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Obama administration officials are working to control the H1N1 flu message after shortages have forced many to wait for the swine flu vaccine.

The Washington Post reports that the message they are pushing is that “despite shortages, the program has been more successful than expected in some ways and that millions of doses are quickly becoming available.” Homeland Security Secretary Janet Napolitano and Health and Human Services Secretary Kathleen Sebelius held a briefing for reporters where they asked for patience. “Officials had projected that as many as 120 million doses of vaccine would be available by now, but later downgraded that projection to 40 million and then 28 million. So far, 23.3 million doses have become available” (Stein, 10/29).

USA Today: “The rate of vaccine production was lower than manufacturers had hoped because the virus’ growth rate was slower than expected, [Napolitano] said: ‘We were getting some pretty rosy scenarios, and not until growth began did we know for sure.’ Now vaccine companies have had time to switch to faster-growing strains, so production is more robust. Nine million doses were produced in the past seven days, and ‘the pace is picking up,’ she said” (Weise, 10/28).

The shortage represents a political test for Obama, The New York Times reports. “The shortage, caused by delays in the vaccine manufacturing process, has put the president in exactly the situation he sought to avoid — one in which questions are being raised about the government’s response. … Now, with officials at the Centers for Disease Control and Prevention reporting that H1N1 is widespread in 46 states, public health experts and leading senators are giving the Obama administration only mixed grades” (Stolberg, 10/28).

Facebook has released a developer "roadmap," which it says will simplify communication for users and developers, improve app discovery and engagement, and provide developers with more comprehensive tools for building or expanding their business with Facebook.

"Through these new APIs and tools, we are giving all developers building with Facebook and those in our largest application category — gaming — new ways to attract and engage users," says Facebook’s Ethan Beard.

Facebook is giving developers access to user email addresses, and it is focusing Facebook communication on the stream and the inbox. "This consolidates developer and user communication into the two most powerful channels — stream and Inbox — and provides new features to help users stay engaged with applications," says Beard. "User-to-user communications commonly in the notifications and requests channels will be moved to the Inbox."

Some Facebook app developers aren’t thrilled with Facebook’s upcoming platform changes. "The so-called social games on the site are bringing in hundreds of millions of dollars in yearly revenue and the market is expanding rapidly,"

explains Lucian Parfeni at Softpedia. "But one of the reasons for the expansion is the amount of spammy messages and notifications they have come to rely on and Facebook is now looking to put an end to that."

"The notification and request channels will now be integrated in the Inbox and will lose their dedicated spots on the homepage. This is one of the most disruptive changes for apps as many relied on notifications to drive traffic up. " adds Parfeni.

Some Facebook app developers have found their businesses disrupted by the changes not only to the Facebook platform, but by the recent redesign of Facebook’s home page, which separates the news feed and the live feed. Before, when it was one, everybody saw all of the instances of their friends using apps. Now, they don’t see them as much, and developers are finding that their apps are not getting as many new users.

But Facebook says it is also working on ways to improve application discovery and engagement. Facebook doesn’t want apps to suffer. Improvements will come in the form of simplified navigation, prominent new dashboards, and a new Counter channel.

"To make it easier for users to quickly find and engage with applications, their favorite apps will be featured on their home page with bookmarks and new dashboards," explains Beard. "Applications will also be represented on canvas pages with a format that increases brand association with users. In addition, users will be able to better represent applications on their profile following short-term changes that include focusing profile integration on application tabs, as well as removing profile boxes, the info section of boxes, and the Boxes tab."

The counter channel will allow app developers to prompt users when they need to perform an action within an application.

Related Articles:

> Facebook Developers’ Business Models Threatened or Maintained?

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> Over 50 Million Facebook Users Related to Somebody

If you long for the ability to watch high definition TV on a seven-inch screen that’s resolution is a mere 480×234 but you also want to have the option to watch standard definition DVD’s as well, then here’s your next purchase.

According to Hammacher Schlemmer, this is “The First Portable HDTV And DVD Player.”

Will it be the last? Probably not.

