How blockchain technology will reshape health care

Blockchain advocates say a breakthrough “killer app” is imminent that will change the business of healthcare as we know it. In the meantime, however, there are at least five practical uses for the technology that permits the distribution of digital information, but not the copying of that information.

These include:

• “Smart” contracts. Contracts automatically go into effect when certain previously agreed upon conditions are met.
• Supply chain processes. The new technology could make supply chains more efficient and transparent, improving the warehousing and delivery of medical goods and supplies.
• Physician credentialing. A company called ProCredEx recently launched Professional Credentials Exchange to do this with a private Medicare claims processor, a private provider of Medicaid managed care and Medicare Advantage plans, and the Michigan-based Spectrum Health System.
• Peer-to-peer data exchange. A system with features that can include preventing people from getting multiple opioid prescriptions and verifying clinical trial data. The hope is that this function can also be used to shrink processing time for prior-authorization requests down to less than five minutes.
• Proof of work. In medical liability cases where attorneys may claim that physician defendants have altered their records, clinical notes entered in blockchain time-stamped blocks create a tamper-proof ledger of what a physician did and when.

The full article from the American Medical Association can be found at this link.  

The simple idea that could help end America’s opioid epidemic

I spent a lot of 2018 reporting on complex systems and policies that could help end the opioid epidemic, which is now the US’s deadliest drug overdose crisis ever.

But behind all the reporting that I did was a simple idea: America needs to see addiction as a medical condition, and approach addiction treatment like any other form of health care.

The full Vox article can be viewed at this link.  

Diagnosing rare diseases can take 30 years – but world’s largest medical database could speed it up

Currently, there is no global database that collects all the information doctors require when diagnosing a patient with a rare – and often unknown – disease.

Mendelian says it is building the world’s largest repository of medical information to address this issue.

The full Compelo article can be found at this link.  

Diagnostic diversity – an indicator of institutional and regional healthcare quality

Our aim was to estimate the diagnostic performance of institutions and healthcare regions from a nationwide hospitalisation database.

The Shannon diversity index was used as an indicator of diagnostic performance based on the International Classification of Disease, 10th revision, German Modification (ICD-10-GM codes). The dataset included a total of 9,325,326 hospitalisation cases from 2009 to 2015 and was provided by the Swiss Federal Office for Statistics. A total of 16,435 diagnostic items from the ICD-10-GM codes were taken as the basis for the calculation of the diagnostic diversity index (DDI). Numerical simulations were performed to evaluate the effect of misdiagnoses in the DDI. We arbitrarily defined the minimum clinically important difference (MCID) as 10% misdiagnoses. The R statistical software was used for all analyses.

Diagnostic performance of institutions and healthcare regions as measured by the DDI were strongly associated with caseload and number of inhabitants, respectively. A caseload of >7217 hospitalisations per year for institutions and a population size >363,522 for healthcare regions were indicators of an acceptable diagnostic performance. Among hospitals, there was notable heterogeneity of diagnostic diversity, which was strongly associated with caseload. Application of misdiagnosis-thresholds within each ICD-10-GM category allowed classification of hospitals in four distinct groups: high-volume hospitals with an all-over comprehensive diagnostic performance; high- to mid-volume hospitals with extensive to relevant basic diagnostic performance in most categories; low-volume specialised hospitals with a high diagnostic performance in a single category; and low-volume hospitals with inadequate diagnostic performance in all categories. The diagnostic diversity observed in the 26 Swiss healthcare regions showed relevant heterogeneity, an association with ICD-10-GM code utilisation, and was strongly associated with the size of the healthcare region. The limited diagnostic performance in small healthcare regions was partially, but not fully, compensated for by consumption of health services outside of their own healthcare region.

Calculation of the DDI from ICD-10 codes is easy and complements the information derived from other quality indicators as it sheds a light on the fitness of the institutionalised interplay between primary and specialised medical inpatient care.

The full article can be downloaded below.  

Mean Body Weight, Height, Waist Circumference, and Body Mass Index Among Adults: United States, 1999–2000 Through 2015–2016 

This report presents trends in mean weight, height, waist circumference, and body mass index (BMI) among adults in the United States from 1999–2000 through 2015–2016.

Data were obtained from physical examinations of a nationally representative sample of adults aged 20 and over in the National Health and Nutrition Examination Surveys during 1999–2016. The tables present means and standard errors of the mean for weight (n = 45,047), height (n = 46,481), waist circumference (n = 43,169), and BMI (n = 44,859) separately for men and women overall, by age group, and by race and Hispanic origin for each 2-year survey period. Changes in these body measures over time were evaluated using linear regression.

