Blind movie critic Tommy Edison educates the masses

Tommy Edison knows you've got questions about blind people � because people have been asking him those questions all his life.

Like: Do you see stuff in your dreams?

And: How do you count your paper money?

And: Do you think you could hit a golf ball?

Actually, that last one was a question Edison had and decided to answer, along with the others, in a online video series he calls "The Tommy Edison Experience." The videos are shot and edited by his buddy Ben Churchill, a documentary filmmaker, and share a website with a series called "Blind Film Critic."

Yes, a blind guy reviews movies. In fact, Edison � who works as a traffic reporter for a Connecticut radio station � became mildly famous for his pithy reviews about a year ago. His web traffic spiked after master critic Roger Ebert mentioned him online, Edison says.

With the attention, came the questions �starting with how a blind man can appreciate movies.

"I like strong characters in a good story and I like a few laughs," Edison says in a phone interview. Lots of dialogue helps.

But in between going to movies and reporting on traffic tie-ups (using police scanners and calls from listeners), Edison is just a regular forty-something guy who has been blind since birth. The point of the "experience" videos, he says, is "to show sighted people how I live and how I do things," educate a bit and have some fun.

So Edison has answered questions about his:

�Dreams: "I don't see in my dreams. It's all smell, sound, taste and touch," he says.

�Money: In one video, he buys a beer and has to ask the cashier to name the bills as he takes his change so he can line them up in order. Every blind person needs a system, he explains, because U.S. paper currency is not differentiated in a way blind people can detect (though it soon will be, say advocacy groups for the blind).

�Golf game: It's pretty good - for a blind guy. (He hits a ball after a few lessons).

�Travel style: He's an able-bodied guy, but has to explain to an airport employee (repeatedly, with impressive good humor and politeness) that he doesn't need a wheelchair to get through a terminal.

�Celebrity curiosity: If he could see three celebrities, he'd choose singer Tom Waits ("I've got to see the face that goes with that voice"); actress Angelina Jolie ("I keep hearing how beautiful she is") and Jay Leno ("the devil himself," says the Conan O'Brien fan). He's also curious about the Muppets.

Edison doesn't speak for all blind people. But it's nice to have someone out there answering the kinds of questions many blind people get all the time, says Eric Bridges, director of advocacy at American Council of the Blind. "People are naturally curious," he says. "And humor is the greatest device to sort of cut the tension and put people at ease."

The videos seem "very positive and informative," says Chris Danielsen, director of public relations at the National Federation of the Blind. Social media creates opportunities for many blind people "to get our own stories out," he says.

For Edison, that means sharing his reviews of Cabin in the Woods and The Hunger Games (he didn't love either) and answering the question: "Can you open your eyes?" The answer, as he demonstrates in one video, is yes, he can. "Next time," he promises, "I'm going to show you how I perform surgery."

6 reasons today's heath IT systems don't integrate well

Although the healthcare community has been clamoring for integration of its IT systems for decades, the industry is still in a rather elementary stage when it comes to useful and practical systems integration, according to Shahid Shah, software analyst and author of the blog The Health IT Guy.

"Our problem in the industry is not that engineers don’t know how to create the right technology solutions or that somehow we have a big governance problem," he said. "[Although] those are certainly issues in certain settings, the real cross-industry issue is much bigger – our approach to integration is decades old [and] opaque, and [it] rewards closed systems."

Shah outlines six reasons today's health IT systems don't integrate well.

1. They don’t support shared identities. These shared identities include single sign-on (SSO) and industry-neutral authentication and authorization, said Shah. "Most health IT systems create their own custom logins and identities for its users, including roles, permissions, access controls, etc., stored in an opaque part of their own proprietary database," he said, adding that ONC should mandate all future EHRs use "industry-neutral" and well-supported identity management technologies, so each system has, at least, the ability to share identities. "Without identity sharing and exchange, there can be no easy and secure application capabilities, no matter how good the formats are," he said.

2. They're too focused on "structured data integration." Instead, said Shah, systems should be focused on practical app integration in the early phases of a project. "In the early days of data collection and dissemination, it's not important to share structured data at detailed, machine-computable levels first, [but it's more] important that different applications have immediate access to portions of data they don't already manage." Once app integration is in good shape, he continued, then it's time to focus on structured data integration, and all the governance and analytics associated with it. "When we do structured data integration too early, we often waste time because we don't understand the use cases well enough, so we can't iterate to best-case solutions," he said. "We're driven to worst-case implementations."

[See also: 5 technologies every hospital should be using.]

3. They're more "push" data-focused versus "pull" data-focused. "A common question we ask at the beginning of every integration project is, 'What data can you send me?'" said Shah. "This is called the 'push' model, where the system that contains the data is responsible for sending to all those that are interested." Future EHRs need to implement syndicated ATOM-like feeds, which could contain HL7 or other formats, for all their data, so they can share and allow anyone who wants it to "subscribe" to the data, continued Shah.  In turn, this is known as the "pull" model, or when data holders simply allow secure, authenticated subscriptions to their data without worrying about direct coupling with other apps. "If our future EHRs became completely decoupled secure publishers and subscribers of the data, many of our integration problems would go away like they did for others using modern Internet approaches," said Shah. 

4. They're more focused on "heavyweight, industry-specific formats" instead of "lightweight, or micro formats." According to Shah, appointment scheduling in the "health IT ecosystem" is a major source of "health IT integration pain," he said. "If EHRs just used industry standard iCal/ICS publishing and subscribing, we could solve 80 percent of appointment schedule integration instantly." Shah continued and said to think about how an iPad can sync with an Outlook/Exchange server at work. "It's not magic – it's a basic, industry-neutral and appropriately securable standard, widely used and widely supported." Another example, he said, is the use of HL7 ADTs for patient profile exchanges, instead of more common and better-support standard like SAML. "If you've ever used your Google account/profile to log into another app on another website, you're using SAML," said Shah. "Again, no magic – it works millions of time a day with 'good enough' security and user-controlled privacy."

5. Data emitted are not tagged using semantic markup, so they're not shareable by default. "Even when we do have full data governance, we do our structured data integration and then we present information on the screen," said Shah. "We don't tag data with proper semantic markup, when it's basically free to do." Future EHRs, he continued, should generate Resource Description Framework-in-attributes (RDFa), using industry neutral schemas for common information, such as personal data. "Using RDFa as a start, EHRs can then start publishing full RDF in the future, so it's easier to discover where certain kinds of meta data can be found, without requiring massive registries and other old-style opaque techniques," he said. "None of this is technically challenging, insecure, or difficult to implement, if we really care about integration and are not just giving it lip service." 

[See also: 5 stages of EHR maturity and patient collaboration.]

6. They don't produce common output in a security- and integration-friendly way. Shah said future EHRs should start to use industry-neutral CSS frameworks, such as Twitter's Bootstrap, which is both free and open source. "When using Javascript, EHRs should use common, lightweight, and integration-friendly libraries, like jQuery, and not Javascript frameworks that take over the app and view port, and prevent easy discovery and integration." When you omit Javescript Object Notation (JSON) from your APIs, Shah continued, offer both JSON and JSONP, so secure integration can occur more easily. "All of these techniques … are commonly accepted, secure Web practices and need to make their way into our EHRs," he said. 

Kenta Biotech relocates to Zurich

BERN, SWITZERLAND – Kenta Biotech announced that it is relocating from Bern, Switzerland to Bio-Technopark in Zurich-Schlieren. In its new headquarters, Kenta Biotech will rent state-of-the-art laboratories, allowing it to boost research efforts and development of treatments for hospital-acquired infections.

Among the site’s advantages are its proximity to academic research centers in Zurich and the support provided by local authorities.

“This is definitely a strategic move for the company and we are now located at the best possible place for a young and innovative biotech company in Switzerland,” said Franco Merckling, CEO of Kenta Biotech.

Kenta Biotech has for six years developed technologies and products to fight hospital-acquired infections. With its relocation, officials say the company hopes to send a positive message to current and future investors and partners.
 

Health Insurance Cutbacks Squeeze The Insured

Hide caption Amber Cooper lives in Modesto, Calif., with her son, Jaden, 5, and her husband, Kevin. She had a liver transplant when she was 10 years old and needs daily medication so her body won't reject her liver. Deanne Fitzmaurice for NPR Hide caption When Amber's employer changed health care plans, she could no longer afford the blood tests that monitor her liver. She also had trouble paying for her medication. A charity, Healthwell Foundation, stepped up to help pay her health care costs. Deanne Fitzmaurice for NPR Hide caption Jaden climbs into a kitchen cabinet, removing the food from the shelves so he can fit. Amber says she can't afford to buy him new shoes or clothes because of her health care expenses. Deanne Fitzmaurice for NPR Hide caption After coming home from his job, Kevin works on a fence he is building around their home. The Coopers have stopped taking trips, eating out and spending money on anything else they don't need. Deanne Fitzmaurice for NPR Hide caption Amber waits for her monthly blood test at a lab in Modesto. For several months she couldn't afford the tests, but then her company changed insurance again and she was able to resume them. Deanne Fitzmaurice for NPR Hide caption The family tries to find entertainment at home � like letting Jaden play in the sprinklers and walking to a neighborhood park � to save money. Deanne Fitzmaurice for NPR

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Amber Cooper and her husband were doing OK. They had jobs, a healthy 5-year-old son, a house in Riverbank, Calif., and health insurance from her job in the accounting department of a small manufacturing company.

