis for island patients and Scotland's biggest telehealth system are among a raft of hi-tech projects to help more patients be treated quicker and closer to home.

EHealth investment totalling £1.6million - including funding from the NHS's major IT partner - has been announced today by Scottish Health Secretary Nicola Sturgeon.

Speaking at the first annual Scottish Telehealth and Telecare conference, Sturgeon unveiled details of projects extending the use of electronic technology in the NHS, including:

 

Touch screens in the homes of hundreds of patients with chronic conditions in Lothian, allowing them to be monitored from home;

 

 

Online scanning allowing patients in Orkney to be diagnosed remotely, avoiding lengthy trips to hospital;

 

 

New software in Glasgow transmitting patients' records directly to consulting rooms.

 

"Telehealthcare technologies and eHealth have huge potential to benefit patients, by harnessing all that technology can offer to make care quicker, safer and closer to home. It also allows more efficient working and better support for our health and care staff," Sturgeon said.

"In eHealth, our joint investment in 16 pilot projects will help patients in hospital and at home. At the West of Scotland Heart and Lung Centre, for example, they're replacing cardiac databases with the latest systems to improve patient safety.

"Together with NHS Lothian, we're also rolling out Scotland's biggest telehome monitoring system. Four hundred people living with conditions like heart failure or chronic lung disease will have touch screens to monitor their vital signs from home, helping them avoid repeated hospital visits."

The overall eHealth funding announcements made by the Cabinet Secretary totalled £1.6million - £564,000 of which comes from the Atos Origin Alliance, an innovation fund from the NHS's main IT partner.

The Atos Origin Alliance comprises Atos Origin, BT, IBM and Sopra Group.

The roll-out of the £700,000 telehealth project for long term-condition patients is funded equally between the Scottish Government and NHS Lothian.

Fewer antibiotics prescribed for children

The number of antibiotic prescriptions for kids declined 14% from 2002 to 2010, but antibiotics remain the most frequently prescribed drugs for pediatric patients, a federal analysis finds.

Antibiotics accounted for about a quarter of all pediatric prescriptions; amoxicillin leads the list.

Overall, 263.6 million prescriptions were written for patients 17 and under in 2010, down 7% from 2002, finds the analysis of prescription claims databases by Food and Drug Administration researchers, published today in the journal Pediatrics. By comparison, 3.3 billion were dispensed for ages 18 and up, 22% more than in 2002.

The medical community has made "an enormous effort to decrease antibiotic use" for kids in the past decade "by educating parents about the futility of treating viral infections with antibiotics" and about antibiotic resistance, the FDA study says.

Those efforts "are succeeding to some extent," but this study and others show antibiotic overuse "is still a big problem," says Adam Hersh, assistant professor of pediatric infectious diseases at the University of Utah. He says overuse of azithromycin and other broad-spectrum antibiotics "is contributing to the epidemic of antibiotic-resistant infections."

Other drug categories down from 2002-2010 were allergy medications (61%); pain (14%); and cough/cold without expectorant (42%). But prescriptions increasing include corticosteroids for asthma (14%); contraceptives (up 93%, possibly because of secondary uses, such as acne) and attention deficit hyperactivity disorder (46%).

"It's good news that cough and cold prescriptions are down, given that they don't work and can have serious side effects," says Danny Benjamin, a professor of pediatric medicine at Duke University. In 2008, the FDA advised against them for the youngest children. But he says the rise in prescriptions for ADHD and off-label use of proton pump inhibitors for certain gastrointestinal disorders is worrisome. Safety of long-term ADHD drugs is unknown, he says. The study cites 358,000 outpatient prescriptions for lansoprazole (Prevacid) for infants, despite labeling that it is not effective in babies under 1 year.

UPMC deploys Wi-Fi-based RFID

PITTSBURGH – University of Pittsburgh Medical Center has implemented RFID technology to automate temperature monitoring at UPMC St. Margaret Hospital, and it will soon roll out wireless monitoring and asset tracking across most of its U.S. hospitals.

Officials say UPMC will deploy AeroScout’s Healthcare Visibility Solutions, which use advanced radio frequency identification (RFID) technology that will leverage UPMC’s standard Wi-Fi network to avoid the purchase, installation and maintenance of a proprietary RFID network.

After researching real-time location systems (RTLS) for several years, UPMC decided to use a Wi-Fi-based solution to leverage the investment in its Wi-Fi network and the related expertise it had developed, officials say. AeroScout technology can use low frequency and ultrasound for additional use cases such as par level management, and offers integration capabilities to allow other UPMC software providers to utilize location and condition information, for instance, temperature readings, for specific clinical and operational applications.

