Lab Soft News

Potential Cost Savings Associated with Palliative Care Teams in Hospitals

I have posted previous notes about the topic of palliative care services in hospitals (see: Aggressive Care, Not Palliative Care, the Norm in New York Academic Hospitals; Impressive Growth in Hospital-Based Palliative Care Teams). I had previously been under the impression that hospitals were deploying palliative care teams primarily because of quality concerns and that the cost of them was on the negative side of the ledger. However, a recent article got me thinking that there may actually be cost savings associated with palliative care (see: Death With Dignity Why is dying at home more the exception than the rule?). Below is a quote from Dr. Michael Levy from this article;

"The main reason for the current interest in palliative care by hospitals and healthcare systems is its potential to reduce healthcare costs by de-escalating expensive, futile, aggressive care, preventing the escalation of care to expensive, futile, aggressive care, and by reducing 30-day readmission rates. The net result of this tumultuous development of palliative care as a welcomed approach to optimize how patients live until they die, is a shortage in trained, certified, palliative care professionals and delivery models and an incomplete integration of palliative care into our healthcare delivery system. Ideally, palliative care should be offered at the beginning of life-threatening illness and not wait until the end. Even if there were enough palliative care available to care for all the patients that need it, many physicians still view it as something less than hopeful and valuable to offer to patients than continuing to fight their disease.

A lot of wisdom is contained in this very short passage. First of all, palliative care, in addition to being a a very humane approach to the care of patients with terminal diseases, can also help to "de-escalate expensive, futile, and aggressive care" and, in so doing reduce the cost of care. The second important point is that there is a shortage of certified, trained and certified professionals in this area so resources need to be expended to expand this pool. The third important point is that a barrier to effective palliative care is "[its] incomplete integration...into our health delivery system." The conclusion that a very sick patient needs the attention of the hospital palliative care team may not always come easily to the physicians caring for him or her. Physicians are trained to provide aggressive care to the end and this is probably what many patients are also seeking. 

Adding to all of this discussion is that the scope of palliative care is now expanding. Here's a quote from the the Wikipedia article on palliative care: "The term "palliative care" is increasingly used with regard to diseases other than cancer such as chronic, progressive pulmonary disorders, renal disease, chronic heart failure, HIV/AIDS and progressive neurological conditions. In addition, the rapidly growing field of pediatric palliative care has clearly shown the need for services geared specifically for children with serious illness (see: Palliative care)."

Greater Transparency for Hospital Charges Slowly Becoming the Norm

We seem to be moving to a new environment in which hospitals are being forced to post their charges to enable patients to become smarter healthcare shoppers. This has been a long time in coming. It would be unthinkable in any other industry not to offer such pricing transparency, Here is an article about this topic (see: In move toward transparency, Virginia Mason posts procedure price information online) and below is an excerpt from it:

Virginia Mason Medical Center will start posting price estimates online for its medical procedures, marking one further step toward transparency. Last year, the medical center introduced its patient cost estimator to help take the guesswork out of medical bills. Now, Virginia Mason has added to its website the estimated prices for its 100 most common outpatient surgical procedures. In the wake of health reform, health systems more and more are trying to be transparent about the costs of health care. That means helping patients factor in their insurance and deductibles when trying to figure out how much they will have to pay when they get a bill in the mail weeks later, and being more up-front about procedural costs before insurance is taken into account. One Puget Sound-area startup is even capitalizing on the demand for greater transparency and harnessing federal data to rate cost against quality for medical procedures. Additionally, Virginia Mason will provide individuals a written estimate of their out-of-pocket expenses for scheduled or planned inpatient and outpatient medical procedures.“Changes in health insurance plans often mean individuals are paying higher out-of-pocket costs for health care services,” said Steve Schaefer, vice president of finance for the health system. “Understandably, they are looking ever more closely at cost and quality, and weighing those factors in their decision-making.”