Then one day everything changed.

"We were in a conference room ... and I had heard rumors but didn't know if it was true, and I started crying in front of everyone and actually had to excuse myself to gather myself together and go back in. It was devastating for me," Cooper said.

Devastating because the rumors � her worst fears � had come true. She was in that conference room for a meeting about her health insurance.

Cooper had a liver transplant when she was 10. She takes a drug twice a day so her body won't reject her liver.

 

"Every year my company changes the insurance. And instead of giving us three different choices for insurance plans, they were changing to one, which was a high-deductible plan with no prescription coverage," she said.

Cooper was stunned. Her anti-rejection medicine costs way more than she could afford on her own � more than $1,000 a month.

Cooper, 30, started a frantic search for help. Finally, she found the HealthWell Foundation, which was willing to pay for her medication. But she still couldn't afford the $300 blood test she needs every month to make sure she's not rejecting her liver.

"It is scary because the only way to tell if you're going to go into rejection is by the blood work. Your numbers will be a little bit crazy, and then the doctors will be like, 'OK, you need to get in and we need to check you out and make sure you're OK.' So I really took a risk not getting that blood work done. But I couldn't afford to get it done. I really couldn't," she said.

What happened to Cooper is happening more and more these days.

Health insurance has been changing dramatically "beneath the surface," said Drew Altman, president and CEO of the Kaiser Family Foundation, a private, nonprofit, nonpartisan research group. "In plain language, it's becoming skimpier and skimpier and less and less comprehensive."

Paul Fronstin of the Employee Benefit Research Institute says that is the trend nationally.

"Deductibles have gone up. Copays have gone up. You see cost-sharing for out-of-network services have gone up," Fronstin said. "It seems to have accelerated in the last few years. Health care is just continuing to take a bigger bite out of take-home pay."

So even people with insurance are paying thousands of dollars out of pocket before their insurance kicks in. And even when it does, insurance picks up less than it used to � often a lot less.

More than 1 in 5 Americans had a problem getting insurance to pay for a hospital, doctor or other health care in the past year, according to a new poll by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

Altman says this comes as many families are struggling to get by.

"This affects not only how people seek health care � they're more reluctant to get it if they can put it off. But it also affects family budgets in a very real way, especially as we're still coming out of recession and families are still crunched by a weak economy," Altman said.

Cooper's family has stopped taking trips, eating out, fixing up their house or spending money on anything else they don't have to. Their son gets by with hand-me-downs, she said.

"He's 5 and growing out of everything. I haven't been able to buy him any clothes and shoes. Those are things I haven't been able to purchase because of the increase in the health care," she said.

And Fronstin says the weak economy is driving more and more companies to cut back on coverage because of simple math: It's the only way they can keep up with rising health care costs.

"Employers are trying to manage those costs. They're trying to keep those cost increases as close to inflation as possible. And they're doing everything they can to get their workers so that they think twice about the health care that they are using," Fronstin said.

Cooper is just grateful she's getting her drugs every month. And she started those monthly blood tests again when her company changed insurance again this year. But it's still not as good as it used to be. So she and her husband don't go to the doctor when they get sick if they can avoid it. The same goes for their son.

"There were a couple of times where he got sick where I just tried to do the best I could with what I had, whether it was children's ibuprofen or cooling him down with cool rags and that sort of thing," she said.

She can't help but worry about the next company meeting about her family's health plan.

"It changes every year, so I really have no clue what's going to happen next year and with them making that change, I really don't know what to expect every year," she said.

Health Think Tank Crunches Health Prices For The Masses

Ricardo Reitmeyer/iStockphoto.com

It turns out we may not know nearly as much about all the money spent on health care in the U.S. as we thought we did.

But there's a new group that wants to, well, remedy that.

The problem, Martin Gaynor, chairman of the Health Care Cost Institute, told Shots, is that "two-thirds of the population has private [health] insurance, but most of the information comes from Medicare."

That's because Medicare, being government run, is the only large insurer whose claims information has been available for academics to crunch. In fact, it's been the detailed analysis of Medicare data that's has allowed the Dartmouth Atlas to show the wide variations in health care across the U.S.

Still, many have worried that what happens to people age 65 and over may not necessarily reflect what's happening to everyone else.

 

So Gaynor, who's also a professor of economics and health policy at Carnegie Mellon University in Pittsburgh, along with a small group of academics, persuaded four of the nation's largest private health insurers � Aetna, Humana, UnitedHealthcare and Kaiser-Permanente � to give them access to information about what the insurers paid for care given to some 40 million people. (Personal information has been removed from the database.)

"That's 40 percent of the privately insured population in the U.S.," Gaynor said.

The group's first study, which examines spending and use trends in 2010 in the under-65 population, is already finding trends that would be hard to discern from Medicare data.

The first big take-home message, said Gaynor, is that while spending went up relatively slowly � about 3.3 percent � the biggest factor was an increase in "prices to providers." In other words, people didn't get more care, but they and their insurers paid more for the care they got. That also showed up in the fact that individuals' out-of-pocket spending grew slightly.

Prices rose for both inpatient and outpatient surgical procedures; for emergency room visits, and for brand-name prescription drugs from 2009 to 2010. Generic drugs were about the only category for which prices fell, 6.3 percent.

HCCI

Some analysts, like Aaron Carroll, are already using the new numbers to worry about potentially ominous trends in the health care system.

Another of the more provocative findings in the study is that spending rose fastest � 4.5 percent � for the 18 and under age group, something you'd never find in Medicare data. That rise compares to 3.1 percent for those aged 55-64 and 2.3 percent for those aged 19-44.

Why? Gaynor says an answer will take more research.

And HCCI says it will be happy to share what it expects to be a twice-a-year data dump with other academics and nonprofit research outfits. "Our goal is to create a data resource," he says.

Louisa-Care: Making Health Insurance More Affordable for Small Businesses

Louisa McQueeney is general manager and chief financial officer of Palm Beach Groves, a small, family-owned Florida gift and food shipping company. She believes it�s important for a small business to provide health insurance for its employees: �It creates a long-term relationship with your employees,� she says.

The health care law, Louisa says, is helping Palm Beach Groves continue to provide health coverage its employees by funding a health care tax credit for targeted small businesses. For Palm Beach Groves, that tax credit amounted to a $7,400 savings that could be used to offset health insurance costs. �

�It�s the first time in 12 years that I�ve actually seen a reduction in [health coverage] cost for the business,� Louisa says. �The decrease in our cost is directly tied to the tax credit. If it wasn�t for the Affordable Care Act, we would not be talking about a tax credit.�

With new hospitals come new data centers

CHICAGO – Silver Cross Hospital’s recently opened data center puts it at the forefront of an emerging healthcare trend, according to Mortensen Construction, a company with hospital projects across the country. Combining construction of new hospitals with new data centers is becoming more common, according to company executives.

The trend is driven, they say, by the need to accommodate an explosion in applications and patient data – not only documents, but also images and videos.
 
With the February, 2012 opening of its 600,000 square foot, $370 million medical complex with outpatient center, medical service building and hospital, Silver Cross Hospital, a 289-room facility in New Lenox, Ill., needed to update and expand its aging data resources, which were already operating at capacity. So, the project also included a new 2,450 square-foot data center, 50 percent larger than its existing one.
 
Silver Cross also became one of the first hospitals to install patient tracking software so families know where a patient is at all times. New communication equipment supports wireless voice and data networks throughout the hospital, providing access to patients and their families while freeing clinicians to use phones and computers where needed instead of based on location. Also, medical telemetry enables remote monitoring of patient vital signs.

[See also: Chicago health system rolls out $3M virtual data center]

“From day one, the new capabilities have helped us improve care and have helped our medical staff to be more effective,” said Kevin Lane, Silver Cross vice president and CIO.
 
Other hospitals, including OSF HealthCare’s new Children’s Hospital of Illinois in Peoria and the soon-to-open Ann & Robert H. Lurie Children’s Hospital of Chicago, have combined new data centers with new medical facilities. As Mortenson executives see it, the hospitals are establishing a technology foundation for the emerging era in healthcare that will be dominated by electronic health records and new care delivery approaches that require real-time coordination and information exchange among multiple providers, payers, patients and locations.
 
