Category Archives: public health

Visualizing Data

A very interesting post by Engin Erdogan on GOOD.is on presenting data: http://www.good.is/post/how-might-we-visualize-data-in-more-effective-and-inspiring-ways/.

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PHAT Conference Schedule – May 1

The Public Health & Technology on May 1, 2009 schedule is below. It’s not too late to register: www.hsph.harvard.edu/phat. I will post all the video on this blog as soon as it is available.

10:00 am, Kresge Ground Floor
Registration Begins

10:30 am, Kresge G-2
Introduction – Health Information Technology: Where are we in 2009?

Ashish Jha, MD, MPH, Professor, Health Policy & Management, Harvard School of Public Health


11:00 am, Kresge G-2
Panel – Health Information Exchange

  • ModeratorBlackford Middleton, MD, MPH, MSc; Director of Clinical Informatics Research & Development; Chairman of the Center for Information Technology Leadership (CITL); Partners Healthcare System
  • Ray Campbell; Executive Director & CEO, Massachusetts Health Data Consortium
  • David Cerino, MBA; General Manager, Consumer Health Solutions Group, Microsoft Corporation
  • John Loonsk, MD; Vice President, CGI Federal, Inc.
  • John Moore; Founder and Managing Director, Chilmark Research

12:30 pm, Kresge G-1
Keynote – Connecting Patients, Providers, and Payers

John Halamka, MD, MS; Chief Information Officer, CareGroup Health System; Dean for Technology, Harvard Medical School; Chairman, New England Health Electronic Data Interchange Network; CEO, MA-SHARE; Chair, US Healthcare Information Technology Standards Panel (HITSP)


1:30 pm, FXB Atrium
Networking Lunch with Speakers and Invited Guests

2:30 pm, Kresge G-1
Panel – Health Information Technology & the Stimulus Bill

  • ModeratorKaren Bell, MD, MMS; Sr. Vice President, Health Information Technology Services
  • Jonathan Bush, MBA; CEO, President, & Chairman, AthenaHealth
  • Sharona Hoffman, JD, LLM; Professor of Law and Senior Associate Dean, Case Western School of Law; Co-Director, Law-Medicine Center
  • Isaac Kohane, MD, PhD; Director, Boston Children’s Hospital Informatics Program; Professor, Pediatrics and Health Sciences & Technology, Harvard Medical School

Public Health & Technology Conference, May 1, Harvard School of Public Health

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The HSPH Public Health & Technology Forum is hosting the 1st annual Public Health & Technology Conference on Friday, May 1 featuring keynote John Halamka, CIO of Boston Beth Israel Deaconness Hospital and Harvard Medical, and panelists Karen Bell (ONC), Blackford Middleton (Clinical Informatics Research & Development, Partners HealthCare), John Loonsk (ONC), John Moore (Chilmark Research), Ashish Jha (HSPH), Isaac Kohane (Boston Children’s Medical Informatics Program), Jonathan Bush (AthenaHealth), Sharona Hoffman (Case Western Law School).

Despite health IT’s promise of better, faster, and cheaper health care, adoption of electronic health records in the US remains low. This conference brings together many of the leaders in the field to explore the potential to use health IT to improve health delivery, the challenges of health information exchange and the impact of the 2009 American Recovery and Reinvestment Act on health IT.

Registration is free and all are welcome (www.hsph.harvard.edu/phat).

Public Health Experts Need to Reclaim the Phrase “Preventive Medicine”

“Preventive medicine” is a hot phrase in discussions of health reform. If we just get more people (why not everyone!) screened we can find disease early and save money by attacking these diseases before they become serious and expensive.

But this use of  ‘prevention’ is expensive. Or said another way: There’s a lot of money to be made in this kind of ‘prevention’.

True preventive medicine prevents disease: Reducing airborne particulate matter and pollution prevents incidence of asthma. Funding schools to provide healthy meals prevents childhood obesity. Eliminating the use of lead in paint prevents abnormal development in exposed children.

We must recognize that health screening technologies are not tools to prevent disease; rather, they are tools of early detection of disease. In a sense they define disease. Indeed as screening tools increase in specificity, the thresholds in defining disease status follow in their specificity. Certainly, early detection may give the upper hand to the patient and provider who can implement treatments that reduce the likelihood of that condition becoming life-threatening. But do all abnormalities warrant medical intervention?

Screening technologies such as MRIs are become increasingly sensitive to discovery. In his book How Doctors Think, Jerome Groopman, M.D., cites a physician: “The hateful part of MRIs – I mean they can be a wonderful technology – but they find abnormalities in everybody.” No doubt, part of the rise in the number of chronic conditions can be attributed to our increased ability to find abnormalities, even though not all abnormalities may warrant a medicinal response.

Screening tools do not and cannot prevent abnormalities. They can only find abnormalities.

The primary driver of health care costs is medical technology. Earlier detection coupled with expensive (yet often unproven) interventions have reduced mortality while increasing morbidity. Indeed, many diseases which even 15 years ago would have been a death sentence have now become manageable chronic conditions (HIV/AIDS is an obvious example). This is a testament to our ability to innovate and develop life saving technologies.

Simultaneously, technology has improved our ability to detect ‘disease’ while ensuring chronic care management through pharmaceuticals and/or invasive intervention through biopsies and more. Today, more than half of all Medicare beneficiaries have more than 5 chronic conditions. Soon it will not be uncommon for the bulk of Medicare beneficiaries to have eight or even ten chronic conditions.