The trend toward greater transparency in hospital pricing has been historically promoted by Medicare (see: Medicare Officials Post Hospital Prices; A Step in the Right Direction). Often unwillingly, some hospitals now seem to be following suit, perhaps, in part, to gain a competitive edge in their local environments (see: Medical price transparency toolkit unveiled by American Hospital Association). This is only half of the battle, however. Healthcare consumers need to take advantage of this opportunity to shop on the basis of both cost and quality. In the past, there was little need for insured patients to take hospital prices into account because the hospitals and health insurance companies negotiated reimbursement rates that had little relationship to the hospital posted prices. The insurance companies paid most of the bill. Only the uninsured were stuck with "rack rates." All of this has now changed as a greater percentage of insured patients choose high-deductible policies that require them to shoulder more of the cost of care out-of-pocket. 

There is still a great deal of "friction" to the process by which a hospital is chosen by a patient based in part on his or her insurance policy and the hospital to which a physician or surgeon has admitting privileges. Nevertheless, this initiative by Virginia Mason Medical Center is definitely a step in the right direction. I am sure that the cost-estimation tools and services offered by hospitals, both in person and on the web, will continue to grow more sophisticated. It will be interesting to see whether hospitals such as Virginia Mason will stand by the cost estimates generated for prospective patients. The use of the term "estimate" suggests that this is not always the case and I understand that complications can occur that would alter such estimates. The next step will be "cost guarantees" by hospitals for individual surgical procedures.

NHS Launches Suite of Online Resources with Emphasis on Mental Health

Increasingly, healthcare consumers are turning to various types of health apps, many running on mobile phones, for health assessments, health monitoring, and even therapeutic recommendations. Even the most enthusiastic supporters of health apps will admit that a number of them have little value or may even be harmful. We need to come up with some process for assessing and vetting this software avalanche. Relevant to this discussion to is that the NHS is now making available apps, on-line courses, and social networks devoted to mental health on its official web site (see: England’s NHS launches library for accredited mobile health apps). Below is an excerpt from the article:

The National Health Service of England is taking steps to create a curated database of government-approved mobile health apps, starting in the area of mental health. NHS launched a library of five approved apps on its NHS Choices website, which gets 40 million visits per month, according to the NHS. As a large public health system, NHS struggles with waiting lists for health services including mental health. So they’ve aggressively looked to mobile health as a way to connect people to health services more efficiently. NHS began publicly evaluating mental health apps in February 2013, when they published a discussion paper on the subject....Right now, the site has five vetted online resources: Beating the Blues, a CBT-based computer (cognitive behavioral therapy) self-help course for anxiety and depression; Big White Wall, an anonymous, curated social network for people dealing with depression; FearFighter, a CBT-based self-help course for phobias; Ieso Digital Health, which offers live CBT therapy via secure instant messaging; and SilverCloud, an online platform that offers programs for different mental health conditions. The site offers descriptions of each program, instructions for accessing them, and a link to the clinical evidence that the program works. The plan is to add additional mental health apps over time, as well as to eventually expand into other mobile health areas. NHS chose mental health to start because of a large base of evidence that these interventions are effective.

It should come as no surprise that the NHS has launched a set of on-line resources devoted to mental health. It claims that interventions such as these can be effective and I am in no position to argue with this assertion. The NHS is  chronically underfunded so this approach, if it works, is certainly a cost-effective way to deal with mental health problems in England. I believe that similar programs would never see the light of day in the U.S. Mental health professionals would mount a spirited attack on such an approach, probably citing the potential harm it might inflict on patients. They may be right but part of such opposition could be based on turf and financial issues. However, such a discussion may now proves to be unnecessary. The NHS is running the necessary "experiment" and we should soon know if this approach proves to be useful. 

I found the article cited above to be very confusing in the sense that it conflates health-oriented apps running on smart phones with web-based networks and instant messaging systems. I have not spent enough time on the NHS Choices web site to determine whether the various options are made more clear there. Perhaps the problem is that CBT self-help courses are still very new and the naming conventions relating to them are in a state of flux.