“State-of-the-art data centers will become as essential to new healthcare construction as private patient rooms with flat-screen televisions,” said Greg Werner, Chicago office head for Mortenson Construction. Mortenson has built more than $4.5 billion in healthcare projects in the past 10 years, according to Werner, including Silver Cross and Lurie Children’s, with partner Power Construction. It has also built more than 11 million square feet of data centers – mission-critical space – nationwide, totaling more than $1.1 billion. 
 
Given the escalating IT demands, growth of bigger and better healthcare data centers is only likely to strengthen, Werner said. In a fall, 2011 survey by Mortenson of 90 data center and facilities experts at the 7x24 Exchange Conference, 92 percent of respondents ranked healthcare as the industry with the greatest need for new data centers in the next five years.

[See also: 6 keys to data storage]

Sick From Fracking? Doctors, Patients Seek Answers

Kay Allen had just started work, and everything seemed quiet at the Cornerstone Care community health clinic in Burgettstown, Pa. But things didn't stay quiet for long.

"All the girls, they were yelling at me in the back, 'You gotta come out here quick. You gotta come out here quick,' " said Allen, 59, a nurse from Weirton, W.Va.

Allen rushed out front and knew right away what all the yelling was about. The whole place reeked � like someone had spilled a giant bottle of nail polish remover.

"I told everybody to get outside and get fresh air. So we went outside. And Aggie said, 'Kay, I'm going to be sick.' But before I get in, to get something for her to throw up in, she had to go over the railing," she said.

Nothing like this had ever happened in the 20 years that Allen has been at the clinic. After about 45 minutes, she thought the coast was clear and took everyone back inside.

"It was fine. But the next thing you know, they're calling me again. There was another gust. Well, the one girl, Miranda, she was sitting at the registration place, and you could tell she'd had too much of it. And Miranda got overcome by that and she passed out," she said.

'It's The Unknown I Think That's The Scariest Thing'

This sort of thing has been happening for weeks. Mysterious gusts of fumes keep wafting through the clinic.

Science And The Fracking Boom: Missing Answers

Explore key components of the natural gas production process � and the questions scientists are asking.

NPR

View Interactive

In fact, just the day before being interviewed by NPR, Allen suddenly felt like she had been engulfed by one of these big invisible bubbles.

"And all of a sudden your tongue gets this metal taste on it. And it feels like it's enlarging, and it just feels like you're not getting enough air in, because your throat gets real 'burn-y.' And the next thing I know, I ... passed out," Allen said.

Half a dozen of Allen's co-workers stopped coming in. One old-timer quit. No one can figure out what's going on. For doctors and nurses used to taking care of sick people, it's unnerving to suddenly be the patients.

"It's the unknown I think that's the scariest thing," she said.

Richard Rinehart, who runs the rural clinic, can't help but wonder whether the natural gas drilling going on all around the area may have something to do with what's been happening.

"I lay in bed at night thinking all kinds of theories. Is something coming through the air from some process that they're using? I know they use a lot of chemicals and so forth. Certainly that could be a culprit. We're wondering, Is something coming through the ground?" Rinehart said, noting that he'd just noticed a new drill on a hill overlooking the back of the clinic.

Now, no one knows whether the gas drilling has anything to do with the problems at the clinic. It could easily turn out to be something completely unrelated. There's a smelting plant down the road and old coal mines everywhere.

"Anything could be possible, and we just are trying to get to the root of it," he said.

Mysterious Symptoms, Lots Of Questions

People living near gas well drilling around the country are reporting similar problems, plus headaches, rashes, wheezing, aches and pains and other symptoms.

state impact

Shale Play: Natural Gas Drilling in Pennsylvania

Doctors like Julie DeRosa, who works at Cornerstone, aren't sure how to help people with these mysterious symptoms.

"I don't want to ignore symptoms that may be clues to a serious condition. I also don't want to order a lot of unnecessary tests. I don't want to feed any kind of hysteria," DeRosa said.

To try to figure out what's going on, the clinic called the Pennsylvania Department of Environmental Protection, which is investigating. It also started testing the air for chemicals, monitoring wind direction around the clinic and keeping diaries of everyone's symptoms. In addition, the clinic contacted Raina Rippel, project director for the Southwest Pennsylvania Environmental Health Project.

The local nonprofit was set up recently to help people in this kind of situation. Her team tested tap water from inside a men's room and from a stream out back.

Rippel says she knows people in the area have a lot of questions: "Is my water fit to drink? Is the air fit to breathe? Am I going to suffer long-term health impacts from this?"

Connecting Experts In Search Of Answers

To try to answer these questions, her project is connecting doctors and patients with toxicologists, occupational health doctors, environmental scientists and other experts.

"People go from physician to physician, because 'nobody seemed to be able to treat this awful rash that I have,' or 'nobody seemed to be able to deal with my gastrointestinal pain that I have.' And so they go from place to place, trying to find someone who can do that," said David Brown, a toxicologist who helped set up the project.

The project is also starting to educate doctors about what kinds of tests they can try and what kinds of advice to give. In addition, a nurse practitioner visits and counsels people who are sick.

Dr. Sean Porbin, a private doctor who advises the project, gives the project's nurse practitioner advice when she needs it. But Porbin is skeptical that many people are getting sick from the drilling, which is commonly called "fracking." There are about 5,000 new wells in Pennsylvania.

"If it's true, you'd expect people dropping all over the place based on the amount of fracking that's going on here. You would look around and see people dropping like flies. It's not the case. I don't see anybody affected. And it's not for a lack of looking," he said.

Porbin, who like a lot of people in the area has leased some of his land for drilling, wants to make sure no one's missing more mundane explanations � like Lyme disease, sinus infections and migraines.

"We have an old saying in medicine: When you hear hoof beats, you don't think zebras � you think horses," he said.

Lots Of Anecdotes, Little Evidence

The natural gas industry says there's no evidence the drilling is causing health problems.

Public health experts say the only way anyone is going to really know whether the drilling is making people sick is to do some big studies.

"There's a lot of anecdotal evidence out there. And so a well-conducted study looking at a number of communities could help us better understand if there's an impact, what its magnitude [is], how we should avoid having that impact if there is one," said Christopher J. Portier, director of the National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry.

Explore Shale: Go deep inside the natural gas drilling process � and how it's regulated � in this interactive from Penn State Public Broadcasting.

In the meantime, patients and doctors don't have a lot of options. In western Pennsylvania, a lot of them are referred to Charles Werntz at West Virginia University. Werntz, an occupational medicine specialist, is used to dealing with chemical exposures. Lately, he's seeing more people who live near the drilling.

But for now, he says he can't really do much more than offer basic advice: Drink bottled water, air out the house, leave your shoes outside. If it's still too bad, move � if possible.

"It is frustrating. As a physician, I like it when somebody can come to me with a problem and I can help them solve the problem. Whether it's through a specific treatment or, you know, whatever. And this is frustrating, because in this case, the treatment is to get away from the exposure. And that's hard to do," Werntz said.

Back at Cornerstone, Rinehart just wants to get back to taking care of patients.

"We are in the business of trying to improve and maintain the public's health here. And now we are in the throes of it. And we're trying not to point fingers," Rinehart said.

The next day, people got sick again, and the clinic had to be evacuated once more. So they've moved the clinic to temporary offices until someone figures out what's going on.

Wednesday on Morning Edition, NPR's Jon Hamilton will report on researchers who think they have a good shot at answering whether drilling is making people sick.

The audio version of this story was produced by Rebecca Davis.

Texas partnership selects Orion Health for HIE

ARLINGTON, TX – The North Texas Accountable Healthcare Partnership on Monday announced its collaboration with Orion Health on a regional health information exchange.?

More than 12,000 physicians will be provided with HIE technology, affecting nearly 7 million patients from 140 hospitals in the Dallas-Fort Worth area and 13 surrounding counties. Officials say the deployment will be the largest such partnership in Texas and one of the largest in the United States.?

"North Texas Accountable Healthcare Partnership is first and foremost community-focused, led and driven," said Joseph W. Lastinger, CEO of the North Texas Accountable Healthcare Partnership. "We are committed to improving patient care and the overall health of the community and delivering value to all involved: patients, clinicians, hospitals, labs, employers, and more."

He added that Orion Health’s "proven global experience with successful large deployments combined with the breadth and depth of the Orion Health solution convinced us that they are uniquely suited to help address the challenges and demands of healthcare delivery to millions of patients in North Texas."?

Partnership officials say the group selected Orion Health HIE for its powerful information sharing capabilities in addition to its flexibility. Orion Health will work with the partnership to build a master patient index that will allow care providers in affiliated facilities to see a holistic view of the patient regardless of the location of the patient or provider.

In the future, the partnership plans to implement Orion Health’s patient portal and cloud-based EHR solutions, both which will empower patients with chronic illnesses such as diabetes or heart disease to better manage their conditions and enable their physicians to improve care coordination.?

