Archive for May, 2011

Where are the Women CEOs in Health IT?

May 31st, 2011 | 1 Comment | Source: Commentary

The Health Tech 2011 Conference, held earlier this month in Boston, featured presentations from startup CEOs in the health and wellness space. The conference had nothing to do with gender issues or leadership per se. Yet the Twitter feed from the conference (#ciht11) contained this:

@ml_barnett By my count, only 3 of 27 speakers are women. RT @taracousphd: where are the female entrepreneurs? It’s healthcare!!!

taracousphd and @ml_barnett reminded us of a painful fact. There aren’t many female CEOs in Health IT. Why is this?

Women certainly aren’t short on content knowledge in health care. In fact, they dominate men in this area. More than 40% of all practicing physicians and 50% of all medical school graduates are women. Women earn nearly 3 times more PhDs in psychology (useful content knowledge for startups in the space covered by Health Tech 2011). Nearly 94% of nurses and 74% of physical therapists are women, and they rule the workforce in public health, social services and pharmacy  as well.

The problem–and it’s a big one–has to do with the ‘IT’ part of ‘Health IT.’ In 2008, only 6% of Fortune 500 technology companies had female CEOs and 13% had women corporate officers of any kind, according to the National Center for Women and Information Technology. Among tech startups that raised venture capital in 2009, only 4.3% were led by female chief executives. A recent Business Week list of the ‘best young entrepreneurs in tech’ included 45 people, only 3 of which were women.

Among the many explanations for the gender disparity among chief executives in IT, the 4 that make the most sense to me are these:

Women aren’t in tech, periodAlthough women hold 51% of all professional jobs in the US, they comprise only 26% of the IT workforce. The number of women in IT actually dropped by 76,000 between 2000 and 2008, according to the Bureau of Labor Statistics.

Then again, if the gender disparity in Health IT leadership was a simple workforce issue, we’d expect from the data presented above that about 26% of tech CEOs would be women. Clearly there is more to the story.

Women are undertrained in tech-In 2006, only 15% of the people who took the computer-science AP exam were women. That’s lower than any other AP test. Similarly, only 18% of college graduates with computer science degrees are women, and the percentage of female PhD computer scientists is lower still. The latter statistic is particularly galling since these individuals frequently become entrepreneurs and have grant-writing skills and professional networks that can help them succeed. (more…)



The HHS Plan to Reduce Racial Disparities in Health Care

May 26th, 2011 | No Comments | Source: Commentary

Twelve years after our nation began a serious effort to reduce racial disparities in health care, minorities in our country are still less likely to get the preventive care they need and more likely to suffer from serious illnesses. And when they get sick, racial minorities are still less likely to have access to quality health care.

To progress matters, the Department of Health and Human Services (HHS) has recently released an action plan. The plan calls for development of new care models and more service delivery sites. It bolsters the nation’s health and human services workforce through a pipeline program that channels people from underserved communities into public health and biomedical sciences careers. There are targeted efforts to reduce cardiovascular disease, childhood obesity, tobacco-related diseases, flu and asthma. And there are plans to improve health data collection and increase outcomes research.

Strengths of the Plan
As we described last week, the problem of racial disparities in health care is exceedingly complex. Efforts to address it must feature a broad, multifaceted approach if they are to have any chance for success. The strength of the HHS plan is that it contemplates just such an approach.  The plan should trigger useful activity at National Institutes of Health, the Centers for Disease Control, the Health Research and Services Administration, the Agency for Healthcare Research and Quality, the Indian Health Service and other agencies as well. Cross-agency collaboration of the sort envisioned by HHS is likely to generate effective outreach and preventive programs and more capable oversight of such programs.

A narrower plan—for example, one that focused solely on providing insurance to those who don’t have it—would have a surprisingly small impact on racial disparities.

Take Canada for example, a country that has universal, free access to health services. If poor access was primarily responsible for disparities in health care, then disparities shouldn’t exist in Canada.

However a recent study by David Alter and colleagues shows unequivocally that disparities do exist there. In their prospective study of 15,000 Canadian adults, Alter’s team showed that participants in the lowest income group were nearly 3 times more likely to die of any cause than those in the highest income group. They were also more likely to have diabetes, high blood pressure, cancer, cataracts and many other conditions. (more…)



31 Years On

May 24th, 2011 | 2 Comments | Source: Commentary

Happy Anniversary Lori!