Cleveland Clinic Broadens Its Mission and Reduces Costs

In a recent article about the Cleveland Clinic in the New York Times, it was reported that it was broadening its mission (see: Cleveland Clinic Grows Its Inpatient Volume; Relatively Unique Business Model) to include more primary care and services to underserved population in Cleveland (see: Cleveland Clinic Grapples With Changes in Health Care). Not surprisingly, the Cleveland Clinic executives are also grappling with the cost of care in the face of declining reimbursements from governmental programs and increased attention to the cost of care from the health insurance companies. This is a problem common to all hospitals both big and small. Here's a quote from the article discussing how the chief financial officer of Cleveland Clinic views the financial situation:

The Cleveland Clinic must also figure out how to deliver care less expensively. As they develop narrow networks, private insurers are dropping hospitals that they consider too costly or poor-quality care providers. While the details remain vague, Medicare has announced plans to tie as much as half of its payments to value or quality payment models by 2018. Regardless of what happens, “the challenge still points to making health care more affordable,” said Steven C. Glass, the clinic’s chief financial officer. The clinic cut expenses by roughly $500 million last year. The system is avoiding unnecessary lab tests, for example, and performing a hip replacement for $1,500 less than it did two years ago by standardizing the devices used and using less blood and other supplies, all, it says, without sacrificing quality. Its doctors are typically on salary, making it much easier for the clinic to work with them to figure out how to better care for patients.

I can't think of many cases where a hospital with a reputation for delivering highly sophisticated tertiary care has extended its mission to include primary care, particularly for underserved populations. I must admit, however, that this make sense given the critical niche the Cleveland Clinic fills in Cleveland and Ohio. It could also have a public relations problem if it only served the insured and the affluent. This broadening of  mission will reinforce the need to cut costs -- no hospitals improve their economic outlook by expanding primary care and services to underserved populations.

In the light of all of this, a recent note I posted about the new relationship between Cleveland Clinic and Theranos makes even more sense (see: Cleveland Clinic Develops Business Partnership with Theranos). Theranos claims on its web site that the charges for its broad test menu offered in Walgreens drug stores are always less than 50% of published Medicare rates. We need to take such a statement with a grain of salt because many Silicon Valley startups provide services at less than their cost, or even free, in order to gain a toehold in the market. Nevertheless, the new relationship between the Clinic and Theranos will certainly enable the Clinic to assess whether this low-cost claim by Theranos would hold up in a hospital environment. 

As I have stated many times before, lab testing is the best bargain in healthcare today. Typically a hospital expenditure for all of its lab services amounts to about 5-6%  of the its operating budget. Recall that lab test results come into play for some 70% of all diagnoses. Lab test results often play a key role in the ordering of other diagnostic procedures such as imaging. Reimbursement for inpatient care is fixed and based on the diagnosis of a patient so the labs are a cost center. If the Cleveland Clinic were to determine that, using the Theranos technology, it could shave  two or three percentage points from the overall cost of the clinical labs, this would have a major impact on the cost of care. Clinical lab testing would become even a bigger bargain than it is today.

"Unpatient" Health Data Ownership Manifesto; An Idea Whose Time Has Come

I picked up on Twitter some stirrings about the need for more attention to patient data access rights (launched by @leonardkish and David Maizenberg @biologypartners). This interest has resulted in a web page devoted to "unpatients" and their need for unfettered access to personal health information. Here is a paragraph copied from the home page of this web site regarding such rights:

We believe you have a right to know data about yourself and to control your own data-driven destiny. That means you have a right to access health data that is derived from you. We believe this data should always be available to you with full privacy and security, independent of any third party.

Here are all of the elements of the manifesto from the same web site (boldface emphasis mine):

• An individual’s access to data about him/herself is a fundamental human and property right.
• Platforms will be developed to enable the rights and transactions around such property.
• We support the development of these platforms.
• Monopolies on medical knowledge and information are unethical.
• Individuals have a right to any data that comes from a measurement of an internal state of their body, including medical devices.
• Individuals own their lab data (see CLIA).
• Individuals have the right to their data in standardized, machine-readable forms.
• Individuals have the right to have this data analyzed by any human or machine intelligence that they choose.
• Individuals will be able to store, donate, share or even sell limited access and limited rights to their personal data resources.
• Individuals have literally died waiting for their lab data.
• Lab data should be made accessible to individuals as soon as it is available.
• Medical regulations exist to protect individuals from medical harm.
• Data, ideas and information in and of themselves cause no medical harm.
• Individual may have access to metrics and analysis about their own body without a doctor’s permission as long as accessing that data poses no medical risk.
• Individuals have a right to health data privacy.
• Rights to sharing must be established with the individual it originates from, or their legal agent, in advance of sharing.

There is nothing particularly radical about this manifesto. I that that all of these rights are mandated by current laws including HIPAA or commonly accepted in healthcare. The problem is that most patients are uninformed about their access rights to information and these rights may be ignored by hospitals for the sake of convenience. Hospitals are also concerned about the potential cost of responding to these issues in an organized way. In order to address some of the complexities of responding to patient rights to information, the healthcare industry has developed the concept of health data stewardship, which can be described, in part, in the following way (see: Health Data Stewardship: What, Why, Who, How; PDF)

A central concept of data stewardship is accountability, which resides in a named data steward with formal responsibility for assuring appropriate use of health data, and with liability for inappropriate use. Health data stewardship supports the benefits to society of using individuals’ personal health information to improve understanding of health and health care while at the same time respecting individuals’ privacy and confidentiality.

I am not attacking the idea of health data stewardship. However, there needs to be some process that enables healthcare organizations to carry out their mission efficiently while respecting the rights of patients. The problem is that most of the discussion about this topic comes from healthcare professionals, perhaps with some token representation by "professional" patient advocates. I think, therefore, that this nascent patient movement will prove to be valuable in providing a voice in this conversation for the unheard healthcare consumers.

Hospitals as a Major Barrier to the Pursuit of EHR Interoperability

I have posted a number of notes about how to promote EHR interoperability (see, for example: Revisiting EHR Interoperability; Standardized Content and Vendor Strategy; E-Prescribing Giant, SureScripts, Provides EHR Interoperability Solution). I have also stated that hospital executives constitute one of the major barriers to clinical information exchange among hospitals, although EHR vendors like Epic certainly deserve part of the blame. Hospital executives are not enthusiastic about medical record portability because it encourages patients to shop around for the best prices and quality. If hospital executives vociferously demanded this feature, EHR vendors would certainly be more responsive. Here is a quote from one of my notes on this topic from five years ago (see: Judith Faulkner, EMR Interoperability, and Washington IT Politics):

Hospital CEOs and CIOs have little interest or enthusiasm for multivendor interoperability, either within their hospitals or hospital systems or across the outside hospital systems that they compete with....They would thus rather have shrink-wrapped integration delivered by a vendor like Epic, the so-called "enterprise solution." Moreover, CEOs don't want to encourage broad patient and clinical data portability because it gives the payers (insurance companies and the federal government) a strategic advantage during negotiations about reimbursement.

A recent article makes this same point (see: How a Broken Medical Records System is Endangering America’s Health) and below is an excerpt from it:

[S]everal of the largest electronic health records systems have prioritized billing and regulatory reporting over other aspects of care. And many hospitals are still wedded to “fee for service” models, which reward doctors for pricey procedures and tests, rather than patient outcomes. The medical record vendors are helping these hospitals thrive in the status quo by driving up volumes of pricey procedures, policymakers say, and there is little incentive to share access to the records of those lucrative patients.“These fee-for-service hospitals are fighting tooth and nail to retain patients — and the vendors are responding to these needs,” said Dr. Bob Kocher, one of the key architects of the Affordable Care Act....“They [some hospitals] have not wanted features that make it easier to share information.” The inability of medical records to be easily electronically accessed in different places is a major failure in America’s health care system, experts like Kocher say, despite more than 20 years of political and health industry leaders advocating for streamlined system as a critically needed tool to improve patients’ health.

Even if fee-for-service were eliminated tomorrow, I don't think that most hospital execs would embrace EHR interoperability except perhaps when it works in their favor. This occurs for large teaching hospitals that receive referral cases. Having rapid access to the electronic records of those patients would be helpful. Even this could be a stretch, however, because interoperability can be technically challenging for hospitals and EHR alike. Hospitals won't pursue it actively, and pressure their EHR vendors, without some major incentives to do so. Some type of reimbursement hit might be the ticket. However, it's politically more palatable for the government to single out the vendors regarding the need for interoperability because the hospitals are such big employers and critical for the economic health of most cities. However, I think that hospital executive need to be invited to the interoperability party.

