Cuthbertson v. Rasouli
Delaware MOLST
This morning, I made a presentation on advance directives and MOLST with these slides at the Delaware VA Medical Center. I hope that I raised awareness and introduced providers to the rationale, benefits, and operation of MOLST.
But it was humbling to discover the wide range of detailed questions for which we do not have prepared answers. Education, training, and policy-writing will be a long process. As the excellent AARP Public Policy Institute report advises: "Advocates should expect a multiyear implementation process."
Jesus Cornelio v. Banner Health
Earlier this week, I posted some video news reports on the Phoenix, Arizona case of Jesus Cornelio. As the case is not in litigation and neither the family nor the hospital has released detailed facts, it is difficult to make informed comments. It is unclear if this is a medical futility case, a medical deportation case, or what. According the ABC News and other independent news sources, at least the following facts appear to be true:
- The patient's brain was without oxygen for more than 10 minutes, which doctors say caused severe damage to his brain.
- The patient is not a U.S. citizen.
- The patient does not have health insurance.
- The patient does not qualify for Arizona Medicaid.
- The patient's medical expenses to date total about $120,000.
Arizona Health Information Network Chooses OptumInsight (United HealthCare Company) for Their HIE Exchange–Subsidiary Watch
It seems everywhere you turn today with Health IT investments there’s a chunk of changed headed toward United. The company was an acquisition made by the large behemoth in August of 2010. If they can’t buy the exchange I guess the next best thing here is to get your subsidiary in action. We heard that a few days ago with Blue Cross buying an exchange. In addition to the medical records that Ingenix (OptumInsight) has owned and sold for years, the acquisition of Axolotl gives them a second EHR to sell along with HIE capabilities. 
Ingenix Acquires Health Information Exchange Services/EHR Provider Axolotl-United Health Group Behemoth Continues to Grow–Subsidiary Watch
Axolotl (A Subsidiary of Ingenix) Creates Reporting and Analytics Solution for Health Information Exchanges–Algorithms for HIE–Business Intelligence -Subsidiary Watch
Optum Insight was formerly known as Ingenix and last year completed the settlement with the AMA for the 15 year lawsuit whereby their analytics underpaid doctors and patients for out of network services and other insurers are still settling various lawsuits as they all licensed the data base which is now gone and been replaced with the actions of Andrew Cuomo. BD
AMA Has Online Assistance and Forms For Filing Claims For UnitedHealthCare/Ingenix
The Health Information Network of Arizona (HINAz) and OptumInsight are teaming up to create a state-wide health information exchange (HIE).
HINAz will implement a HIE platform from OptumInsight, formerly Axolotl Corp., to allow the sharing and exchange of clinical data from all available sources across the state, officials from the two organizations said.
HINAz is an Arizona not-for-profit organization that grew out of the work of Southern Arizona Health Information Exchange and Arizona Medical Information Exchange. The two entities joined together to build a more comprehensive HIE for Arizona.
http://gcn.com/articles/2011/09/28/arizona-health-information-exchange.aspx
Bad Science and Bad Analytics That Misleads–TED Video Takes on Advertising on Steroids and Danger of Mis-Matched Analytics And Distortion of Clinical Trials (Video)
This is great and goes along with some of my recent posts with analytics on steroids for marketing only and also makes a point about what gets put in journals today too. Dr. Ben Goldacre, talks fast so listen up carefully, but he gets it. Fish Oil pills is one he takes on as well as coffee and cancer, yes it does and no it doesn’t. On the pills they calculate and project how the children would have done without the pills..bunk. 
I am so glad this is finally getting attention so consumers may start asking questions if posed with something you know is weird and yet it persists in the papers every day, day in and day out! You have to laugh at some of this for goodness sakes. Now if you want to go the next step and see how you can be deceived, read the post below and mathematical deception is the next step when steroid marketing kicks in. Even the real scientists hate this stuff and it adds confusing for advocacy groups to untangle. 
“Numbers Don’t Lie, But People Do”–Radio Interview from Charles Siefe–Journalists Take Note, He Addresses How Marketing And Bogus Statistics Are Sources of Problems That Mislead the Public & Government
How all this really gets a stronghold in society today is the use of math which is what it considered to be the most accurate way to prove truth, well it was until modern day algorithms kicked in, where writing the unreadable starts to be an issue. So what is WellPoint going to load up in Watson…that needs scrutiny to work. Again worth a mention I had to laugh when one of our lawmakers asked Google about their “secret sauce”..come on folks digital literate people call those algorithms:)
We know our beliefs do this, look at what politicians do with this and he talks about pharma distorting reports as well with stacking up the bad stuff so the good stuff looks better or the negative information goes missing in action. He says he’s a nerdy doctor and does a lot of reading. One drug he uses an example that 76% of the data was withheld from the doctors. Anti-depressant data drug information has been withheld.
Do you wonder why doctors get upset when they are graded on the drugs they prescribe? It’s gets hard when you have Quants and health insurance companies breathing down their backs all the time doesn’t it?
One more comment, add on this insanity with a credit agency trying to tell doctors that they have the “secret sauce” to determine if patients will take their meds and they blatantly sell this to the pharma companies doing clinical trials and insurance companies. 