One article published in the New England Journal of Medicine notes:

The demands of the public for definitive wellness are colliding with the public’s belief in a diagnostic system that can find only disease. A public in dogged pursuit of the unobtainable, combined with clinicians whose tools are powerful enough to find very small lesions, is a setup for diagnostic excess… Clinical medicine can only say, “With the methods we used, we found none of the diseases we looked for.” No one can measure the absence of all disease. (emphasis mine)

The unfortunate reality is that it is possible to over ‘prevent’ (to use the expensive version of the word). What is needed is not a halt on innovation nor a moratorium on technology. Rather what is needed is a conscious assessment as to when to screen and when treatment is necessary.

The decision as to when to do what should be made between physician and patient, but information is needed to build suggestive guidelines. Health IT, allowing for the aggregation of (anonymous) data, can help.

MCPI Growth Factors

According to the National Health Statistics Group (NHSG), the primary drivers of personal health care spending growth between 2008 and 2017 will be increasing medical prices and utilization followed by the changing age-sex mix and population growth. What surprised me is that the aging population is not the primary problem.

MCPI Growth Factors

The article unfortunately requires subscription or one-time fee, but it may be worthwhile. Here’s the abstract:

Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming To Medicare

Sean Keehan, Andrea Sisko, Christopher Truffer, Sheila Smith,Cathy Cowan, John Poisal, M. Kent Clemens the National Health Expenditure Accounts Projections Team

The outlook for national health spending calls for continued steady growth. Spending growth is projected to be 6.7 percent in 2007, similar to its rate in 2006. Average annual growth over the projection period is expected to be 6.7 percent. Slower growth in private spending toward the end of the period is expected to be offset by stronger growth in public spending. The health share of gross domestic product (GDP) is expected to increase to 16.3 percent in 2007 and then rise throughout the projection period, reaching 19.5 percent of GDP by 2017.

Keehan S et al.  Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming To Medicare. Health Aff., March 1, 2008; 27(2): w145 – w155.

Copenhagen Consensus 2008

Over the last 2 years, many of the world’s top economists, including 5 Nobel Laureates, ranked 30 high-impact solutions to address the world’s greatest challenges. The panel estimates there is a $17 return for every dollar invested into these solutions, in terms of reduced medical expenses and significantly increased earnings.

At the top of the list is providing micronutrient supplements for children (esp. vitamin A and zinc), meaning that the panel of economist that formed the Copenhagen Consensus believe that providing vitamin supplements is the most cost-effective way that the world can improve the state of our planet. Complying with the Doha development agenda would be the second, and so on down to 30. Malnutrition tops the list, with 5 solutions in the top 10, with education and women next. Diseases of the developing world are of course high priorities, but perhaps more surprisingly, so is acute care for heart attacks. 7 entries for global warming and air pollution are also on the list.

These solutions provide a great template for planning cost-effective, high-impact, and globally relevant interventions. The development community would do well to focus on these.

Read more about each of these solutions at  Copenhagen Consensus 2008.

 
Solution
Challenge
1
Micronutrient supplements for children (vitamin A and zinc)
Malnutrition
2
The Doha development agenda
Trade
3
Micronutrient fortification (iron and salt iodization)
Malnutrition
4
Expanded immunization coverage for children
Diseases
5
Biofortification
Malnutrition
6
Deworming and other nutrition programs at school
Malnutrition & Education
7
Lowering the price of schooling
Education
8
Increase andimprove girls’ schooling
Women
9
Community-based nutrition promotion
Malnutrition
10
Provide support for women’s reproductive role
Women
11
Heart attack acute management
Diseases
12
Malaria prevention and treatment
Diseases
13
Tuberculosis case finding and treatment
Diseases
14
R&D in low-carbon energy technologies
Global Warming
15
Bio-sand filters for household water treatment
Water
16
Rural water supply
Water
17
Conditional cash transfers
Education
18
Peace-keepingin post‐conflict situations
Conflicts
19
HIV combination prevention
Diseases
20
Total sanitation campaign
Water
21
Improving surgical capacity at district hospital level
Diseases
22
Microfinance
Women
23
Improved stove intervention
Air Pollution
24
Large, multipurpose dam in Africa
Water
25
Inspection and maintenance of diesel vehicles
Air Pollution
26
Low sulfur diesel for urban road vehicles
Air Pollution
27
Diesel vehicle particulate control technology
Air Pollution
28
Tobacco tax
Diseases
29
R&D and mitigation
Global Warming
30
Mitigation only
Global Warming

Mobile Health and the Inter-American Development Bank

In a previous post, More on Mobile Phones, I discussed the potential for mobile phones to change the way the development community approaches global health. The Inter-American Development Bank, Science and Technology Division just released an excellent white paper entitled Mobile Health: The potential for mobile telephony to bring healthcare to the majority. According to the IDB, “there is no invention that has provided more distinct opportunities in innovation for development than the mobile phone.” The paper identifies 6 categories for innovation:

  • Surveillance – PDA-based data collection and disease monitoring
  • Information – appointment and prescription reminders
  • Consultation – information on waiting times or questions on STDs, for example
  • Education – primary care behavior information
  • Monitoring – chronic disease severity information
  • Diagnostic – remote diagnostic assistance

Mobile health is becoming an important component in the current movement to consumer-centric care, allowing greater interactivity between patient and provider, enabling remote care and notification, increasing accessibility of health information, and facilitating chronic disease management. The value chain below illustrates how comprehensive an effect mobile health could have on delivering additional value to health consumers. Mobile networks have access to all paricipants in the health system–patients, doctors, administrators, etc.–and mobile telephony, as a systems integrator, has the potential to connect the health system to healthcare providers, pharma industry, high-tech industry, and handset manufacturers. All of these have the potential to deliver increased value to citizens.

m-health-value-chain

The document ends with some great additional resources which I will re-post here: