UnitedHealth Launches Patient Info Cloud Storage

First appeared in Associated Press

UnitedHealth Group's Optum business is launching a service that allows doctors to share information about patients over the Internet, as health care companies continue their push to improve care with better coordination.

The system, known as cloud computing, involves storing information and software applications on remote servers that are accessed through a secure Internet connection.

In health care, this means a doctor does not have to go to a particular computer for patient information or care updates. He or she can use portable devices like smart phones or tablet computers.

Optum's cloud provides a platform that health care providers can use for software that helps them track patients. For instance, a doctor can use cloud-based applications, or apps, to receive automatic updates on a hospitalized patient's condition or to be notified when a patient visits an emergency room or fails to fill prescriptions, a company spokesman said.

Currently, most doctors have to rely on patients to tell them when they visit another physician or the ER.

Cloud computing also can allow doctors to share patient records and discuss a case more efficiently.

Optum worked with Cisco, IBM and Hewlett-Packard Co. among others, to design the cloud and is launching a set of apps called Optum Care Suite to help providers use it. But it also is encouraging providers to design their own applications for the cloud as well.

UnitedHealth Group Inc., based in Minnetonka, Minn., is the largest U.S. health insurer. Its Optum business provides technology outsourcing, among other services.

Insurers and care providers have been more intent on improving care coordination. Last month, another insurer, WellPoint Inc., said it will boost primary care reimbursement by paying for care management it doesn't currently cover.

Some care providers also are forming accountable care organizations that coordinate care among doctors, specialists and hospitals.

Cloud computing platforms first started appearing in health care a few years ago, said Lisa Gallagher, senior director of privacy and security for the industry group Healthcare Information and Management Systems Society, or HIMSS. She said about 30 percent of health care providers like hospitals or physician practices now use some form of cloud computing.

Experts say care coordination leads to better care for patients. It helps doctors catch prescriptions that may conflict or cause a bad reaction. It also cuts down on test duplications and can help people remember when to see the doctor or refill their prescriptions.

It also can lower costs by cutting wasteful spending.

Care coordination currently is left mostly to the patient or his or her family, said Dr. Ann O'Malley, a researcher with the Center for Studying Health System Change. She said that's a task best left to primary-care doctors.

"Right now, coordination is horrible in this country for the most part," she said.

Survey Shows Doctors Aren’t Always Honest

First appeared in Associated Press

Trust your doctor? A survey finds that some doctors aren't always completely honest with their patients.

More than half admitted describing someone's prognosis in a way they knew was too rosy. Nearly 20 percent said they hadn't fully disclosed a medical mistake for fear of being sued. And 1 in 10 of those surveyed said they'd told a patient something that wasn't true in the past year.

The survey, by Massachusetts researchers and published in this month's Health Affairs, doesn't explain why, or what wasn't true.

"I don't think that physicians set out to be dishonest," said lead researcher Dr. Lisa Iezzoni, a Harvard Medical School professor and director of Massachusetts General Hospital's Mongan Institute for Health Policy. She said the untruths could have been to give people hope.

But it takes open communication for patients to make fully informed decisions about their health care, as opposed to the "doctor-knows-best" paternalism of medicine's past, Iezzoni added.

The survey offers "a reason for patients to be vigilant and to be very clear with their physician about how much they do want to know," she said.

The findings come from a 2009 survey of more than 1,800 physicians nationwide to see if they agree with and follow certain standards medical professionalism issued in 2002. Among the voluntary standards are that doctors should be open and honest about all aspects of patient care, and promptly disclose any mistakes.

A third of those surveyed didn't completely agree that doctors should 'fess up about mistakes. That's even though a growing number of medical centers are adopting policies that tell doctors to say "I'm sorry" up front, in part because studies have found patients less likely to sue when that happens.

Not revealing a mistake is "just inexcusable," said Dr. Arthur Caplan, a prominent medical ethicist at the University of Pennsylvania. Beyond decency, "your care now has to be different because of what happened."

The vast majority of those surveyed agreed that physicians should fully inform patients of the risks, not just the benefits, of treatment options and never tell a patient something that isn't true - even though some admitted they hadn't followed that advice at least on rare occasions in the past year.