FICO Analytics Press Release Marketing Credit Scoring Algorithms to Predict Medication Adherence–Update (Opinion)
Have you been mathematically deceived of late? It’s a good question to think about and that’s why I write such articles like this, to open eyes and hopefully get people to think before the algorithms for profits completely take over, don’t believe all the stats you see out there today and your social networks are running a gambit trying to also convince you as such with flawed profiles, etc. they collect with data scraping and it just aint so all the time. Algorithms are only as good at the data it sits on top of. It’s interesting to crunch numbers and get stats and nothing wrong with that but when flawed data as such is brought down to the individual level to risk asses and judge, the numbers are not right. Be aware as this is part of the insane world of algorithms for profit distorting the good science we have out there. BD
http://www.ted.com/talks/ben_goldacre_battling_bad_science.html
SEC Sues Quant–Undisclosed Error in Trading Algorithm- Miscalculating “Risk”-Healthcare Software Evaluates This Factor Too
How often do we hear “risk” assessment in healthcare? If you are in the payable and IT side of it, all the time. It comes back again to the algorithms. In Health IT this is why we have the certification processes for medical records, but when it comes to the payment side and risk management done by insurance companies, there’s not checking and balancing as we are at the mercy of their algorithms for risk assessment. With steroid marketing today in healthcare, we have some situations too where such algorithms are overstated and oversold, but nobody does anything sadly. It’s just the same old factor of fleecing those who see numbers and believe that all numbers and reports they see are accurate, not so. Here’s a good post to read and listen to as the professor describes how math is and can be used to deceive. 
“Numbers Don’t Lie, But People Do”–Radio Interview from Charles Siefe–Journalists Take Note, He Addresses How Marketing And Bogus Statistics Are Sources of Problems That Mislead the Public & Government
When the dollar amounts are high to find code that can make big bucks, code gets written and we can track that back to AIG, it was all over the news. It’s kind of scary but even our government folks at times speak at meeting and conventions and relay the same thing to attendees, write code and get rich, which is kind of weird for government executives in my opinion but I guess they too are maybe mixed up in all the steroid marketing that is going on today too. We also get the other side to where they want developers to work for almost nothing too, so again are you confused with government sales pitches today like me?
Why Is Almost Everyone In Healthcare Marketing Their “Ass” Off
What are they doing? In the contest below when the dollars rewards are so high I can’t help but think if someone is in a spot to win $3 million they want their algorithms to apply and will go to great lengths to make a case, even if they are not fulfilling 100% accuracy and relativity, they want the bucks.
So What’s Going on Over at the Heritage Health Prize Competition to Predict Who Ends Up Being Re-Admitted to the Hospital–A Lot of Mathematical Algorithms For One…
Granted there are more accurate assessments than not, but when it comes to making a buck, coders will skew and that’s some of the problem areas today out there as the reach extends to correlate data that in essence is really not related. This guy on Wall Street knew back in 2009 that strange results were kicking out and it did not assess risk for the clients, they lost money. Same stuff can go wild in healthcare calculations too as insurers are all profit oriented. 
Another great article came out about marketing algorithms and it’s worth a read as well as the article states the algorithms are only as good as the data it sits on top of and he speaks of transparency, something we are not seeing enough of with some of the code written today. He states that most of the marketing algorithms are skewed and flawed today for that exact reason, flawed data. People want real value and of course this is forth standing in healthcare too and not “magic” formulas that disappoint and kick out flawed queries. We have a credit agency selling that pretty much here with over extending their claims as taking meds and credit ratings may be interesting numbers to crunch but they are not grounds to determine if someone is going to take their prescriptions.
FICO Analytics Press Release Marketing Credit Scoring Algorithms to Predict Medication Adherence–Update (Opinion)
Even the Dow Jones has done this to a degree with what they call transparency but it’s not really. We all know how data input over the years with medical claims is riddled with flaws, people make errors with data input or doctors had bad billers, and there’s a number of reasons for this but it is what it is. The only thing I can get out of this wanting to put Medicare claim data out there is the desire to pump up a company to make a ton of money doing a ton of work for a lot of expense to try to correct all the data before showing it to the public. Shoot consumers don’t have enough time right now as it is and this is a waste and will not accomplish much at all; however law enforcement should and does have access to detect fraud and that’s where the information should rest and be available.
Dow Jones Files Lawsuit Against HHS To Overturn Ruling To Keep Medicare Physician Compensation Confidential In the False Name of Transparency-Distraction is More Like It
Just like the SEC found this Quant having flawed algorithms, DOJ and others are the ones to pursue this with analytics that they now have available with medical fraud. It’s people who have never experienced medical billing and have seen the other side that get these hot shot ideas and kind of mis use transparency as their grounds for frivolous lawsuits and desires as such. The big for profit folks out there with the rating sites don’t get it right either as all the hospital and MD rating sites have flawed data, more on that below and it’s been going on for years. It’s find to maintain a listing and so forth, but again we have marketing over extended and over sold to the consumers.
HealthGrades And Other MD Rating and Referral Sites List “Dead Doctors” on Their MD Information Pages And Even Include the Insurance Plans the “Dead Doctors” Honor
We are surrounded by it and here’s on case below to where WellPoint put some algos online so you could figure out how to fix yourself. It is any wonder consumers are not biting at the bit for all of this?
WellPoint Puts More Algorithms Online So You Can Go Fix Yourself and Understand What a Grandfather Is
Below is a good example on making sure medical record software calculates accurately but again the payable side runs hog wild with what ever a new business model cooks up.
HHS Issues Final Rule for Health Insurers To Justify Increases–Need to Certify Insurance Algorithms For Calculation Just Like We Certify Electronic Record Algorithms
Sometimes those models get caught too with the consulting algorithms folks that insurers contract with too. There’s more below at the links for some examples of business model algorithms that patients and doctors live with every day but nobody asks very many questions.
Med Solutions and Blue Cross Caught On the Stress Test Denial Algorithm (video)
WellPoint Creates Reimbursement Algorithm to Cut Down Hospital Annual Payment Increases and Reward Only Those Who “Score” Well–Analytics on Steroids
SAS® Business Analytics – Algorithms Used by Blue Cross Blue Shield For Business Intelligence, Integration, and Analytics
So again, just like this Quant on Wall Street knew of his flawed algorithms, how many are out there floating around in healthcare? It’s a good question to ask when few are actually ever held accountable and the marketing on steroids continues to flourish. I like data and the intelligence it brings for better care, but there’s always that other side that seems to have little or no accountability and this is scary in healthcare as we are dealing with people’s lives. Worth a mention too is the MIB that does data mining and collects claim information from insurers along with other data. There are stories on the web where consumers spend years trying to fix erroneous data that is used to “risk” assess them that they had in involvement with the input, and MIB has turned into marketing too in the last few years with their analytic software, so consumers just can’t win sometimes with trying to correct he flawed data in their files. The link below has a video of a woman and her battle. You know I kind of wonder with all the analytics out there and being use to risk assess patients, why are they not doing any better on fraud prevention?
