A Recent Study on the Adoption of Telemedicine Reveals Who Runs the Show in Healthcare

Just yesterday, a study was published in Telemedicine and E-Health that featured the findings of the Mayo Clinic in Arizona, C3O Medical Group in Ojai, CA and UCLA Medical Center in West Los Angeles. They asked what is helping and impeding the use of robotic telemedicine in emergency and critical care applications in these institutions. They found that “Administrative Burdens” and “limits on reimbursement” are the primary culprits impeding the use of telemedicine.

The sad thing is, the authors are not shocked. Noted as the biggest issues are:

• Licensing restrictions
• Admin burden of giving physicians credentials and privileges to practice telemedicine and make sure malpractice insurance is in place
• Limitations in billing and reimbursement.

No one is surprised because the practitioners of healthcare in the US are not in charge. Neither are the providers of technology that enable them. Our US healthcare system is now run by an “Administrative Financial Complex” (compare to the Military Industrial Complex of Ike Eisenhower and Oliver Stone fame) which has now become self-aware like SkyNet in the Terminator movies and is now nearly solely focused on insuring its own survival and growth. We collectively marvel at how our health insurance rates continue to rise meteorically, while healthcare practitioners, institutions and and consumers keep getting squeezed.

The Great Sucking Sound You Hear is Administration Vacuuming Healthcare Dollars

In 1992, Ross Perot talked about the “great sucking sound” of jobs being drawn overseas for cheap labor. Today the great sucking sound is generated by the healthcare insurers, the Administrative Financial Complex which is charged with topline growth by Wall Street, and whose growth comes at the expense of our US healthcare system. While you can argue whether the sound levels are increasing or decreasing, they are way too much for our system to handle, and something HAS to change. Either something will change or it will break. And we really don’t want it to break.

Health insurers are necessary and are an important part of the checks and balances that are built into a managed care methodology for making decisions on healthcare. However, it should not have the power it has, primarily because it is not first interested in better more affordable care; it is interested in growth.

Not Many Answers Here, Which is the Big Problem

This is however, not a problem easily solved. Charging the Government with this responsibility is not going to make things better, absolutely for sure. Conservative political forces have no interest in non-market based solutions, which is smart, but not going to enable limits on topline revenue insurer growth. Liberal political forces have little credibility with the private sector, and have a poor rapport with healthcare providers as well.

Somehow, we have to find a way for those who invest in healthcare insurers to receive gains when company leaders reduce the size of their companies, reduce the amount of raw dollars that flow into them from premiums and create new efficiencies in the US healthcare system. This is not impossible, but will require the ourage to to do battle with some of Washington’s most powerful lobbies, the will to espouse politically dangerous ideas such as being against the growth of healthcare insurers and numbers and estimates to persuade. Who has the most to gain from doing this?

The answer is the healthcare provider community coupled with the providers of tools and technology enablement; they together stand to gain the most from a new schema and likely have their own lobby as well. A well-conceived effort to craft a way for a special class of organizations to trade on their cost containment and efficiency achievements to be qualified, along with a commitment to sensible limits (higher than CMS guidelines but sensible just the same) on the cost of care and some financial modeling would be a great place to begin the debate. Given something that really makes sense, the more results oriented members of our government would take it from there.

One Last Thing…

Harkening back to the article that began the conversation, a significant factor in the stunted use of telemedicine is the fear of litigation, or the risk-reward equation. It is out of balance and must be corrected. This means that we also have to simultaneously pass tort reform as well. That has proven to be a tough nut to crack, but with the combined juggernaut of the above proposal, maybe now is the time to roll the whole thing through the process. It may just be the most important thing we do for our future.

Bottom line, both are important, and both have their best use cases.  Each are indispensable when they are needed.  Some are absolutely unacceptable when contraindicated (a scenario not mentioned is when your client’s targets  are competitors in their market, it is tough to sit in a room with your competitors and talk about your strategic plans).

The article is here for your review, taken from Quirk’s December issue.

Qualitatively Speaking: The focus group vs. in-depth interview debate

By Carey V. Azzara

If  debate is healthy, you might describe the debate over qualitative methods as positively athletic. There are plenty of opinions regarding which qualitative approach provides the best results. You, no doubt, have your own opinion.

To explore the reasons professionals feel strongly about the merits of focus groups (FGs) versus in-depth interviews (IDIs), we asked 20 of them when and why they choose to use FGs versus IDIs. The themes that emerged from our asynchronous debate process are illuminating.

