Drugs can be expensive, difficult to research, hard to get approved, and, according to a recent report, don't work on large parts of the population. These factors likely put a great deal of pressure on pharmaceutical companies to research drugs that have the highest probability of turning a profit rather than those that could help the most people. But this paradigm may be shifting with the help of IT and big data. The industry has found new ways IT and big data are making a major impact on the way drugs are being researched by helping create more effective trials. Before we examine the benefits IT is bringing to this arena, let's try to understand what's wrong with the traditional (and ongoing) way most drugs enter trial.
Any conversation focused on what's great about America usually includes a mention of optimism, hopefulness or some variation on the theme. Americans generally still believe in a brighter future, and especially the ways in which technology can enable that future. But that sense of optimism contains a kernel of potential disappointment when we ask technology to do too much. Consider the case of mental health care, a profession that faces massive budget shortfalls. According to Robert Glover, executive director of the National Association of State Mental Health Program, from 2009 to 2012 states cut roughly $5 billion in mental health services and eliminated about 4,500 public psychiatric beds.
For the past four years, US hospitals participating in the Electronic Health Records (EHRs) Incentive Program through Medicare and Medicaid have been eligible for financial incentives if they met meaningful-use criteria. This year, however, hospitals participating in the Medicare portion of the program could face financial penalties for not meeting meaningful-use requirements. According to a new study by Julia Adler-Milstein, Catherine M. DesRoches, Peter Kralovec, Gregory Foster, Chantal Worzala, Dustin Charles, Talisha Searcy, and Ashish K. Jha, being released by Health Affairs as a Web First, this "carrot and stick" approach has worked. Using 2008–14 nationwide data on EHR adoption trends, the authors found that by 2014, 75 percent of US hospitals had adopted at least a basic EHR system—up from 59 percent in 2013.
The primary concern had been that providers would have multiple claims bounced back from insurers due to errors or unspecified codes. And while that's happened to some degree, it hasn't created widespread problems.
California providers reported few problems with the transition to ICD-10 in October and a minimal number of claim denials linked to coding errors.
"We've heard about a few issues with providers having claims rejected but nothing on a large scale," said Molly Weedn, associate vice president of public affairs for the California Medical Association. "And the few instances we've heard about where there are coding issues, they've been resolved pretty easily between the physicians and insurers."
There were a number of concerns in the run-up to ICD-10 and its more detailed system of codes. The primary concern was that providers would have multiple claims bounced back from insurers due to errors or unspecified codes. And while that's happened to some degree, it hasn't created widespread problems.
One the state's largest medical groups, Brown & Toland Physicians, said there was "nothing really to report" in terms of problems with ICD-10 coding. "We did a lot of education with our doctors—more than a year's worth—and the doctors on our EHR system had less to worry about since the system was updated to ICD-10 codes," said Richard Angeloni, director of integrated marketing and communications for San Francisco-based Brown & Toland.
Other states are also having a smooth transition into ICD-10. Barbie Hays, coding and compliance strategist for the American Academy of Family Physicians (AAFP), said she's heard about some problems but nothing widespread.
"We're not hearing about any catastrophes," said Hays. "We're hearing about some claims being rejected because they're missing vital information or because they listed a condition as unspecified."
Hays said concerns about the new coding system being too labor intensive for clinicians and physicians have been justified to some degree. "Before the launch of ICD-10, physicians were worried that they'd be up until 2 a.m. doing paperwork," said Hays. "But from what we're hearing, physicians are only taking an extra two or three minutes per patient [for paperwork]."
Hays added that some coding problems appear to be linked to certain electronic medical record systems. "We're hearing that some EMR systems are not doing as well as others and that the whole claims process is taking longer," said Hays.
Both the CMA and AAFP credit a yearlong program of training and testing leading up to the rollout of ICD-10 for the smooth transition. "We did a lot of work with our members leading up to the transition and that work seems to have paid off," said Weedn.
The Centers for Medicare & Medicaid Services (CMS) reported that only 10.1% of Medicare and Medicaid claims were denied during the first four weeks of October, just slightly more than the average rate of 10% of claims denied in a typical month.
"CMS has been carefully monitoring the transition and is pleased to report that claims are processing normally," CMS said in a statement. "During the first four weeks of October, 2% of all claims were rejected due to incomplete or invalid information and less than 1% were rejected due to invalid ICD-10 coding."
The California Department of Health Care Services (DHCS) said it's rejected a minimal amount of claims due to ICD errors since October 1. "DHCS has determined that an average of less than 1% of claims are being rejected for ICD-10-related errors," said DHCS spokesperson Carol Sloan. "The errors on the rejected claims are due to providers billing by using an incorrect code set or an incorrect ICD-10 indicator." She added that provider calls and questions regarding claims in October "have been consistent with historical baseline data."
Your doctor may soon prescribe you a smartphone app in addition to drugs and physical therapy. Hospitals are developing new mobile apps to help patients manage serious medical conditions and feed information back to their doctors between visits, often in real time. The new apps aim to help with highly specific issues such as recovering from surgery and managing cancer-related pain. Because they are prescribed by physicians and used under medical supervision, researchers say, they stand a better chance of being integrated into patients' daily routines, compared with health apps that consumers download and use without their doctors' involvement. [Subscription Required]
When you're coming down with a cold, there are a few items you typically reach for to start feeling better: cough drops, herbal tea, maybe an over-the-counter medication. For most of us, though, a smartphone wouldn't top that list. But that may change as health care companies increasingly steer customers toward streaming video apps that connect patients with doctors online. The push toward virtual health care comes as many primary doctors are over-booked and patients struggle with their own busy schedules. At the same time, insurers and employers see an opportunity to save money by reducing pricier visits to doctors' offices and urgent care clinics.