The MIB – Health Insurance Bureau Business Intelligence Mining May Go Beyond Just Healthcare Information
When you stop and think of how complicated code is today, why do huge companies like Microsoft put out betas? They do it to find flaws and issues they missed and that’s just the way it is with complexities today and I’m glad they do it and wish more would think in that direction as it’s all of us working together for accuracy and truth in numbers. It still comes down to humans to use data wisely to make the best informed decisions possible and when the numbers get skewed and individuals believe that all the math presented to them is 100% accurate we have problems and people can get denied care and services in healthcare. A while back all you have to do is look at the Arizona Governor who didn’t know how to use such formulas and could not find money in the budget to cover transplants, and it was there, others found it, but digital illiterate politicians are like walking time bombs out there for the rest of us as their mis informed decisions can impact all of us. BD
Barr M. Rosenberg agreed to settle the charges and will pay the SEC $2.5 million for purposely hiding major errors in the computer code of Axa Rosenberg LLC's quantitative investment model.
The SEC's lawsuit says that Rosenberg detected the errors in 2009, but kept them quiet, and instructed other members at his company to do the same.
Investors in the fund lost $217 million because of the error in his algo.
The material error in the model's computer code disabled one of its key components for managing risk and affected the model's ability to perform as expected. Clients raised concerns about this underperformance, and Rosenberg knew about and discussed these concerns with others at AXA Rosenberg...
The Model consisted of three components: the Alpha Model, Risk Model, and Optimizer. The Alpha Model evaluates public companies based on their earnings and valuation. The Risk Model identifies risk on two primary bases – specific stock risk and common factor risks. Common factor risks include, among other things: (i) specific industry risks, which are risks associated with certain industries (such as oil, automobiles, or airlines); (ii) country risks, which are risks associated with particular countries; and (iii) stock fundamental risks, which capture price to earnings ratios and similar metrics. The Optimizer takes the output from the Alpha and Risk Models, balances them against each other, and recommends an optimal portfolio for the client based on a benchmark chosen by the client, such as the S&P 500.
Then in 2007, Rosenberg commissioned a new model of the risk model. Computer programmers finished designing the program in 2009, and noticed that it was spitting out weird ("unexpected") results.
Some Risk Model components sent information to the Optimizer in decimals while other components reported information in percentages; therefore the Optimizer had to convert the decimal information to
percentages in order to effectively consider all the information on an equal footing. Because proper scaling did not occur, certain decimal information was not converted to percentages and the Optimizer did not give the intended weight to common factor risks.
http://www.businessinsider.com/quant-charged-with-hiding-flaws-in-his-algo-from-investors-2011-9
Oracle Announces Insurance Exchange Platform - Purchasing Health Insurance Platform–Available for State Governments
Not too long ago Microsoft announced their platform availability for state governments as well. The Oracle suite will connect with Siebel for CRM 
capabilities. With both big company offerings this leaves a couple options besides have to buddy with an insurance company offering. Actually this is better I think with actual technology companies as it will defer any conflicts of interest and keep things cleaner as subsidiaries with insurers today have all types of business models out there and with technology provided by companies who don’t sell insurance I think it’s a cleaner operation for sure.
In other Oracle news, they have opened a a Translational Research Center Platform to support transitioning to personalized medicine. The full press release can be read here. Oracle offers platform as a service for the enterprise in private clouds.
T”o ensure that the new platform meets the needs of health sciences organizations, Oracle worked closely with numerous development partners, including Merck, Roche, Erasmus University Medical Center, Inova Health System, Moffitt Cancer Center, and Oregon Health &Science University (OHSU) Knight Cancer Institute. The solution has been benchmarked on millions of patient records demonstrating scalability for large-scale applications.”
“Oracle Health Sciences Translational Research Center enables pharmaceutical and biotech companies, contract research organizations,as well as academic research organizations to normalize, aggregate andanalyze data from numerous internal and external sources to identifynew predictive biomarkers, best practices for diagnosis and treatment and more effective and safe therapies for individuals.”
In addition Larry Ellison received some nice recognition this week over at the friends of the NIH. If you go to the link below, see his classic explanation of “this is a box” video. BD
Larry Ellison Announced As Distinguished Medical Informatics Awardee for His Contributions to Health IT and the Ellison Foundation From the Friends of the National Library of Medicine (NIH)
Oracle has announced a health insurance exchange (HIX) platform that aligns several of its existing applications to allow states to create a marketplace for purchasing health insurance.
Under the 2010 Patient Protection and Affordable Care Act (PPACA), states must establish health insurance exchanges by 2014.
"The impending rollout of health insurance exchanges will require state governments to establish state-regulated and standardized health care plans, from which individuals may purchase health insurance that is eligible for federal subsidies," Mark Johnson, senior vice president for Oracle's public sector, said in a statement.
Oracle designed the platform to support multiple programs to allow states to deploy HIXs quickly and cost-efficiently, the company reports. Oracle will phase in additional applications as legislation changes dictate.
"To help address the challenges state governments will face related to these requirements, Oracle offers a robust solution which consists of proven technologies that are architected to work together and include the necessary capabilities needed to deliver a successful program," Johnson said.
The foundation of the HIX platform includes Fusion Middleware, particularly the Oracle SOA Suite. Fusion is a leading application infrastructure platform.