In general, there were three, somewhat predictable, positions: one-on-one interviews are superior to focus groups; focus groups are superior to one-on-one interviews; align the research approach with the research objectives.

Each person who took one of the first two positions gave well-thought-out reasons for his or her choice. It typically related to the specific research problem they faced. Another reason for a preference was skill. Practicing what you know how to do best makes sense. Many professionals are better at one approach than another; this factor obviously plays a role in the choices practitioners make.

Aligning the approach with the objectives was an overarching theme even among professionals who strongly favor one technique over the other. Thus, our next questions are, what are the “when and why” answers experts gave? And, can we create a concise best-practice statement from the collective wisdom of 20 practitioners?

Arguments for in-depth interviews

IDIs provide the best opportunity to explore decisions and compare differences and similarities among reference group members. When the research objective is to understand individual decision processes or individual responses to marketing stimuli (e.g., Web sites) IDIs are typically the choice. IDIs allow detailed exploration of a single respondent’s reactions without contamination. They are particularly valuable when researchers want individual reactions placed in the context of the individual’s experiences.

A preference for IDIs is likely when group interactions are unimportant or detrimental. A few scenarios are:

• when it is easier to reach target respondents with IDIs;

• when there is a better cost-benefit for IDIs;

• when it is preferable to collect responses without the group influence factor;

• when probing and/or laddering techniques are part of the data collection process;

• when project objectives require a direct correspondence of specific findings to specific respondent segments; and/or

• when a device or process is being tested for usability.

Additionally, if the topic is highly sensitive (e.g., serious illnesses) use of IDIs is indicated. Subjects which are highly personal (e.g., bankruptcy) or very detailed (e.g., divorce decrees) are best probed deeply with IDIs.

Sensitive subjects are also a factor in business research. Topics with competitive consequences are sensitive areas (for example, companies consider information-technology practices proprietary, especially security technology). In addition, businesses are wary of participating in FGs with competitors (such as when participants are from the same vertical industry, etc.).

A preference for IDIs was evident when:

• working with small populations, especially if geographically-dispersed;

• avoiding operational pitfalls is a concern (e.g., the threat of 60 percent of a group cancelling or possibly inviting the wrong people; it’s easier to recover from one bad-fit IDI than a FG with eight people); and

• you need deep layers of information from probing (e.g., interviewing “experts”).

In the final analysis IDIs are a practical approach and typically easier to manage. However, it’s important to distinguish between the ease-of-use factor versus the better-approach factor!

Arguments for focus groups

Several versions of the following comment were typical: “My rule of thumb is to assume focus groups and switch to IDIs only if necessary.” A basic question is, “Will the group dynamics add to the findings?”

There are triggers to suggest when to do groups versus using other qualitative approaches. FGs are particularly compelling:

• when consensus or debate is required to explore disparate views;

• to generate opportunities for point-counterpoint discussion and resolution;

• as an excellent approach for broad, exploratory topics, and as a mechanism for helping people generate and share their ideas;

• when the interaction between the participants sparks a discussion that illuminates a topic, draws out latent issues;

• when you want people to work in teams;

• when the rich quality of respondent interactions is needed or you are exploring common trends; and/or

• when you are early in the exploration of a concept or topic, as group dynamics are powerful in the discovery process.

Focus groups have an advantage when trying to engage clients (decision-makers) in the research process. When research sponsors take time to view focus groups it expedites their buy-in, moving the study to final recommendations faster. You are less likely to “lose” your client in the course of two or four hours compared to the time associated with IDIs. For some practitioners focus groups were preferred when speed is important, but apply caution here: advocates of IDIs use this argument too. FG practitioners believe IDIs take longer to execute than FGs and are harder and more time-consuming to analyze.

Focus groups of no more than eight respondents was a recommendation echoed by several practitioners. Triads and mini-groups were suggested as alternatives for generating ideas while allowing in-depth questioning. Mini-groups are well-suited to obtaining reactions to product stimuli and generating refinements. Contrary to most opinions, sensitive issues are not only okay in groups, but may be explored as well as or better than in IDIs, because respondents engage when discussing their condition or issue with others in the same boat.

Finally, the statement, “I favor the group situation; people are forthcoming among peers when attention is focused on many rather than one,” depicts a popular position.