Perhaps least surprising is that doctors give overly positive prognoses. It's hard to deliver bad news, especially when a patient has run out of options, and until recently doctors have had little training in how to do so. But Iezzoni said patients with the worst outlook especially deserve to know, so they can get their affairs in order, and patient studies have found most want to know.

What else might doctors not tell? There are shades of gray, said Caplan, the ethicist. For example, he's heard doctors agonize over what to tell parents about a very premature baby's chances, knowing the odds are really bad but also knowing they've seen miracles.

Doctors prescribe placebos sometimes, and telling the patient could negate chances of the fake treatment helping, he noted. Sometimes they exaggerate a health finding to shock the patient into shaping up.

And sometimes it's a matter of dribbling out a hard truth to give patients a chance to adjust, Caplan said: "OK, this looks serious but we're going to order some more tests," when the doctor already knows just how grim things are.

Withholding the full story is getting harder, though, Iezzoni said. Not only do more patients Google their conditions so they know what to ask, but some doctors who have embraced electronic medical records allow patients to log in and check their own test results.

State Legislatures Looking to Decide What Doctors Can Do

First appeared in USA Today

State legislatures are considering a host of measures that would make it tougher — or easier — for doctors to perform surgery outside of their specialties, including in their offices.

Only 20 states require doctors doing surgery in their offices to have facilities that are licensed or accredited, according to the American Association for Accreditation of Ambulatory Surgical Facilities. Los Angeles plastic surgeon and AAAASF President-elect Geoffrey Keyes says licensing or accreditation helps ensure there is adequate emergency equipment and procedures and that doctors are properly trained in what they are doing.

But some doctors say it's too costly and restricts available care for needy patients.

Legislators are also increasingly grappling with "scope of practice" issues, which involve ways medical professionals want to expand what they are allowed to do.

It includes anything from OB/GYNs doing cosmetic surgery to optometrists who want to do cataract surgery to pharmacists seeking to expand the vaccines they can give.

Iowa state Sen. Jeff Danielson, a Democrat who chairs the State Government committee, says about a third of his time is spent weighing issues involving medical professionals wanting to expand what they can do. At least 10 bills in Florida involve scope of practice issues.

"As insurance reimbursements go down and physicians' overhead goes up, they're trying to find new ways to meet their economic needs," says Florida state Sen. Eleanor Sobel, a Democrat who is vice chair of the Senate Health Regulations panel. "But they're not necessarily qualified to do what they're doing."

New Jersey state legislators are deciding whether offices where doctors perform surgery should be licensed or accredited. Democratic state Rep. Herb Conaway says he sponsored the House version of the bill in part because of data showing many office-based facilities didn't have proper emergency equipment.

Other bills:

·         Chiropractors in Florida are fighting to be able to provide medical clearance for young athletes to return to sports fields after concussions. Their opposition to a bill that would allow only doctors to grant clearance scuttled the bill last year.

·         Iowa legislators are considering whether outpatient surgery facilities should have to be licensed and accredited as hospitals are.

·         Dentists trained as oral surgeons could perform cosmetic surgery in New York under a measure reintroduced in that state legislature.

Conaway, an internal medicine doctor and lawyer, says accreditation or licensing of office surgery facilities is a matter of safety: "Who would have thought two years ago that someone would attempt to do breast augmentation in their office? Now we're hearing about those procedures being done."

Fraudulent Scientists

First appeared in Time: Heartland

Dipak Das

In January 2012, University of Connecticut officials announced that Das, director of the Cardiovascular Research Center, had fabricated his research 145 times in papers published in 11 scientific journals. Das studied the effects of a compound in red wine, resveratrol, on the heart.

The university launched an investigation of Das’ work in 2008 after an anonymous tip raised questions about  images in his papers, which were turned out to be manipulated.  In its 60,000 page report, the investigators say some of the images were created at a time when there wasn’t anyone in the lab with the proper expertise to generate them, and that Das divided the work on experiments so that even lead authors of papers weren’t fully involved in preparing data and figures. Das testified to the investigators that he had no knowledge of the manipulations, a claim that the panel says “lacks credibility.” The report was filed with the U.S. Office of Research Integrity, which is conducting its own investigation into the fraud. As for Das, a university spokesperson said he “remains employed by the UConn Health Center pending dismissal proceedings per university bylaws.”