"The North Texas Accountable Healthcare Partnership’s HIE will help our physicians and clinicians coordinate care and focus on preventive care strategies, so we can begin to transition into a wellness focused system in North Texas," said Michael Darrouzet, chairman of the board of the North Texas Accountable Healthcare Partnership. "This is especially important when managing chronic conditions such as diabetes and congestive heart failure."?

Darrouzet added that Orion Health's flexible service "meets needs of all healthcare organizations in our area regardless of their size, technology infrastructure or budget. Plus, its features and functionality are very easy to use and physician-friendly, allowing clinicians to set their own parameters for information delivery to ensure that they receive the most accurate and relevant patient information at point of care.”

“North Texas Accountable Healthcare Partnership has shown a deep understanding of what it takes to create successful community-wide health information exchange," said Paul Viskovich, president, Orion Health North America. "In addition to its commitment to involve all stakeholders in the region in decision making – including physicians, hospitals, payers and local employers – the partnership recognized the need to build a powerful and flexible technology infrastructure that can support physicians and empower patients now and well into the future as the North Texas healthcare landscape changes."

The partnership is one of the 16 regional HIEs awarded funding by the State of Texas through the Statewide HIE Cooperative Grant Program. The partnership received $4.9 million in funding from the state to help develop the necessary infrastructure in North Texas.? ? ?

 

TB patient charged in Calif. for not taking meds

SAN FRANCISCO(AP)�Authorities in California took the unusual step of jailing and charging a tuberculosis patient who they say refused to take medication to keep his disease from becoming contagious.

Health officials said Armando Rodriguez, 34, of Stockton has active pulmonary tuberculosis, which can include coughing up blood or phlegm and can spread through the air.

Rodriguez has been noncompliant with his treatment and could become contagious as a result, Ginger Wick, nursing director for San Joaquin County, said in a letter requesting a warrant for Rodriguez's arrest.

After failing one time to give himself the drugs, Rodriguez told a nurse he had gone on an alcohol binge and taken methamphetamine and didn't want to hurt his liver, Wick said in her letter.

Rodriguez was arrested Tuesday and is expected to be arraigned Thursday on two misdemeanor counts of refusing to comply with a tuberculosis order to be at home at certain times and make appointments to take his medication.

He will likely be appointed a public defender.

Tuberculosis is a bacterial infection that usually attacks the lungs. Many people have a latent form, and the active form usually only affects adults whose immune systems are compromised, which can happen from drug use.

Public health experts are divided on the issue of mandatory treatment and criminal charges for patients who don't comply with treatment orders.

Many of those who do support criminal prosecution in the rarest of cases when public health is in jeopardy oppose the jailing of patients.

"I think it's an error to confine someone in the criminal justice system for a public health crime," said Lawrence Gostin, a Georgetown University public health law professor who drafted a model law adopted by several states struggling with the issue. "The whole intention is to protect the public's health. It's not to lay blame on someone."

Implementing mandatory treatment should be a last resort, and prosecuting someone for disobeying a public health order is unhelpful and sends the wrong message if protecting public health is the intent, Gostin said.

Instead, the afflicted should be given incentives such as transportation to and from treatments rather than punishment as an incentive to take their medicine, he said.

The Centers for Disease Control and Prevention said laws to control the spread of tuberculosis have been in use for more than a century, though regulations differ in each state.

As many as 12,000 new cases of tuberculosis are reported in the country each year, the CDC reported. California recorded 2,317 new cases in 2011, a low since records have been kept.

Nonetheless, officials throughout the nation continue to struggle to stop the spread of tuberculosis, with several drug-resistant strains emerging in recent years.

Federal and state officials don't keep records of the number of people prosecuted for refusing to take their medicines. But some say it's exceedingly rare to file criminal charges in such cases.

San Joaquin County has had more than 30 tuberculosis prosecutions since 1984, prosecutor Stephen Taylor said, noting the county is more aggressive than other jurisdictions in prosecuting patients to get them to take their medication.

"The criminal cases we're dealing with generally involve drug users who are harder to treat and manage because the TB medicines conflict with street drugs," he said. "We have to throw these people in jail and treat them as in-patients. They don't cooperate as out-patients."

Karen Furst, San Joaquin County public health officer, said the county arranges transportation and other services to help patients stick to their drug regimen and turns to the legal system only as a last resort.

"I have to make sure that if I'm aware that somebody is in a position that could possibly be spreading a disease to another person, that I take steps that are necessary to prevent that from happening," she said.

Rodriguez was discharged in March from San Joaquin General Hospital with four medications for active tuberculosis and agreed to take the drugs under observation by a county health official on weekdays and on his own on weekends, authorities said.

He allegedly refused to take the drugs on another day and then was not at home on three occasions and missed an appointment.

Each charge against Rodriguez carries a maximum penalty of a year behind bars. In her letter, Wick said Rodriguez would need nine months of treatment.

���

Associated Press writer Paul Elias in San Francisco contributed to this report.

HHS aims to help public gauge how healthcare is doing

WASHINGTON – The Department of Health and Human Services  has made available an online tool that makes it easy for the public to monitor and measure how the nation’s healthcare system is performing.

The Health System Measurement Project enables policymakers, providers and the public to develop consistent data-driven charts and views of changes in important health system indicators.

[See also: HHS launches $1B innovation initiative]

The web-based application brings together datasets from across federal agencies that span topical areas, such as access to care, cost and affordability, prevention and health information technology. It presents these indicators by population characteristics, such as age, sex, income level, insurance coverage, and geography.

A user can look at data on a given topical area from multiple sources, compare trends across measures and compare national trends with those at the state and regional level.

For example, an individual could use the tool to examine the percentage of people who have a specific source of ongoing medical care or track avoidable hospitalizations for adults and children by region or ethnic group. Or explore the percentage of non-elderly individuals who have health insurance.

[See also: HHS aims to spur software apps development]

“Ensuring all Americans have access to these data is an important way to make our health care system more open and transparent,” said HHS Secretary Kathleen Sebelius in a May 15 announcement.

The measures are drawn primarily from existing publicly available datasets. The tool contains information on how the measures were calculated and provides users with direct links back to the original data sources.

The HHS Office of the Assistant Secretary for Planning and Evaluation developed and selected the measures in the Health System Measurement Project.
 

Continua makes new design guidelines available to developers

BEAVERTON, OR – Hoping to drive more "plug-and-play" connectivity of personal health technologies, Continua Health Alliance has made available its most recent design guidelines as a free download for device vendors.

The design guidelines, called Adrenaline, aim to help technology developers build end-to-end systems more efficiently and cost-effectively by facilitating connectivity between personal connected health products such as smartphones, gateways and remote monitoring devices. They were previously available only to Continua members during interoperability testing.

He added that the guidelines are meant to "decrease time-to-market and reduce development costs, further supporting the widespread adoption of personal connected health solutions.”
 
Continua also announced new guidlines for its members. Called Catalyst, and currently undergoing interoperatbility testing, officials say they incorporate Bluetooth Smart, the low energy technology at the heart of the Bluetooth v4.0 specification. The low power consumption, security and stability of Bluetooth Smart products makes them well-suited for health and fitness devices; monitoring systems for vital signs such as heart rate, blood pressure and temperature; or on-body sensors. Continua plans to publicly release these guidelines at no cost later this year.

Parents play favorites when helping adult kids out

SAN FRANCISCO�More than 60% of today's young adults have received financial help from their parents � and those described as having more agreeable personalities as children get more money than others, finds a study to be presented today at a meeting of the Population Association of America.

Among the 62% of young adults getting parents' help, the average amount was $12,185, says lead author Patrick Wightman of the University of Michigan-Ann Arbor.

About 42% of parents help adult children pay their bills, 35% help with college tuition, 23% help with vehicle expenses, and 22% help with rent away from home, researchers found.

Children who parents said were cheerful, self-reliant and got along well with others before age 12 were more likely to receive financial gifts or loans as young adults, Wightman says. And in families with more than one child, "if they perceive one of those kids to have a better attitude or to be more self-reliant, that kid has higher odds of receiving this type of support," he says.

The analysis is based on more than 2,000 interviews with 1,368 people ages 19-22 and their parents in 2005, 2007 and 2009.

The research found that 82% of higher-income parents ($99,910 or more a year) provide help, vs. 47% of those with lower incomes (less than $37,274). Yet lower-income parents provided as great a share of their incomes overall � about 10%.

A study in the current issue of the Journal of Adult Development found similar percentages of students getting parents' assistance � about two-thirds of 402 undergraduate students ages 18-27 at four U.S. campuses.

That research, co-written by Larry Nelson, an associate professor of family life at Brigham Young University in Provo, Utah, found that when parents covered everything, "their children worked the fewest hours and were engaged in the greatest number of risk behaviors," defined as drinking, binge drinking, smoking and marijuana use.