Siebel customer relationship applications provide states with the infrastructure to operate multichannel customer service and include analytics tools for evaluating calls. Siebel also handles case management for the exchange, Curry said.
Technorati Tags: Oracle,government,HIX,insurance exchanges,healthcare,Health IT,SOA Suite,Siebel,analytics,personalized medicine
Blue Cross and AllScripts Going to Pick Up the Tab for Doctors Electronic Medical Records In North Carolina
This is interesting as Blue Cross doesn’t have a medical record program and I have said in the past the next move will be insurers buying up the EHR folks. NCPath is 
the name of the program and 85% of the tab will be picked up, except the free clinics will not have to pay at all. So it sounds like with the certified records system in place they will all be able to attest for stimulus money too. Right on websites it seems like we used to see more about better patient outcomes but like most on healthcare anymore, well you can see the image below to where profitability is the focus.
Some carriers, such as United have sold their medical records programs for a number of years under the Optima name, formerly known as Ingenix so it makes one wonder how long and what companies the insurers will be buying next. We have already seen a big rush in this area with both United and Aetna in the last couple years with load of acquisitions. In imaging company purchased by a United subsidiary put the VA right into business with United, Picis was the company purchased. Everywhere you turn today with Health IT, it’s not hard to find some dollars going right to United’s pockets today.
VA Awards Contract to Picis, Subsidiary of Ingenix for Anesthesia Record Keeping Software
Presently Blue Cross in California bought a huge Medicare HMO called CareMore and United is doing the same so when you look at the race to consume and build monopolies, the health insurance business sure looks that way as the daily chains of subsidiaries gets longer and more complex all the time, so I just wonder if Blue Cross going to buy an EHR company soon? If you follow 
the partnerships they sometimes offer some clues in that area, not all the time, but it certainly is becoming much more frequent as data systems get connected, as it’s all about the data. Let’s see by the time this gets rolling I might guess Blue Cross might be out there shopping around for an HIE company or two so that could also be tied into the entire configuration too. Wellpoint just bought a private insurance company exchange a couple weeks ago from their own Blue Cross VC company, Sandbox.
WellPoint & Partners Buy Bloom Private Health Insurance Exchange From Their Own Venture Capital Company (Sandbox) –Subsidiary Watch
As a side note I have not been able to figure out why the government REC center in Orange County California never got off the ground and the fact that the state Medicaid contractor, Cal-Optima got the contract might have something to do with it as they are buried but I still do wonder where the $7 million in grants went? If insurers are coming in to provide medical records, and the REC offices were only supposed to be temporary, maybe that’s the deal coming in the OC and why the REC office never got off the ground, but still who got the $7 million? BD
Chapel Hill, N.C. — North Carolina's largest health insurer is part of a $23 million effort to get hundreds of physicians statewide to produce patient records electronically instead of using paper files.
Blue Cross Blue Shield of North Carolina and Chicago-based Allscripts, which creates and markets electronic health records, announced a partnership Wednesday to offer software, training and support to more than 750 physicians, including those who work in 39 free clinics across the state.
"It's meaningful when a family receives vital, faster, better care because vital records are available when doctors need them most wherever a patient might be," Blue Cross President and Chief Executive Brad Wilson said.
Blue Cross is investing $15 million and Allscripts is kicking in $8 million for the initiative.
Under the federal health care reform law, the government is offering subsidies of up to $44,000 over several years to physician practices that convert to electronic medical records.
http://www.wral.com/lifestyles/healthteam/story/10194566/
Technorati Tags: Blue Cross,medical records,healthcare,North Carolina,Allscripts,free clinics,HealthIT,attest,stimulus
FDA Approval Given for Face Mask Designed for Children and Awards Pediatric R and D Device Grants
The mask is to be used in hospitals to reduce the spread of airborne bacteria and 
viruses and is designed for ages 5 to 12. In other FDA pediatric news the agency has given out grants for Orphan Product Development. We are starting to hear a lot about orphan diseases and the need for more research and many Children’s hospitals are a deep dive into it with R and D efforts. The full story can be read here. BD
- James Geiger, MD and Andre Muelenaer, MD, at the University of Michigan Pediatric Device Consortium (M-PED) & Pediatric Medical Device Institute (PMDI) Pediatric Medical Device Consortium, $1,100,000/per year for two years.
- Michael Harrison, MD, and the University of California, San Francisco Pediatric Device Consortium, $500,000/per year for two years.
- Barbara Boyan, PhD, and the Atlanta Pediatric Device Consortium, $900,000/ per year for two years.
WASHINGTON (Dow Jones)--The U.S. Food and Drug Administration cleared a face mask designed for children that is made by Kimberly-Clark Corp. (KMB), the agency announced Wednesday.
The FDA said the mask is the first pediatric single-use mask meant for use in hospitals and health care facilities to help reduce the spread of airborne respiratory tract bacteria and viruses.
The mask is designed to fit children ages 5 years to 12 years, and is designed with material to accommodate children, who do not breathe as forcefully as adults
MelaFind Device Finally Given FDA Approval For Detecting Melanoma –It Took 7 Years
This has been a long haul for Melafind as back in November of 2010 the FDA panel 
approved the device, and here we are in September of 2011 with now jut getting approval. Below is a video from the Wall Street Journal that depicts some of the history on Melafind.
New Melanoma Identification Device Gets FDA Panel Approval–Questions About How Human Intervention Works with Melafind Algorithm Arise From Discussion 
In August 27, 2009 I reported that the device company was waiting approval so here with even my blog you have a bit of history.