Andrew Wakefield

Do vaccines cause autism? Medical experts say no, but we can thank Wakefield for introducing the doubt that won’t die in many parents’ minds. In 1998, the  gastroenterologist at Royal Free Hospital in London published a study describing a connection between the measles-mumps-rubella (MMR) vaccine and autism, after he found evidence of these viruses, presumably from the shot, in the guts of a dozen autistic children, eight of whom developed autism-like symptoms days after receiving their vaccination.

Other scientists could not replicate Wakefield’s findings, nor verify a link between the vaccine and autism. In 2010, the journal that published his paper retracted it, and its editors noted that “it was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false.” Later that year, the General Medical Council in the U.K. revoked Wakefield’s medical license, citing ethical concerns over how he recruited the patients in the study as well as his failure to disclose that he was a paid consultant to attorneys representing parents who believed their children had been harmed by vaccines.

The final shoe dropped a year later, when another prestigious medical journal concluded that his research was also fraudulent, after evidence that some of the timelines of the children’s symptoms were misrepresented.

Wakefield maintains his innocence, and penned a book defending his work and his continued belief in a connection between vaccines and autism. Infectious disease experts and pediatricians, meanwhile, routinely confront conflicted parents who question the safety of vaccines, despite immunization’s long-standing record of successfully controlling childhood diseases with relatively few side effects.

Woo Suk Hwang

It’s not often that scientists achieve rock star status, but that’s what Hwang enjoyed when, seemingly out of nowhere, the Seoul National University professor of veterinary medicine catapulted South Korea to the top of the science hierarchy with his 2004 success in cloning human cells and making human embryonic stem cells.

Or at least that’s what he and everyone else in the world thought he had done. It was the first time anyone had taken a human cell, inserted it into a donor egg, and coaxed it to grow, in theory into a clone of the original cell. He followed that stunning announcement a year later with another first — using the same process to generate embryonic stem cells from patients with spinal cord injury and diabetes, opening the possibility that patients might benefit from stem cell therapies to cure these and other diseases.

That same year, however, anonymous tips raised questions about images depicting the stem cell lines in one of the papers, and a university and government investigation revealed that the stem cells did not come from the cells as Hwang claimed, but from IVF embryos. Hwang said was not aware of the fraud, which he maintained was perpetrated by members of his lab, but was stripped of his position at the university and banned from conducting stem cell research in Korea. He is reportedly seeking investors to fund his research outside of the country.

Dr. Roger Poisson

Sometimes fraud can be driven by good, but misguided intentions. Poisson, a professor of surgery at the University of Montreal, was a member of the prestigious National Surgical Adjuvant Breast and Bowel Project (NSABP), a joint U.S. and Canadian research effort that since 1958 has conducted studies on some of the most effective treatments for breast cancer. In 1994, the U.S. Office of Research Integrity found that for nearly a decade, Poisson had enrolled patients who were not eligible for trials and then falsified or fabricated their medical records to cover up their ineligibility, in an effort to involve as many women as possible in the studies. Investigators found two sets of patient books in Poisson’s lab, one marked ‘true’ and another labelled ‘false.’ The women were part of trials that established that lumpectomy plus radiation was as effective as mastectomy in lowering risk of recurrent breast cancer.

Other studies have since confirmed the benefits of lumpectomy combined with radiation, but the misrepresentation caused many who underwent the procedure to question whether they had made the right decision. “People who are not on the front line of the battle have no idea how frustrating it can be to prepare an eligible patient for a trial, with several pep talks and a great deal of discussion, explanation for the informed consent and to convince the patient to participate and — at the last moment — to realize the patient [is ineligible],” he wrote to the investigators in his defense. Poisson was banned from receiving U.S. government research funding for eight years.