Remember the sunset at Mont Saint-Michel? How about the hail storm at Lake Solitude, the drive through Stonehenge with Gigi, the squalls over Cornwall and the July 4 snowstorm on the Grimsel Pass?

Sure I believe you got 28 inches of snow on April Fool’s Day.”

Eze. St. Paul de Vence. Portofino. The ferry from Dubrovnik to Hvar.

Come. You shall return,” to Angiers, Chinon, Chambord, Chenonceau, Usse and more. Etivaz. Grindelwald. Santorini. Paleokastritsa. Pylos. San Gimignano. Bellagio. Ravello. Amalfi. The Ryoan-ji Temple. The Moss Temple. The Bucaco Forest.

 “Look buddy. It says ‘Diesel’ on the gas cap!”

MOMA. The Tate Modern. La Galarie Maeght. L’Orangerie. Le Jeu de Paume. Le Centre Pompidou. The Picasso Museum. The Rodin Museum.

The Monterey Jazz Festival. The Newport Jazz Festival. The Montreaux Jazz Festival. The Stones at the Superdome. Wynton Marsalis in Bar Harbor.

Shelby Scott, Jack and Liz. Mike Wankum, Jeff and Karen. Tim Caputo! Mad Men. Masterpiece Theater (not). Vacation. There’s Something About Mary. Austin Powers. Ace Ventura, Pet Detective.

Two kids in diapers…twice! Our best sitter was an alcoholic. The terrorization of Lana. “Let’s buy a car for a sitter we don’t even know!”

The Park Entrance Oceanfront Motel, room A-5. Enya. 2-day old Corey visits JP Licks on the way home from the hospital. Soccer practice, soccer games. Softball practice, softball games. Swim practice, swim meets. Homework, homework, homework. “Who’s doggin’ it?”

A tree falls on the Foster’s driveway. Butterfly World. The batting cage. New Year’s at Grammy’s. Yankee gear in Fenway Park. The rear window on the Navigator, circa 2007.

The Cinnamon Club. Jean Bardet. Le Chevre d’Or. Johnny’s. Cabot’s. Guppy’s. The Carriage House. The Ferry House. Crepes at Les Baux. Picnics on the Loire. “Party of one?” at Marshall Majors.

The search for Paris’ best strawberry tart. The search for Prunotto vineyards.

From the Louvre to L’Arc du Triumphe via Jardin des Tuileries. Fiery Furnace. Delicate Arch. The Narrows. The Beehive (when Corey was 4 years old). Precipice.

Front row seats at women’s volleyball. Michael Johnson races for gold. US men’s hoops.

The Bagel. Houlihan’s. Cantina Abruzzi. Friendly’s. The Chinese place that fried hamburgers. Capuccino’s. Colorado Public Library. Armani Café. Putterham Deli. Miguel’s. Androuette’s.

I forgot my cummerbund. I spilled red wine on your gown at a Joslin gala. I rear-ended somebody on the Champs Elysees. I locked the brisket in the oven, and then I pressed ‘clean’. I ordered a ‘whore du vere‘ on our first date.

We got mooned on the way to our own wedding. We couldn’t punt in Cambridge. We actually ate at Brasserie Lippe. We flushed dinner down a toilet at a ryokan in Kyoto. We were attacked by no see-ums on Sanibel Island, black flies on Mt. Katahdin and wild turkeys on Hartman Road. We went to Crete, but it was closed. The sliding door fell off our minivan. Our basement bathroom flooded. Three times.

To the next 31 years!



Racial Disparities in Health Care: The Hundred Years’ War

May 18th, 2011 | No Comments | Source: Commentary

It was 1999 when the Federal government first acknowledged our nation had a problem with race and health care. That year, Congress tasked the Institute of Medicine to study the matter, and the resulting report was not good. Minorities were in poor health and receiving inferior care, the report said. They were less likely to receive bypass surgery, kidney transplants and dialysis. If they had diabetes, they were more likely to undergo amputations, meaning their disease had been poorly controlled. And there was a lot more where that came from.

