July 16, 2002
E-HEALTH: JOINED AT THE HIP
"Slow broadband deployment is the
key limitation in our high technology economy." Andrew Grove,
Here's a pop quiz -- the answer might
surprise you: What percentage of US households have high-bandwidth
Internet connections? What percentage of South Korean households?
Several recent reports have examined
the compelling advantages of broadband (high-speed) Internet and
have highlighted some of the most promising health care
applications. This brief reviews key excerpts and highlights some of
the surprising findings.
Broadband: A 21st Century Technology
and Productivity Strategy
Office of Senator Joseph I. Lieberman, May 2002
Press release or
Broadband applications for e-medicine include (Table 1):
monitoring of patient vitals
Virtual physical examinations
consultations between health professionals
consultations between patients and physicians
health training programs
Automated patient inquiry handling
Broadband Difference: How online Americans' behavior changes with
high-speed Internet connections at home"
Pew Internet Project; June 23, 2002
There are three major ways in which broadband users distinguish
themselves from their dial-up counterparts. For high-speed home
users, broadband lets them use the Internet to:
creators and managers of online content;
satisfy a wide range of queries for information, and;
in multiple Internet activities on a daily basis.
Because of their active information
gathering, home broadband users report that the Internet helps them
in various dimensions in their lives:
half (47%) say the Internet has improved the way they get health
extra time spent online due to broadband -- and the wider range
of online activities done by broadband users -- comes at the
expense of the use of traditional media, shopping in stores,
working at the office, and commuting in traffic.
Broadband users do not report that the Internet has had much
impact on the time they spend with family, friends, or attending
Age Wave Meets the Technology Wave: Broadband and Older Americans"
Senior Net, June 2002
Broadband technology may have the greatest impact on the lives of
seniors in the area of health. One of the most innovative uses of
broadband networks will be to help people remain independent as they
age and become more frail.
But we have not yet made the changes
to our health care system that are required to make telemedicine
part of the mainstream. In addition, the quality of applications
that can be delivered over low-speed networks is severely limited.
The growth of high-speed networks will make it possible to deliver a
much broader range of high-quality health services to patients at
home or wherever they may be.
The answer to the pop quiz: while
less than 10% of US households currently have broadband Internet
access, over 50% of South Korean households have high-bandwidth
connections! ...and what's more surprising is how broadband
Korea's "hypersocial culture"
PROFILE THE CHRONICALLY ILL
"Medicare: Cost and Prevalence of Chronic Conditions"
Partnership for Solutions, July 2002
"A Portrait of the Chronically Ill in America, 2001"
The Foundation for Accountability and the Robert Wood Johnson
GOVERNMENT PAYMENT FOR MEDICARE -- DM AND OTHER PROMISING OPTIONS
"Report to the Congress: Assessing Medicare Benefits"
Medicare Payment Advisory Commission, June 2002
The Medicare Payment Advisory Commission (MEDPAC) advises the U.S.
Congress on Medicare issues. This report examines options for
expanding the benefit package to cover additional services:
prescription drugs, mental health, case and disease management,
preventive, vision, hearing, and dental. The report acknowledges
that "although adding benefits in those areas would raise Medicare
spending, spending by other payers would fall."
Although the report devotes several pages to disease management
coverage options (see pp. 54-55), its conclusions are bland. "To
better meet the health care needs of beneficiaries with chronic
conditions and potentially reduce total health care spending, policy
makers may want to consider covering case and disease management
services as part of fee-for-service Medicare."
The report suggests several issues to
consider in pending disease management demonstration projects:
services should Medicare pay for and who should deliver them?
could financial incentives be used to encourage providers to
offer cost-effective, clinically appropriate services?
could benefits be managed cost-effectively?
AHRQ REPORT LISTS
TOOLS TO IMPROVE PATIENT AND PROVIDER DECISION MAKING
Patient-Centered Care to Empower Patients and Assist Providers"
Agency for Healthcare Research and Quality (AHRQ), May 2002
This report describes tools developed by the Agency for Healthcare
Research and Quality (AHRQ) that are currently available to help
patients and their providers make better decisions. It suggests that
a broader application of existing tools, as well as the development
of similar tools for different areas of care, will improve the
quality of care from the perspectives of patients, providers, and
WHAT HAPPENS AFTER
EVERYBODY HAS A CELL PHONE?
"Invisible Mobile Ignites Telecom"
Forrester Research, May 2002
In Europe telecom companies are challenged by the already-high
penetration of wireless voice services. Over 70% of the population
already has a cell phone, so opportunities to create new users are
Telecom companies are exploring new ways of developing data driven
applications for cellular service. This report highlights promising
applications, including a fascinating discussion of patient
MORE CHOICE TO EMPLOYEES
Choice in Health Care: Five Steps Employers Can Take Now"
National Center for Policy Analysis; June 17, 2002
- Let employees know what health
- Allow cash-outs
- Eliminate community rating
- Increase employee choice
- Increase direct pay
IN ONLINE HEALTH COMMUNICATIONS -- 5 TIPS FOR EMPLOYERS
"CIGNA Survey Shows Online Disconnect: While Most Employers Now
Offer Online Benefits, 4 of 5 Workers Say Effort Still Misses the
Cigna Press Release; June 24, 2002
Full Description of 5 Tips for Employers
1) Keep it simple
2) Online education
3) Personalization wins out
4) Make it interactive. The most popular online health care services
Opportunity to select a doctor
Reviewing the status of medical claims
Determining co-payments and deductibles
Reviewing health plan options, and
Accessing health and wellness information.
5) Broad, integrated company
STUDIES OF TELEMEDICINE ARE LACKING
"Systematic Review of Cost Effectiveness Studies of Telemedicine
British Medical Journal; June 15, 2002
Conclusion: There is no good evidence that telemedicine is a cost
effective means of delivering health care.
...There is little published evidence
to confirm whether or not telemedicine is a cost effective
alternative to standard healthcare delivery.
The authors found that only 55 of 612
identified articles presented ANY actual cost benefit data, and that
only a subset of these articles addressed the issue adequately (see
REVIEW OF STUDIES
EXAMINING ASTHMA DM
"Disease Management Balancing Cost and Quality: Studies of the
benefits of disease management services for the treatment of asthma"
National Pharmaceutical Council, April 2002
ON THE STATE-OF-THE-ART IN DIABETES CARE
"More Than the Patch: New Medical Technologies"
New York Times; June 2, 2002
American Diabetes Association (ADA)
Scientific Sessions Online;
June 14-17, 2002
"The Role of Primary Care Professionals in Managing Diabetes"
Clinical Diabetes, Volume 20, Number 2, 2002
"Telemedicine payment expansion sought.
One measure would require that Medicare pay physicians the same fee
for remote monitoring as for face-to-face encounters."
American Medical News; July 8/15, 2002
"Routine maintenance: Disease-management programs continue to grow,
but lack of physician and patient cooperation remains a sore spot"
Modern Healthcare; July 1, 2002
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mentioned this issue.
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