Can new semiconductor packaging ploys cut health care costs?

Can flex and other advanced packaging materials and techniques now coming under scrutiny to cut costs as well as reduce IC size in next-generation cell phones and game machines wind up inside your anatomy some day in medical implant devices like pacemakers? If biotechnology advances match predictions, the human body could prove an explosive market for ICs and other componentry, providing the next frontier for the packaging community.

Ways to make the semiconductors inside medical implant devices less expensive are coming under scrutiny as the national drive to lower health care expenditures moves forward. Premium quality and reliability standards must still be maintained, however, in such life-and-death applications. Can cheaper IC packaging techniques such as use of flex and other materials as replacements for ceramic substrates meet the rigorous demands of medical electronics destined for the human body?

Yes, according to several researchers who will present their findings at this week’s High-Density Interconnect and Systems Packaging conference in Denver. Flex can successfully replace ceramics in medical electronics applications, just as it is currently doing in many other areas, they contend.

“Today, miniaturized electronic devices for medical applications cannot be considered as high-priced products in a secured market. Due to increasing competition and pressure on health expenses, cost for hardware is quickly gaining importance for successful marketing,” note Mike Stampanoni and Walter Schmidt of Dyconex Ltd., Zurich, Switzerland, in a paper. They will review “Modern Interconnect Solutions for Miniaturized Medical Electronic Devices” at the Denver meeting.

The paper discusses packaging options for implantable medical devices, analyzing the unique system challenges. Devices such as pacemakers, defibrillators, and hearing aids require long-term, reliable packaging in small volume with low weight, the paper states. Fortunately, the environment for such devices, the human body, is not very demanding in terms of temperature variations and mechanical shock.

Purpose: To check the accuracy of the Internet-derived medical information.

Materials and Method: We tested the validity of randomly chosen Internet-derived statements concerning four common orthopaedics problems. Two-hundred statements were gleaned by two nonmedical persons from 30 chosen websites, after employing a common search engine. Fifty statements were derived on each of four separate topics (knee osteoarthritis, hip osteoarthritis, low back pain, and osteoporosis). Five residents in orthopaedic surgery were then asked, to independently rank the accuracy of these statements using a five point rating scale with 1 being strongly disagree to 5 being strongly agree with the statement. Means were then obtained for each question and ranked on validity with > 4 being very valid, > 3 being somewhat valid and

Results: Overall score for the 200 statements was 3.81 with 61% deemed very valid, 20% deemed somewhat valid and 19% deemed invalid. For knee osteoarthritis, the overall score was 3.63 with 63% being very valid, 18% being somewhat valid and 19% being deemed invalid. For hip osteoarthritis, the overall score was 3.75 with 58% being very valid, 21% being somewhat valid and 19% deemed invalid. For low back pain, the overall score was 3.91 with 48% being very valid, 36% being somewhat valid and 16% deemed invalid. For osteoporosis, the overall score was 3.96 with 59% being very valid, 18% being somewhat valid and 23% deemed invalid.

Conclusion: Approximately 20% of medical information found on the Internet is misleading and, invalid. Patients and physicians who use the Internet to access health information, should be aware of these inaccuracies and better seek advice from reliable medical web sites of universities.

Healthcare organizations are no different than most large corporations. Running them efficiently means putting in place a financial information system (FIS) that operates effectively on all levels, from individual departments to the corporate office. When an organization grows, especially through acquisitions, coordinating these systems across the enterprise is crucial.

The problem in healthcare, however, is that the best-of-breed approach taken by many institutions has created a world of disparate systems that require interfacing with other hospital systems. This can be a daunting task within a single hospital, let alone among a dozen facilities owned or operated by a parent company.

But things are beginning to change. Large healthcare organizations, and some vendors, have realized that financial information systems can no longer be relegated to back-office status. Their importance in patient billing, claims processing, materials management and even strategic planning requires that standardized business applications be accessible to key personnel across the entire enterprise, whether that means one hospital or a dozen.

In the case of St. Vincent Health in Indianapolis, that meant a network of 16 hospitals. For Orlando Regional Healthcare in Orlando, Fla., a total of seven facilities needed to be linked. Each organization’s decision to choose a single, integrated FIS that could be rolled out at each institution not only improved overall efficiencies, but also provided the flexibility necessary to support future growth.

Medical practice is increasingly being computerised. In our offices we use our PCs to prescribe electronically with fewer errors, automatic recognition of potential drug interactions and allergies, and more legible scripts. Clinical decision support software offers the potential to add rigour to our decision making. Many of us use real time web access to support this functionality. How can these important developments be extended to our work in the emergency department, on home visits, while caring for patients in institutions, and other settings where the practitioner is away from the office and its resources?