"After our extensive testing and due diligence, it was clear to us that Wi-Fi-based healthcare visibility solutions were not only the best model for our health system, but also the standard that would prevail industry-wide because of the important advantages they offer over proprietary systems," said James Venturella, CIO, Physician and Hospital Services at UPMC. "By using our existing Wi-Fi infrastructure, the AeroScout solutions are easier to deploy, allowing us to see the associated productivity and patient care benefits more quickly."

The asset management technology enables UPMC staff to track the location of critical medical equipment throughout its facilities, ensuring that it's at the right place at the right time and eliminating the need to manually search for items.

UPMC uses the temperature monitoring solution to automatically and wirelessly monitor the temperature of refrigerators and freezers, helping prevent spoilage of medicines, vaccines and even food. Both applications free up a significant amount of time so that staff can focus on caring for patients, officials say.

Following the success of its current implementation, UPMC plans to extend the technology. It will use AeroScout when it introduces a SmartRoom system at its new UPMC East hospital in Monroeville, which is scheduled to open this summer. Officials say the SmartRoom will use RTLS to identify caregivers as they walk into a patient’s room and provide clinicians with real-time, relevant information at the patient’s bedside.

Health advocates go sour on sugar

The war on sugar is raging again.

This week, Walt Disney announced that it's going to stop advertising junk food to kids on its TV channels, radio station and website by 2015. It's eliminating ads for sugar-laden fruit drinks, candy and snack cakes.

Last week, New York Mayor Michael Bloomberg outlined a plan to ban large-size sugary beverages sold at the city's restaurants, movie theaters, sports venues and street carts. Some states and cities are working on "soda taxes" on sugary drinks. And in recent years, major health groups have discouraged the consumption of large amounts of added sugars.

The motivation is clear: The USA is in a full-fledged state of hand-wringing about overweight Americans who are among the most obese in the world and are heavier than they've ever been before.

It's a battle being waged on a number of front lines: Schools are beefing up their offering of fruits and vegetables, food and beverage marketers are being strong-armed to change how they market to kids and trans fats have been squeezed out of most processed foods.

Increasingly, the focus is being placed on sugar, the sweetener with a history that goes back 8,000 years.

Is something so sweet really that harmful to health? Or is it just being maligned as people look for a scapegoat for the obesity epidemic?

The American Heart Association says in a statement that research has tied a high intake of added sugars to many poor health conditions, including obesity, high blood pressure, type 2 diabetes and other risk factors for heart disease and stroke.

Diabetes educators often advise people with diabetes and pre-diabetes to watch their sugar intake, especially their consumption of sugary beverages. Nutritionists have said for years that sugar represents empty calories with no nutritional value.

The consumption of added sugars, especially from sugar-sweetened beverages, among some people in the country "is out of control," says Rachel Johnson, a spokeswoman for the American Heart Association and a nutrition professor at the University of Vermont.

Americans adults consume an average of 22 teaspoons a day, or about 355 calories, from added sugars, Johnson says. Every teaspoon has 15 to 16 calories.

You don't remember adding 22 teaspoons of sugar to your coffee or cereal?

Consider that sugar is used in everything from cakes, candy and cookies to muffins, jams, chocolates and ice cream.

People are downing table sugar, brown sugar, high-fructose corn syrup (in soda), maple syrup, honey, molasses and other caloric sweeteners. Added sugars make their way into many prepared and processed foods and beverages, from soda, sweet tea and lemonade to energy drinks and sports drinks.

One 16-ounce serving of regular soda, the proposed NYC cap, contains the equivalent of at least 12 teaspoons of sugar, says Cynthia Sass, a registered dietitian in New York City. "Many of my clients don't realize how much hidden sugar creeps into their diet, even in foods that don't seem sweet, like salad dressing, soups and crackers."

Sugar is "toxic" in the amount it's consumed by Americans, says pediatric endocrinologist Rob Lustig, a professor of pediatrics at the University of California-San Francisco and one of the country's most vocal critics of added sugars.

A little bit is OK, but it's the quantity that people are consuming that's harmful, Lustig says. "Everyone knows the dose determines the poison. I agree with that. There is a threshold, and right now we are way above that threshold."

The heart association recommends that most American women consume no more than 6 teaspoons a day, about 100 calories, from added sugars, Johnson says. For men, it's 9 teaspoons or about 150 calories. Kids should limit their intake to about the same amount, she says.