This one, however, costs a whopping $300 and features two hours of battery life for HDTV watching or 2.5 hours for DVD playback. You can also view pictures and video files using the built-in memory card reader.

The digital tuner supports broadcasts in 720p and you’ll have to bring along the included “sensitive external antenna” in order to reel them in.

The First Portable HDTV And DVD Player [Hammacher Schlemmer]

The nation’s ailing economy continues to affect insurance companies, which could also face a wave of costly COBRA claims as policyholders rush to get treatment before government subsidies expire.

The Associated Press reports: “The government’s effort to help workers keep health benefits after they lose a job could wind up costing WellPoint Inc. and other insurers dearly in the fourth quarter. Indianapolis-based WellPoint said Wednesday it expects a spike in claims from a money-draining customer segment that includes people who continue their employer-sponsored insurance coverage under the federal law known as COBRA. Many insurers already face declining enrollment and rising costs related to swine flu cases. The expected jump in COBRA-related claims would make a bad situation worse.”

“All these factors likely will contribute to future rate increases. Insurers normally lose money on COBRA enrollment because the people who keep their coverage generally do so because they need it for ongoing treatments or illness. WellPoint, for instance, spends between $1.50 and $2 on claims for every dollar it collects in premiums. Healthy people often pass on the coverage, which can be too expensive for someone who just lost a job, or they only sign up for it when they need treatment. People have 60 days after being laid off to enroll in COBRA. Earlier this year, the federal government started offering temporary subsidies that pay 65 percent of the cost of COBRA coverage. The first wave of those subsidies will start expiring in the fourth quarter. WellPoint officials expect an increase in claims as customers cram in as much health care as they can while they still have coverage” (Murphy, 10/28). 

NPR explores the reasons for the high rates of HIV/AIDS infection among black women: “African-Americans, who only make up 1+2 percent of the U.S. population, account for nearly half of those living with HIV. More specifically, black women represent 61 percent of the new HIV cases among all women. The popular suspicion has been that many infected black women have contracted the virus from their black male companions, who secretly have sex with other men (also known as the ‘down low’). But a new study shows that correlation is flawed. Dr. Kevin Fenton, of the Centers for Disease Control, explains the misconception and talks about prevention.” Fenton discusses the relationship of various factors including incarceration, multiple sex partners, unprotected sex and drug use and HIV-infection (Martin, 10/28).

The Washington Post reports: “China’s health-care system is in disarray, a side effect of the market reforms that have spurred private enterprise and rapid growth since 1980. Before then, state-owned companies offered cradle-to-grave care, part of a system based on danwei, or work units, that provided health, education, pensions and other benefits. But as the economy has grown more diverse, an increasing number of Chinese have had to fend for themselves, with only a porous government insurance program to help.”

Like the U.S., China is trying to fix its ailing health care system. “Over the past five years, the government has tried to provide coverage to more of its 1.4 billion people. But even people covered by a minimal health insurance program are often left with big hospital bills and must pay for most outpatient services and medication. More than 300 million people do not have any health insurance.” In addition, “the gap in the quality of care has been steadily growing, too. Peking University People’s Hospital, for example, has computerized charts, GE scanners, top-flight doctors and a deluxe ward where the wealthy can pay extra for private suites. But community clinics in most cities or rural areas tend to be understaffed and poorly equipped” (Mufson, 10/29).

State Medicaid and other health programs have fallen under the axe or been moved onto the chopping block this week.

Associated Press: “Gov. Jay Nixon cut an additional $204 million from Missouri’s budget Wednesday and eliminated nearly 700 jobs in attempt to offset a continued decline in state tax revenues.” The cuts include lowering Medicaid payments (Lieb, 10/18).

Columbia Missourian: “Under Nixon’s plan, Medicaid programs face a loss of more than $32 million, mental health programs will lose $3 million, and MU Health Care-affiliated hospitals and clinics around the state will lose $3 million. … Nixon said services will not be drastically affected. Health care advocates, however, said there would be an impact on health care” (Beitsch, 10/29).