It is possible, although impractical, to take a laptop along and access the internet either via standard or mobile telephone. However, use of a hand-held computing device offers a much more palatable solution. There are many devices on the market. For months now I have used a Palm Pilot Vx (www.palm.com) weighing just over 100g and fitting into my shirt pocket as diary, address book and notepad, and it synchronises with my office PC easily’ through a cradle or infrared port. Recently’ I have also started using it in my medical practice.

Firstly, I installed a comprehensive clinical drug information guide that I now regularly use to check my prescribing when out of the office. The database is automatically updated daily through the web when I synchronise the Palm with my office PC. Thus, using the Palm to support my prescribing is quicker, more accurate, and much more accessible than any paper-based resource. My Palm now also has, among others, programs to calculate cardiovascular risk, intravenous drug doses, and gestational age . This weekend I found the Merck Manual (one of my favourite resources) available for free download in Palm format and the entire manual now resides on my Palm.

I saw 56 patients while on duty at the local hospital yesterday. I used the Palm to check prescribing 10 times and to inform my therapeutic decision making six times. Access was simple, easy, quick and unobtrusive to the clinical encounter.

I feel that I have entered a new era in my medical practice. For the first time I have evidence in easily accessible format at my fingertips wherever I am.

Physician Internet Medical Information Seeking and Online Continuing Education Use Patterns. Casebeer L, Bennett N, Kristofco R, et al. J Contin Educ Health Prof. 2002;22:33-43.

Nearly all physicians report access to the Internet through home or at work for personal or professional goals. It has been unclear, however, what online sources physicians find helpful for their professional development. Recently, the number of online continuing education (CE) providers has increased. This study was designed to examine the behaviors of physicians regarding their search for medical information and the relevance to continuing education providers who develop the online activities. A survey instrument of multiple-choice questions was faxed to nearly 324,000 US physicians of all specialties. A total of 2,200 survey questionnaires were returned and utilized. Demographic information such as gender, specialty, location of practice, years since graduation, and years having used the Internet were obtained. The survey included questions related to variables that physicians deemed important when seeking medical information, how frequently they accessed online CE, how frequently they utilized the Internet and whether it was for personal or professional use, and what motivated them to seek medical information on the Internet. It was determined that there are differences in Internet use by gender, location of practice, and specialty, but not with age or Internet experience since graduation. Most physicians use the Internet to supplement their traditional learning activities of reading journals and attendance at local meetings. The majority of physicians indicated that they search the Internet for specific patient management problems. The problems of using the Internet for seeking medical information include the extensive, yet nonspecific, amount of information for the topic at hand and little time to browse. Physicians indicated that online CE must be immediate, relevant, credible, and easy to use. The results of this study suggest that online CE providers reconstruct their roles by helping physicians locate, rather than develop, materials by providing links to association updates, breaking news, and specific-patient management. This new idea, however, poses difficulty for assigning CE credit. Although the Internet is an excellent way to deliver educational information, it creates a challenge for CE providers to provide credible, relevant, and accessible content.

HSBC has agreed to sell the entire issued capital of HSBC Salud (Argentina) S.A. to Swiss Medical Group. The net negative equity of HSBC Salud (Argentina) S.A. as at 30 June 2003 (under UK GAAP) was ARS3.6 million.

HSBC Salud (Argentina) S.A. is one of the leading providers of prepaid medical insurance in Argentina. The company has a network of branches across Argentina serving over 158,000 individual and corporate clients. Swiss Medical Group is a leading provider of health insurance services in Argentina with 300,000 clients and an annual turnover of ARS450 million.

The provision of prepaid health insurance is not a core business for the HSBC Group and, following the sale of a similar business in Brazil earlier in the year, it has decided to sell the business in Argentina. HSBC will use the majority of the sales proceeds to strengthen the capital position of its other businesses in Argentina.

The sale of HSBC Salud (Argentina) S.A. to Swiss Medical Group is effective 23 December 2003. Swiss Medical Group will take over the 422 employees who work for the company.

What members are talking about

“‘Fixing’ the health problems of patients. Physicians would be happy if they could just do this and nothing else. Medical group practices allow the physician to do this with minimal concern for the day-to-day operations that are handled by the professional administrative staff.”

Irene S. Heinemeier, CMPE, MGMA Board member and administrator, Cardiovascular and Thoracic Surgery Associates, Annandale, Va., iheinemeier@aol.com

“Physicians value group practice because of call coverage - they have the secure knowledge that when they are away, their patients are well taken care of and in good hands if a problem arises. Physicians also value the ability to mentor and be mentored in the medical group setting. New physicians learn from the practical experience of an established physician, and established physicians stay abreast of new training and techniques through their affiliation with newly trained physicians.”