Others say not so fast. Added sugars have been "unfairly demonized" by some researchers, and "the reality is much more complicated," says James Rippe, a cardiologist who studies nutrition and fitness. He's worked with the food industry, including the Corn Refiners Association, which represents companies that make high-fructose corn syrup and other corn products. "Obesity is a bad problem, but to single out one component of the diet as a silver bullet to fix it is fantasy.

"And it distracts us from the serious multifaceted national commitment that we must have to solve this enormous public health problem of obesity," he says.

Sugar doesn't deserve to take the rap for the country's weight problem, says Andy Briscoe, president and CEO of the Sugar Association. "Sugar has been around for thousands of years. It's all natural. It's 15 calories (a teaspoon). It has been used safely by consumers by our grandmothers and our grandmothers' grandmothers."

What the research says

Research about the effects of excessive intake of sugary foods and drinks is coming out all the time, and there's not much that's reassuring, says Marion Nestle, a nutrition professor at New York University and co-author of Why Calories Count: From Science to Politics.

Johnson says recent studies show a link between high consumption of sugar-sweetened beverages and high blood pressure. So no surprise that when researchers conducted a study of people who reduced that consumption, their blood pressure dropped.

People with diabetes or pre-diabetes are often advised to watch their sugar intake. "The first thing we tell people to do for the prevention or management of diabetes is to not drink sugar-sweetened beverages," says Stephanie Dunbar, director of clinical affairs for the American Diabetes Association.

When someone with diabetes drinks a large quantity of sugary beverage, they get a huge dose of sugar at one time, she says. It hits their system quickly, raising blood glucose levels, she says.

That's not healthy for anyone, especially someone with diabetes or pre-diabetes, because high blood glucose causes damage to blood vessels, increasing risk of complications such as heart attacks, amputations and blindness, she says.

There are many kinds of studies that show sugared beverage consumption is linked to increased risk of obesity and type 2 diabetes, says Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity. There are a few studies showing no links, mainly funded by the beverage industry, but these stand against study after study showing that these beverages are having harmful health consequences, he says.

Is sugar to blame?

Much of the fuss about sugar comes because of questions about its role in a nation that has become way too heavy.

Thirty-six percent of adults in this country are obese, which is roughly 30 or more pounds over a healthy weight. About a third of children are overweight or obese. Obesity increases the risk of many chronic diseases including type 2 diabetes, heart disease and cancer.

Is sugar to blame for our bulging waistlines?

Overall, calorie intake has gone up since 1970, and about 16% to 17% of people's total daily calories come from added sugars, according to the U.S. Department of Agriculture's Economic Research Service.

Sugar is just one reason for obesity, but for many people, it's the big reason, Nestle says. "Some overweight kids drink 1,000 to 2,000 calories a day from sodas alone, and sweet desserts are a major source of calories in American diets."

The most important health concern about sugar intake is that it adds calories to the diet, which can be a ticket to weight gain and obesity, agrees Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis. "The calories we consume in beverages that contain sugar do not make us feel as full as when we eat the same amount of calories in solid food, so consuming large amounts of sugar-sweetened beverages or fruit juices can pack on the pounds."

Klein, an expert on fatty liver disease, says that when you gain weight, fat can accumulate in your liver and reduce the effectiveness of insulin, the hormone that regulates blood sugar. Extra body fat affects the liver, and your pancreas works harder to try to keep blood sugar normal.

Whether or not you're overweight, consuming high amounts of sugar can increase triglycerides (blood fats) and increase fat production in your liver, he says. Possible explanations: High amounts of fructose, found in both sugar and high fructose corn syrup, can cause chemical reactions in the liver that lead to health problems, he says.

For many people, reducing the consumption of high-sugar beverages is a good first step for maintaining a proper body weight and improving their health, Klein says.

When it comes to added sugars' impact on health, including the liver, Rippe says, "this is some of the most complex biochemistry you can ever imagine. The literature on this is very mixed."

As for sugar's impact on obesity, Rippe says, "Americans are eating about 425 calories a day more than they were in 1970, according to the government statistics, but only 9% of those increased calories come from added sugars."

Briscoe adds: Most foods and beverages add calories to the diet and can lead to weight gain and obesity if overconsumed, "so we do not feel sugar should be singled out. We need to look at total caloric intake in the fight against obesity."

The addiction question

Studies on food and addiction show that sugar works on the brain very much like classic substances of abuse, Yale's Brownell says. He has researched the topic for an upcoming book, Food and Addiction: A Comprehensive Handbook. "Sugar doesn't have as strong of an effect on the brain as heroin or cocaine, or even alcohol or nicotine, but the addiction still exists. Sugar activates the same reward pathways of the brain."