Young adults without financial support from parents "were working the highest number of hours just trying to make money and survive. They weren't engaged in risk behaviors."

However, Nelson cautions they also are at risk � of dropping out of school. "They burn out. They don't finish school and have lower starting salaries."

Big budgets translate to big technology

When it comes to implementing technology, money – and whether you have it ­– really can make a difference. This year there have been some high profile, high-budget implementations that have made big news.

Cleveland Clinic’s plans to open two new, spacious facilities this fall struck a chord with Healthcare IT News readers, who chose it as having the biggest impact on healthcare information technology.

One reason the $634 million facilities will be so roomy is to house all the technology they’ll be using.

The facilities, the Sydell and Arnold Miller Family Pavilion and the Glickman Tower, will house state-of-the-art technologies, including advanced heart and urological, advanced 3-D imaging, robotic interventional surgical devices and a fully computerized communications system.

One Healthcare IT News reader said, “I appreciate their ability to accomplish ‘big news’ producing projects and still provide excellent patient-centered care.”

“Cleveland Clinic has not only pushed its healthcare technology internally, they’ve been very vocal on what they are doing that works,” said Michael Wallace, of the PrimaryData Corporation.

Another big budget item was Kaiser Permanente’s massive electronic health records system, called KP HealthConnect, which had a price tag of $4 billion. HealthConnect is the world’s largest privately funded electronic health record, covering 8.7 million members.

Kim D. Slocum, a HIMSS Fellow and president of KDS Consulting, called it a “groundbreaking success, not just in getting HIT in place, but in using it to improve care.”

 “I believe that the implementation process that Kaiser has gone through can teach many large facilities the rights and wrongs of EMR,” agreed Deborah Smith, RN, of Grand Strand Hospital in Myrtle Beach, S.C.

Advisory panel cautious about federal HIE proposals

WASHINGTON – The Health IT Policy Committee has concerns over some of the health information exchange requirements contained in the meaningful use Stage 2 proposed rule.

At the committee’s April 4 meeting, the group hashed out some of the HIE requirements as part of their preparations for providing recommendations  to the Office of the National Coordinator for Health Information Technology by May 7.

The proposed regulation, released Feb. 24, calls for prescriptions and lab results to be shared electronically. It also calls for electronic communication among providers across care settings.

It is important to make the requirements clear and balanced so providers will have a better chance at accomplishing them, according to Micky Tripathi, chair of the committee’s information exchange panel at the April 4 meeting. He is also president and CEO of the Massachusetts eHealth Collaborative.

Health information exchange is a critical aspect of this next stage of meaningful use to start using data to coordinate care and improve patient outcomes.

Among the differences with the meaningful use proposed rule, the committee wants to restore its recommended requirement for hospitals to send structured lab data, Tripathi said. The Centers for Medicare and Medicaid Services did not follow that recommendation in its proposed rule released in February.

CMS noted that this might be a burden on hospitals, but Tripathi said in his conversations, many hospitals do not see this as a burden, and some might find it beneficial to have a standard rather than a lot of optionality that exists today both within the organization and in dealing with EHR vendors.

“We’re requiring that EHRs be certified to receive according to a set of standards. We’re also requiring that clinicians have a certain amount of their labs be structured labs. But we’re not requiring that the last piece of puzzle that is responsible for a large fraction of the results delivery meet that standard,” he said.

Hospitals sending lab information in standardized data format directly affects the ability of physicians to achieve their structured lab result requirement and will also affect clinical quality measure capabilities, Tripathi said.

The panel also recommended removing a cross-vendor requirement that 10 percent of electronic exchange of transition care summaries be transmitted to organizations that they are not affiliated with and that are on a different vendor platform.

While the panel agreed with the first part, it did not agree with cross-vendor exchange requirement. In many markets, there is often a single vendor that has high penetration.

“What we want to do is create an incentive for vendors to incorporate the national standards deeply into their products,” he said.

The cross-vendor exchange requirement instead provides an incentive to artificially create a two tier system by deeply integrating proprietary technology with the EHR product but then do this other tier with lower integration for the national standard.

Farzad Mostashari, the national health IT coordinator, said that the rationale for the cross-vendor requirement was to avoid a “walled garden” scenario where providers could meet the exchange requirement within their own vendor’s context yet never share data outside of it. 

“From a policy view, is there comfort that without the cross-vendor requirement we won’t end up in a situation where there is a significant number of providers not exchanging information outside of their vendor boundaries?” Mostashari asked.

Tripathi said that providers “are going to exchange with whom they need to exchange from a patient care and business perspective independent of what platform they are on. So you should create and enforce the standards for the platforms that they are on regardless of whom they are exchanging with in terms of vendors,” he added.

 

 

Panel backs sharing studies of lab-made bird flu

NEW YORK(AP)�The U.S. government's biosecurity advisers said Friday they support publishing research studies showing how scientists made new easy-to-spread forms of bird flu because the studies, now revised, don't reveal details bioterrorists could use.

The decision could end a debate that began in December when the government took the unprecedented step of asking the scientists not to publicize all the details of their work.

The research, by two scientific teams � one in Wisconsin, the other in the Netherlands � was funded by the United States. It was an effort to learn more about the potential threat from bird flu in Asia. The virus so far doesn't spread easily among people. But the new lab-made viruses spread easily among ferrets, suggesting they would also spread among humans.

Last year, after reviewing earlier versions of the papers, the National Science Advisory Board for Biosecurity said publishing full details would be too risky. The federal government agreed.

Scientists around the world debated the matter. Many argued that full publication would help scientists track dangerous mutations in natural bird flu viruses and test vaccines and treatments.

On Friday, board members, meeting in Washington, announced they are satisfied with the revised papers. The panel's advice now goes to the U.S. Department of Health and Human Services for a decision.

The board unanimously supported publication of one study, led by Yoshihiro Kawaoka, of the University of Wisconsin. By majority vote it supported publication of the key parts of a second study, from Ron Fouchier, of the Erasmus Medical Center in Rotterdam, the Netherlands.

In an email, Kawaoka said the revisions to his paper "were mainly a more in-depth explanation of the significance of the findings to public health and a description of the laboratory biosafety and biosecurity."

Editors of the journals Science and Nature, which plan to publish the works, said they were pleased by the recommendation.

"Subject to any outstanding regulatory and legal issues, we intend to proceed with publication as soon as possible," said Philip Campbell, editor-in-chief of Nature.

The manmade viruses are locked in high-security labs. Publication in scientific journals is how scientists share their work so that their colleagues can build on it, perhaps finding ways to better monitor and thwart bird flu in the wild, for example.

University of Pennsylvania bioethics professor Art Caplan said the board's recommendation makes sense, primarily because the information in the studies is already being shared among scientists.

"The details of this paper are already out, these two papers. The horse is out of the barn, and trying to yank it back doesn't make much sense," Caplan said.

Natural bird flu has infected people through close contact with animals, and it doesn't easily spread from person to person. Scientists fear that a highly transmissible bird flu could cause a lethal pandemic.

The researchers say the transmissible germs they created did not actually kill the lab animals.

The bird flu virus, called H5N1, has spread mostly through poultry in Asia for the past decade. It has killed more than 300 people since 2003, mostly in Asia.

When an elephant forgets: the individual mandate

For nearly 20 years the GOP trumpeted the virtues of the individual mandate as a vehicle to get the 2 percent who could afford -- but refused to buy -- insurance in the pool. But once President Obama turned their talk into action, they went sour on the idea.

You'll be excused if you think � with the rhetoric surrounding the Supreme Court hearings�� that the individual mandate was the Democrats' idea.

Actually, it was conceived by Republicans who insisted that those without health insurance are milking the rest of us.

No free rides

Mitt Romney sees those folks as "free-riders" since hospitals are required to treat them regardless of their ability to pay. As Massachusetts Governor, he insisted on a mandate as a matter of fairness. Newt Gingrich spent��20 years�calling for a federal mandate. Senate Republicans�twice introduced bills that would establish a mandate,�but were unable to get one passed.

Making sausage: the hard work of governing

As a candidate in 2008, Barack Obama�opposed a mandate.�Efforts for compulsory health insurance have been attempted since 1915, and it's a goal that stymied Roosevelt, Truman, Johnson, Nixon and Clinton.�The German statesman Otto von Bismarck famously said, "politics is the art of the possible" and that's as good a reason as any for why President Obama adopted several long-championed Republican ideals, including the mandate, in the ACA.

Von Bismarck also famously decreed, "Laws are like sausages, it is better not to see them being made." Obama, time and again, reached out to craft a bipartisan health care bill, even if he wasn't able to arouse bipartisan support. The Republicans were like the barnyard animals in the story about�The Little Red Hen�� they didn't want to actually do any of the work to help solve our health care problems.