Associated Press: “Health care services for the needy may be sharply reduced if New Mexico Gov. Bill Richardson signs a budget-cutting measure approved by the Legislature, the administration said Tuesday.” The health department stands to lose about $38 million in state funding, as well as an additional $115 million in federal matching money (Massey, 10/28).

Associated Press: “Colorado Gov. Bill Ritter laid out his plan to cut another $286 million from the state budget on Wednesday, including reductions in Medicaid provider rates” (Paulson, 10/28).

Providence Journal: In an unrelated story, two nonprofit Rhode Island hospitals have gained approval to affiliate under a corporate parent. The new company would control 15 percent of the state’s hospital market. Officials said their main concerns where that the new hospital company continue providing care to Rhode Island patients, and that it preserve jobs (Salit, 10/29).

Las Vegas Sun: The Nevada health department has begun an investigation into an allegedly negligent nursing home. “All 139 elderly patients at an assisted-living and Alzheimer’s facility may have gone without their medications for weeks.” (Allen, 10/29).

Today, the Health IT Standards Committee within the Department of Health and Human Services will begin an unprecedented effort to get the public’s view on how our work might "pull forward" the benefits of healthcare information technology (IT).  Specifically, we’re interested in uncovering new strategies to accelerate the adoption of health IT standards.  This effort began with the passage of the American Recovery and Reinvestment Act of 2009, calling for recommendations on standards to promote safe, secure, healthcare information exchange.

“Standards” are really the guardians of quality, consistency, and interoperability.  Without thoughtful, clear and uniform standards, we cannot enable the seamless and secure exchange of electronic health information (or the benefits that accrue to providers and patients from such protected exchanges).

So, while the exploration of technical standards may seem mundane to some, it is foundational to electronic health records (EHRs) and electronic health information exchange more broadly.  In other words, it’s worth paying some attention to, and voicing your opinions.

Our process continues with a public hearing today in Washington, DC. Find out how to participate via phone and webcast here. We are convening four panels of experts with on-the-ground experience in interoperability standards – providers, quality stakeholders, health IT vendors, and a group with lessons drawn outside of healthcare. Thanks to HIT Standards Committee member Judy Murphy for her leadership on this effort.

The public hearing draws to a close this afternoon but we will continue the conversation through an Online Forum over the next two weeks.  Thanks to Committee Member Cris Ross for his leadership on this effort.  Given the breadth of interests, we have arranged a series of Committee Member blog posts to begin the dialogue, starting with HIT Standards Committee Vice-Chair John Halamka’s summary of our work to date, which will post on Friday.  We will concurrently enable ongoing discussion threads on the following topics:

Proposed Standards (General Discussion)
Interoperability
Vocabularies
Privacy
Security
Quality
Implementation Case Studies (Your Story – the good, bad and
in-between)

We have also enabled a "voting" feature on submissions to allow you – the public – an opportunity to emphasize points raised in a given post. Our goal is to harness the shared wisdom of our community to inform the work of the HIT Standards Committee in the weeks and months ahead.

The tight schedule of this process is designed to ensure that your ideas inform the HIT Standards Committee at its November 19th meeting.  However, your ongoing feedback on our efforts is also encouraged via written submission or public comment at any of the subsequent monthly meetings of the HIT Standards Committee.

The process of accelerating the adoption of health IT standards will not end this week, this month, or this year. This is an ongoing effort, and your participation will continue to be essential to its success.

Aneesh Chopra is U.S. Chief Technology Officer

Though the question of whether Democratic leaders would include a public option in the Senate’s health reform bill has held the spotlight, a variety of other big issues also remain unresolved, The Hill reports. For instance, “Sen. Charles Schumer (N.Y.), the third-ranking Democrat in the upper chamber, said Wednesday that insurance affordability, a controversial excise tax on high-cost insurance plans, whether most employers will be required to offer health benefits, how to raise needed tax dollars and whether to create a federal long-term-care insurance program are the remaining issues.” Concessions to liberals on the public plan and other issues have created a rift between the progressive and centrist wings of the party (Young, 10/29).