When you are really addicted to something, your willpower goes out the window, he says. "If a kid gets off of the bus everyday and has to have a soda, is his brain hijacked by sugar?

"The question is: Is sugar addictive enough to create a public health menace? And I think the answer is yes."

Rippe says this theory "is very controversial." Most of that food-addiction research is based on work on animal brains, and animal brains are much different than human brains, he says.

"When we eat any food, the reward pathways light up. That's why we eat, because it's pleasurable," he says. "The scientific literature on this is very mixed and very inconclusive."

Charles Baker, chief science officer for the Sugar Association, says, "The same brain reward pathways are set in motion by any food a person happens to like. Unraveling the intricacies of the crosstalk within the brain and between the brain and digestive tract during eating, is still an evolving body of science. Reward pathways are simply one part of a multi-part system."

A matter of degree

Even nutritionists have a bit of a sweet tooth and don't want to come down too hard on something so tasty. Consuming some sugar is OK for many people, they say. "Even the staunchest anti-sugar advocates say it's a matter of degree," Nestle says. "Nobody worries about 10% of calories or less from sugar. It's only when the amounts go over that problems kick in."

Johnson agrees: "Sugar is not the root of all dietary evil. A little bit of sugar adds to the taste of foods. But we've lost sight of moderation because of the gigantic portion sizes. You have to be so vigilant about portion sizes to avoid overconsuming.

"We have to be careful not to demonize one ingredient in the diet," she says. "We did that with fat, and it backfired because then low-fat products came on the market that were low in fat but high in sugar.

"It didn't lead people to an overall healthier diet which is one that is rich in fruits, vegetables, whole grains, non-fat dairy and lean protein."

ACOs digging in to stay, experts say

WASHINGTON – The message was loud and clear at the Third National Accountable Care Organization (ACO) Summit in Washington, D.C., June 6-8. ACOs of today are not like the bygone HMOs of the 1980s. The new ACOs are backed by advanced healthcare IT this time, and an even greater urgency to contain costs that will keep them around, speakers said.

Several speakers commented on the momentum under way.

Marilyn Tavenner, acting administrator for the Centers for Medicare & Medicaid Services (CMS) in a keynote on June 7 said the past two years have been exciting. "It's interesting to see dialogue move from 'change is needed' to 'what type of change is needed?'"

"Since we started doing these conferences three years ago, there has been a huge uptake," said Mark McClellan, MD, director of the Engelberg Center for Health Care Reform, Brookings Institution and former CMS Administrator.

Now, the healthcare industry is dealing with the practical issues of establishing ACOs. "We're much more focused today," he said. "The actual challenges are in large-scale implementation and how to overcome them."

Deficit reduction politics is anticipated to color every decision in Washington, following the election this fall, McClellan said. If the Republicans win the White House and overturn the ACA, the pressure "will only go up" for them to do something to lower healthcare costs.

"The choices will be not if this will happen, but how well it will happen," McClellan said, of healthcare payment reform, including ACOs. There is not much more that can be done to "squeeze down" on Medicare fee-for-service. "Whatever happens [in the upcoming election], pressure to use ACOs will be bigger than ever," he said.

McClellan also said if the Supreme Court decides in June to revoke healthcare reform, CMS still has enough existing authority to establish ACOs.

Elliott Fisher, director of Population Health and Policy at the Center for Population Health, The Dartmouth Institute for Health Policy in Lebanon, N.H., attributed the growing ACO trend to positive outlook and early signs of success. The Medicare Shared Savings program is actually saving money, Fisher said. Energy has started to emerge in early ACO pilots. "All it takes is one positive deviant, and everyone else starts to follow," Fisher said.

For those physicians who are still skeptical, Fisher said the improved care ACOs can give to patients will draw them in. Physicians will be assisted to make wise decisions and patients will be well-informed, Fisher said.

In the past, patients thought savings was coming at their own expense, McClellan said. ACOs will prove to them it will be different this time.

Learn all you can about health care alternatives

The following editorial is from www.Courier-Journal.com.

The challenge is for citizens to get involved. the public must do its part by educating itself about the various alternatives, and letting their representatives in Washington know what they conclude.

How broken is our current system?

Some 47 million Americans are uninsured; another 50 million are underinsured (not fully covered).

About 8.7 million children are uninsured.

Most bankruptcies have a health reason as a major cause, and 68 percent of those people who have gone belly up do have health insurance policies.

The World Health Organization ranks the level of U.S. health care at 37th in the world.