Many Democrats voted for the Affordable Care Act�(ACA) fully aware that it might cost them their seats in the mid-term elections.That's political courage.�In the mid-terms, we replaced a do-something Congress with a�do-nothing Congress.

Will these impotent lawmakers retain their seats this fall?�We deserve the government we vote for. See how they vote here.

CDC: Kids' accidental deaths down 30 percent

The number of children and teens who die from any kind of accidents has dropped nearly 30% from 2000 to 2009, mostly because of a decline in traffic deaths, says a new report from the Centers for Disease Control and Prevention.

The good news � that more than 11,000 lives have been saved by the reductions in unintentional deaths for those from birth to age 19 over that period � is offset by the sobering news that more than 9,000 young people still die annually from motor-vehicle-related accidents, fires, poisoning, drowning, falls and other unintentional injuries.

Unintentional injuries are still the leading cause of death in the United States for children 1-19 and the fifth-leading cause of death for newborns and infants age 1, the report says.

"Most of these events are predictable and preventable," said Ileana Arias, principal deputy director at the CDC. "One child's death is one death too many."

Keeping your baby safe

Some infants die during sleep from unsafe sleep environments. Some of these deaths are from entrapment, suffocation, and strangulation.

Some infants die from sudden infant death syndrome (SIDS). However, there are ways for parents to keep their sleeping baby safe, says the American Academy of Pediatrics. The group offers these guidelines for safe sleeping for healthy babies up to one year of age.*

- Place your baby to sleep on his back for every sleep.

- Place your baby to sleep on a firm sleep surface.

- Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the crib.

- Place your baby to sleep in the same room where you sleep but not the same bed.

- Breastfeed as much and for as long as you can.

- Schedule and go to all well-child visits.

- Keep your baby away from smokers and places where people smoke.

- Do not let your baby get too hot.

- Offer a pacifier at nap time and bedtime.

- Do not use products that claim to reduce the risk of SIDS.

*Note: A very small number of babies with certain medical conditions may need to be placed to sleep on their stomachs. Your baby�s doctor can tell you what is best for your baby.

A large part of the decline in unintentional deaths was a 41% drop in childhood vehicle-related crash deaths between 2000 and 2009, although they still remain the leading cause of unintentional injury death.

Among the reasons for the decline: improvements in child safety and booster seat use and use of graduated drivers' licensing systems for teen drivers, Arias said.

There are still "troubling trends," she said. Poisoning death rates climbed 91% among teens ages 15-19, largely because of overdoses on prescription drugs such as painkillers.

One puzzling finding was a 54% rise in deaths from suffocation among babies younger than 1.

The deaths from suffocation is "a troubling number," said Julie Gilchrist, a pediatrician and medical epidemiologist with CDC's Division of Unintentional Injury Prevention. Part of the increase may be because of improved death-scene investigation and classification. Previously a suffocation death might have been classified as sudden infant death syndrome (SIDS), she says. SIDS is not included in the study � it's a diagnosis issued when there isn't an explanation for how a child died, Gilchrist says.

"Whether it's a new increase or whether it's the way it has been � it's still almost a thousand infants in a year who are suffocating in their beds in environments that we know aren't safe," she said.

She says many infant deaths from both SIDS and suffocation could be avoided if parents followed the American Academy of Pediatrics' recommendations: Infants should sleep in safe cribs, alone, on their backs, with no loose bedding or soft toys.

In 2009, child and adolescent unintentional injuries resulted in about 9,000 deaths, 225,000 hospitalizations and 8.4 million patients treated and released from emergency departments. State death rates varied widely: Mississippi's was more than six times that of Massachusetts.

Unintentional injuries among children in 2005 that resulted in death, hospitalization or an emergency department visit cost nearly $11.5 billion in medical expenses.

Medicare Open Enrollment: Better Choices, Sooner

Every year, people with Medicare get to explore new choices and pick the plans that work best for them. This year, this Open Enrollment period is starting early � on October 15 � and ending sooner � December 7.

As health plans start their marketing and advertising activities in just a few weeks, we want people to know that the Medicare program is strong and, in 2012, they have a broad array of choices. And, there are lots of new benefits thanks to the Affordable Care Act.

Every person with Medicare will have to choose a �Part D� plan to help them pay for prescription drugs. And people who have chosen to enroll in a �Part C� Medicare Advantage plan for their basic health care services have the option of staying in that plan, choosing a different plan, or going back to the Original Medicare program. These are important choices that should be made with care.

The good news is we have strengthened consumer protections and improved plan choices. We�re making it simpler for people to choose a new health or drug plan by reducing the number of duplicate plans. We�ve also worked with plans to reduce cost sharing on important benefits like inpatient hospitalization and mental health services.

And, thanks to our enhanced bargaining power we can report that average premiums for a Part D plan will be the same in 2012 as in 2011. The average premium for Part C plans is going down by 4 percent. That�s great news for people on Medicare who have a fixed income.

As with last year, people with Medicare will continue to have a variety of Medicare Advantage plan choices. Consumers in every part of the country will have a wide variety of Part D plan choices in 2012, including many plans with zero deductibles and plans with some form of generic gap coverage.

People with Medicare are also enjoying important new benefits. Every person is entitled to an Annual Wellness Visit with their doctor so that they can discuss their health and their health care needs. Prevention services like mammograms and other cancer screenings are now available with no cost-sharing. And people who reach the donut hole in their drug costs will get a 50% discount on covered brand name drugs and a 14 percent discount on generics. That puts money back in your pockets.

More good news for consumers is the fact that we�ll be closely monitoring marketplace performance to protect people from misleading information or prohibited tactics by a small minority of unscrupulous plans. Medicare plans are on notice: we�ll move quickly to take action against plans found to be violating marketing rules.

In short, there�ll be a wide range of health and drug plan options available across the country, including Original Medicare. People can turn to www.medicare.gov, call the 1-800-MEDICARE hotline, or consult with a local State Health Insurance Assistance Program (SHIP) for help. We want to make sure people can identify and enroll in the coverage option that suits their needs in 2012.

UMMS hoppin’ with Toad

Medical school doubles It staff productivity

WORCESTER, MA – It took a Toad to get the University of Massachusetts Medical School’s databases hopping along steadily, says Raymond Lefebvre, director of database and reporting systems.

Developed by Aliso Viejo, Calif.-based Quest Software, the Tools for Oracle Application Developers (now known simply as Toad) has become a ubiquitous mechanism for IT staffs around the country in the past 15 years.

“It has been in every place I ever worked,” Lefebvre said.

The latest generation of Toad has generated positive results at UMMS, he said, doubling IT staff productivity and reducing risk while supporting nearly 1,300 SQL and 125 Oracle server databases that drive mission-critical applications for the medical school and Commonwealth Medicine, the medical school’s healthcare consulting division.

Quest’s leading productivity software, including Toad for Oracle Xpert Edition and Toad for SQL Server have provided the medical school’s developers, administrators and database administrators with a simple, automated and consistent way to build, manage and maintain the databases that support vital enterprise-class business, facilities and ERP applications, including an Oracle-based international stem cell registry.

“We strive to be highly efficient in managing thousands of vital databases,” Lefebvre said. “Quest’s Toad software gives us access to robust features, such as built-in editors, SQL recall, schema compare and schema browser. We chose Toad after evaluating other solutions because of its deep, ‘Swiss Army knife’ functionality.”

Lefebvre says Toad also plays a key role in reducing information governance risks by helping to ensure compliance with HIPAA and SAS70 regulations, which require change tracking and auditing capabilities.

UMMS has a heterogeneous server environment, so Toad is used across all the platforms. Even with the school adding even more databases and taking on new lines of business, the IT department doesn’t need to add staff because Toad allows workers to take on extra growth seamlessly, Lefebvre said.

“Our Oracle and SQL DBAs can move between these servers – they would need to have the proprietary tools otherwise,” he said. “It would be a nightmarish situation to not have it…productivity would plummet and the staff says they would revolt without it.”

With a total of six database administrators, UMMS has been able to increase its productivity with no extra staff, Lefebvre said, because “Toad is not a tool, but a toolbox. With all these tools, the staff doesn’t have to read or memorize syntax like in times past. My team can go in and the tool streamlines the process for them.”

Amit Parikh, product manager for Quest, says the fact that Lefebvre and his team have been able to get more work done around the database is due to one of Toad’s most important facets, which allows customers to reclaim a significant portion of their time spent on daily development tasks.

“Database professionals need tools with functionality that’s deep and complete enough to amplify their productivity beyond what native tools can deliver,” he said. “Ray and the UMMS saw immediate value in Toad by reducing risk of error and improving level of efficiency through the automation of repeated database development and administration tasks.”

UMMS is also counting on Quest’s ChangeAuditor to become a useful implement for compliance and auditing as well, Lefebvre said.