Cleveland Clinic Develops Business Partnership with Theranos

The business model adopted by Theranos is interesting. If successful, it will challenge the status quo on price, technology, direct access testing, and blood draws.  A note that I posted about the company last December has elicited more attention than any other so interest in the company is widespread (see: Finally, Some Important New Details about the Theranos Business Model). Part of the problem relating to the company is that not much information has been released about it's testing methodology which is based on science that has yet to be adequately validated. This has lead to the conclusion on the part of many pathologists that the hype about the company is designed to inflate its value. Now comes news that the Cleveland Clinic is partnering with Theranos to assess its technology and perhaps provide some esoteric testing to the company (see: Cleveland Clinic partners with Innovations winner Theranos for lab tests). Below is an excerpt from the article:

A partnership between the Cleveland Clinic and Theranos...may make blood tests much less painful for many patients in Northeast Ohio.....The Clinic is testing the company's method over the next year to see if it's feasible to use in place of traditional blood testing methods. In October, the Cleveland Clinic named a California-based company's technology for performing blood tests one of its top ten innovations for the coming year. Now, the Clinic is backing up that bet by partnering with the company, Theranos, to test its technology as a potential cost-saver for the entire health system. Theranos...uses a patented technology to perform a bevy of diagnostic tests on a single drop of blood, eliminating the need for long needles and multiple vials....The company, which currently provides its laboratory services through a network of Theranos Wellness Centers inside Walgreens stores in Arizona Northern California, can perform up to 30 tests on a single sample, many at a small fraction of the rates set by Medicare. A standard lipid panel, for example, costs $2.99 via Theranos, and can cost anywhere from $60 to hundreds of dollars, depending on where and when it's performed.....Though some patients may see the Theranos technique for blood draws in use at the Clinic as part of this early research, it will be at least a year before the health system has enough information to determine if it will use the new method in place of routine lab tests.....Part of the partnership does include the potential of expanding Theranos' portfolio of tests, though there are not yet concrete plans to do so....Pathologists at the Clinic may also provide diagnostic services to Theranos for the Clinic's patients or for Theranos' testing nationwide, and the Clinic's reference laboratory may also partner with Theranos to offer the diagnostic testing the company does not yet provide.

Pathologists who are skeptical about the Theranos claims about its chip-based analyzers and its low cost-per-test suggest that Cleveland Clinic may take a hit in its reputation if these claims are not borne out in its forthcoming assessment. I personally think that the Clinic has maneuvered itself into yet another win-win situation analogous to its radical policy of  six years ago of not hiring smokers (see: Want a Job at the Cleveland Clinic?: Smokers Need Not Apply). This was a very gutsy move on the part of the Clinic that few other health systems would take for fear of legal repercussions and civil libertarian backlash. By taking this step, the Clinic lowered its employee health costs and made a powerful statement about its support for wellness. The only people it upset were smokers seeking jobs at the Clinic, a rapidly diminishing minority. 

In terms of its announced relationship with Theranos, the Clinic now positions itself once more as an innovative organization that is embracing new technology that could potentially lower the cost of care. If it ends up validating the Theranos technology, it places itself in a position to deploy it early in its hospitals. It will also be able to provide esoteric testing to Theranos as it expands its presence in the myriad Walgreens stores. If it finds the Theranos technology inadequate, even if it withdraws from the relationship quietly, it will gain favor in the eyes of the Theranos critics. There is no way that the Clinic will endorse the Theranos technology if it does not provide quality test results, even if it stands to gain financially from a positive endorsement. 

