Comments on: Where Our Health-Care and Innovation Systems Both Fall Down http://mmwaldrop.com/Starclouds/2007/12/10/where-our-health-care-and-innovation-systems-both-fall-down/ Mon, 06 Oct 2008 16:53:03 +0000 http://wordpress.org/?v=2.6.2 By: Mitch http://mmwaldrop.com/Starclouds/2007/12/10/where-our-health-care-and-innovation-systems-both-fall-down/#comment-28 Mitch Fri, 14 Dec 2007 17:17:16 +0000 http://mmwaldrop.com/Starclouds/2007/12/10/where-our-health-care-and-innovation-systems-both-fall-down/#comment-28 An emailed comment from Jeffrey Murrah, <a href="http://www.RestoreTheFamily.com" rel="nofollow">http://www.RestoreTheFamily.com</a> : My experience is that government policy interferes with innovation in health care. Innovation is not rewarded, but rather penalized. There are efforts to standardize procedures, but these are often driven by utilization of financial resources and legal risks, rather than innovation. Besides government regulation and policy, there is the problem of insurance. Many insurance companies only pay for specific procedures based on variables they determine rather than being driven by patient care. The insurance companies go so far as to limit the medications available to the patient. They limit their consideration to the specific formularies that the company approves. Innovation involves risks. Anytime procedures are performed that are outside of the defined "standards of care", they are frowned upon at a minimum. In hospitals, there is usually additional paperwork and scrutiny when someone deviates from the accepted procedure, which tends to stifle innovation. Innovation is also stifled by lawsuits which make anyone who attempts innovative procedures or techniques look negligent. They often define negligence as deviating from the accepted procedure. Since most people in health care do not want to be sued, they stay within the "accepted" procedures and policies. The systems set up for health care have put restraints on innovation. There is some innovation, but even that is limited to following the established procedures for trials, studies, etc. If government and insurance companies took off the restraints, health care could operate more like a science rather than kitchen that only prepares approved dishes prepared in approved methods. An emailed comment from Jeffrey Murrah, http://www.RestoreTheFamily.com :

My experience is that government policy interferes with innovation in health care. Innovation is not rewarded, but rather penalized. There are efforts to standardize procedures, but these are often driven by utilization of financial resources and legal risks, rather than innovation. Besides government regulation and policy, there is the problem of insurance. Many insurance companies only pay for specific procedures based on variables they determine rather than being driven by patient care. The insurance companies go so far as to limit the medications available to the patient. They limit their consideration to the specific formularies that the company approves.

Innovation involves risks. Anytime procedures are performed that are outside of the defined “standards of care”, they are frowned upon at a minimum. In hospitals, there is usually additional paperwork and scrutiny when someone deviates from the accepted procedure, which tends to stifle innovation. Innovation is also stifled by lawsuits which make anyone who attempts innovative procedures or techniques look negligent. They often define negligence as deviating from the accepted procedure. Since most people in health care do not want to be sued, they stay within the “accepted” procedures and policies.

The systems set up for health care have put restraints on innovation. There is some innovation, but even that is limited to following the established procedures for trials, studies, etc. If government and insurance companies took off the restraints, health care could operate more like a science rather than kitchen that only prepares approved dishes prepared in approved methods.