The IOM report was a call to action. In subsequent years, lawmakers crafted policies and established goals for improvement. Federal and state governments and numerous foundations set aside billions to fund projects. Health services researchers expanded their efforts to study the problem.

Twelve years later, we have something to show for the effort. Steep declines in the prevalence of cigarette smoking among African Americans have narrowed the gap in lung cancer death rates between them and whites, for example. Inner city kids have better food choices at school. The 3-decade rise in obesity rates, steepest among minorities, has leveled off.

Nevertheless, racial disparities persist across the widest possible range of health services and disease states in our country. The overall death rate from cancer is 24% higher for African-Americans than white people. The racial gap in colorectal cancer mortality has widened since the 1980s. African Americans with diabetes experienced declines in recommended foot, eye, and blood glucose testing between 2002-2007.

Why is this problem so hard to solve?
The reason is that the problem is exceedingly complex. Hundreds of factors contribute to racial disparities in health care. Progress on just a few of them is therefore unlikely to move the needle much (which isn’t to say we shouldn’t try!). The key contributing factors are these:

Identifying Target Populations-Studies of racial disparities in health care rely fundamentally on tools that classify people by race. These tools are notoriously imprecise. Most of them classify all people whose family immigrated from a country that was once considered part of the Spanish empire as “Hispanic,” for example.  This means people of Panamanian, Mexican and Venezuelan descent are grouped together (to name but 3 countries).

The resulting “Hispanic population” in studies of health disparities is actually a polyglot of culturally-driven lifestyle choices, tendencies to seek care from physicians, and dozens more behaviors that impact health. This heterogeneity severely undermines the value of information obtained from the studies.

The Genetics Don’t Work: The genes responsible for phenotypic traits that forensic pathologists and anthropologists use to study race aren’t the same ones that govern how sodium-potassium ATP pumps work (and how they impact hypertension risk, for example). They have nothing to do with the genes that govern the body’s tendencies to store fat and establish a basal metabolic rate (and how they impact obesity risk). In fact race is largely a red herring in the search for genetic links to cardiovascular disease, cancer and other conditions that kill US minorities disproportionately . (more…)


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HealthTech 2011: Conference Recap

May 15th, 2011 | No Comments | Source: Commentary

@MichaelSheeley  #ciht11 Lots of cool & innovation going on in the health & fitness world. Very exciting things are happening!

Indeed there are. The latest evidence for this could be found at Friday’s HealthTech 2011 conference in Boston. Sponsored by Careinnovators, #ciht11 drew hundreds of entrepreneurs, who used the day to share ideas, hear what investors thought about their space, and for a few of the heartiest, to nail their elevator pitch in a bar during the height of happy hour.

The Entrepreneurs
The large, engaged crowd suggests that #ciht11 touched a nerve, at least among entrepreneurs. Many of them believe we are entering a renaissance era in health and wellness, even bigger than the 1980s bubble which produced Access Health and HealthWise, among others.

The renaissance is being driven, they say, by strong tailwinds from many sources. The aging of the baby boomers creates a vast new market, including millions who want to maintain good health and even more who will inevitably develop chronic diseases. Inexpensive smartphones and monitoring devices are becoming ubiquitous, giving consumers real-time access to support networks and non-obtrusive ways to record data. Today’s Web-based platforms make it easy to develop products and store data.

Plus, it won’t be long before people who never knew life without the Internet will outnumber those who grew up before it. If these people can spend hours tending to eStrawberries on an eFarm, then surely they will use cool games that help them stay healthy.

There have been early successes in the space, as yesterday’s conference showed. Companies that track your work-out, like MapMyRun and RunKeeper have up to 5.5 million registered users and 300,000 active users, according to speakers and Twitterers at the conference. Shape Up the Nation provides health and wellness services to more than 2 million people via contracts with employers and payers.

The Venture Capitalists

@PearlF #ciht11 Bessemer’s Stephen Kraus: there will be next generation gaming plays on wellness, 4 now not investing, hard 2 separate from noise

Venture Capitalists seem to be more circumspect about the supposed renaissance, however. They have invested only sporadically in the space, although the few investments they have made—including a remarkable $2.25 million bet that Aza Raskin, the former creative lead at Firefox and Sutha Kamal can grow Massive Health from scratch—are noteworthy.

