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Understanding US Health Care Reform

July 25, 2012 1 comment

US Health Care Reform: A big deal!

As we travelled from Canada to and from Boston around the first week of July, the US Supreme Court ruling on health care reform dominated all media coverage.  Hype and polarizing condemnation of the high court’s decision was rampant, with Republican presidential nominee, Mitt Romney, vowing to undo it if elected.  This is not surprising. What was surprising was that most Americans we spoke to – Democrat or Republican – were also unhappy with the decision.  Concerns ranged from fears that the new health care reform law would result in rationing of health care, to expectations that it would result in lower quality of care, along with increased costs to individuals, small businesses and the government.  Many were skeptical about being required to buy insurance, seeing it as a curb on individual freedom and a step down a slippery slope towards socialism.

Need for reform

The US health care system is an expensive and inefficient system (see the McKinsey Global Institute report: Accounting for the cost of US health care: A new look at why Americans spend more. According to the US Census Bureau report: Income, Poverty, and Health Insurance Coverage in the United States: 2010, 49.9 million people were estimated to be without health insurance (p. 23).  An overhaul of the system seems necessary, but with all the hype and political wrangling, it is difficult to sort out what is being proposed and why.

So what is being proposed?

Illustrating Health Reform: How Health Insurance Coverage Will Work

This 10-minute animated movie, written and produced by the Kaiser Family Foundation, is an excellent, balanced summary of what is being proposed and why.

Kaiser Health Reform Gateway

Statistics, analysis and discussion from the Kaiser Family Foundation web site.

US Health Care Reform

Details on health reform from the White House governmental web site.

New York Times: Health Care Reform

Article and related discussion, debate and news links.

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Two practical and useful social media guides for research and policy engagement

September 19, 2011 Leave a comment

Two practical and useful social media guides for research and policy engagement

Social media has a significant impact on how individuals communicate, interact and collaborate.  It should be an important component in any researcher’s toolkit, to engage stakeholders, gather and analyse data, and disseminate findings. However, most often it isn’t, because  it is still so new, and because there is yet much to be discovered, explored and understood regarding its capabilities, utilities, pitfalls, and practical uses as a tool and mechanism in conducting and disseminating research.   Social Media: A guide for researchers  produced by Alan Cann of the Department of Biology at the University of Leicester, and Konstantia Dimitriou and Tristram Hooley of the International Centre for Guidance Studies, offers a  useful  and practical guide to engaging a range of resources.

Impact 2.0 – New mechanisms for linking research and policy  was originally developed by Cheekay Cinco and Karel Novotney, at the Association for Progressive Communications (APC) and is now managed and updated by Fundacion Comunica, with the financial support of the International Development Research Centre (IDRC).  It seeks to develop a body of knowledge about the use of Web 2.0 in policy-oriented research and design.  Perhaps on account of the scale, scope and speed of change in new communication tools and technologies,  these  tools have not been extensively exploited in promoting and strengthening links between research, advocacy and policy. This guide can be helpful to researchers who wish to better understand how social networking tools can be used to identify the main policy actors,  issues, connected themes, and opportunities; how  these tools can be used to encourage discussion, debate and collaboration; and  how to leverage them in  engaging and maintaining relations with policy makers and other important stakeholders.

Peer review under review

August 16, 2011 1 comment

Two interesting reports were mentioned on  DocuTicker today concerning the use of peer review in scientific publications:  Peer review in scientific publications by the U.K. House of Commons Science and Technology Committee; and Alternatives to peer review in research funding by the Rand Corporation.

A detailed examination of the current peer-review system was conducted this year by the UK Science and Technology Committee,  examining its effectiveness, and  touching on issues of impact, publication ethics and research integrity.  Among its recommendations the report advocated for a development of standards and training for all editors and, particularly, for early-career researchers in peer review, acknowledging that the system depends on the integrity and competence of the people involved, and the degree of editorial oversight and the quality assurance of the peer review system itself.  The committee felt strongly that research data should be fully disclosed and, especially in the case of publicly funded research, made publicly available, to ensure reliability, testing, and reproducibility. Citing the importance of post-publication peer review and commentary, the use of new media and social networking tools was seen as an “enormous opportunity for experimentation” as a supplement to pre-publication peer-review. As well  post-publication review was recognized as an important vehicle in ensuring wide and expedient transmission of interesting research,  facilitation of rapid review by the global audience, and  in alerting the community to ”potential deficiencies and problems with published work”.

The Rand Europe Report, Alternatives to Peer Review in Research Project Funding  acknowledged that while peer review is considered the gold standard for reviewing research proposals, it is not always the best methodology for every research funding process.  The discussion of a set of established approaches that offer alternatives to traditional peer review are presented to inspire thinking among research funders to apply based on their situation and mission.

The what, why and how of implementing Personal Healh Record Systems

September 14, 2010 Leave a comment

Electronic health record (EHR) systems have greatly improved efficiency and safety in health care delivery: consolidating patient information, tracking prescription use, and enabling decision support.  These systems are controlled by the healthcare providers, some of whom can and do make patient information available to them electronically or via specially requested printed reports.  Patient health record (PHR) systems, introduced in the last couple of years, are a new development, allowing patients improved ability to access their health record at any time outside the care setting, and to even control information and access to that information.  While there are obvious concerns about privacy, control, and legitimacy, the attraction of PHRs to providers and policy makers is the ability to engage patients in their care and, in doing so, to improve care as well as control costs.

