The Case
In 2009, administrators at St. Joseph Medical Center in Maryland wrote letters to patients of Mark Midei, informing them that its staff cardiologist may have subjected them to a coronary artery stenting procedure inappropriately. That communication prompted an article in a local newspaper, which triggered an investigation by the Senate Finance Committee.

The Committee subsequently released a report which asserted that Midei performed nearly 600 stenting procedures unnecessarily, and charged Medicare nearly $4m for these procedures. According to the report, all the procedures involved stents made by Abbott Labs. Abbott, in turn, had paid Midei $31,000, added him to its roster of top stent volume cardiologists, and feted him with a pig roast at his home to celebrate a prodigious day in which he implanted 30 stents (apparently a company record). Then, after St. Joseph’s dropped Midei from its roster, Abbott hired him to provide services in Japan and China. In the subsequent year, the number of patients who received stents at the hospital fell to 116 from 350 in the previous year.

Most recently, the Maryland Board of Physicians revoked Midei’s license to practice medicine after concluding that he did implant stents into the coronary arteries of 4 patients inappropriately. The Board also determined that he exaggerated the severity of coronary blockages, and claimed incorrectly that they had unstable angina. Midei has denied the allegations and sued St. Joseph for damaging his career.

The Context
The Midei case is particularly egregious, but a recent study in the Journal of the American Medical Association suggests that many thousands of percutaneous coronary interventions (PCIs)—perhaps as many as 4% of all those performed each year in the US—are inappropriate.

The study was organized by Paul Chan of Saint Luke’s Mid America Heart and Vascular Institute. Chan’s team found that when PCIs were done for acute indications like an evolving myocardial infarction (heart attack), the overwhelming majority of cases (98.6%) were performed for appropriate indications. A remarkably low 1.1% were done inappropriately (in the other cases, the benefit was uncertain).

For elective procedures like the ones performed by Midei however, fully 11.6% of all PCIs were inappropriate, and an additional 38% were carried out for indications associated with unclear benefits. Most of the procedures deemed to be inappropriate were carried out on patients with no angina (54%), low-risk ischemia as determined by exercise testing (72%), or patients that were not receiving ‘maximal’ medical therapy (96%). Ninety-four percent of these patients also did not have ‘high risk’ coronary anatomical findings. (more…)

Opioid Implant Cuts Positive Urine Screens. An implantable formulation of the opioid addiction drug buprenorphine (Probuphine) kept more patients “clean” over six months than did a sham implant, according to drug maker Titan Pharmaceuticals.

AIDS Drugs Can Prevent Infection, Studies Show. Two new studies show that AIDS drugs can prevent heterosexuals from acquiring HIV, adding to a growing number of methods to slow the spread of the virus. Many researchers now believe that we have developed sufficient tools to contain the pandemic, though tight budgets may limit their deployment.

Antipsychotic Drugs Used Commonly for Parkinson’s Disease. Despite warnings about the risks of using antipsychotics to treat older patients at risk for dementia, the powerful drugs are routinely prescribed to elderly Parkinson’s patients.

Stinky Foot Odor May Prevent Malaria Deaths. Researchers at the Ifakara Health Institute in Tanzania are developing traps using natural and artificial foot odors to lure mosquitoes and prevent them from spreading diseases like malaria, in a project funded by the Bill & Melinda Gates Foundation.

Small Physician Practices Not Using Key EHR Features. Few small and midsize physician practices use electronic health record system functions that are seen as essential components of patient-centered medical home model of care, according to a study. Features include care coordination, electronic disease registries, e-prescribing and online communication with patients.

Poor are Healthier with Medicaid. Enrolling patients in Medicaid increases their use of healthcare services, reduces financial strain on these impoverished patients and improves their sense of well-being, according to a randomized study.

Romance Novels are Bad for Your Health. The novels’ escapist fantasies can get confused with reality, leading women to make poor choices, according to psychologist Susan Quilliam. Real-life sex is not always perfect, relationships are not always smooth and pregnancies are not always trouble-free, she said.

MIT Researchers Use iPhone To Detect Cataracts. Researchers at the Massachusetts Institute of Technology have developed Catra, a cheap plastic lens that clips onto the iPhone’s screen. Catra software can provide a diagnosis within minutes and requires no training.