For instance, centrists oppose the long-term-care insurance program, originally proposed by Sen. Ted Kennedy, D-Mass., and favored by the more liberal House Democratic Caucus, CBS News reports. Seven centrist Democrats signed a letter asking Reid not include that provision in his final bill, because, they say, it will add to the deficit over time (Condon, 10/28).

Thirty senators sent Reid a letter asking him to include a public option, showing the greater weight liberals pull in his caucus, the Wall Street Journal reports. But, ultimately, Reid “needs the support of 60 senators twice — first in a vote to consider the health bill, then later to approve it. Even some Democrats who oppose the bill in its current shape may support the leader in the initial vote just to get it to the Senate floor. If so, it will kick off a weeks-long debate, including votes on numerous amendments and horse-trading to address the concerns of particular senators” (Bendavid, 10/29).

“As became apparent this week, Reid has secured promises from only most of his 60-member Democratic Conference to vote to begin debating the bill,” Roll Call reports. “But aides and Senators this week said Reid is charting the only path he can on health care reform given the rules of the chamber and the Members with whom he is working.” One reason for moving ahead without full support “is that it would be nearly impossible to corral all Democrats before the floor amendment process has even begun, considering many Members are inclined to withhold their support to try to influence the final bill” (Pierce and Drucker, 10/29).

Business leaders who thought they had dodged a bullet when the Senate Finance Committee decided against offering a government-run public option as part of their health bill are pushing back after the plan’s re-emergence.

The Wall Street Journal reports that several groups, including the Business Roundtable and the U.S. Chamber of Commerce began this week to lobby lawmakers to drop the option. President Obama will meet with small-business owners today to argue that the reform will allow them to control costs. “Large employers are concerned that the plan will end up raising their health-insurance costs. They believe that if the government pays doctors and hospitals at lower rates than do private insurance companies, the health industry would try to pass the cost on to those with private insurance.” Small businesses too are mostly against the plan, as is their group, the National Federation of Independent Business. Some small-business groups, though with decidedly less clout than the NFIB, are for the plan, including the Small Business Majority (Adamy, 10/29).

Politico reports that the U.S. Chamber of Commerce and several other business groups sent a letter to Senate Majority Leader Harry Reid and Senate Republican leader Mitch McConnell that said they support reform efforts, but not just any reform offering. “None of the points are particularly new. The letter mainly serves as a not so subtle reminder of what the business community wants from reform. The message: It’s getting late and unless we start seeing some progress, you won’t have our support” (Frates, 10/28).

Meanwhile, the GOP is urging business groups to speak their mind freely on the reform if they oppose it, The Hill reports. They are focusing on the NFIB and the Business Roundtable to take a more active approach. “Senate Republican leaders on Oct. 20 called representatives from the Business Roundtable, NFIB and other business groups to a meeting at the Capitol to find out what they planned to do during the upcoming Senate floor debate on healthcare reform, according to sources familiar with the session.” Senate Republicans are worried that deals between Democrats and the pharmaceutical industry (and one suspected with the American Hospital Association) may be harming efforts to criticize the reform bills (Bolton, 10/28).

Massachusetts Gov. Deval Patrick, a Democrat, and former Gov. Mitt Romney, a Republican, both say that federal health reform plans should do more to address rising costs than their state’s initiative. “Unlike the Massachusetts plan, which focused first on getting residents to sign up for insurance and only now is turning to cost containment, federal legislation must include measures to trim medical costs if it wants to garner and keep public support, Patrick said,” Bloomberg reports. “The 2006 Massachusetts law, with its combination of public and private insurance programs, has reduced the number of uninsured to 2.6 percent of its population, the lowest rate in the nation, according to the U.S. Census Bureau. At the same time, per capita health spending in Massachusetts is projected to double from 2009 through 2020, according to a June report by the state.” (Wechsler, 10/28) 

Meanwhile, Romney “is acknowledging that the health care plan he famously implemented as governor did nothing to address costs,” CNN reports. “We were unable to deal with — and didn’t have any pretense we would somehow be able to change — health care costs in Massachusetts,” said Romney. “We still have a fee for service, a re-imbursement system here like every other state in America. That’s the way Medicare and Medicaid are structured, that’s the way the insurance industry is structured,” he continued. Romney added that “‘Massachusetts is not the model’ for reducing health care costs” (Gupta, 10/28).