“Our organization has four main purposes – higher education, health sciences, clinical research and human health services,” he said. “For HIPAA PHI, PII security and other sensitive data, we need to automatically create trails of changes made – the capability to show how changes were made and who made them.”

The organization has also expanded its suite of Quest products with the addition of Spotlight on Oracle and SQL servers, which provide operational diagnostics, administration and automated database tuning.

“The user community has always been fundamental in helping shape the evolution of Toad,” said Claudia Fernandez, director of product management for Toad Solutions. “The community-driven nature of the product is what made it such a success and so popular among the database community, and that aspect will never change.”
 

 

Melanoma cases rising; young women at greatest risk

Planning to head to a tanning salon to beef up your bronze looks for prom and graduation or to get a head start on beach season? Young people might want to reconsider.

A dramatic rise in skin cancer rates among young adults is leading health officials to shed light on the risk factors, specifically tanning salons, which women are more likely to use.

Women under 40 are hit hardest by the escalating incidence of melanoma, according to a Mayo Clinic study published in the April issue of Mayo Clinic Proceedings, out today.

Researchers examined records from a decades-long database of all patient care in Olmsted County, Minn., and looked for first-time diagnoses of melanoma in patients 18-39 from 1970 to 2009. Melanoma cases increased eightfold among women in that time and fourfold for men, the authors say.

"We need to get away from the idea that skin cancer is an older person's disease,'' says report co-author Jerry Brewer, a dermatologist at the Mayo Clinic in Rochester, Minn.

The findings might be explained by gender-specific behaviors addressed in other studies, the authors wrote. "Young women are more likely than young men to participate in activities that increase risk for melanoma, including voluntary exposure to artificial sunlamps."

The study is the latest evidence of a steady rise in skin cancer. A major government study published Wednesday reported that while new cases of many of the most common cancers are declining, melanoma cases are increasing.

"We're very concerned about the melanoma rates and the damage done by early exposure to sun, but also the increasing use of tanning beds," says physician Marcus Plescia, director of the division of cancer prevention for the Centers for Disease Control and Prevention.

Tanning industry disagrees

The Indoor Tanning Association defends tanning lamps. "There is no consensus among researchers regarding the relationship between melanoma skin cancer and UV exposure either from the sun or a sunbed," says executive director John Overstreet. "I expect more from the Mayo Clinic. There is no direct link from their report to tanning beds."

Yet, according to the National Institutes of Health, excess exposure to ultraviolet light increases risk for all skin cancers. UV light is invisible radiation that can damage DNA in the skin and can be generated by the sun, sunlamps and tanning beds.

Skin cancer most often occurs in people 50 and older. Melanoma is the most serious type and is potentially deadly. Symptoms include changes in an existing mole or development of an unusual growth on your skin, according to the Mayo Clinic. People with fair skin are at higher risk. The authors noted that the population of Olmsted County is mostly white.

The 'Jersey Shore' effect

Fair skin has less pigment to protect the body from UV radiation. Other risk factors: one or more severe sunburns as a child, an unusual number of moles, a family history of melanoma � and exposure to UV light.

The possibility of skin cancer might seem remote to young people. "I think (TV) shows like Jersey Shore portray healthy people as someone who has a great tan,'' says Laura Hopwood, 22, who was diagnosed with melanoma a year ago. "Somehow you're not attractive unless you're deeply tanned. Before I developed melanoma, a friend scolded me about not using sunscreen."

Hopwood, who works at Barnard College in New York, says she did not do enough to protect herself from sun damage but has never used a tanning bed. Her parents have not had melanoma. A surgeon made an incision from below her left eye to nearly her chin to remove damaged skin. Now she gets routine skin checkups every six months.

"The people most affected are not just Baby Boomers but actually young adults," says Hopwood's dermatologist, Kavita Mariwalla, director of dermatological surgery at Beth Israel Medical Center in New York. "Tanning before prom or big events has become a 'norm' for many teenagers. What they don't know is that each time they visit a tanning booth, their risk of skin cancer rises."

New CBO Report Supports Innovation Center’s Approach to Improving Care

The United States has one of the best health care systems in the world � and one of the most innovative.� We lead the world in developing new treatments, drugs and procedures to help heal patients.� At the same time, we know that we need to do more to help ensure every patient gets the very best care � and that we are spending our health care dollars wisely.

Last week, a report from the independent, non-partisan Congressional Budget Office (CBO) outlined how difficult this challenge is. The report showed how projects implemented by previous Administrations struggled to reduce Medicare costs.

And the same report recommended that future efforts focus on collecting better data, targeting resources at the patients who need it most, and encouraging care providers to work together.

Even before this report came out, the Center for Medicare and Medicaid Innovation was already putting some of these lessons and recommendations into practice. �The Innovation Center is charged with engaging doctors, hospitals, and other providers that want to try new approaches to keeping their patients healthy and out of the hospital. Here are just a few examples of how the Innovation Center has already adopted some of CBO�s recommendations:

CBO Recommendation: Gather timely data on the use of care, especially hospital admissions.Innovation Center Action: Health systems participating in the Pioneer ACO and ACO Shared Savings models will receive updates on care received by their patients within a few weeks of when it occurred, down from 6 months or more in previous demonstrations. �CBO Recommendation: Focus on transitions in care settings. �Innovation Center Action: The Community-Based Care Transitions Program will invest up to $500 million in organizations such as Area Agencies on Aging that help seniors as they leave the hospital, including through home visits. �In addition, the Demonstration to Reduce Hospitalizations of Nursing Facility Residents will invest $134 million in providing additional care and supports to help reduce preventable hospitalizations among nursing home residents.CBO Recommendation: Use team-based care. �Innovation Center Action: The Comprehensive Primary Care Initiative provides new supports from both Medicare and private health insurers to make sure that participating primary care practices have robust care teams � which could include nurses, pharmacists, and dieticians � available 7 days a week to coordinate care and avert visits to the emergency room.CBO Recommendation: Target interventions toward high-risk enrollees.Innovation Center Action: Along with the Medicare-Medicaid Coordination Office, the Innovation Center is empowering states to invest in new models targeted toward beneficiaries that are eligible for both Medicare and Medicaid, a group of beneficiaries at particularly high risk for having multiple chronic health conditions and high health care costs. �CBO Recommendation: Limit the costs of intervention. �Innovation Center Action: The Innovation Center is testing several new payment models, such as the Pioneer ACO Model and the Bundled Payments for Care Improvement, with no upfront payments to participating doctors and hospitals. �Rather, these groups will be rewarded once their innovative approach is proven to have reduced costs and kept patients healthier.

In addition, the CBO report cited the Medicare Participating Heart Bypass Center Demonstration as one example of a pre-Affordable Care Act project that succeeded in reducing Medicare costs without harming the quality of care seniors received.� Based on this evidence, the Innovation Center launched in August of last year the Bundled Payment for Care Improvement initiative, which will allow seniors in other parts of the country to benefit from the success of the Heart Bypass Center Demonstration.

The Innovation Center is a new way of doing business for Medicare and Medicaid.� We are looking to models of health care that are already working in communities across America and finding ways to help doctors and hospitals in many other parts of the country make similar improvements for their patients. And we�re learning from Medicare�s previous work to develop better, more effective ways to save money and improve the quality of care. By putting into practice important lessons learned from both the private and public sectors, the Affordable Care Act is working to ensure that seniors in every community can enjoy the benefits of higher-quality, more affordable health care.

For more information on the Innovation Center you can visit www.innovations.cms.gov.

National Council on Aging, Humana pilot online disease management program

ST. PETERSBURG, FLA – The National Council on Aging and Humana Inc.’s Humana Cares have announced they will partner to pilot Stanford University’s online Chronic Disease Self-Management Program (CDSMP).

This is the first time that the Stanford online self-management workshops have been offered as part of a chronic care management solution by a national health insurer, the groups announced in a written statement April 12.

One hundred Humana members throughout the United States will participate in the online workshops that focus on better managing the problems common to those suffering from any chronic condition, such as heart disease, arthritis, stroke or diabetes, according to the news release.

"Stanford’s approach aligns perfectly with our goal of helping our members attain the best quality of life possible," said Jean Bisio, Humana Cares president. "It’s a truly interactive program designed to help people be more engaged in managing their own health, and benefit from interacting with others who also live with chronic illness every day.

"In the original trial, after six months, CDSMP participants reported many significant improvements in their health, including increased energy, decreased disability, fewer hospitalizations, and better communication with their physicians," she added.

According to the groups, Stanford’s CDSMP has been proven through more than 20 years of development and research supported by grants from the National Institutes of Health (NIH), the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Disease Control and Prevention (CDC).

During the six-week workshops, members are equipped with proven practical skills to help them manage their conditions over the long-term. They participate in self-management activities, including proper diet, exercise, appropriate use of medications, symptom management and enhanced communication with their doctors, nurses, and other health care professionals.