]]> By: Jack Scott http://mmwaldrop.com/Starclouds/2007/12/10/where-our-health-care-and-innovation-systems-both-fall-down/#comment-27 Jack Scott Wed, 12 Dec 2007 15:45:29 +0000 http://mmwaldrop.com/Starclouds/2007/12/10/where-our-health-care-and-innovation-systems-both-fall-down/#comment-27 In October 2006, the National Institutes of Health launched a major initiative designed to promote and accelerate the translation of basic biomedical research into clinical studies, and ultimately, into clinical practice. Called the Clinical and Translational Science Awards (CTSA) program, this initiative will provide funding for up to 60 academic health centers across the US by the year 2012. The CTSA program is one of the cornerstones of the NIH's Roadmap for Medical Research effort. It is based on a clear recognition that the pace of translation of findings from basic research within the US has slowed over the past several decades for a number of reasons,and that revitalizing this system will require a massive "re-engineering of the clinical research enterprise". To date, 24 institutions have received funding through this program. The CTSA program addresses this re-engineering effort in two fundamental ways. First, it seeks to remove some of the structural obstacles that might impede clinical and translational research by supporting the development of research infrastructure (e.g., biomedical informatics, etc.) and the streamlining of internal processes (such as the Institutional Review Board process.) Second, it funds the development of new training programs to train the next generation of clinical and translational researchers, and supports the development of institutional career paths and incentives to attract these young investigators to clinical and translational research and retain them over time. If you want more information about this, there is a good website on the program which you can find at http://www.ctsaweb.org. In October 2006, the National Institutes of Health launched a major initiative designed to promote and accelerate the translation of basic biomedical research into clinical studies, and ultimately, into clinical practice. Called the Clinical and Translational Science Awards (CTSA) program, this initiative will provide funding for up to 60 academic health centers across the US by the year 2012. The CTSA program is one of the cornerstones of the NIH’s Roadmap for Medical Research effort. It is based on a clear recognition that the pace of translation of findings from basic research within the US has slowed over the past several decades for a number of reasons,and that revitalizing this system will require a massive “re-engineering of the clinical research enterprise”. To date, 24 institutions have received funding through this program.

The CTSA program addresses this re-engineering effort in two fundamental ways. First, it seeks to remove some of the structural obstacles that might impede clinical and translational research by supporting the development of research infrastructure (e.g., biomedical informatics, etc.) and the streamlining of internal processes (such as the Institutional Review Board process.) Second, it funds the development of new training programs to train the next generation of clinical and translational researchers, and supports the development of institutional career paths and incentives to attract these young investigators to clinical and translational research and retain them over time.

If you want more information about this, there is a good website on the program which you can find at http://www.ctsaweb.org.

]]> By: Ken Jarboe http://mmwaldrop.com/Starclouds/2007/12/10/where-our-health-care-and-innovation-systems-both-fall-down/#comment-25 Ken Jarboe Mon, 10 Dec 2007 23:17:26 +0000 http://mmwaldrop.com/Starclouds/2007/12/10/where-our-health-care-and-innovation-systems-both-fall-down/#comment-25 Diffusion of innovation has always been the laissez faire portion of the process. It is assumed that if the innovation is good enough, the market will work its magic (build a better mousetrap ...). Every once and awhile some one realizes that in a specific area, diffusion needs help. That was the rationale for the Agricultural Extension Service (to diffuse new agricultural science) and the Manufacturing Extension Partnership. But the idea of a more systematic process for diffusing innovation generally is seen as an anathema -- "picking winners and losers." Maybe we need to change our mindset. Diffusion of innovation has always been the laissez faire portion of the process. It is assumed that if the innovation is good enough, the market will work its magic (build a better mousetrap …). Every once and awhile some one realizes that in a specific area, diffusion needs help. That was the rationale for the Agricultural Extension Service (to diffuse new agricultural science) and the Manufacturing Extension Partnership. But the idea of a more systematic process for diffusing innovation generally is seen as an anathema — “picking winners and losers.” Maybe we need to change our mindset.

]]> By: Josh Chamot http://mmwaldrop.com/Starclouds/2007/12/10/where-our-health-care-and-innovation-systems-both-fall-down/#comment-24 Josh Chamot Mon, 10 Dec 2007 18:29:35 +0000 http://mmwaldrop.com/Starclouds/2007/12/10/where-our-health-care-and-innovation-systems-both-fall-down/#comment-24 This would be an interesting question to pose to the authors of the Academies reports -- they've done several. From personal experience (not much of a source, I know), I've been very pleased with how my new doctor tracks my visits over an electronic system. She followed a checklist while doing my initial exam and then was able to link my medical records from that single point from that day forward -- even my cardiologist was able to access these records when I had later visits with him and my bloodwork labels are regularly printed from that source as well. Simple system, but incredibly valuable. This would be an interesting question to pose to the authors of the Academies reports — they’ve done several. From personal experience (not much of a source, I know), I’ve been very pleased with how my new doctor tracks my visits over an electronic system. She followed a checklist while doing my initial exam and then was able to link my medical records from that single point from that day forward — even my cardiologist was able to access these records when I had later visits with him and my bloodwork labels are regularly printed from that source as well. Simple system, but incredibly valuable.

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