MelaFind Medical Device for Detecting Melanoma Skin Cancer Awaiting FDA Decision
We all know early detection with melanoma is key. The FDA letter of approval from the FDA indicates that labeling and use is still being worked on before the product is out on the market, but it’s coming. The device recently received the European CE mark of approval as well. BD
IRVINGTON, NY, Sep 26, 2011 (MARKETWIRE via COMTEX) -- MELA Sciences MELA -0.81% today announced that the U.S. Food and Drug Administration (FDA) has issued an Approvable Letter for the MelaFind(R) Pre-Market Approval (PMA) application. The company intends to work with the agency to finalize the physician and patient labeling, package insert, user's guide, training program and clinical
protocol for a post-approval study in order to obtain final approval.
"The FDA's Approvable Letter for MelaFind represents a monumental milestone for MELA Sciences and the millions of Americans who are at risk of developing melanoma, the deadliest form of skin cancer," said Joseph V. Gulfo, MD, President and CEO, MELA Sciences. "The company has worked tirelessly to develop an objective tool to help dermatologists detect melanoma at its earliest, most curable stages. Although melanoma is virtually 100% curable if detected at its earliest stage, one American dies from the disease every hour. We firmly believe that MelaFind has the potential to lower those tragic numbers. We are extremely pleased with the FDA's decision and will work diligently to answer all open questions and finalize the post-market study protocol in the coming weeks."
The Approvable Letter from the FDA comes on the heels of the CE Mark for MelaFind issued earlier this month. CE Mark approval allows MelaFind to be sold across the 27 nations of the European Union.
Technorati Tags: FDA,CE Mark,Mela Sciences,MelaFind,healthcare,PMA,skin cancer,diagnosis,medical devices
Baby Joseph Maraachli Dies
The CBC reports: "Joseph Maraachli, the terminally ill baby at the centre of a legal and ethical battle, has died at his Windsor, Ont., home. Baby Joseph, as he affectionately became known, suffered from a degenerative brain disease. He was 20 months old when he died late Tuesday afternoon."
As a father, I am pleased that the parents were able to get so much time with their son since the Ontario United States
Larry Ellison Announced As Distinguished Medical Informatics Awardee for His Contributions to Health IT and the Ellison Foundation From the Friends of the National Library of Medicine (NIH)
There are some other known recipients but this is Larry’s day in my book:)
Dr. Oz is also in here for an award as well as other research and development individuals at the Howard Hughes Institute. Dr. Oz gets enough publicity and most of the time is on key. Larry Ellison is always in the press with nobody 
understanding him at times, but he’s brilliant and started out writing code. For all his life he has had to live with being upstaged less than 24 hours of having the largest IPO by Microsoft so it was short ordeal. Oracle does quite a bit in healthcare and has grown with several acquisitions. When Windows 95 was out it connected to Oracle data bases via ODBC, so Oracle and Microsoft worked together going way back. He’s also part of the Gates Foundation Giving Pledge, one of the first members.
The Giving Pledge Call for Philanthropy Continues to Grow–40 Billionaires Committed
When President Obama goes to the Silicon Valley, Larry’s in the group for dinner.
President Obama Meeting with Tech Industry Leaders–CEOs and Some of the Smartest CEOs (Algo Men) Who Write Code
He’s always known for being a little different but the folks with brains and code know how are, but it makes them special people by all means. One of my favorite Larry Ellison videos, “this is box”. Congrats to Larry for all his contributions. BD
Press Release:
Bethesda, MD – Today, Friends of the National Library of Medicine (FNLM) announced its 2011 Award Recipients, which will be presented at an Awards Gala and celebration of the National Library of Medicine’s 175th Anniversary at the Library of Congress on November 3, 2011.
Mehmet Oz, MD, and Michael Roizen, MD, are recipients of the Paul G. Rogers Award for their combined and individual efforts to deliver health information to the public, through their book, YOU: The Owner’s Manual, The Dr. Oz Show, and the Real Age program. The award honors individuals who have provided significant services to improve the public’s health, and is in honor of Representative Paul Rogers, the former chair of the House of Representatives’ Subcommittee on Health and the Environment, and longtime advocate for medical advancement and accessible healthcare in the United States.
Larry Ellison, founder and CEO of Oracle, is the recipient of Distinguished Medical Informatics Award for his contributions to healthcare through information technology and the Ellison Foundation. The Distinguished Medical Informatics Award is given to an individual who has made a significant contribution in technology, allowing healthcare professionals and individuals to use technology to communicate more effectively and efficiently. Mr. Ellison is the first recipient of the award.
Purrell Choppin, MD, is the recipient of the Medical Research Award for his extraordinary leadership of the Howard Hughes Medical Institute. The award is given to a medical researcher who has made significant contributions During his tenure, the annual budget grew from $76 million to more than $500 million, and significant contributions to AIDS, cancer, cystic fibrosis, diabetes, and heart disease research were made.
Ms. Ann Duesing is the recipient of the Michael E. DeBakey Library Services Outreach Award for her work to provide healthcare information to rural and underinsured communities. Ms. Duesing is the Outreach Librarian at the University of Virginia’s Claude Moore Health Sciences Library, and was the first outreach librarian in southwest Virginia.
The Friends of the National Library of Medicine is a non-profit organization that supports and promotes the National Library of Medicine (NLM), the world’s largest medical library and a vital part of the National Institute of Health. It was founded in 1986 to increase public awareness about NLM, as well as to support its many programs in research, education and public service.
For more information about the National Library of Medicine,
please visit www.nlm.nih.gov.
For more information about the Friends of the National Library of Medicine,
please visit www.fnlm.org.
Technorati Tags: NIH,Larry Ellison,Oracle,National Library of Medicine,awards,research and development,Health IT,NLM
Miami-Dade County Fires Deloitte Consulting–Couldn’t Get A Straight Answer, Those Algorithms and Complicated Legal Text Once Again Making It Tough For Mere Humans
This goes to an item the County needed clarification on and the Deloitte and their attorneys just couldn’t give them a straight answer, so they got fired. In reading this Deloitte asked the County if they had been properly following federal tax rules while making a 5 percent pre-tax deduction. Deloitte had to subcontract with a law firm and they declined to comment, don’t you just love this, that kettle is too hot for me to jump into. Sometimes its even damn hard to get a judge who’s up to date with all their investments as they don’t seem to pay enough attention sometimes and find themselves in a conflict of interest and wonder how did that happen until someone else who maybe discovered it explains, it’s transparency today. 