The PHR market is still very immature, but there are a number of approaches and developments already underway internationally, with vendors offering a range of possibilities.  Two reports may be useful to those considering the why, what and how of implementing a PHR system:

A 2008 report: The Value of Personal Health Records, by the Center for Information Technology Leadership (CITL), synthesized the best-available evidence and expert opinion into a simulation model of costs and benefits in different PHR scenarios to develop the value proposition of a PHR system.

CITL considered two primary components in a PHR system: infrastructure and applications utilizing the infrastructure. The PHR infrastructure included components and functions that would allow patients to collect and share their health information. Privacy and security functionality are expected to be embedded throughout the PHR system in both infrastructure and applications. The CITL model estimated costs to develop the PHR infrastructure; and the applications to support:

  • information sharing (medication history and test results);
  • information self-management (remote monitoring, web-based educational support); and
  • information exchange (medication renewals, appointment scheduling, e-visits).

Although the model has only been validated by a consensus review process among domain experts and so may differ dramatically from what will actually be experienced, CITI hopes that this will provide a framework for analysis and that extrapolation from the model can facilitate predictions of potential value to those considering employment of PHRs.

A more recent report by Alberta Health Services: Engaging the patient in healthcare: an overview of Personal Health Record Systems and Implications for Alberta, presents a very through and useful overview of PHRs, evaluation of PHR capabilities, a comparison of vendors and benefits and caveats of PHR systems.

There are three distinct categories of PHRs, differentiated by their underlying IT architectures:

  • Stand alone: For example, WebMD and RevolutionHealth: that offer an external user interface and data repository, allow patients to create profiles based on their medical history,  health-tracking that can identify patient risk factors for a range of diseases,  and enable users to connect directly with one another , but they don’t automatically interact with EHRs.
  • Tethered: Offered by large healthcare IT vendors that are predominantly focused on EMR/EHR solutions, for example: Eclipsys Sunrise, Epic Systems MyChart, Cerner Health Connections, and McKesson HorizonWP, who offer a PHR system as an extension of the provider’s health information system, allowing patients to view their personal information through a patient portal. These modules can include tools that enhance patient-provider interaction (e.g., e-scheduling, e-visits, pharmacy requests), disease/health management (via dashboards), and financial services. They offer limited decision-support and social networking capabilities, but most vendors are partnering with services such as GoogleHealth and Microsoft HealthVault to broaden the range of services and make patient data portable beyond the provider’s internal systems. Recently, Telus acquired an application by Sunnybrook Health Sciences Centre in Toronto: MYchart that enables patient access to health records, messaging to providers and clinicians, and limited health-management trackers. However, it apparently offers little ability to scale and interact with multiple systems.
  • Interconnected: Google Health, Dossia, Microsoft Health Vault, and Telus HealthSpace (in Canada) are the major players in this market, which is just getting started.  The  interconnected PHR.combines elements of stand-alone and tethered PHR systems, providing an external repository of health information that users can control and to which health systems can connect. The PHR functions as the user interface for a broad set of IT functions that can be linked to or built into the PHR through the vendor’s development tools. These systems can also collect data from multiple repositories across multiple settings or health systems. Telus HealthSpace is a licensed version of Microsofl HealthVault, but data is stored in Canada. Also, while most major players currently in the interconnected PHR systems market offer their solutions for free, Telus will charge health systems to build onto HealthSpace.

Apparently an interconnected PHR need not necessarily replace a tethered PHR, but be used in addition, to provide the user interface and access point for patients, with the tethered PHR system providing the connection with other IT capabilities (e.g., secure physician email). The most successful PHRs implemented at large health systems today have taken this approach (e.g., Kaiser Permanente, Cleveland Clinic, Beth Israel Deaconess Medical Center).

This white paper is the result of a two-week investigation, which included interviews with McKinsey experts in global healthcare and IT, and an expansive literature review, and analysis of industry and market research.  As the report points out, there are over 200 vendors in the fledgling, but rapidly growing PHR market, so there is a high degree of variability in both the nature and scope of product offerings.  This value of this report, therefore, is in understanding what is available, what is possible, and how to make the choice between alternative systems.

Exciting Development in Open Access Publishing: SpringerOpen

July 7, 2010 1 comment

Springer Science+Business Media one of the world’s largest Scientific, Technical and Medical (STM) publishers announced, on June 28, 2010, a significant expansion of its open access publishing activity with the launch of SpringerOpen, a new series of open access journals that will span all STM disciplines. Articles published in SpringerOpen journals will be freely and immediately accessible online, licensed under the Creative Commons Attribution License. BioMed Central, acquired in 2008 by Springer, will provide its expertise and technology to help establish the SpringerOpen portfolio.

Per BioMed Central’s blog on this development:

BioMed Central’s open access publishing expertise and technology will be used by Springer to launch this new series of titles, which will extend the benefits of open access publishing to authors and readers across all disciplines. BioMed Central’s Open Access Membership scheme, offered to institutions, societies, funders and corporations, will be extended to include the SpringerOpen titles. Articles published in SpringerOpen journals will also be sent automatically to participating institutional repositories via BioMed Central’s automated SWORD deposit mechanism.

The SpringerOpen journals will complement Springer’s existing titles and BioMed Central’s growing portfolio of 200+ open access journals in medicine and life science. The first SpringerOpen journals, which will open for submissions shortly, are:

  • Planetary Science
  • Global Energy
  • Journal of Mathematical Neuroscience
  • Health Economics Review
  • Journal of Mathematics in Industry
  • Journal of Remanufacturing
  • Environmental Sciences Europe
  • Security and Intelligence Informatics
  • Applied Microbiology and Biotechnology Express
  • Bulletin of Mathematical Sciences
  • Gold Bulletin
  • Psychology and Well-Being Research