Halloween is coming up and if there’s one thing I know it’s that geeks love Halloween. The opportunity to hide behind a mask, to subvert the status quo, and to dress up like sexy nurse/sexy witch/sexy balloon boy is a cause for celebration. That said, we’re offering one Xbox 360 Modern Warfare 2 Limited Edition Console to the winner of our First Annual CrunchGear Halloween Costume Contest.

Here’s how to enter.

The Associated Press looks at what benefits medical homes may bring to health care by looking at one in Iowa: “A thousand miles from the health care debate in Washington, Dr. Don Klitgaard and his colleagues are carrying out their own reform in a small Iowa community.” Policymakers, including President Barack Obama, “have praised such experiments” as a way to achieve “better quality without costly complications. But change doesn’t come easy. In a traditional practice, the doctor is the center of universe. In the new model, he or she is part of a team. … Klitgaard is wondering if Congress will do enough for primary care doctors, the ones expected to carry out the transformation. Medicare, the government health program for seniors, doesn’t pay for the care coordination, monitoring, and coaching of patients that are part of his model” (Alonso-Zaldivar, 10/28).

Lawmakers target Medicare and Medicaid fraud to generate greater savings in health care reform while doctors worry about efforts to cut waste. The Wall Street Journal reports: “The federal government needs to further step up efforts to fight Medicare and Medicaid fraud to generate more savings to help pay for a health-care overhaul, lawmakers said Wednesday. … Health-overhaul legislation moving through Congress contains provisions to beef up the government’s antifraud effort. The U.S. loses at least $60 billion to health-care fraud every year, and some estimates put the cost as high as 10% of the nation’s total health-care spending, which exceeds $2 trillion.”

The Journal also adds, “Sen. John Cornyn (R., Texas) said government officials still need to figure out why Medicare and Medicaid have a higher rate of fraud than private insurers, especially since Congress is considering creating a public-insurance program. Bill Corr, deputy HHS secretary, said HHS and the Justice Department are making progress, especially by using specialized teams to ferret out fraud. But he agreed that the task is huge. Medicare alone, he testified, receives 4.4 million claims each day, which have to be paid between 14 and 30 days. The Medicare program, which spends more than $400 billion a year, reviews only 3% of those claims, he said. Medicare has reported that it improperly paid more than $10 billion in claims in the fiscal year that ended Sept. 30, 2008” (Zhang, 10/28).

The Associated Press reports: “The Obama administration is considering a way to bring together patients, doctors, insurers and law officers to combat fraud in Medicare and Medicaid, a Health and Human Services official said Wednesday. The summit, still under consideration, would enhance an increased effort to find and prosecute fraud in the programs, said William Corr, deputy HHS secretary. … The administration created a Justice Department-HHS team last May on preventing health care fraud. … The government is using new methods of data analysis and intelligence gathering to detect patterns of crime and the regions with the worst problems, he said” (10/28).

The Indianapolis Business Journal reports on doctors’ criticism of lawmakers’ efforts: “[S]ome doctors say the way the Senate Finance Committee bill tries to [cut waste] would be disastrous. The bill would require all physicians to participate in Medicare’s Physician Quality Reporting Initiative by 2012 and then, in 2014, use those reports to cut Medicare reimbursement by 5 percent for any doctor whose level of testing and procedures is in the top 10 percent of all doctors in his or her field. … They worry the government will not be able to collect the data needed to make sure the new law doesn’t punish doctors who do lots of tests and procedures because they see the sickest and poorest patients” (Wall, 10/28).

Meanwhile, the Houston Chronicle reports: “Seven people associated with a medical clinic have been indicted for alleged Medicaid and Medicare fraud and federal authorities seized millions of dollars in cash and property in Mississippi and Texas, court records said. Statewide Physical Medicine Group Inc. billed Medicare and Medicaid for more than $39 million in services in Mississippi during the alleged conspiracy, from 2000 to 2005, according to the indictment. The government agencies paid out $18 million. It’s not clear how much of that was obtained by allegedly fraudulent billing. The government has seized more than $3.6 million from various accounts” (Mohr, 10/28).