Private health insurance companies, which have doubled the premiums since 2000, have a bureaucratic overhead of 28-31 percent while Medicare operates at 3 percent efficiency. Therein lies a large part of the problem. These companies have an incentive to reduce benefits to patients.

The most persistent solution on the grassroots level is a single-payer system, the single payer being the federal government. This program involves a Medicare-type approach for everyone, but it would be expanded to include dental care, vision care and preventive programs. Overall, it would cost about the same — maybe a little more, maybe a little less — as the present 15 percent of the Gross National Product (GNP). All other industrialized nations with full coverage for all citizens average about half the costs in total medical care.

A single-payer system is best outlined in congressional bill HR676, which would set up the National Health Insurance (NHI) program. What it is not is “socialized medicine.” England and Spain have socialized medicine, wherein the doctors and hospitals are all employees of the federal government. Under HR676 the present system would stay; doctors would remain private vendors and would submit their bills to one payer, the U.S. government, not to the 1,500 private health insurance companies. Patients would still choose their doctors. (More about HR676 later)

Is a single-payer system just the blue-sky proposal of some Washington, D.C., think tank? Not by a long shot. It is the work product of Rep. John Conyers and has 90 other congressmen as co-sponsors. This is about one in five House members. Also endorsing HR676 are the U.S. Conference of Mayors (a nonpartisan group of 1,100 members), Physicians for National Health Care Program (more than 10,000 doctors), League of Independent Voters, the United Church of Christ and the United Methodist Board of Church and Society, 32 city councils (including Louisville, Indianapolis, Baltimore, Detroit and Boston), 14 national and international labor organizations, the American Medical Students’ Association, the National Family Farm Coalition and more.

There was a time when the doctors would (and did) kill any national health care plan in the womb. Today a solid 59 percent of U.S. physicians now support national health insurance. Particularly strong on the issue are psychiatrists (83 percent), pediatric sub-specialists (71 percent), emergency medicine physicians (69 percent), general internists (64 percent) and family physicians (60 percent). Doctors and hospitals have to employ huge staffs just to process insurance claims from a multiplicity of insurance firms. About 20 percent of private doctors’ income goes to pay for this staff.

Businesses are now leaning toward a national program. The Business Coalition for Single Payer Healthcare in New York (www.BusinessCoalition.net) poses this scenario: “If you own a small business with a $100,000-per-month payroll, your health care costs can be reduced from typically $15,000 per month to just $3,300 — from 15 percent to 3.3 percent of wages, a savings of $140,400 per year.”

General Motors, which says health care adds at least $1,500 to each car, is paying people to leave their jobs so they can hire replacements at 50 cents on the dollar with reduced health benefits. This may help the bottom line and the company can compete better, but it is a sad commentary on the state of American health care, especially for the newest of workers.

Neither of the two major presidential candidates favored a single-payer program. Democrat Barack Obama comes up with a halfway reform that includes the insurance companies in the mix. His plan would offer help to nearly half of the uninsured people and would cover all children. Republican John McCain’s plan was only a small reform that features a tax credit plan of $5,000 for a family. This wouldn’t come close to paying a normal $12,000 premium for family health care. And the McCain plan, from some analysts’ viewpoint, would offer help to only about 4 to 5 million uninsured people.

Neither Republican nor Democrat solutions take advantage of the tremendous savings realized from eliminating the waste in the private health insurance industry. This waste alone, by the estimates of several studies, would pay for health coverage for all of the uninsured. More than several states have tried systems of mandating and subsidizing policies from insurance companies. Minnesota, Tennessee, Vermont, Washington and Massachusetts have learned the hard way in failing to fix the system by including the health insurance industry.

Where else would the money come from to support a national program? HR676 calls for a modest payroll tax on all employers and employees of 3.3 percent each, in addition to a 1.45 percent tax that they are already paying for a total of 4.75 percent each. Also there would be a 5 percent health tax on the top 5 percent of income earners and a 10 percent tax on the richest 1 percent . A small tax on stock and bond transfers is also envisioned along with the closing of corporate tax loopholes and repealing the Bush tax cut for the highest 1 percent of income earners.

When you subtract the cost of insurance premiums, the deductibles and the co-pays, most businesses and most people would pay less for national health care than they do today. Even if the cost did go up some, the coverage would be much broader and medical needs would be met much more easily.

What we are learning is that the United States is all alone among its peers in the whole world. This is the only country that treats health care as a commodity distributed according to ability to pay, rather than as a social service distributed according to medical need.

The challenge is to get fully informed citizens involved in changing things for the better.

DAVID ROSS STEVENS
Borden, Ind.