Scientists Fear Spread of a Gonorrhea Superbug. Scientists announced the discovery of a new, antibiotic-resistant strain of gonorrhea in Japan, raising concern among health officials worldwide.

Grand Rounds is up at InsureBlog. The “It’s Up To Us” edition focuses on personal responsibility. It features an article from Pizaazz.

Industries Lobby Against Nutrition Guidelines. The food and advertising industries have launched a multi-pronged campaign against government efforts to create voluntary nutritional guidelines for foods marketed to children.

Electronic Glasses Can Read Emotions. The ‘emo-specs’ use a camera to record facial motions and facial expression software that interprets the wearer’s emotions based on a database of previously-collected facial expressions. The emotion is then displayed visually within the glasses.

Unlocking Dyslexia in Japanese. Scientists have shown that some dyslexics have an easier time with a character-based language like Japanese, than a language based on phonemes, like English. The observations could help improve teaching techniques for affected individuals.

Colorectal Cancer Screenings Make a Difference. Increased screening during the last decade for colorectal cancer, the nation’s second-leading cause of cancer deaths, has put a dent in the prevalence of the disease and in the number of deaths resulting from it, the CDC said.

CMS Pilot Programs to Analyze Quality Data Collection via EHRs. CMS rules proposed last week provide new details of pilot programs aimed at testing online reporting of clinical quality data from electronic health records.

In the last month, the Obama administration announced programs to reduce racial disparities and increase prevention in health care. Neither program was funded with actual money, so they are about political showmanship as much as any real desire to tackle the worthy causes. After all, who would oppose such programs? I half-expect the administration to follow-up these announcements with one focusing on moms and apple pie.

But have a closer look at what Iowa Democrat Tom Harkin said at the press conference introducing the latter initiative. “For every dollar we invest in prevention, we save $6. We need to provide an approach that makes it easier to be healthy and harder to be unhealthy.”

I haven’t found the report on which Harkin bases his assertion about the returns on health prevention efforts, but my sense is its more complicated than Harkin would have us believe. Some screening and prevention programs are not effective at all. Others are effective, but prohibitively expensive. Any national program to improve prevention needs to evaluate each potential component to assure it reflects Harkin’s focus on cost-effectiveness.

Many recently proposed screening programs do not meet this criterion, in fact. Let’s take a look at a few of them.

Screening for Prostate Cancer
Two months ago, scientists reported the results of a 20-year follow-up study of 1,500 Swedish men between the ages of 50-69. The study found that routine screening for prostate cancer did more harm than good. The screening program (which included digital rectal exams and prostate-specific antigen tests) enabled physicians to detect and treat nearly a third more cancers, but there were problems with overtreatment and treatment related side-effects. More importantly, prostate cancer death rates were the same in the screening group as they were in the control group. (more…)

The Real Story of Cloud-Based Health Record Security Breaches. A report by Software Advice found extremely few security breaches involving Web-based EHRs, and suggested that they offer advantages over client-server models in that no patient data is stored locally and subject to theft.

PopCap Games To Be Acquired For $1 Billion+. The company behind hits like Plants vs Zombies and Bejeweled is in the process of being acquired, Techcrunch has reported. Among the potential suitors are Zynga, Electronic Arts and several Asian gaming companies.

SMART Health App Challenge Crowns $5,000 Winner. A developer challenge issued this spring by researchers at Children’s Hospital Boston and Harvard Medical School, aimed at inspiring innovation in health IT applications, has awarded its prize to a multilingual EMR interface.

Supreme Court Overturns Ban on Drug Data Mining. The US Supreme Court, on a 6-3 vote, struck down as unconstitutional a 2007 Vermont law that prohibited the collection and sale of physicians’ prescription data without consent.

Guidelines for Cancer Surgery Not Always Followed. Surgical oncologists got a mixed review for adherence to clinical guidelines, including high grades for adjuvant therapy but low marks for nodal management, according to the results of retrospective study.

Insured Consumers Caught in Fights Over Ambulance Bills. When you’re calling for an ambulance, chances are good that you won’t think to ask for one that’s in your health plan’s provider network. You probably wouldn’t have much control over it anyway. That could leave you with hassles and extra charges for an out-of-network ride.

