These results aren’t that surprising, but what concerns me the most is the cost-saving potential of getting the correct test ordered, completed, and reported to both physician and patient in a short period of time. We waste a huge amount of money in our health system because test results are often not available or are vague (for example, the physician sends the patient a note with the words “positive” or “negative,” or otherwise lacking clarity, such as “within normal limits.”) If that patient must go to another provider or if the patient lands in the emergency department, that facility must redo the test, even if the patient can say “hey, they told me that my count for [insert test here] was a little bit high.”

Part of this problem is the lack of electronic medical record (EMR) implementation across the board.  If the only copy of your lab results is sitting in a manilla folder at your primary care physician’s office, the ER doctor will never know that your cholesterol is dangerously high. Part of the problem is also patients. The idea of a Personal Health Record, or PHR, that would contain this information is still a bit pie-in-the-sky… although companies such as Microsoft, with HealthVault, and Google Health are promising an EMR/PHR revolution through their products.

Regardless of the technology barriers, the physician ordering a test should have the responsibility for getting the result back and contacting the patient as soon as possible, whether by telephone or mail (or another secure avenue). Not only is it poor customer service to leave patients hanging (or to not ever tell them their results, letting many assume they are fine when there might be a problem), it’s poor business practice, and it can lead to overspending and overtesting.

Post from: EveryJoe

Family Physicians — Testing Positive for Lab Result Errors

At the same time, the New York Times is reporting on Philadelphia area insurers that are offering bonus payments or increased payments to physicians for using tools such as telephone visits, e-mail “visits,” and electronic monitoring of patients’ conditions to improve continuity of care and chronic disease care.

Can we save money by spending more? The statement seems counterintuitive, but paying more for the rightkinds of care and treatment can save money in the long run. For example, e-prescribing is often safer (no messy handwriting, less potential for drug interactions) and less of an administrative burden (less paperwork, faster transmission of information) than prescribing on paper. Checking in on patients daily or weekly and tracking blood sugar or blood pressure over time rather than waiting for the patient’s condition to become a crisis leads to lower spending, just as prevention is cheaper than a cure. With that in mind, both of these programs should be on the right track.

Post from: EveryJoe

Will higher physician payments and bonuses lead to lower costs?

Is this a trend that we’re going to see more and more of — incorporating video games and more things that seem like “virtual reality” into health care? We’re already using video games to train surgeons, so I suppose it makes perfect sense to use them for patients as well.

Post from: EveryJoe

Nintendo Wii — now it’s part of rehab!

“this appears to be waiting for a good reporter

The “TNO Netherlands Organization for Applied Scientific Research, Leiden” is listed as one of the “Author Affiliations” for the RFID study (http://jama.ama-assn.org/cgi/content/short/299/24/2884).

A recent announcement (May 2008) was made regarding strengthened collaboration between TNO and Sintef, another research organization in Europe similar to TNO (http://www.mwjournal.com/search/article.asp?HH_ID=AR_5758&SearchWord=TNO) .

Wilfred Booij is a senior scientist at Sintef.

Wilfred Booij is also CTO of “Sonitor Technologies”.

What does Sonitor Technologies do? They have a competing technology to RFID for real-time location systems which they are pushing in healthcare.They are heralding the study on their website as validation of their own technology, saying “JAMA report lends credibility to Sonitor’s Technology” (http://www.sonitor.com/)”

With all of the news about conflict of interest lately, I thought I’d take a look into this matter.

The authors of the study were:

Remko van der Togt, MSc; Erik Jan van Lieshout, MD; Reinout Hensbroek, MSc; E. Beinat, PhD; J. M. Binnekade, PhD; P. J. M. Bakker, MD, PhD

Let’s see what their affiliations are.

Spatial Information Laboratory, Institute of Environmental Studies, VU University, Amsterdam, the Netherlands (Mr van der Togt and Dr Beinat); Department of Intensive Care and Mobile Intensive Care Unit (Drs van Lieshout and Binnekade), Department of Clinical Epidemiology, Biostatistics and Bioinformatics (Dr Binnekade), and Department of Quality Assurance and Innovation (Dr Bakker), Academic Medical Centre, University of Amsterdam, Amsterdam; TNO Netherlands Organization for Applied Scientific Research, Leiden, the Netherlands(Mr Hensbroek); and Faculty of Sciences, University of Salzburg, Salzburg, Austria (Dr Beinat).

TNO Netherlands Organization for Applied Scientific Research has a Wikipedia page here if you’re interested (TNO = Toegepast Natuurwetenschappelijk Onderzoek, or “Applied Scientific Research”) TNO and SINTEF did indeed sign an agreement earlier this year:

“The leading research organizations TNO (the Netherlands) and SINTEF (Norway) have signed a Memorandum of Understanding (MoU) to develop and market their joint services on a number of fields of technology.”

I checked out Wilfred Booij’s profile on LinkedIn, and he does have affiliations with SINTEF and Sonitor. Here is a screen shot:

Even more interesting, Booij is quoted as discussing the superiority of Sonitor’s technology to RFID, and he speaks directly about the JAMA report:

“Ten years ago, the scientists at Sonitor Technologies concluded that the use of RF technology for tracking and positioning of equipment, people and charts should be avoided in a healthcare environment because of the serious risk of electromagnetic interference with sensitive medical equipment.” says Dr. Wilfred Booij, CTO of Sonitor Technologies. “This was a key reason for why Sonitor Technologies set out and developed a positioning and tracking solution based on (non-RF) Ultrasound signals. Ultrasound signals inherently do not cause interference with medical equipment since ultrasound signal are acoustical pressure waves just as ordinary sound. – And as we all know sound does not interfere with medical equipment.”

My verdict? Definitely a little fishy. I think that this merits further investigation… if anyone else finds some interesting stuff, post it in the comments!

Post from: EveryJoe

RFID, TNO, Sonitor… and a potential conflict of interest?

It’s important to note that the study (abstract from JAMA here, with a nice commentary from Dr. Donald Berwick of IHI here) was done in an ICU with no patients, so although some instances of potentially hazardous interference between RFID and another technology were observed, this data is certainly not a death knell for RFID technology — it only means that some workarounds might be necessary, along with weighing of potential pluses and minuses for especially at-risk patient populations, maybe including those in intensive care units.

This hurdle is certainly one that technology will overcome. RFID is an enormously promising technology that could save money and lives when applied to numerous health care interactions.

Post from: EveryJoe

RFID Chips – Good for health care, but potentially dangerous?

Why I think doctors are not adopting EMRs:

- Many EMR vendors make it tough to determine who is offering what and which products are really going to work

- Installing an EMR system and transitioning/migrating from paper to electronic records is expensive and time-consuming, not only in terms of direct cost, but also in terms of time lost and patients not seen during the transition

- Few EMRs exist that really handle some of the more complex specialties, such as cardiology and oncology, really well

- Doctors are skittish about regulations such as HIPPA and don’t necessarily have a thorough understanding of the interplay between information technology and the relevant laws and regulations

- While insurers/payors benefit from the implementation of EMRs, they don’t pay any extra for it, so moving to an EMR is basically a non-reimbursable task, and that time could be spent seeing patients or investing in something that gives a more predictable return on investment

Post from: EveryJoe

How can we bring IT to the doctor’s office?