It’s all about providing employee health insurance benefits too, what else. It sounds like the two tried to reconcile and I would hate to the be sales rep for Deloitte right about now too. This is becoming more common place in the US too as the algorithmic worlds, largely built by insurance companies for healthcare are a bitch, let’s face it and nobody and I mean nobody likes it as our bodies “hurt” from being shoved into so many data bases and then being “sequelled” (SQL) to death and out of that we get some score that tells us our risk assessment. The only folks that like all of this are those who make a buck off it. Granted there’s a lot of good health IT services out there, but this one of them that is known to be deceitful and they get their algorithms wrong all the time too. When the public complains, insurers adjust the algorithm up to let a few more claims through with adjusting the parameters set and when the public attention dies down, they go adjust it back up again. It’s been that way for years.
Let’s take a look at a post I made back in August of 2009, we need a department of algorithms as we certify and go over medical records systems with a fine tooth comb but the insurers get to do what ever they want with their algorithms whenever they want and nobody audits. I read today even the SEC has no audit trails for transactions either. I don’t know who’s software Deloitte uses but many insurers own a lot of those folks too so who knows maybe software from an insurer subsidiary complicated matters here too when questioning the County to check their procedures?
3 Judges in Health-Care Lawsuits Caught Up In Potential Conflict of Interest-It’s Called Subsidiary Watch-Be Aware of Your Investments With Mergers and Acquisitions
It’s all about providing employee health insurance benefits too, what else. It sounds like the two tried to reconcile and I would hate to the be sales rep for Deloitte right about now too. This is becoming more common place in the US too as the algorithmic worlds, largely built by insurance companies for healthcare are a bitch, let’s face it and nobody and I mean nobody likes it as our bodies “hurt” from being shoved into so many data bases and then being “sequelled” (SQL) to death and out of that we get some score that tells us our risk assessment. The only folks that like all of this are those who make a buck off it. Granted there’s a lot of good health IT services out there, but this one of them that is known to be deceitful and they get their algorithms wrong all the time too. When the public complains, insurers adjust the algorithm up to let a few more claims through with adjusting the parameters set and when the public attention dies down, they go adjust it back up again. It’s been that way for years.
Let’s take a look at a post I made back in August of 2009, we need a department of algorithms as we certify and go over medical records systems with a fine tooth comb but the insurers get to do what ever they want with their algorithms whenever they want and nobody audits. I read today even the SEC has no audit trails for transactions either. I don’t know who’s software Deloitte uses but many insurers own a lot of those folks too so who knows maybe software from an insurer subsidiary complicated matters here too when questioning the County to check their procedures?
“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?
So this case to me from what I read here looks like both parties got fed up with the complicated algorithms and this is what we got and even the attorneys didn’t want to be in here. A lot of the time, companies who write analytical software never use it themselves, but I do give Microsoft credit here as they do “eat their own dog food”. All we hear of late is write code and get rich so somebody got rich here and they are long gone and we have 2 focuses here that just got sick and tired of the complications and algorithms some programmer wrote along the way. BDMiami-Dade County, frustrated over what it asserts is an inability to get a straight answer, fired Deloitte Consulting LLP as its employee-benefits consultant Monday, alleging breach of contract.http://www.miamiherald.com/2011/09/26/2426580/miami-dade-county-fires-deloitte.html
The spiraling dispute stems from Miami-Dade’s request — amid heated labor contract negotiations — for a legal opinion from Deloitte on whether the county can, under federal tax law, offer to deduct 10 percent of employees’ pay for health-care premiums.
The county needs clarification on the pretax health care deductions quickly, since it is pushing to have labor agreements with 10 unions by Nov. 1. The mayor has pledged to begin layoffs if agreements aren’t in place by that deadline in order to ensure the county stays within budget.
The county, which currently makes 5 percent pretax deductions from salaries for health-care coverage, wanted to offer unions the 10-percent pretax deduction as an alternative to pay cuts.
Technorati Tags: Health benefits,algorithms,Miami-Dade,healthcare,taxes,consulting,county,formulas,insurance,contracts
Massachusetts Governor and Israel Chief Scientist Form Massachusetts-Israel Innovation Partnership (MIP)–Applications Being Taken For Funding Biotech, Pharma, Medical Devices And More In Life Sciences
Full information on the project is at the link at the bottom of the post. This is an interesting relationship as Israel is known for their technology both in high tech and in life sciences. When you think of that Intel processor in your computer, think Israel because that’s where a lot of the silicon technology for chips is developed, big R and D.
“The projects must aim to develop a new or significantly improved product or 
process for commercialization in global markets but also be beneficial to Massachusetts in terms of additional jobs and income.”
Israel is also going through some stressful times and some of it is kind of like what we have here with doctors and the shrinking middle class. Officials as you can read below blame themselves for bringing in private insurance and didn’t realize years back what would happen and how it would evolve.
Officials In Israel Blame Themselves for Allowing Private Care and the Selling Supplementary Insurance For Degrading Their Public Healthcare System
A few months ago I attended the Israel Convention here in Los Angeles and what a learning experience I had, it was all good and unlike any conference I had attended before. What I found was really wild was that when I mentioned I used to write code the conversations immediately accelerated at least 10 levels, in other words let’s talk intelligent geek if you will. I spent time talking with many companies and a doctor from Israel with her device she created for neck disorders. 