Mr. Stevens is a member of the Southern Indiana branch of Hoosiers for a Commonsense Health Plan (whose Kentucky counterpart can be reached at www.kyhealthcare.org).

EHRs widely used but fall short of federal standards

SAN FRANCISCO – California physicians are finding themselves cornered in an EHR catch-22, a new report finds. The data shows that although a majority of the state’s physicians now use EHRs – technology pushed by the federal government – most of the implemented systems fail to meet new federal meaningful use requirements.  

The report, conducted by the University of California at San Francisco (UCSF) in conjunction with the California Medical Board and the California Department of Health Care Services, comes as a disappointment for the state's medical community. 

“We found that physicians are more likely to have electronic health records with functions that support individual patient visits rather than functions that support overall quality improvement,” said lead author Janet M. Coffman, assistant professor at the UCSF Philip R. Lee Institute for Health Policy Studies and UCSF Department of Family and Community Medicine.

Coffman pointed out that 61 percent of the surveyed physicians use EHRs that enable them to record clinical notes but only 45 percent are able to generate routine reports of quality indicators, such as the percentage of patients with diabetes who receive recommended lab tests, foot exams, and eye exams.

The research also showed the size of a physician’s practice to be the strongest predictor of having an EHR. Physicians who practice in Kaiser Permanente, other large medical groups, the Department of Veteran Affairs, or the military are much more likely to have EHRs than physicians in smaller practices.

Core objectives, menu objectives and electronic reporting on the quality of care are identified by federal regulations as the three categories of objectives aimed at achieving meaningful use of the technology. 

To encourage increased adoption of EHRs, incentive payments will be provided to hospitals and providers that achieve meaningful use of the technology.

The Health Information Technology for Economic and Clinical Health (HITECH) Act incentive payments could total up to $27 billion over 10 years, or as much as $44,000 (through Medicare) and $63,750 (through Medicaid, called Medi-Cal in California) per clinician. This funding also will provide the basis for the creation of a nationwide network of EHRs.

“The Medicare and Medicaid incentive payments will provide valuable resources to physician practices that do not yet have EHRs that will meet meaningful use standards,” said Coffman.  “Medicaid payments especially are important since we found that community health centers, rural health clinics, and other practices that primarily serve Medicaid beneficiaries and uninsured persons are less likely to have EHRs. Many of these practices are struggling to keep their doors open. Medicaid incentive payments give these practices an opportunity to purchase EHRs.”

This report summarizes a survey of California physicians about their current use of EHRs and their eligibility for the Medi-Cal EHR incentive program.

Some key findings:

Although 71 percent of physicians surveyed have an EHR system, only 30 percent have EHRs configured to meet all 12 of the meaningful use objectives measured in the study.Rates of EHR availability are lowest among physician solo practitioners, small partnerships, and community/public clinics. Office-based physicians are less likely to have EHRs than those in hospitals, and rural physicians are less likely to have them than urban physicians.Most physicians who, based on their survey responses, are eligible for incentive payments (70 percent) do not currently have EHRs that can meet all 12 of the meaningful use objectives measured.Many physicians are not familiar with the eligibility rules for the Medi-Cal EHR incentive payment program. A substantial percentage of survey respondents who are eligible for the payment program believe that they are not eligible, do not plan to apply, or need further information before deciding to apply. At the same time, a number of respondents who plan to apply do not appear to be eligible.

Massachusetts Voters Say YES to Single-Payer Healthcare, and NO to Mandates

From MassCare.org:

Dear Single Payer Supporters –

In an election that has brought out the highest voter turnout in Massachusetts probably since 1928, local ballot initiatives supporting single payer and opposing individual mandates passed by landslide margins in all ten legislative districts where they appeared. With almost all precincts tallied, roughly 73 percent of 181,000 voters in the ten districts voted YES to the following:

“Should the representative from this district be instructed to support legislation creating a cost-effective single payer health insurance system that is available to all residents, and oppose laws penalizing those who fail to obtain health insurance?”

The measure passed with margins ranging from 65 percent in the Fifth Middlesex to 82 percent in the Third Hampshire. A table of results, along with other local non-binding referendum outcomes, is available at the Boston Globe website.

Thanks to everyone in these ten districts for your hard work, and congratulations!

Finally, A Map Of All The Microbes On Your Body

Enlarge Ayodhya Ouditt/NPR

Ayodhya Ouditt/NPR

Scientists Wednesday unveiled the first catalog of the bacteria, viruses and other microorganisms that populate every nook and cranny of the human body.