Bad news, you guys. If you were thinking of dropping $120 on TomTom’s iPhone car kit and then another $100 on TomTom’s navigation app for use with your first-generation iPhone or second-generation iPod touch, it now looks like you’d to run into some compatibility issues.

AppleInsider is reporting “that although the Car Kit dock is compatible with all iPhone models, the TomTom application will only work with the iPhone 3GS and iPhone 3G – even with the dock connected to a first-generation iPhone or iPod touch.”

You’ll recall that the hardware dock features its own built-in GPS chip and speaker to amplify GPS signal strength and the volume of turn-by-turn directions, so it appears that if you were to dock an iPod touch or older iPhone that you wouldn’t be able to take advantage of those enhancements. Basically, you’d have a $120 car charger.

AppleInsider further reports that “When asked whether the application could be updated to allow it to work with the iPod touch and first-generation iPhone, a company spokesman simply said that TomTom has not made any ‘public announcements.’”

It doesn’t seem like it would be rocket science to add the extra compatibility, and TomTom would theoretically benefit from the expanded hardware base of potential customers but, suffice to say, it’s best to hold off for now.

TomTom Car Kit, navigation software will not work with iPod touch [AppleInsider]

One news outlet studies the practical meaning of public insurance option by examining some of the approaches that are already in existence. Meanwhile, another examines the number of people who would have access to the public plan. And a former insurance executive takes issue with the industry’s current stance.

ProPublica: “About a third of Americans already get health care from a publicly administered program. From celebrated programs like the VA’s or the military’s, to the troubled ones like the Indian Health Services, here’s a snapshot of how they actually work.” ProPublica assesses TRICARE, the Veterans Health Administration, the Indian Health Service, Healthcare Group of Arizona, Medicare and Medicaid (Shankman, 10/28).

The San Francisco Chronicle reports that “lost amid the ideological battle for or against a public option is a key overlooked fact: The vast majority of Americans would have no access to a public option even under its most expansive versions.” That’s because “House and Senate bills limit the option to the smallest businesses and to individuals who cannot get insurance, or whose health care costs exceed 12.5 percent of their income. Even seven years into an overhaul, an estimated 90 percent of Americans, including nearly everyone who has employer-based coverage now, would be shut out of a public option” (Lochhead, 10/29). 

Meanwhile, Lois Quam, a former executive at UnitedHealth Group, is throwing her support behind the public option, The Star Tribune reports. At a speech at the University of Minnesota on Wednesday, Quam “took on the insurance industry head-on, noting that insurers had opposed (unsuccessfully) the creation of Medicare in the 1960s and opposed (successfully) health care reform during the early years of the Clinton administration. Now they’re doing it again, she said: ‘The insurance industry’s actions in the current health care reform debate have too often just been wrong. Their opposition to a public option, and the efforts to protect themselves, rather than Americans, are simply wrong’” (Yee, 10/28).

The proposed Microsoft-Yahoo deal seems to have hit a small and oddly unspecified bump.  The companies missed an October 27th deadline by which they hoped to have some details ironed out.

Yahoo admitted yesterday in an SEC filing, "The Letter Agreement specified that the parties would execute Definitive Agreements by October 27, 2009, but given the complex nature of the transaction, there remain some details to be finalized.  The parties are working diligently on finalizing the agreements, have made good progress to date, and have agreed to execute the agreements as expeditiously as possible."

The Microsoft-Yahoo partnership hasn’t been derailed, then, and considering all the time and energy everyone’s spent following these dealings, that’s a bit of a relief.  There’s just the question of why this delay has occurred.

Microsoft and Yahoo might be holding some quiet discussions with regulators in order to make sure they get things right on the first try.  Or maybe, considering that this is a ten-year deal, both sides’ lawyers have just gotten a little overwhelmed with paperwork.

Anything more serious would probably merit a mention in the SEC filing.

So hang in there and we’ll see what happens.  Yahoo did not establish a new target date, by the way.

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