Physical Virtue Solution To Assess and Train Neck Disorders, Microsoft Kinect And More As Shown This Week at the Israel Conference
Israel already has a big Microsoft R and D presence there and has for years and that’s where Kinect came from and I chatted with Ilan Spillinger from Microsoft and was able to hear the whole story on how it all came about. It was funny to hear many talk about their “tough” work ethics too and take a few shots at themselves, again in good humor. Scott Eisenstein from PowerMat was also very interesting and you see their products now in Best Buy and they were in the news with a recent new partnership too of late with Duracell, so the partnering makes sense to bring jobs and better economic conditions to both countries with the MIP association. You can read further as there are a few other organizations involved in the project to include MIT.
Massachusetts Governor Deval Patrick, Israel’s Chief Scientist Avi Hasson, the U.S. Israel Science and Technology Foundation (USISTF), and three Massachusetts economic development agencies are now accepting applications for projects under the “Massachusetts-Israel Innovation Partnership” (MIIP).
Today there are nearly 100 companies with Israeli founders or Israeli-licensed technologies in Massachusetts. Local firms exported over $180 million worth of goods to Israel in 2009 where 377 hospitals and 37,000 practicing physicians are located.
The partnership is a formal collaboration between Israel and the commonwealth to encourage and support innovation and entrepreneurship between Massachusetts and Israel’s life sciences, clean energy, and technology sectors. Massachusetts is the first U.S. state to establish such a program with the State of Israel.
The three Massachusetts economic development agencies participating, the Massachusetts Life Sciences Center, the Massachusetts Technology Collaborative, and the Massachusetts Clean Energy Center are committing nearly $1 million in collective funding for companies in Massachusetts engaged in cooperative industrial research and development projects with an identified Israeli partner company. The Israeli Office of the Chief Scientist will provide up to $1 million in matching dollars for corresponding Israeli partner companies.
Applications are due February 6, 2012. For more information, go to www.masslifesciences.com or email Angus McQuilken at amcquilken@masslifesciences.com or Bridget Scrimenti at scrimenti@masstech.org.
http://telemedicinenews.blogspot.com/2011/09/massachusetts-israel-partnership.html
Technorati Tags: Israel,Massachusetts,collaboration,funding,biotech,Life Sciences,Technology,partners,MIP,economic development
Cancer - Do Not Overdiagnose, Overtreat, Overpromise
"Dying cancer patients should not be given 'futile' drugs" - That is the title of Martin Beckford's article in the Telegraph reporting on this Lancet Oncology Commission report, “Delivering Affordable Cancer Care in High-Income Countries.”
Similar to an ASCO report from this spring, the LOC finds that “in developed countries, cancer treatment is becoming a culture of excess. We overdiagnose, overtreat, and overpromise." Among other factors driving “overutilization,” the Report notes:
- It is “quicker and easier” to order treatment or a scan than to tell a patient it may not be necessary or worthwhile
- The fear of being sued if clinicians fail to take every possible course of action
- Demand from patients who do not personally pay the bills
- Both doctors and patients need to be educated about the cost-effectiveness of available treatments.
- "The cancer community needs to take responsibility and not accept a substandard evidence base and an ethos of very small benefit at whatever cost."
Supreme Court Likely to Rule on Healthcare Law Early Next Year–This Gives The Justices Time to Rent Some Computing Space from the DOE As They Will Need It
Well after this amount of time and different interpretations we want to make sure that all data and information is included so we get it right. Why the DOE? They have the third fastest computer in the world and they do rent out space. HHS and the NIH have research running on it now so when it comes to something this big, get the right tech power to handle the details and put everything into a format that they can work with. It makes sense and is exactly how business functions today so there’s not reason to go by the seat of our pants on this. Here’s a little history on the Super Computer’s power and computing space.
1.7 Billion Super Computer Hours Awarded by the DOE–Biomedical Research Projects Included for Parkinson’s and Cancer
So far the decisions coming out of the courts have been a bit like Forest Gump’s box of chocolates in not knowing what we will get.
One More “Forest Gump” Judicial Ruling on Healthcare Law-
Insurer Business Models and Algorithms Have Changed So What’s Wrong With A Law That Can Adjust to Accommodate
Insurer Business Models and Algorithms Have Changed So What’s Wrong With A Law That Can Adjust to AccommodateOne other suggestion before digging in would be for the justices to check their current stock investments too for disclosure. We have had some articles in the news where we had conflicts of interest to where they were not up to date with mergers and acquisitions and then by surprise found themselves in conflicting positions too. Let’s get that out of the way first so we can eliminate any more such news as this is important.
3 Judges in Health-Care Lawsuits Caught Up In Potential Conflict of Interest-It’s Called Subsidiary Watch-Be Aware of Your Investments With Mergers and Acquisitions
I think we are all very tired of some of the avoidable unintended circumstances we get today too. Today I was looking at one insurance company and their huge list of subsidiaries and gee they have everything from consulting with the FDA all the way down to reimbursement payments from the actual insurance side, so again it’s very much worth looking at for potential conflicts of interest as if through subsidiaries and decisions made, it could be one big conglomerate doing it all if they received all the contracts. The post below has a few more details on the consulting arm to help drug/device companies with the FDA.
United Healthcare (Optum) Owns A Consulting Firm for FDA Drug and Device Approvals, Clinical Trials–CanReg - Subsidiary Watch
A while back too I wondered if any judge was capable of covering all bases and tendering an accurate decision and again it takes high powered tech to cover it all to query and organize.
Healthcare Reform Law– Is Any Judge Fully Capable of A Decision on a Law That is Challenged By Constantly Changing Algorithms?
We are in a technological battle here to where the regulators have no clue how far advanced the financial world, including Health IT is and we should wake up soon. I just hope the “default” issue from the 70s doesn’t arise as it does with Congress to distract. 