The “Baltimore Case”

The difference between making a mistake and committing fraud is one of intention, and it’s often a fine and obscure line.

That became clear in 1989, when Congress opened hearings into alleged misconduct by Thereza Imanishi-Kari, an assistant in the lab of Nobel laureate David Baltimore at Massachusetts Institute of Technology. In 1985, Baltimore and Imanisi-Kari had published a paper describing their success in injecting a mouse with a gene that altered its immune system so the animal could produce antibodies against a given bacteria or virus. The findings raised the possibility that the human immune system could be modified in the same way, enhancing our ability to ward off infections.

A postdoctoral fellow working in the lab failed to reproduce the results, however, and those concerns eventually led to the Congressional hearings in which Baltimore staunchly defended the work. Imanishi-Kari was found guilty of scientific fraud and Baltimore’s reputation was tarnished by association, leading him to resign from his new position as president of Rockefeller University.

In 1996, however, an appeals board of the National Institutes of Health re-analyzed the case and determined that the paper did not contain fraudulent data, but errors that both co-authors later acknowledged. Imanishi-Kari was exonerated and Baltimore went on to helm California Institute of Technology.

Charles Dawson

The passion of belief, even in scientific discovery, can be enough to perpetuate a hoax across decades, as the case of “Piltdown man” shows. In 1912, Charles Dawson, an amateur archeologist, claimed to have been presented with pieces of a skull dug up by a laborer in the English village of Piltdown. Along with a respected member of the Natural History Museum, Dawson presented his fossil as a remnant of man’s earliest ancestor. Other funny-looking fragments from the same region were unearthed in following years, all eagerly labelled as fossils of an early man.

It wasn’t until 1953, when more sophisticated dating techniques became available, that the fossils were determined to be a hoax, actually made from what appeared to be an orangutan’s jaw. It’s not clear whether Dawson was the original mastermind behind the fraud, or whether he was the front for others who had reason to stick it to the British scientific establishment (Sir Arthur Conan Doyle, of Sherlock Holmes fame, was one possible candidate), but regardless who the culprit was, he was certainly the one who enjoyed the last laugh.

Doctor Groups Set New Ethics Codes to Curb Pharmaceuticals' Influence

USA Today

 

 

No more letting industry help pay for developing medical guidelines. Restrictions on consulting deals. And no more pens with drug company names or other swag at conferences.

These are part of a new ethics code that dozens of leading medical groups announced Wednesday, aimed at limiting the influence that drug and device makers have over patient care.

It's the most sweeping move ever taken by the Council of Medical Specialty Societies to curb conflict of interest — a growing concern as private industry bankrolls a greater share of medical research.

The council includes 32 medical societies with 650,000 members, from neurologists and obstetricians to family doctors and pediatricians. They include the American College of Physicians, the American College of Cardiology and the American Society of Clinical Oncology, the largest group of cancer specialists in the world.

"We take very seriously the trust that is placed in us by physicians and patients to be authoritative, independent voices in cancer care," ASCO's chief, Dr. Allen Lichter, said in a statement. He led the panel that developed the code.

One of its most controversial rules: requiring top leaders of any medical society and top editors of its journals to have no consulting deals or financial ties to industry.

"When a physician stands up to represent medicine and his or her specialty, there shouldn't be any confusion as to who they're speaking for," said Dr. Norman Kahn, the council's chief executive and a former rural medicine doctor from California.

The code requires groups to:

•Publicly post any industry support the group receives, such as money for continuing education sessions.

•Decline industry funding for developing medical practice guidelines, such as who should get a drug, a test or treatment. Require that most members of a guidelines panel be free of financial ties to industry.

•Disclose any financial ties that leaders and board members have with companies.

•Ban company or product names and logos from pens, bags and other giveaways at conferences.

Fourteen groups in the council, including ASCO and the College of Physicians, have already adopted the code. Most of the rest plan to by the end of the year.

Last year, leading medical journals agreed to use a uniform conflict-of-interest disclosure form for researchers publishing in their journals. The new ethics code the council is adopting should make financial ties more transparent to patients and breed professionalism and trust in doctors, Kahn said.