Researchers hope the advance marks an important step towards understanding how microbes help make humans human.

The human body contains about 100 trillion cells, but only maybe one in 10 of those cells is actually � human. The rest are from bacteria, viruses and other microorganisms.

"The human we see in the mirror is made up of more microbes than human," said Lita Proctor of the National Institutes of Health, who's leading the Human Microbiome Project.

 

"The definition of a human microbiome is all the microbial microbes that live in and on our bodies but also all the genes � all the metabolic capabilities they bring to supporting human health," she said.

These microbes aren't just along for the ride. They're there for a reason. We have a symbiotic relationship with them � we give them a place to live, and they help keep us alive.

"They belong in and on our bodies; they help support our health; they help digest our food and provide many kinds of protective mechanisms for human health," Protor said.

Microbes extract vitamins and other nutrients we need to survive, teach our immune systems how to recognize dangerous invaders and even produce helpful anti-inflammatory compounds and chemicals that fight off other bugs that could make us sick.

"These microbes are part of our evolution. As far as we can tell, they are very important in human health and probably very important in human disease as well," said Martin Blaser of New York University.

These bugs generally don't make us sick. But when we disrupt the delicate ecosystems they carefully construct in different parts of our bodies, scientists think that can make us sick.

"There can be a disturbance in the immune system. There can become some kind of imbalance. And then you can get a microorganism which, under normal circumstances, lives in a benign way and can become a disease-bearing organism," Proctor said.

Taking too many antibiotics, our obsession with cleanliness and even maybe the increase in babies being delivered by Caesarean section may disrupt the normal microbiome, she said.

So the idea behind the micobiome project was to get the first map of what a normal, healthy microbiome looks like.

More than 200 scientists spent five years analyzing samples from more than 200 healthy adults. The samples came from 18 different places on their bodies, including their mouths, noses, guts, behind each ear and inside each elbow.

"This is the only study to date anywhere in the world where peoples' microbiomes across a human body were sampled and analyzed. Here was an effort to really investigate the full landscape, if you will, of the human microbiome across the body," Proctor said.

Scientists identified some 10,000 species of microbes, including many never seen before, according to the first wave of results, which are being published in 16 papers in the journals Nature and PLoS.

"This is like going into uncharted territory � going into a forest and finding a new species of butterfly or new type of mammal or something like that � a new kind of bird," said George Weinstock of Washington University in St. Louis.

Those 10,000 or so species have more than 8 million genes, which is more than 300 times the number of human genes.

And scientists found some very interesting things when comparing microbiomes.

"People were very different from each other, but skin was more like skin and gut was more like gut. So the composition of microbes and the kinds of genes that they have are very much habitat-specific," Proctor said.

Now that scientists have an idea of what a healthy microbiome looks like, they can start to explore this super-organism � this complex mishmash of human and microbial cells.

"How do they talk to our human cells? And how do human cells talk back to them? Because it's really a concert that they're playing together, and that's what makes us who we are," Weinstock said.

Scientists have already discovered some intriguing clues. For example, the microbes in a pregnant woman's birth canal start to change just before she gives birth. Scientists think that's so their babies are born with just the right microbiome they'll need to live long, healthy lives.

11 technologies pegged as best to tackle chronic disease

CAMBRIDGE, MA – Health policy institute NEHI has identified 11 emerging technologies that have the potential to improve care and lower costs for chronic disease patients, especially those in at-risk populations.

Each of the technologies are profiled in NEHI’s new report, “Getting to Value: Eleven Chronic Disease Technologies to Watch,” published with support from the California HealthCare Foundation. The report also identifies lessons learned about the role of technology in creating value and offers an overview of some of the barriers to adoption.

[See also: $103M in government funding targets chronic disease]

The “technologies to watch” target a range of chronic illnesses, including diabetes, asthma, stroke and heart disease, and reflect the growing emphasis on empowering patients to monitor their own care through the use of mobile platforms, social networking and home-based telehealth technologies.

“Nearly half of all American adults have at least one chronic illness,” said NEHI president Wendy Everett. “And these 11 emerging technologies hold the promise of greatly helping them manage their disease and connect with their doctors in real time.”

The 11 technologies on NEHI’s watch list include:Tele-stroke careVirtual visitsMobile asthma management toolsIn-car telehealthExtended care eVisitsMobile clinical decision supportMedication adherence toolsSocial media promoting healthMobile cardiovascular toolsHome telehealthMobile diabetes management tools

[See also: Pennsylvania hospital strengthens fight against chronic disease]

“These 11 technologies have the potential to extend care of chronic diseases beyond a doctor’s office to places where patients spend a great deal of their time - on their Smartphones, personal computers and in their cars,” said Everett. “And they are helping physicians get real-time data about their patients and, in some cases, share resources where staffing or financial constraints limit proper chronic disease management.”