Patient Assistance Programs Keep Drug Prices High and May Actually Be Illegal

Given the lofty price of many drugs these days, one would assume that the so-called patient assistance programs for drugs would be beyond reproach. These programs offer drugs at reduced prices to patients with lower incomes. However, a recent article discusses how such program may actually serve to keep drug prices artificially high (see: Lifesavers or kickbacks? Critics say patient-assistance programs help keep drug prices high). Below is an excerpt from the article:

 [P]atient-assistance programs, which often are funded largely by drug makers  have helped many Americans...afford the medications they need. But these programs' ties to pharmaceutical companies carry a high cost for the healthcare system, critics say....Critics say patient-assistance programs help manufacturers keep prices high and demand for their branded products strong, and discourage patients and doctors from switching to cheaper alternative medications. Even though some drug makers have publicly disclosed their contributions to these programs—many of which purport to be independent charities—information about contributors remains incomplete....While some drugmakers have publicly disclosed their contributions to these programs, information about contributors remains incomplete, making it hard to figure out how much influence the donors have.

The federal government has raised questions about whether some independent patient-assistance programs funded by drugmakers constitute illegal kickback schemes. And some researchers have urged that drugmakers contributions to these programs be disclosed through the CMS' Open Payments website established by the Physician Payments Sunshine Act. Health insurers also aren't happy about these assistance programs, including coupons offered by drugmakers to help patients afford their drug copays. Insurers say the programs drive up overall drug costs and therefore increase premiums....PAN [Patient Assistance Network Foundation], which is independent but almost entirely funded by pharmaceutical companies, has provided more than $700 million in assistance to more than 360,000 patients since 2004 to help them afford their out-of-pocket healthcare costs, according to the foundation. 

So how does providing financial assistance to patients to purchase drugs keep drug prices high? Here are some  possible explanations of this theory:

• The drug companies can deflect criticism of their high prices by saying that assistance is being provided to those patient who can't afford them.
• Offsetting the cost of some very expensive drugs serves as an incentive for patients, and their prescribing doctors, to continue to use them rather than searching for less expensive but equivalent drugs.
• Given that the drug companies seems to be underwriting these patient-assistance programs, the cost of them needs to be made up in some way by the companies, thus contributing to the overall high price for drugs.

I don't know much about the definition of a kickback under the law and whether it applies to the end-users of some good. To me, these patient assistance programs seem to fall into such a category. Moreover, one needs to pose a very key question here. The patient assistance at first glance seem philanthropic. If this is the case, why would drug companies try to hide their financial support for them. A logical conclusion might be, firstly, that they have actually been designed by the pharma companies to maintain the high prices of drugs, the strategy referred to in the bulleted list above. A second reason is that the companies are nervous about whether they are legal. Unfortunately, Congress does not seem predisposed to take any action about high drug prices regardless of the underlying cause.

Epic to Remain Private with Creation of the Epic Charitable Foundation

It seems like the guessing game is now over about the continuing status of Epic as a private corporation (see: Faulkner funds foundation to keep Epic private). The founder and CEO Judith Faulkner has announced that she will leave much of her stock holdings in the company to a charitable foundation. Below is an excerpt of an article announcing this news with some of the details:

Epic Systems Corp. founder and CEO Judith Faulkner has decided to leave much of her holdings in her privately held company to a specially created charitable foundation that will operate and fund not-for-profit organizations in healthcare and other areas....The donation will come following Faulkner's death....“I am, fortunately, healthy,” said Faulkner, 71. The foundation also will help Faulkner keep Epic in private hands, a goal she has long cherished....The foundation will control the stock. This plan is designed to preserve the company as a private company forever....Epic's gross revenue in 2014 was $1.77 billon, Faulkner acknowledged. Publicly traded EHR competitor Cerner Corp., Kansas City, Mo., reported revenue of $3.4 billion in 2014 and, with a share price of $70.14 at the market close Monday, had a market capitalization of $24.08 billion. Calculating a straight comparison of revenue to market cap, Epic would be worth about $12.5 billion. Last year, Forbes placed Faulkner at 239th on its list of the 400 wealthiest Americans at $2.4 billion. It has since upgrade her wealth to $2.8 billion....The trust is being called the Epic Foundation, for the time being, but the name will likely be changed....Faulkner has been adamant about the company she leads remaining privately held. When a company is private, “You don't have to have the tyranny of the quarter,” Faulkner said