"Harnessing the power of self-management will improve health and save money, and we thank Humana Cares for piloting this program as part of its approach to improving the health and reducing the cost of care for people with multiple chronic health conditions," said Jay Greenberg, NCOA senior vice president for Social Enterprise.

"Providing members with tools that increase their confidence and get them more engaged in their own care is important," he added.

The first of four workshops consisting of about 25 Humana Cares members is already under way, and the national pilot is expected to conclude by the end of 2012.

Follow Diana Manos on Twitter @DManos_IT_News.

Community health centers under pressure to improve care

Hundreds of the nation's nearly 1,200 community health centers, which serve millions of mostly poor people, fall short on key measures such as vaccinating children and helping diabetics control blood sugar, federal data show.

More than 20 million sought care at the non-profit, mostly privately run centers last year � double the number a decade ago. The centers are poised to take an even more central role in the U.S. health system if President Obama's health law is upheld, because it would give 30 million people health coverage starting in 2014.

A Kaiser Health News-USA TODAY analysis of 2010 health center data showed:

�Centers in the South generally performed worse than those in New England, the Midwest and California

�Nearly 75% of the centers performed significantly worse � at least 10% below the national average � in screening women for cervical cancer. The national average reflects the care of all Americans.

�About 73% performed significantly below average in helping diabetics maintain their blood sugar levels.

�Roughly 28% performed significantly below average for immunizing two-year-olds.

"We feel good about quality overall, but there is clearly room to improve," says Jim Macrae, who oversees the health centers for the U.S. Health Resources and Services Administration.

Consumer advocates worry about the implications for patients.

"Of course this (data analysis) raises a concern for us," says Cindy Zeldin, executive director of Georgians for a Healthy Future, an Atlanta-based consumer health group. "We have so many uninsured for whom the community health centers are one of the few places where they can go for primary care."

Claude Earl Fox, a top health official in the Clinton administration, says community health centers have had a good reputation for providing quality care.

"If some centers are failing to provide a certain level of care, that needs to be corrected," says Fox, who now heads the Florida Public Health Institute.

Macrae points out that some centers do better than the national average in certain areas. For instance, three out of four centers performed significantly better in helping hypertensive patients keep their blood pressure under control, and more than four in 10 do significantly better in making sure women get timely prenatal care.

The centers face greater challenges than the average doctor's office because their patients are nearly six times as likely to be poor, more than twice as likely to be uninsured and nearly three times as likely to be on Medicaid, the state-federal health insurance program for the poor.

Those that treat large numbers of migrant workers and the homeless also tend to have worse outcomes because their patients face more challenges, Macrae said.

The centers have been required to report data to the federal government since 2008 on six performance measures, including how well they care for their patients with diabetes and high blood pressure, screening rates for cervical cancer, vaccination rates for children, provision of timely prenatal care and rates of low birth-weight babies.

"We are asking for more transparency to help drive better performance," Macrae says.

Georgia was the only state to rank near the bottom on four of the six performance measures the federal government collects from clinics. Four other states � Louisiana, Virginia, Kansas and Kentucky � ranked near the bottom for three measures.

Zeldin says she's not surprised that patients at Georgia's 27 health centers fare worse, given the state's high levels of obesity and diabetes.

But there were bright spots, even in Georgia: Albany Area Primary Health Care, a center with 11 clinic sites in southern Georgia, keeps more than 80% of its diabetics' blood sugar under control.

Elizabeth Rayes, 38, of Warner Robins, Ga., credits a nurse at the center for counseling her on how to control her diabetes even though she can't afford a blood glucose meter to test herself. "They do a great job," she says.

Contributing: Paul Monies, USA TODAY

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communications organization not affiliated with Kaiser Permanente.

Coalition of medical societies urges questioning treatments

Physicians and patients should question some commonly used tests and treatments that often are unnecessary and costly and may in some cases be harmful, says a report out today that's part of a new campaign to improve care and cut waste.

Some of the recommendations have been around, but the campaign represents a rare coordinated effort among multiple medical societies.

Nine leading physician specialty societies � including the American Academy of Family Physicians, the American College of Cardiology and the American College of Physicians � each identified five procedures, treatments and tests (for a total of 45) that the groups say are routinely used but may not always be necessary. Their lists are being released today as part of the ABIM (American Board of Internal Medicine) Foundation's Choosing Wisely campaign (choosingwisely.org), which is being done in conjunction with Consumer Reports magazine.

For instance, the American College of Radiology says people don't need routine chest X-rays before surgery if the patient has an "unremarkable" medical history and physical exam.

One goal of the campaign is to make people "feel empowered to go to their doctor and say, 'Do I really need this test?' " says Christine Cassel, president of the ABIM and the group's foundation.

John Santa, an internist and the director of the Health Ratings Center for Consumer Reports, says, "I think it's courageous of cardiologists, internists and family physicians to suggest reducing services that they know generate income for some of their members. I'm sure some of their members won't be happy."

Among the campaign's advice to physicians and patients:

�Don't do imaging for lower back pain within the first six weeks unless there are red flags, such as decreased strength in a leg, says the American Academy of Family Physicians. It does not improve outcomes but does increase costs.

�There's no need to repeat colorectal cancer screening for 10 years if a high-quality colonoscopy comes back negative in average-risk individuals, the American Gastroenterological Association says.

�Don't routinely prescribe antibiotics for acute mild-to-moderate sinus infection unless symptoms last for seven or more days, the American Academy of Family Physicians says. Most sinusitis is due to a viral infection and will resolve on its own.

�Don't use dual-energy x-ray absorptiometry (DEXA) screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors, the family physicians group says.

�Don't obtain a stress test or treadmill test for individuals who have no symptoms of heart troubles and are at low risk for coronary heart disease, the American College of Physicians says.

The report's release was not timed to coincide with the current Supreme Court debate on health-care legislation, Cassel says. "But we live in the same world. We all know we are paying too much on health care. If we can cut some of our costs, then we can have enough resources to provide health care for those who need it."

Sidney Wolfe, an internist and director of the health research group at Public Citizen, a consumer group, was not involved in creating the new campaign. But he says it is "identifying unnecessary, overused tests. Unnecessary tests frequently lead to unnecessary surgery or unnecessary drugs being prescribed, which can lead to unnecessary injuries, unnecessary surgeries and unnecessary deaths."

Eating with Ellie: Spring cleaning is for your kitchen, too

Spring invites a fresh-start mentality. It is a perfect season to clean house, literally and figuratively.

This year, incorporate changes that also support a healthier way of eating. It is remarkable how simple changes in how we stock and organize our kitchens can pave the way to eating better.

Remove. A big first step toward developing new, better habits is making room for them. So go through your cupboards, refrigerator and freezer and get rid of anything that is expired, unidentifiable, freezer-burned or stale. Ditch spices more than 2 years old; they have lost their potency by now. Consider tossing unhealthy snacks, soft drinks and sugary cereals or moving them to a hard-to-reach place (more on that below). Once you eliminate what's not helping, you open up your kitchen and life to new possibilities.

Replenish. Fill your newly cleaned freezer with frozen vegetables and fruits with no sauces or sugars added.

Health start shopping list

Frozen vegetables:
Peas
Corn
Spinach
Broccoli
Stir-fry medleys

Frozen fruit:
Berries
Peaches
Mangos
Mixed fruit

Whole grains
Brown rice
Whole-grain pasta
Oatmeal
Quinoa
Bulgur

Herbs and spices:
Curry
Cumin
Coriander
Cinnamon
Chili powder
Paprika
Oregano
Rosemary

Frozen produce, studies show, is comparable in nutrition to fresh, and stocking it means having fruit and vegetables at your fingertips even when you can't get to the market. Because fruit and vegetables are nutrient-rich and satisfying without a lot of calories, they are your No. 1 ally for good nutrition.

Whole grains have more fiber, minerals and health-protective antioxidants than refined; they cause a slower rise in blood sugar and help you feel full faster on fewer calories. So making them your new go-to could help you stay healthier and eat less. Branch out and try at least one whole grain you have never tried before. Quinoa and bulgur are especially quick-cooking and easy to use.

Spices and dried herbs not only add flavor to food, enabling you to cut back on salt without sacrificing taste, but they also have serious antioxidant power. The fresher they are, the more flavor and healing power they provide, so unless you use large quantities, buy small containers and replenish often.

Rearrange. A study in the journal Environment and Behavior found that we are more likely to choose a food if we are visually reminded of it, it is within easy reach and it looks appealing. So set up a beautiful bowl of fresh fruit front and center in your kitchen and replenish it every few days. To avoid unhealthy choices, if you can't ban them entirely, stash chips, cookies, candy and the like in tough-to-reach places so they won't entice you every time you open your cupboard. By having to go out of your way to get them, you give yourself a chance to reconsider. With summer on the way, what better time to redesign and reconsider the way we eat?