To be sure, most VCs absolutely do believe that some startups in this space will become wildly successful. It’s just they haven’t yet seen many startups that merit an investment at this point. Too many unproven business models. Too many marketing plans based on the premise—famously recounted at the conference by Excel Venture Management’s Rick Blume—that ‘if I build it, they will come.’

How will these startups overcome the troubling reality that 26% of people who download a health-related app use it just once, or that nearly a third of those who use health apps don’t use them as their developers intended? How realistic is a business plan that relies on users to fundamentally change their health-related behaviors?

@MatthewBrowning #ciht11 ROI, ROI, ROI is most important to investors



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The Dual Online Identities of Physicians

May 11th, 2011 | 1 Comment | Source: Commentary

Like everybody else, physicians are expanding their online personal identities. At the same time, they are trying to comply with codes of conduct that help consumers trust them and their profession.

There’s no problem so long as the personal online activities of physicians don’t jeopardize their obligations as professionals, which means that there is a problem, unfortunately.

In a recent study for example, 17% of all blogs authored by health professionals were found to include personally identifiable information about patients. Scores of physicians have been reprimanded for posting similar information on Twitter and Facebook, posting lewd pictures of themselves online, tweeting about late night escapades which ended hours before they performed surgery, and other unsavory behaviors.

As I mentioned Monday, medical students and younger physicians who grew up with the Internet have to be particularly careful, since they had established personal online identities before accepting the professional responsibilities that came with their medical degree.

Medical schools, residency programs and teaching hospitals can help young professionals manage their dual lives online. Some have implemented curricula and policies that foster appropriate use of social media, but surprisingly these programs are not widespread. In a recent study of medical schools that had experienced at least one incident in which a student used social media inappropriately, only 38% had adopted formal policies to handle future incidents. An additional 11% reported they were developing such policies. We can do better than this.

Non-teaching hospitals, CME providers and professional organizations like the American Medical Association can also help providers navigate the online world. The AMA’s recent guide to Professionalism in the Use of Social Media provides helpful guidance in this regard.

What You Can Do Now
Frankly, this is not something that can wait. If you haven’t already done so, you should immediately take steps to assure your personal online identity doesn’t threaten your professional identity, your patients’ rights to privacy, and other responsibilities you have as a physician. Here are some tips for getting started.

1-Look Before You Leap. If you are just starting to expand your online personal identity (say, by registering for a Twitter account), don’t feel compelled to lay yourself out there right away. There’s nothing about Twitter or Facebook that requires you to do anything after you register (nor for that matter, is anyone compelling you to generate (more…)


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Social Media in Health Care: The Genie is out of the Bottle

May 9th, 2011 | 1 Comment | Source: Commentary

Fifteen years ago, protecting patient confidentiality was a simple matter for physicians. Keep your voice down in restaurants and elevators, make sure the door is closed when you speak on the telephone, and guard your patients’ paper medical records like a mother hawk.

Social media has changed that. Two weeks ago, a physician was fired from a Rhode Island hospital and cited for ‘unprofessional conduct’ by the state medical board after she posted information to Facebook that could be used to identify a patient. She did not name the patient, but included information about the patient’s unusual condition that would have allowed unauthorized third parties to identify the patient if they wanted to.

The physician deleted her Facebook account and will attend a CME course to help her get clear on patient-physician confidentiality issues in the age of social media.

This physician is not alone. A recent review by Lagu and colleagues showed that 17% of blogs by health professionals included information that could be used to identify a patient or the patient’s physician. Three blogs contained identifiable pictures.

Nothing in their training or their experiences in the era before social media could prepare physicians for the sudden, profound impact it has had on their practices. These new tools are disrupting decades-old codes of conduct, not to mention the very processes by which care is rendered and providers communicate with patients and their colleagues.

To be clear, I firmly believe that physicians and all health professionals should aggressively adopt social media to enhance the care and support they give to patients. This includes providers who have yet to get in the game. At a minimum, providers are obligated to join the fray because their patients use these sites to find information, seek support and make health decisions for themselves. (more…)


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Who Killed Homo EHRectus?

May 4th, 2011 | No Comments | Source: Commentary

An ancient smartphone, unearthed near the fossilized remains of a predecessor to modern man, has provided clues about how the hominid died, according to French archeologists.