So all of this puts to rest the periodic rumors that Epic could get snapped up at some point by a for-profit diagnostics or pharmaceutical company. However, no knowledgeable industry observers have ever given much credence to this idea given Faulkner's penchant for control and micromanagement. Moreover, she has never seemed all that interested in matters outside of the company and the world of science fiction fantasy. To restate the obvious, however, there are a lot of things that can happen to a septuagenarian and most of them are not all that favorable. I am not a lawyer so I can't speculate on the ways that a charitable foundation interacts with a company for which it holds all of the stock. One thing about all of this is sure, however. Epic without Faulkner at the helm would look and operate differently than the company as it stands today, even if the management team was composed of veteran Epic insiders. The fate of the company post-Faulkner is obviously of great interest to hospitals that may have invested millions of dollars in an Epic EHR. Today's news provides details about only one piece of this puzzle.

FDA Develops App to Track Drug Shortages; Also APIs to Access FDA Databases

Drug shortages are an increasing problem, particularly for drugs with low profit margins (see: Chronic Hospital Drug Shortages; Can This Problem Be Solved?; Obama Takes Steps to Alleviate Critical Drug Shortages). Note that some of these companies have grown accustomed to drugs that sell for more than $100,000 per year. The FDA has developed an app to track such drug shortages (see: FDA releases app for clinicians to track drug shortages). Here is an excerpt from the article:

The FDA has launched a new app, called DrugShortages, to help health care practitioners and pharmacists track current drug shortages, resolved shortages, and discontinuations of drug products....“The new mobile app [according to an FDA spokesperson,] is an innovative tool that will offer easier and faster access to important drug shortage information. DrugShortages is available on iOS and Android devices. Users can search the database available in the app for a generic name or active ingredient. They can also search for drugs alphabetically or therapeutic category. The app also provides instructions for how an app user can report a drug shortage or supply issue. The FDA hopes the app will help health care practitioners make quick decisions about patient treatment based on the information the app provides. In the past couple years, the FDA has released a few other digital resources for consumers and professionals.In 2012, Epidemico relaunched their app, MedWatcher, in collaboration with the FDA. The app helps consumers report side effects or adverse events of medical devices directly to the FDA....Last summer the FDA launched an API-driven initiative, called openFDA that is designed to help web developers, researchers, and consumers access the FDA’s large public health data sets. The goal for the initiative is to get developers to build their own apps on top of openFDA using the data.

On its web site, OpenFDA describes its mission as providing the following: Open-source APIs for FDA drug, device, and food data. On the home page are listed the following FDA databases as well as the APIs that can be used to guide the development of interfaces to them:

Drugs

• Adverse events (api.fda.gov/drug/event
• Labeling (api.fda.gov/drug/label)
• Enforcement reports (api.fda.gov/drug/enforcement)

Devices

• Adverse events (api.fda.gov/device/event)
• Enforcement reports (api.fda.gov/device/enforcement)

Foods

• Enforcement reports (api.fda.gov/food/enforcement)

It is becoming commonplace for various types of companies to publish open-source APIs that developers can then use to access their often useful, in-house databases and "power consumer-facing applications" (see: The Value of APIs for Business). Here's a quote from this web page describing how a company or governmental agency like the FDA can create value by providing such API's.

When an enterprise business releases public APIs that power consumer-facing applications, it enables new ways to engage and connect with its customers through web, mobile, and social apps....As an example, take the hypothetical case of a national auto insurance provider. Over the years, as part of its normal business operations and planning, it has assembled and maintained comprehensive, detailed, and up-to-date data on the quality and condition of local roads all across the country. By making this previously internal data publicly accessible through an API, the company unleashes the creativity of developers and related businesses to devise new uses for the data. Developers create apps that recommend driving routes based in part on road quality. Civic groups develop apps that empower citizens to band together and petition local officials for better funding of transit infrastructure....Simply exposing this previously isolated and hidden data through a public API has given the insurance company a powerful way to extend its reach to thousands of new customers — who now regularly connect with the company in a more personal, meaningful way.