Apple iCloud: Intriguing Options for mHealth. Steve Jobs’ ideas for a cloud-based storage network are generating some buzz about its possible effects on healthcare technology, as clinicians continue to adopt iPhones, iPods and iPads in droves.

SDI Offers Grants for New Approaches to Health Care Research. SDI, a provider of de-identified patient-level data analytics, has announced an program to offer academic grants that promote innovative health data research.

Sanofi-Aventis Data Design Challenge to Take Submissions July 1. Winners of the competition will receive over $200k in prize money, industry-leading mentorship and public recognition.

Cardiology Groups Overhaul Quality Measures. Patient outcomes and achieving control are the major focus in new performance measures for coronary artery disease and hypertension issued by the American College of Cardiology and the American Heart Association.

Facebook Adds Facial Recognition. Without telling its users, Facebook has launched a facial recognition feature designed to make it easier for users to tag photos. As it has in the past, the social networking giant set ‘opt-in’ as the default privacy setting for the new feature.

Sleep Pattern Affects Major League Hitters. A major league baseball player who prefers rising with the larks may hit better in day games than night games and vice versa, a researcher suggested.

Pesticide Residues Taint Apples. The apple industry faces a potential public-relations headache in the wake of USDA testing that revealed pesticide residues in 98% of America’s second-most-popular fresh fruit.

NQF Adds New Serious Reportable Events. The National Quality Forum has expanded its list of serious reportable events to 29. The 4 new ones are patient death or serious injury resulting from failure to communicate test results, and death or serious injury of a newborn baby associated with labor or delivery in a low-risk pregnancy.

Physicians Leaving Practices for Health System Employment. By 2013, less than a third of physicians will be in private practice, electing instead for employment with larger health systems, according to a new report by Accenture.

Regional Patient ID Pilot Could Presage a National Rollout . The idea of a national patient identifier has gone nowhere, but a regional health information organization in LA has begun testing a regional patient ID system with financial help from the Robert Wood Johnson Foundation.

Practice Fusion’s Electronic Health Record System Achieves Complete Meaningful Use Certification. The largest EHR community in the US is now ONC-certified. Practice Fusion’s national network of small medical practices has the potential to earn over $1 billion in incentives.

iCloud, Cloud Computing Services Promise To Change the Way We Use Computers. Apple has announced a free service that allows consumers to store vast amounts of music, video, photos and documents on the Web, one of several emerging offerings that reduce the need for a computer.

Computerized Communication Breakdowns Common Between PCPs, Specialists. A new study investigates the challenges posed by pen and paper workarounds and computerized communication breakdowns associated with electronic health records. Understanding the challenges can help improve coordination of care.

Blumenthal To Chair Commonwealth Fund Commission. David Blumenthal, the former head of the Office of the National Coordinator for Health Information Technology at HHS, has been named chairman of the Commonwealth Fund’s Commission on a High Performance Health System.

Medicaid To Stop Paying for Preventable Events. The Centers for Medicare and Medicaid Services announced that it will no longer pay healthcare providers for treating Medicaid patients with illnesses, injuries or readmissions that should have been prevented.

Meet the First Rock Health Start-Up Class! Congrats and good luck to the health-focused tech startup accelerator’s first class! It includes BrainBot (technology to improve mental performance), CellScope (at-home diagnosis of diseases), Genomera (personal health collaboration), Health In Reach (medical procedure marketplace), Omada Health (clinical treatment social networking), Pipette (patient monitoring and education), Skimble (mobile fitness), and WeSprout (connecting health data and community).

ACO Initiative Draws Fire. Many health providers are claiming they won’t participate in accountable care organizations unless the Obama administration’s proposed guidelines governing their formation include better financial incentives and a reduced regulatory burden.

Dosecast iOS App Targets Medication Compliance. The free edition of the app features reliable push-notifications, flexible scheduling, customizable dose amounts and instructions, reminders, smart silencing, and privacy and security.

CMS: Patients Should Know Who Views Their EHR. Upon request, patients could see who has accessed and viewed their electronic health records, under a proposed privacy rule released by the Centers for Medicaid and Medicare Services.