Archeologists have been excavating the site  since April 22, 1984, the day three teenagers discovered the nearly intact remains of a Homo EHRectus male while hiking in the pristine Dordogne region of France.

The discovery was hailed back then as the most significant archeological finding since a forensic examination of Jim Morrison’s body revealed he was drug free and a virgin.

Archeologists originally theorized that the male Homo EHRectus–a member of the world’s oldest known tach-savvy species–died from severe alert fatigue caused by prolonged exposure to legacy electronic health record systems.

The theory was later dismissed after it was determined the man died of blunt trauma to the head. At that point, the question became who killed Homo EHRectus?

The smartphone appears to hold tantalizing, and rather tawdry clues in this regard. Skinned in a stylish, black polycarbonate case, the ancient device was found 20 meters from the body of the male Homo EHRectus. Carbon dating and other tests suggest the phone once belonged to the man.

The clues were contained on the memory card of the smartphone. The card, it turned out, contained time-stamped geo-location data, credit card purchase information, text messages and a raft of posts its owner had uploaded to social networking sites that were popular back then.

With this information, French Digital Archeologists—and presumably, any contemporary of the male Homo EHRectus who gained possession of his phone—could determine exactly where he was and when, and what he was doing when he was there.

“We were shocked to find all that data on the smartphone,” Kip Nosecrets, a Professor of Digital Archaeology at L’Institut Louis Pasteur told Paris Match. “I wonder if the guy knew his phone was tracking him like that.”

As for the tawdry clues, memory card analysis showed that the male Homo EHRectus had frequented the home of his best friend for years when he was supposed to be at work. Apparently, he had been carrying on with his friend’s wife.

Since the smartphone discovery, archeologists have stepped-up their search for blunt instruments at the site of the friend’s home. They have also begun searching for the remains of the male’s wife in Las Vegas.


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Health Care in the Cloud: A ‘Case Study of What Not To Do’

May 2nd, 2011 | No Comments | Source: Commentary

Amazon Web Services (AWS), “the cloud” for many, experienced a serious interruption in service beginning on April 21st. The problem lingered for at least 6 days. Many websites that relied on Amazon services went down or saw their performance degraded during the event.

The AWS failure disproportionately affected startups like Foursquare, Quora and Reddit, companies that are “focused on moving fast in pursuit of growth, and less apt to pay for extensive backup and recovery services.” 

One of the affected companies was a health care startup. What follows is a transcription (including typos) of an AWS Discussion Forum that this company initiated 24 hours after the outage began. The company’s contributions are in italics.

Life of our patients is at stake—I am desperately asking you to contact

Sorry I could not get through in any other way. We are a monitoring company and are monitoring hundreds of cardiac patients at home. We are unable to see their ECG signals since 21st of April. Can you please contact us? Or please let me know how can I contact you more ditectly. Thank you

Oh this is not good. Man mission critical systems should never be run in the cloud. Just because AWS is HIPPA certified doesn’t mean it won’t go down for 48+ hours in a row.

(+30 minutes since comment thread began) Well, it is supposed to be reliable…
Anyway, I am begging anyone from Amazon team to contact us directly. Thank you

Go to your backups? Or make a big deal out of it on the forums maybe someone will take a look. In any case anecdotal empirical evidence has shown don’t bother with premium support its a freaking joke.

Thanks for the comments, but we are really desparate. Amazon team – please contact us

(+10 hours since comment thread began) Not restored. Not heard from Amazon. People out there – please take a look at our volumes! This not just some social network website issue, but a serious threat to peoples lives!

Your only option at this point is Premium support. However, they’re just going to tell you to wait. Sorry.

(+ 13 hours) There is some progress. 2 servers are operational and one still not working. Unfortunately, the one on which we have the most patients

Aren’t you braking some compliance laws by not having a highly-available environment?

You put a life critical system on virtual hosted servers? What the hell is wrong with you

Not sure whether you’re plain incompetent or irresponsible. Anyway, you should be ashamed and prepare yourself with lots of money to pay for the lawyers. Would it be so difficult to have a contingency plan? another provider? or even another availability zone? Are you so fsklong dumb as to think that nothing could ever happen to a data center. (more…)


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