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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
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care—the paradigm shift from “managing cost” to “managing care”.
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