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E-CareManagement News

September 11, 2000

E-CLINICAL TRIALS: A BOOST FOR DISEASE MANAGEMENT OPTIONS

Two excellent recent studies provide in-depth and up-to-the-minute analyses of advancements in clinical trials. E-clinical trials promise to be a killer application of the Internet in health care.
Clinical trials research is a key aspect of improving disease management processes:

  • Clinical trials are a required step in taking promising pharmaceutical products and demonstrating their safety and efficacy.
  • Pharmaceutical products often can provide improved health and quality of life for patients.
  • Pharmaceutical products often (not always) are cost effective tools for disease management. Treating patients with drugs is often cheaper than paying for emergency room visits, surgeries, or hospital admissions.
  • "Clinical Trials: Where Patient Care and Clinical Research Meet" 
    is published by First Consulting Group (FCG). 

    "e-Pharma: Accelerating Clinical Trials and Enhancing Details" is published by Friedman, Billings, Ramsey, and Co. (FRBC).
     
    The FCG report notes three major forces driving growth of clinical trials:

    Force #1: Growth of the EMR (Electronic Medical Record) market
    Force #2: Increasing regulatory requirements
    Force #3: Growth of consumerism

    The authors describe "Pockets of Potential" for clinical trials:

    Pocket #1: Niche Markets (children, women, minorities, seniors)
    Pocket #2: Biotechnology
    (Pockets? Sounds more like, hmm, well, just about everybody!)

    The FBRC report summarizes the rationale underlying the shift to e-Trials:

  • Inefficiencies of the existing paper-based process
  • Cost of delays in development "...the opportunity cost stemming from a one-day delay in the development progression of a blockbuster drug can result in a revenue loss that easily exceeds $1 million."
  • Lack of institutional memory in a paper-based system
  • The impact of Genomics and Proteomics 
  • The FBRC study describes applications of Internet technology in clinical trials:

  • Trial design (protocol)
  • Patient recruitment
  • Electronic data capture
  • Incorporation of handheld tools in a trial environment
  • Connectivity
  • DOCTOR APATHY STALLS DOT-COMS

    From an editorial in American Medical News, September 11, 2000:

    "Most doctors are simply not interested in what those dot-coms are selling and it may take years before they are."

    "...doctors are resistant to paying for new technology and suspicious -- rightfully so -- of e-health firms' promises to simplify their work lives."

    Commentary: Harsh and to-the-point words. Alternative reactions to this editorial could be "the docs still don't get it", or "they're not hearing us...maybe it's because we're mumbling". Time will tell.

    EMPLOYER HEALTH BENEFITS 2000 ANNUAL SURVEY

    The Kaiser Family Foundation and the Health Research and Education Trust have published "Employer Health Benefits 2000".

    This 174 page report examines health benefits from a number of angles, including cost, choice, employee contributions and cost sharing, benefit levels, drug and mental health benefits, retiree benefits, employer quality and cost concerns, and the uninsured.

    The survey touches on the hot topic of defined contribution (DC) benefits. Under a DC approach for health benefits, employees are given cash to buy health insurance on their own rather than selecting from among plans contracting with an employer. The vast majority of employer respondents say it is unlikely they will shift to a DC approach in the next five years. 7% of firms say it is "very likely" and 13% say it is "somewhat likely" (see Exhibit 14.5).

    EDITORIAL: IMPROVEMENT OF OUTCOMES IN CHRONIC ILLNESS

    From an editorial in the August 2000 issue of the Archives of Family Medicine:

    "Randomized trials have now demonstrated methods in organized medical systems to improve the process and outcomes of care for patients with chronic medical illnesses. These will require systematic changes in roles of professionals as well as the development of information systems that facilitate monitoring of treatment adherence and outcomes. Many systems of care are currently implementing key components of these disease management mechanisms in a stepwise fashion. But in a competitive health care environment, few have the economic resources to systematically provide all the components of the effective programs described in the research trials. Economic incentives by health care insurers such as the Health Care Financing Administration for improving outcomes of chronic illness would likely dramatically speed up the process."

    Commentary: As Vince's 15 year old son would say, "duh". ....and it's refreshing to find this type of editorial perspective in a leading medical journal.

    OLDER AMERICANS 2000: KEY INDICATORS OF WELL-BEING

    Older Americans are living longer and living better than ever before. But many of those age 65 and older face disability, chronic health conditions, or economic stress, according to a new report that describes the status of the nation's older population.

    The Federal Interagency Forum on Aging-Related Statistics is a consortium of U.S. government agencies working together to improve the quality and usefulness of data on older Americans. The Forum developed the report, "Older Americans 2000: Key Indicators of Well-Being" .

    The reported prevalence of major chronic conditions has been increasing. As shown in the table below, among older Americans reporting on six key chronic conditions, only the percentage of women reporting hypertension declined between 1984 and 1995.

    Percentage of Persons Age 70 or Older Who Reported Having Select Chronic Conditions, By Sex, 1984 and 1995 (Indicator 14)

                            1984      1995
    ARTHRITIS
    Men                   45%      50%
    Women              61         64

    DIABETES
    Men                  10          13
    Women             10          12

    CANCER
    Men                  14          23
    Women             12          17

    STROKE
    Men                   8           10
    Women              7            8

    HYPERTENSION
    Men                  37          41
    Women             51          48

    HEART DISEASE
    Men                  19          25
    Women             15          19

    (Caution in interpretation: are the increases due to increased longevity or increased disease rates?)

    eHEALTH CONTENT COMPANIES SHOW IMPROVEMENTS

    According to research by Gomez.com, online health content sites are making great strides to improve the quality and depth of the information and services they offer.

    Specific findings include:

  • Depth of content has improved significantly.
  • Privacy is now being taken seriously.
  • Add e-care to the growing list of services.
  • Integration is still a challenge.
  • Gomez' research shows HealthCentral.com in the top spot on its Internet Health Scorecard for Summer 2000.

    FIRM SCORE
    1. HealthCentral.com 7.00 
    2. WebMD 6.88 
    3. DrKoop.com 6.85 
    4. OnHealth 6.73 
    5. InteliHealth 6.05



    E-CareManagement News is an e-newsletter that tracks a major change in health care and managed care—the paradigm shift from “managing cost” to “managing care”.  This e-newsletter is brought to you by Better Health Technologies, LLC (http://www.bhtinfo.com).  BHT provides consulting and business development services relating to disease management, demand management, and patient health information technologies.

    You may copy, reprint or forward this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2000, Better Health Technologies, LLC. All rights reserved.


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