Two themes

Two themes emerged that we can use to construct a best-practice statement. The first is characterized by the mantra, “Objectives drive design.” Evaluate critically the research objectives and apply the approach most likely to provide insights. A good practitioner chooses the best method for the work and the selection process requires understanding the merits of all available approaches.

A key question is whether the objectives are individual in nature (e.g., decisions, preferences, usability) or group-oriented and benefit from participants’ discussion or perhaps arguments (e.g., concept exploration).

The second theme is summarized by the simple comment, “Why not use both?” Designing qualitative research using IDIs and FGs provides the best of both worlds – and it’s not a cop-out! IDIs provide depth of questioning and personal information while FGs help us understand the social context of issues. The methods are complementary.

For business decision makers, combining the benefits of IDIs and FGs is a great solution if the budget supports it. In fact, perhaps the only real argument against this approach is concern about exceeding a project’s budget.

With the US working hard toward a recovery, we inch closer and closer to the end of the year. That means insurance open enrollment.

Can it go up 30& again this year? I don’t think so.

What do you think? Possible?

A recent find online speaks of an expected smaller increase of 7.2%. As much as I think it shouldn’t increase at all (because they have already received their pay in full), I may be excited about this.

We shall see…

According to the report, in 2010, the U.S. market for VR applications in healthcare reached approximately $670 million in sales. The market enjoyed a compound annual growth rate (CAGR) of more than 10 percent during the 2006-2010 period. Kalorama Information projects market growth to continue at a greater rate through 2015 as equipment and technology spending recovers among U.S. healthcare service providers.

“Virtual reality products have made a profound impact on patient outcomes and the daily workflow of physicians,” says Emil Salazar, market analyst for Kalorama Information. “The once-touted and projected ‘potential’ of VR for healthcare has translated into operational benefits for clients and real market opportunities for original equipment manufacturers, R&D companies and medical software developers. Healthcare VR product providers are well positioned to build upon established client markets and their sales in the U.S. healthcare industry.”

I believe this is going to be a critical trend in the training and ongoing education of physicians, surgeons and dental professionals in the years to come. We will have fewer pigs on pentobarbital, and more professionals learning in very real looking surroundings in their offices.

Granted, there remains additional experiential components, but on balance, it has the potential to measurably improve the quality of delivered care.

Agree? Disagree?

“This important mobile technology provides physicians with the ability to immediately view images and make diagnoses without having to be back at the workstation or wait for film,” said William Maisel, M.D., M.P.H., chief scientist and deputy director for science in the FDA’s Center for Devices and Radiological Health.

Radiology images taken in the hospital or physician’s office are compressed for secure network transfer then sent to the appropriate portable wireless device via software called Mobile MIM. Mobile MIM, manufactured by Cleveland-based MIM Software Inc., allows the physician to measure distance on the image and image intensity values and display measurement lines, annotations and regions of interest.

In its evaluation, the FDA reviewed performance test results on various portable devices. These tests measured luminance, image quality (resolution), and noise in accordance with international standards and guidelines. The FDA also reviewed results from demonstration studies with qualified radiologists under different lighting conditions. All participants agreed that the device was sufficient for diagnostic image interpretation under the recommended lighting conditions.

The display performance of mobile devices can experience significant variations in luminance levels even between mobile devices of the same model. The Mobile MIM application includes sufficient labeling and safety features to mitigate the risk of poor image display due to improper screen luminance or lighting conditions. The device includes an interactive contrast test in which a small part of the screen is a slightly different shade than the rest of the screen. If the physician can identify and tap this portion of the screen, then the lighting conditions are not interfering with the physician’s ability to discern subtle differences in contrast. In addition, a safety guide is included within the application.

Consumer Inquiries: 888-INFO-FDA

SOURCE U.S. Food and Drug Administration

Over the past two years we have seen significant upheaval in our economy. Mainly due to artificial demand created by inappropriately easy access to credit through real estate financial alchemy, we now suffer for what we spent over the last decade (or at least over the second half of the last decade). There are too many books and movies about the topic to mention.