Digital Illiteracy Still Plagues Law Makers–Severe Focus on Abortion Rights Proves It–Is This Where Our Lawmaking Knowledge Leaves Off or Even Begins? Scary…
So let’s make it a good decision that is researched, discussed and studied and get over some hurdles. It maybe not be as simple as a yes or no answer and that’s where that Super Computer from the DOE can really help sort things out and even model different decisions if necessary, big business does his all the time and cranks out a new business model today in less than 48 hours sometimes with their super computers, so laws need to keep up with the same technologies.
If the ruling does not encompass all, then we have big business that will just run their algorithms and modify their model to still gain top profits but the formulas will tell them where the alternations will need to be made to stay legal with loopholes that are not addressed. BD
The Obama administration set the stage Monday for the Supreme Court to rule early next year on the constitutionality of the president’s healthcare law by declining to press for a full appeal in a lower court.
The Justice Department announced it will forgo an appeal to the full U.S. 11th Circuit Court of Appeals in Atlanta. Such an appeal to the 11-member court could have taken months and delayed a final decision from the high court until at least 2013.
In a 2-1 ruling in August, a panel of the 11th Circuit became the first appellate court to declare unconstitutional the new requirement that all Americans have health insurance.
The justices may also want to consider a new issue that could delay a final ruling. This month, the U.S. 4th Circuit Court, based in Virginia, threw out a challenge to the healthcare law by citing a federal law that bars disgruntled taxpayers from going to court until they have paid the disputed tax and filed for a refund. Applying that rule, the judges said no court can rule on the constitutionality of the Affordable Care Act until after 2014, when the first taxpayer pays the penalty.
However, several other courts, including the 11th Circuit, said the penalty is not a “tax” and, therefore, is subject to challenge before it takes effect.
http://www.latimes.com/news/politics/la-pn-healthcare-scotus-20110926,0,675007.story?track=rss
Hoag Hospital Lays Off 175 Staff Members- St. Joseph Cutting 144–Layoffs Occurring Even Within the Affluent Areas of Country–All Comes Back to Reimbursement
Even in Newport Beach, California hospitals are feeling the pinch and you can read below it all comes back around to reimbursements. Hoag hospital works with Aetna Insurance’s IT subsidiaries (Medcity) to connect doctors and health data. In Health IT areas it’s getting down to the linking and competiveness of the insurance IT infrastructures going way beyond just processing medical claims with all the various subsidiaries that are out there today and sometimes hard to recognize as some have some pretty long daisy chains.
Aetna to Acquire Medcity-Health IT Connectivity Vendor-Former CEO Takes Position on Board at Boeing
They are doing a lot in the way of new technologies as shown below so robot’s in and employees out, but the article indicated that the layoffs are not in the clinical areas, just in the administrative side. The ER room uses modern RFID technology to keep track of patients too, again a lot invested here and they do a good job.
Hoag Hospital Using daVinci Robot for Gynecologic Surgery Procedures
Hoag is a good hospital but has it’s incidents like any other in the US, but items as such always make the press but realize any of this can happen at any hospital at any time so hospital ratings really don’t do much that we see on the web, plus they in the case of HealthGrades they can’t even keep the doctors names straight with where they practice. I have clients of mine listed a hospitals they have never set foot in so use reference on the web wisely. The situation below is really sad as they were doing a good thing to try out breast cancer therapy that didn’t use isotopes and the machine had issues and patients were harmed.
Axxent Brachytherapy System Recall-Device Released Particles of Tungsten Throughout Woman’s Breast During Treatment-Lawsuit
MRI Accident at Hoag Hospital – Wrong Gurney Used - MRI Sucked the Patient in and Fractured Her Leg
In addition one other large Untied Healthcare acquisition of Monarch IPA is making all hospitals in the OC nervous as it represents such a huge chunk of the HMO business here and at charity functions for Hoag they have always been present so it goes to say that Hoag has a large number of patients under the Monarch umbrella. 
United Healthcare To Buy Huge Chunk of Orange County, California Managed Care Business with the Purchase of Monarch Healthcare–Subsidiary Watch
Actually with some big conglomerates like United and the long daisy chains of subsidiaries they own enough companies to theoretically be able to bring a drug or device to market to include consulting with the FDA and so forth if they were awarded contracts in every aspect of the process, pretty scary to think that the big insurers have grown this big in a short amount of time via acquisitions. Pay attention to this fact if you want to know where your dollars spent go.
United Healthcare (Optum) Owns A Consulting Firm for FDA Drug and Device Approvals, Clinical Trials–CanReg - Subsidiary Watch
I just received a mailing the other day that Hoag is opening up another clinic in Huntington Beach soon, which is an extension of their services with offices with provider care, i.e. doctors:) So expansion seems to be in the clinic area while the administrative areas of the hospital are cut back and we can’t forget that clinics who are affiliated with hospitals get a bit different compensation from Medicare so thus the reason for expansion and some hospitals buying up medical practices.
Anyway you can see how even hospitals in affluent areas of the US are being hit with economic conditions and the costs involved with IT Infrastructure upgrades and how costly they are. Harvard Medical said their ICD10 costs were ranging up around $5 million, a far cry from what HHS has estimated too, so we need some folks here in the government to work a little bit harder on their data I think as it’s not panning out the way they thought. BD
Hoag Hospital has cut 3.5% of its staff, mostly in non-clinical positions, a hospital spokeswoman said Tuesday. That's about 175 of the 5,000 people who work for Hoag systemwide.
The hospital had been preparing for changes in the industry as the government plans major reforms in medical coverage and reimbursement.
Last year Hoag renovated and reopened the former Irvine Regional Hospital and also has developed a community-based network of facilities and services.
"What we could not predict was how the combination of the weak economy, high unemployment and the shift in the way insurance companies pay for care would force us to take action sooner than anticipated and accelerate our transition plans," said Nina Robinson, spokeswoman for Hoag Memorial Hospital Presbyterian in Newport Beach.
http://www.ocregister.com/articles/hospital-318059-hoag-joseph.html