“Group practice provides the physician with a community of like-minded physicians focused on the continuum of care for their patients. It also provides the opportunity for professional management by partnering with medical executives. Group practice is an ideal business model for the current health care environment, as it provides the foundation required to compete and succeed economically.”

Christine A. Schon, FACMPE, MGMA Board member and director of cardiac services, Deaconess Billings Clinic, Mont.,
“Physicians value the opportunity to collaborate with other physicians and to be able to provide the latest technology and therapies to their patients in an integrated group practice setting. They also value the idea of devoting more time to medical practice with competent administrators taking care of business operations, collections, community relations, etc. This makes physicians more efficient and often allows for an improved earning capacity, more fringe benefits and an improved lifestyle.”

A study released recently by an anti-affirmative action group says the University of Oklahoma discriminates against Whites in medical college admissions, but an OU official denies it.

The study by the Center for Equal Opportunity concluded that OU and four other colleges based some of their admissions on race, having studied admissions data from 1996 and 1999. According to the study, a non-Asian minority applicant — with all other things being equal — was four-and-a-half times more likely to be admitted over a White applicant in 1996 and five times more likely in 1999.

OU spokeswoman Catherine Bishop said the school considers factors in addition to grades and test scores, but that it has no racial or ethnic preferences or quotas.

The Center for Equal Opportunity is headed by Linda Chavez, former director of the U.S. Commission on Civil Rights.

The study showed many students were admitted to medical schools who could not perform and subsequently wasted tax money, Chavez said.

Chavez said using race to determine medical school admission violates the equal protection provisions of the U.S. Constitution. The study was compiled from admissions data from the OU Medical College of Medicine, the Medical College of Georgia, Michigan State College of Human Medicine, State University of New York (SUNY) Brooklyn College of Medicine and University of Washington School of Medicine.

The study concluded that all gave some preferences to minorities.

The study says that in 1999 at OU, the medical college rejected 18 Asian, 18 non-Asian minority and 118 White resident applicants.

Of those, 14 Asians and 70 Whites were rejected despite higher college grades compared with the median grade point average of the non-Asian minority students. Two Asians and 46 Whites were rejected despite having higher MCAT scores than the minority students; and two Asian and 29 Whites were rejected despite having higher grades and test scores.

Bishop said OU officials had not had the opportunity to read the report, but that the medical college is committed to educating well-qualified physicians.

Last year, the Center for Equal Opportunity targeted the admissions practices at public colleges and universities in Maryland, releasing a study indicating that Black students were being admitted with lower SAT scores than those of White students (see Black Issues, Oct. 26, 2000).

Manual provider credentials processing can create hours of data entry work and build mountains of paperwork. An Arkansas medical group learned that lesson quickly–and responded by implementing a credentialing software program that has helped staff save both time and money.

Scaling Paper Mountains

Cooper Clinic is a large multispecialty medical group headquartered in Fort Smith, Ark. The clinic employs 830 workers, including 130 physicians. Debbie Heimark, assistant director of human resources, heads the clinic’s provider enrollment and credentials verification process.

When Heimark joined Cooper Clinic five years ago, there was no credentialing software in place. When a new provider came on board, she had to manually complete as many as 13 different enrollment forms, get the provider’s signature and then mail the completed documents to each insurance carrier. She followed a similar process each time a staff provider’s license or credentialing information needed to be updated. The process amounted to hours of data entry work and piles of paper. Filling out forms by hand was not complicated, she says, but the process was redundant and left room for errors.

“I knew there had to be a better way to do provider enrollment,” Heimark says. About a year later, the medical group bought its first credentialing software. But she felt the headaches soon afterward. Within months, the software was obsolete, Heimark says. Vendor staff lacked medical background and failed to understand end-user needs. “The only thing that system did was warehouse information for us,” Heimark says. “We still had to manually complete many provider forms for various insurance companies.”

Heimark needed to find a more efficient option–and fast. As a member of the human resources department, she could not dedicate the majority of her time to provider credentials. After considering several vendors, Cooper Clinic focused on Brentwood, Tenn.-based Sy.Med Development Inc. and its OneApp healthcare credentialing software.

More than 21 percent of healthcare providers have implemented electronic medical record (EMR) systems, says a survey conducted by the Medical Group Management Association (MGMA) and Pfizer Health Solutions. Responses from 593 organizations also indicate 67.9 percent are still considering implementing an EMR.

Survey findings indicate a higher installed base, better satisfaction with systems, and a more proactive stance toward adoption of technology than has been reported widely. “Many assume the healthcare industry is afraid and slow to adopt technology,” says MGMA president William Jesse. “But these results show [that healthcare] is realizing the importance of technology and is embracing it to improve productivity and patient satisfaction.”