Everett said the technologies address three big problems currently facing healthcare: chronic disease, quality care and patient engagement.

"More than 75 percent of the nation’s total medical costs are spent on chronic disease,” said Everett. “Patients need to be an integral part of their care if we are to increase the quality and decrease the cost of care.”

Of the 11 technologies identified, the three with the most “significant evidence attesting to their clinical and financial benefits” are extended care eVisits, home telehealth and tele-stroke care, said Everett.

“If successful policy interventions are undertaken to surmount barriers, these (three) technologies would be primed for widespread adoption,” she said, noting that the main benefits of these technologies are that they don’t have high cost barriers to use; they leverage mobile and telehealth technology and social media for monitoring patient health; and they allow for the collection of aggregate data.

WHO agency: Diesel fumes cause cancer

LONDON(AP)�Diesel fumes cause cancer, the World Health Organization's cancer agency declared Tuesday, a ruling it said could make exhaust as important a public health threat as secondhand smoke.

The risk of getting cancer from diesel fumes is small, but since so many people breathe in the fumes in some way, the science panel said raising the status of diesel exhaust to carcinogen from "probable carcinogen" was an important shift.

"It's on the same order of magnitude as passive smoking," said Kurt Straif, director of the IARC department that evaluates cancer risks. "This could be another big push for countries to clean up exhaust from diesel engines."

Since so many people are exposed to exhaust, Straif said there could be many cases of lung cancer connected to the contaminant. He said the fumes affected groups including pedestrians on the street, ship passengers and crew, railroad workers, truck drivers, mechanics, miners and people operating heavy machinery.

The new classification followed a weeklong discussion in Lyon, France, by an expert panel organized by the International Agency for Research on Cancer. The panel's decision stands as the ruling for the IARC, the cancer arm of the World Health Organization.

The last time the agency considered the status of diesel exhaust was in 1989, when it was labeled a "probable" carcinogen. Reclassifying diesel exhaust as carcinogenic puts it into the same category as other known hazards such as asbestos, alcohol and ultraviolet radiation.

The U.S. government, however, still classifies diesel exhaust as a likely carcinogen. Experts said new diesel engines spew out fewer fumes but further studies are needed to assess any potential dangers.

"We don't have enough evidence to say these new engines are zero risk, but they are certainly lower risk than before," said Vincent Cogliano of the U.S. Environmental Protection Agency. He added that the agency had not received any requests to reevaluate whether diesel definitely causes cancer but said their assessments tend to be in line with those made by IARC.

Experts in Lyon had analyzed published studies, evidence from animals and limited research in humans. One of the biggest studies was published in March by the U.S. National Cancer Institute. That paper analyzed 12,300 miners for several decades starting in 1947. Researchers found that miners heavily exposed to diesel exhaust had a higher risk of dying from lung cancer.

Lobbyists for the diesel industry argued the study wasn't credible because researchers didn't have exact data on how much exposure miners got in the early years of the study; they simply asked them to remember what their exposure was like.

Further restrictions on diesel fumes could force the industry to spend more on developing expensive new technology. Diesel engine makers and car companies were quick to point out emissions from trucks and buses have been slashed by more than 95 percent for nitrogen oxides, particulate and sulfur emissions.

"Diesel exhaust is only a very small contributor to air pollution," the Diesel Technology Forum, a group representing companies including Mercedes, Ford and Chrysler, said in a statement. "In southern California, more fine particles come from brake and tire wear than from diesel engines."

A person's risk for cancer depends on many variables, from genetic makeup to the amount and length of time of exposure to dangerous substances.

Some experts said the new cancer classification wasn't surprising.

"It's pretty well known that if you get enough exposure to diesel, it's a carcinogen," said Ken Donaldson, a professor of respiratory toxicology at the University of Edinburgh who was not part of the IARC panel. He said the thousands of particles, including some harmful chemicals, in the exhaust could cause inflammation in the lungs and over time, that could lead to cancer.

But Donaldson said lung cancer was caused by multiple factors and that other things like smoking were far more deadly. He said the people most at risk were those whose jobs exposed them to high levels of diesel exhaust, like truck drivers, mechanics or miners.

"For the man on the street, nothing has changed," he said. "It's a known risk but a low one for the average person, so people should go about their business as normal � you could wear a mask if you want to, but who wants to walk around all the time with a mask on?"