Since 1999, mean weight, waist circumference, and BMI increased for all age groups, for non-Hispanic white and Mexican-American men and women, and for non-Hispanic black women. Among non-Hispanic black men, weight, waist circumference, and BMI increased until 2005–2006 and then remained level. No change in height was seen over time except for a decrease in crude estimates among all women, a decrease among men and women aged 40–59, and an increase in both crude and age-adjusted estimates of mean height for men followed by a decrease after 2003–2004. No significant trends were seen in any of the four body measures for non-Hispanic Asian men and women (data available only for 2011–2016).

Mean weight, waist circumference, and BMI in adults have increased over the past 18 years. Conversely, mean height did not change in many demographic subgroups and, in some groups, was lower in 2015–2016 than in 1999–2000.

The full National Health Statistics Reports article can be downloaded below.  

Use of Electronic Health Data in Clinical Development

In clinical research and development, the scientific possibilities for analyzing large volumes of data are still not used to the extent that it is possible in other sectors (e.g. finance, consumer behavior). Health data are often widely distributed and locked in individual databases, standards are highly inconsistent, and data privacy protection complicates data consolidation and data use. This results in complex clinical protocols with often unrealistic selection criteria, and trials are still too often assigned to inappropriate sites. Furthermore, patient recruitment continues to be one of the major problems in the execution of clinical trials. The use of electronic health data (real world data) allows alignment of protocols to actual medical conditions, formulation of realistic inclusion and exclusion criteria and testing their effects on recruitment using real data. In addition, trials can be assigned to sites that have a proven number of patients in their databases, and patients can be identified at the site. Various providers are players in the field of “big data” and it is not always easy to assess which system is best suited to meet the demands of clinical development. Therefore, a requirements specification is presented in the following.

The full article can be downloaded below.  

IMPLANT FILES

Health authorities across the globe have failed to protect millions of patients from poorly tested implants, the first-ever global examination of the medical device industry reveals.

These articles from the International Consortium of Investigative Journalists (ICIJ) can be viewed at this link.  

Health insurance on demand? Some are betting on it

People with health insurance often pay for coverage they never use. A startup wants to shake that up.

It’s a radical idea: On-demand insurance that lets customers buy some of their coverage only if and when they need it, similar to how TV viewers might rent a new release from Amazon instead of paying every month for a pricey cable package they rarely use.

This approach from Bind Benefits is one of the latest wrinkles in a yearslong push by companies and insurers to control costs and make patients smarter health care shoppers. And it’s drawing attention from the nation’s largest health insurer, UnitedHealthcare, and some sizeable employers.

The full Associated Press article can be viewed at this link.  

5 Ways Artificial Intelligence May Affect Health Care in the Near Future and What That Means for You

Technology is changing fast, and the world is changing with it. Concepts that were mere science fiction only a couple of decades ago -- like artificial intelligence (AI) -- are quickly becoming commonplace. Computers have become powerful enough to handle complex AI computations; machine learning algorithms are more accurate and faster than ever; and the cloud and the internet of things have made it possible for even small devices to access artificial intelligence's enormous capabilities.

That's why responsible use of AI solutions in health care could improve, and even save people's lives. On the other hand, health care is an area where recklessness can occur; that's why new developments are regulated and implemented slowly and cautiously.

Here are five ways that AI and machine learning will likely be affecting your health care in the very near future:

• Digital Consultations
• Radiology and Images
• Personalized Medicine: Faster, More Accurate Diagnoses
• Robot Surgeons
• Cybersecurity

The full Entrepreneur article can be viewed at this link.  

Cost of Care Conversations: Practice Briefs

As part of the Cost Conversation projects, Avalere worked closely with the Robert Wood Johnson Foundation project grantees to synthesize the key themes and findings across their exploratory studies and create 7 Practice Briefs. These briefs are intended to act as actionable resources to clinicians, staff, and practice administrators interested in increasing the value and frequency of cost-of-care conversations in the clinical setting. The briefs cover the 7 key topics below.

• Why Do Cost-of-Care Conversations Matter?
• What Your Patients Aren’t Telling You: How To Partner with Patients To Help Manage the Hidden Costs of Healthcare
• How To Welcome Cost-of-Care Conversations in Your Practice
• Structuring the Conversation: How To Talk To Your Patients About the Costs of Their Care
• How To Integrate Cost-of-Care Conversations into Workflow
• Considerations for Facilitating Cost-of-Care Conversations with Vulnerable Patients
• Addressing the Most Common Barriers to Implementing Cost-of-Care Conversations

These briefs on the America's Essential Hospitals site can be viewed at this link.