One author I enjoy reading is John Mauldin.  John is an investment advisor with a gift for explaining what has happened to our economy in plain terms, even if it gets a bit technical at times.  In those instances, I wind up learning something new about financial derivatives and other creative ways to make money that make little in the way of quality of life.  While Mr. Mauldin has been cool about any rapid recovery, he has consistently stated one opinion: that we live in a world dominated by people with the desire to make things better than they are now, and this will produce innovation that we can’t even imagine today.  The US is the hub of this activity.  From a newsletter John sent on Nov 29, 2009, nearly a year ago:

But how many setbacks, bumpy rides, and false starts have I gone through over the decades? Frankly, I try to forget. But the point is that each of those episodes was another learning opportunity. And I woke up the next morning and started trying to figure it all out.

But it’s not just me, it’ is tens of millions of entrepreneurs and businessmen and women in the US, and hundreds of millions worldwide, that have the same ambitions and drive…every day we get up and try to figure out how to turn it into real income. And some of us are talented or lucky (that would be me) enough to make it happen.

Long-time readers know that I think we are in the midst of a secular bear cycle, much like 1966-82. The next decade is likely to produce less than average growth, due to structural problems and the bad choices we have made with personal and government debt. I am perfectly cognizant that unemployment will be over 10% for a protracted time. That is tragic for those unemployed and underemployed. I realize the entire developed world has huge and seemingly insurmountable pension and medical obligations over the next few decades, which we cannot possibly hope to meet. The level of angst that we will live through as we adjust will not be fun.

But the point is, that is just what we do – we live through it. In spite of the problems, we get up every day and figure out how to make it. Would it be better if we could get our act together in (pick a country) and not be forced to adjust because we have come to the end of the line? Yes, I know we will likely have some very tumultuous times ahead of us, making business and investment decisions more than a little difficult.

So what? The future is never easy for all but a few of us, at least not for long. But we figure it out. And that is why in 20 years we will be better off than we are today. Each of us, all over the world, by working out our own visions of psychic income, will make the real world a better place.

He goes on to talk about healthcare and the innovations to come:

Ever-faster change is what is happening in medicine. None of us in 2030 will want to go back to 2010, which will then seem as barbaric and antiquated as, say, 1975. Within a few years, it will be hard to keep up with the number of human trials of gene therapy and stem cell research. Sadly for the US, most of the tests will be done outside of our borders, but we will still benefit from the results.

I spend some spare study time on stem cell research. It fascinates me. We are now very close to being able to start with your skin cells and grow you a new liver (or whatever). Muscular dystrophy? There are reasons to be very encouraged.

Alzheimer’s disease requires somewhere between 5-7% of total US health-care costs. Defeat that and a large part of our health-care budget is fixed. And it will be first stopped and then cured. Same thing with cancers and all sorts of inflammatory diseases. There is reason to think a company may have found a generic cure for the common flu virus.

A whole new industry is getting ready to be born. And with it new jobs and investment opportunities.

I couldn’t agree more.  While we have seen (IMHO) the manipulation of money and its flow wind up creating a banking business model where a profitable, non-recourse mortgage lending business was independent of underwriting the loans (I am not exaggerating here), the future has the potential for the genuine improvement in the quality of life for the world.  This is something to both be excited about and be proud to be a part of as a research company serving the medical device, pharma and healthcare communities.

Let me know what you think…do you agree?

Ever read the blogs from people who are trying to stop taking the new batch of anxiety drugs that are used to treat depression, anxiety and bipolar disorder?  Their stories might cause you to think twice about using these drugs. 

Clearly there is no issue with using these drugs in situations where extreme measures are warranted.  Helping someone get off the streets or preventing violence is a warranted use.  Using them to relieve an unhealthy self-image may be a deal with the devil. I spent some time reading posts from the message boards regarding Cymbalta (Duloxetine) and Effexor (Venlafaxine), two SSRI antidepressants which have wide off label use and have been amazed with what these individuals are confronted with as they try to stop taking these medications.  While it is always challenging to stop taking antidepressants, drugs with pharmacologies such as these lead one to a very important question: are the results worth the potential introduction of permanent after effects that can leave someone worse off than they started, and in some cases, for the rest of their lives?

Certainly there are reasons to take medications such as these; this is in no way a general indictment of their usefulness, and for some they are the difference between chaos and peace.  However, taking them as a substitute for addressing relational problems, the treatment of adolescent misbehaving and more generalized anxiety disorders is a risky proposition. 

What do you think?  Am I being too critical or is it a good idea to have a healthy degree of skepticism surrounding powerful drugs such as these?

Somehow, we got off track and spend more time focusing on remedying problems than preventing them.  At some point, we will do better!