Ownership and access to medical data

Unpatients—why patients should own their medical data

Eric Topol says in Nature Biotechnology:

Today, in the United States, health data live in a plethora of places, from electronic health record (EHR) systems, insurance claims databases, siloed personal health apps, research and clinical trial databases, imaging files and lots of paper. Although seemingly everywhere, any true semblance of an overarching organization or standardization of medical data are lacking, whether at the individual or societal level

His proposal is straightfoward: the ownership of the clinical record is of the patient. This situation is completely different in our country. We have public centralised repositories and the patient is the owner. There is still a lack of coordination and many things to solve, however the basics are covered in the publicly funded System, that's not the case in the private sector.

In contrast to the legal and technical difficulty an individual faces to obtain all his or her own medical data is the relative ease with which hackers have managed to breach ~100 million patient records in the first half of 2015

And his proposal:

 We must begin talking about creating a health data resource in a much broader and more universal context, controlled by the individuals who supply the data. This is a unique moment where we may be able to provide for personal control and, at the same time, create a global knowledge medical resource.

Sounds interesting, though methodology is crucial for success.


PS. Hacking electronic records:

The timeline for electronic medical data hacks in the United States of over 1 million individuals

Cardiovascular disease and diabetes: progress and prospects

OECD Health Policy Studies Cardiovascular Disease and Diabetes

A recent OECD report highlights the huge improvement on cardiovascular disease and at the same time explains the policies and strategies needed for the near future. Treatment improvement accounts for 40% in the decrease of mortality, change in risk factors 50%, while 10% is unexplained. This means that public policy is critical for success. Nowadays it is still the first disease to tackle. On diabetes, the report explains that 85 million europeans are currently suffering from the disease. Therefore, it remains a severe issue.
I suggest you take a close look at the report.

Healthy life expectancy: the key indicator

Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition

In former posts I have advocated that healthy life expectancy should be used as an aggregated indicator of outcomes of health determinants. Unfortunately although it is imperfect, it is the best we have, and today you can check the latest estimates in a salient article in The Lancet.

Countries with highest healthy life expectancy, both sexes, 2013

1	Japan
2	Singapore
3	Andorra
4	Iceland
5	Cyprus
6	Israel
7	France
8	Italy
9	South Korea
10	Canada

Spain has disappeared from the former top 10. I have always said that ordinal rankings have flaws, however, comparisons across time are worth taking into account.
Internally in Spain it is difficult to reverse this trend. If you consider geographic variations of the indicator you can see a range from 55 years up to 65 (p.25) .Therefore there is too much noise when you focus on the state as the unit of analysis. Forget the results and the ranking.
The only situation that is unique in the ranking is Andorra, it always appear at the top and it is a small state. That's remarkable and merits close analysis.

Henri Matisse, Promenades intérieures

Exposition du 12 juin au 4 octobre 2015

Musée Matisse

Beware of healthcare providers consolidation

The Potential Hazards of Hospital Consolidation Implications for Quality, Access, and Price

The key message:

  With the current most substantial consolidation of health care in US history, the concerning implications of the trend of hospital consolidation on quality, access, and price must be carefully considered. However, unlike banks that became too big to fail, 85% of US hospitals pay no taxes because they are designated as nonprofit organizations serving a public good. Hospitals can set prices that are ultimately passed on to others in the form of escalating insurance deductibles and taxes.

The alternative:

 The good work of integrated hospitals should continue to create networks of coordinated care, while at the same time, physicians and patients should insist that hospitals compete on transparent prices and quality outcomes. Achieving this goal is an important prerequisite to a functional health care system.

Tackling obesity: the toolbox

Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking

World Cancer Research Fund International NOURISHING framework 
Food policy framework for healthy diets and the prevention of obesity and diet-related non-communicable diseases. 

 Key message:

The problem of obesity must be reframed to acknowledge on one hand that individuals bear some personal responsibility for their health, but that, on the other hand, environmental factors exploit biological, psychological, social, and economic vulnerabilities that promote overconsumption of unhealthy foods. A vicious cycle is created in which the preference and demand for unhealthy products are not only shaped by the environment, but lead to environmental changes that further encourage consumption of unhealthy foods. This cycle makes it difficult for people to act in their own long-term self-interest, but it can be broken with regulatory actions from governments and joint efforts from industry and civil society to create healthier food systems.

European health regulation on lab tests, the final round?

Medical devices: Council getting ready for talks with EP

Last June 15th, there was a small but significant step towards the final agreement on Medical devices and in vitro diagnostics regulation in Europe. The need for reform has been widely requested but the lack of political consensus and the low priority given to the issue has delayed its approval in many ocasions. It seems that now is the right opportunity, however if finally passes, it will be applied on 2020!!!. It really sounds weird that it would take 5 years to be fully developed.
Anyway, if you want to have a look at the details check here and here. Right now, the lobbies are not on vacation, they are fighting against some provisions that limit their current freedom of market access. Pay attention to final result, just to check who wins and who loses, and the current state of power balance between society and the lobbies.

 



NESBITT, Lowell. Dos ponts a Nova York, 1975

Exhibition at Espai Carmen Thyssen. San Feliu de Guixols

The size of income inequality

 

Income declared to tax authorities, not actual income. Selected statements:

• 3% of citizens account for 30% of tax collection!
• In 5 years, plutocrats have decreased by 50%!
• In 5 years, average work income has plummeted 3,6% and taxes jumped to 9,5%!

My congratulations, tax authorities!