Open Mobile Health Exchange

Getting information about specific patients' current situation is one of the biggest problems in clinical decision support. Perhaps what's needed is a simple short messaging protocol that allows Twitter-like text strings to be both machine- and human-readable. I wish I thought of it, but the good folks at microsyntax.org get the kudos.

OMHE (Open Mobile Health Exchange), pronounced "ooommm," is an open-source microsyntax for text messaging (mobile SMS), Twitter®, medical devices, and other "short text capable" systems.

OMHE has a short list of standard messages and commands like

wt=182

to transmit a current weight or

getphr

to request a copy of your personal health record. The target audience includes cell phone users entering personal info on the go, distributed data collection devices like blood glucose monitors and pedometers, and patient services like personal health records or disease management nurses. I think this idea may have real utility in a variety of settings, and being open-source is a big plus.

More can be found at http://code.google.com/p/omhe/

AMIA Year in Review

This just in - your blogger is bursting with pride as the American Medical Informatics Association released the AMIA Informatics 2009 Year in Review: A compendium of notable publications and events in the field of biomedical informatics. There we are, second in the list of studies about decision support for patients: Littenberg B et. al. The Vermedx Diabetes Information System reduces healthcare utilization. Am J Manag Care. 2009 Mar;15(3):166-70.

Professor Masys of Vanderbilt, who compiles the list, puts a heavy weight on randomized controlled trials in picking the entries, as well he should. Thanks for including us!

Diabetes Quality of Care

AHRQ (the US Agency for Healthcare Research and Quality) recently published an analysis of the quality of diabetes care across the country. The numbers are (still) not good. 7.4% of Americans (16.5 million people) have been told they have diabetes. (Probably another 8 million don't even know it.) Among seniors, the rate goes up to 18.3%.

Only a third of diabetic patients have had the 3 basic tests (an A1C test, an eye exam, and a foot exam) in the last year. The AHRQ didn't even report on cholesterol, kidney function, urine tests or the fact that good care requires 2 to 4 A1C tests per year - not just one.

So, we're still not applying the good science we have about diabetes to the benefit of Americans with the disease. Why not? Lots of reasons including access to care (read health insurance), patient factors (language or cultural barriers, fear, ignorance, illegal residence, etc.), conflicts with other health and personal needs (work, family, etc.), and poor systems of care. We still don't use the tools we have (computers, checklists, flowsheets, reminders and the rest) to ensure that basic needs get met with regularity.

There is hope as more and more people realize the tremendous waste of lives and money associated with sloppy care. The solutions are fast, cheap and easy, but they do require thinking about systems of care, not just visits, and about small investments that yield big savings.

The full report is available for free: Soni, A. Diabetes Management: Tests and Treatments among the Adult U.S. Civilian Noninstitutionalized Population, 2007. Statistical Brief #269. November 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st269/stat269.shtml

The National Association of Managed Care Physicians

The National Association of Managed Care Physicians (NAMCP) will be hosting the annual Fall Managed Care Forum in Las Vegas this week. I'm honored and excited to be on the program on Thursday, November 12 at 1:30 at the Bellagio. I'll be talking about "Treatment Improvement and Cost Savings in Diabetes Care" and how the Vermedx Diabetes Information System improves the quality of care for patients and providers while saving the payer over $2,400 per year.

You can learn more about the meeting at www.namcp.org.

See you in Vegas, baby! 

Vermedx Video

Here is a video presentation about the Vermedx Diabetes Information System and the savings it generates for payers, providers and patients.

Vermedx and Texas

FirstCare Texas has signed a contract with Vermedx, Inc. to provide its patent-pending Vermedx Diabetes Information System (VDIS) for the use of health care providers and patients belonging to First Care Health Plan's health maintenance organization operating in Lubbock, Waco, Abilene, and Amarillo, Texas.

FirstCare CEO Clifford Frank cites the success of the Vermedx Diabetes Information System, as detailed in the March 9 edition of The American Journal of Managed Care. This article describes how Vermedx reduces annual treatment costs by an average of $2,400 per adult patient while improving patient treatment quality. "It's a very cost-effective, quick to implement and easy to operate technology for our providers to add to their repertoire of tools for improving patient satisfaction and enhancing treatment quality," said Frank.

VDIS captures laboratory test results from multiple labs and provides patient-level evidence-based best practices recommendations for care. VDIS also provides quarterly population reports that help clinicians focus on highest risk and out-of-compliance patients in addition to generating automated reminder and alert letters for patients. VDIS is currently being utilized by primary care physicians in managed care and integrated hospital systems in three states, following a successful five-year NIH sponsored clinical trial.

FirstCare is owned by two religious-based health systems -- Covenant Health Systems in Lubbock, Texas, and Hendrick Health Systems in Abilene, Texas. FirstCare has been serving the health insurance needs of approximately 200,000 members since 1986. The corporate headquarters are located in Austin, Texas, with satellite offices in Abilene, Amarillo, Lubbock and Waco.