Sunday, November 1, 2009

Moving Healthcare Forward

Taking time out from his busy schedule on Capitol Hill, Congressman Edward Markey (D-MA) appeared via video at Partners Healthcare’s 6th Annual Connected Health Symposium held October 21-22 in Boston. He stressed that this is a monumental moment for real healthcare reform.

Congressman Markey has had a front row seat in working on health IT issues. In 2008, he introduced the “Independence at Home Act”, to establish a three year Medicare demonstration project using a patient-centered healthcare delivery model to help Medicare beneficiaries with multiple chronic conditions to remain independent for as long as possible.

Also in 2008, he introduced the “Technologies for Restoring Users Security and Trust in Health Information Act.” This piece of legislation would provide patients and consumers with access to health information and ensure privacy, security, and confidentiality.

Most every powerful constituent group focuses on health reform but if it is not their plan—they prefer the status quo, according to Stuart Altman, PhD, Professor of National Health Policy, Heller Graduate School for Social Policy and Management, at Brandeis. “Most people don’t want their healthcare touched.”

In talking about the current healthcare reform bills before Congress, he said “we need to change the way we pay for care and move away from the fee-for-services system while at the same time fully utilizing technology. He touts the Massachusetts plan and how the state is trying to change the payment system.

Dr. Altman wants to see bundling care payments for acute and post acute care, more funds available to train and increase the workforce, value-based payments, the wider use of gain sharing between hospitals and doctors, more efficient home-based services available, and investments in comparative effectiveness to include both clinical and cost effectiveness components.

Jay Sanders, MD., President and CEO, Global Telemedicine Group, looks down the road to see what is here now and what the future holds for healthcare. As a pioneer in the telemedicine field, he has the vision to see how technology can improve the delivery of medicine in the coming years. For example, the exam room will move to where the patient is located since technology is available to help the doctor provide care without the patient ever leaving their environment.

Dr Sanders questions whether yearly physical exams are really needed or they are done because medicine has always been practiced that way. Sometimes patients will come into the doctor’s office with high blood pressure and the doctor puts the patient on medication. But we must begin to realize that this office visit detecting high blood pressure was not the beginning of the patient’s problem— the blood pressure could have started three weeks or maybe years before.

In some cases, it can take weeks or years to move from normal to abnormal. Sometimes chronic illnesses average years before they are diagnosed—sometimes the chronic condition can be detected as long as 10 years before. In the future, if we routinely use monitoring technology, then doctors should be able to define and treat illnesses sooner.

How the power of social networks can greatly influence our health was discussed at the Symposium by Nicholas Christakis M.D., PhD, MPH, and Professor of Medical Sociology at the Harvard Medical School. He along with James Fowler PhD, Associate Professor at the University of California, San Diego, have both written a thought provoking book titled “Connected”. The book points out how the surprising power of social networks is able to shape lives.

Dr. Christakis in discussing the science of social networks talked about the epidemiological study known as the Framingham Heart Study that started in 1948, and how the study has provided physicians with invaluable data throughout the years. The Study kept meticulous handwritten records with information on friends, relatives, coworkers, and neighbors for each participant. These records provide thorough information on the social networks of all the participants and information on their weight and height was easily retrievable.

In studying these facts, it was found that the average obese person was more likely to have friends, friends of friends, and friends of friends of friends who were obese than would be expected due to chance alone.

This finding illustrates that social networks have communities within them and these communities can be defined not only by their interconnections but also by the ideas and behaviors that their members share. Further study showed that if a mutual friend becomes obese, it nearly triples a person’s risk of becoming obese. In addition to friends, it was found that weight gain could spread through a variety of social ties from person to person but they had to be close relationships.

According to the authors, studies have shown that obesity is contagious but scientists are trying to understand how this is possible and how other health problems may spread in this way. So the authors are posing the question “What are the implications of knowing that a key feature of our health depends on a key feature of the health of others found in social networks?”

For more information on the Symposium’s many speakers and sessions held, go to