Health for life

Talk about a compelling story that went ignored.
In the November 19 issue of the Annals of Internal Medicine, Caroline Lubick Goldzweig and colleagues examined the published science on the purported advantages of electronic health record (EHR) portals.

Recall that portals are web-based entryways that on-line health consumers can reportedly use to access their records, request medications, correspond with their doctors, manage their health conditions, reduce health care costs, increase U.S. life expectancy, reduce our national dependency on jumbo-sized sugary drinks and fix everything else that ails the U.S. health system.

Unfortunately, facts have intruded.  After looking at fourteen randomized prospective trials, 21 observational, hypothesis-testing studies, five descriptive studies and six qualitative studies, the authors concluded...

 "...evidence that patient portals improve health outcomes, cost, or utilization is insufficient."

Ouch. 

In particular, any impact on diabetes care was short-lived or nonexistent, patients with heart failure had no meaningful improvement, blood pressure control did not improve and adherence to prevention recommendations were marginal.  One observational study found persons with heart failure were more likely to use the emergency room.  The only study that found any benefit involved a single randomized control trial that examined the impact of portals in the co-management of depression.

After looking at this review, depressed advocates of EHR portals may have to personally use their own portals to communicate with their docs health care medical neighborhood.

The only good news is that there were some data that suggested that a substantial number of consumers liked using the portals.  But the DMCB likes channel surfing too, but that doesnt mean that the spouse agrees that its television-watching quality has improved or that the cost of all those premium channels is moderating.

The authors pointed out that it was difficult to isolate the impact of a portal vs. a portal plus care management.  To the DMCB, that means that portals are at best a means-to-an-end of enabling care managers to better communicate with their enrollees. 

To the thousands of DMCB readers, that is not a surprise.

In the meantime, the Feds and the NCQA have one more reason to re-examine their many cherished assumptions about health information technology and the stand-alone electronic record. The last time the DMCB looked, the federal government continues to extoll portals stand-alone virtues. The National Committee on Quality Assurance (NCQA) still includes two way communication for appointments, errals and prescription errals as a standard for the medical home.  Finally, the Feds promotion of the electronic health record (EHR) approves of portals as an option in meeting meaningful use criteria.

Image from Wikipedia

When asked in the July 23rd Democratic Presidential Debate what he would do to keep entitlement programs such as Medicare from going broke, New Mexico Governor Bill Richardson replied:


Heres the transcript:

QUESTION: Whats the dirtiest little secret in Washington? The U.S. is going broke. With the retirement of the baby boomers, things are only going to get worse. Fed Chairman Bernanke has said Medicare, Medicaid and Social Security need to be radically changed to avoid this crisis, yet everything is business as usual in D.C.

There are two solutions, both of which are politically unpopular: Raise taxes or cut benefits. Which would you choose, and how would you convince the public to support you?

COOPER: Governor Richardson?

RICHARDSON: The best solution to those two issues is a bipartisan effort to fix it.

Medicare - 33 percent of it is diabetes. Lets have major prevention programs, and also ways that we can ensure that we find a cure.

Is that true? Does diabetes account for a third of Medicare spending? Apparently, yes. The Department of Health and Human Services states:

"About 18 percent of Medicare beneficiaries have diabetes, yet they account for 32 percent of Medicare spending."
- US Center for Medicare and Medicaid Services

Its certainly worth finding a cure!________