Richard Gunderman goodAmericans tend to like fast things: instant coffee, sports cars, and speed dating. Many share a fascination with record holders, such as the world’s fastest runner or texter. And increasingly, the same goes for medicine. The number of minute clinics is exploding. Some emergency rooms now post their current wait times on roadside billboards. And increasingly, physicians and other health professionals are under pressure to increase the speed at which they see patients.

A friend of mine, a family physician, was recently advised by the new manager of his practice that he will be penalized if he doesn’t increase the number of patients he sees each day in clinic. A thorough and compassionate physician who is known for the quality of the relationships he builds, he asked the man, “How am I supposed to work faster and still provide good care?” The practice manager thought for a moment and responded, “Why don’t you stop asking open-ended questions?”

To be fair, there is something remarkable about fast medicine. Consider Robert Liston, a 19th-century British surgeon who is said to have called out to his students, “Time me, gentlemen, time me!” It was widely known that Liston could amputate a leg in under three minutes, a hastiness attributable in part to the fact that inhalation anesthesia had not yet been invented. Yet such speed has drawbacks. In one of Liston’s most celebrated cases he removed his patient’s testicles, and in another he also amputated his assistant’s fingers.

Continue reading “Fast Med”

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Eating advice in the United States has taken leave of its senses. It is no wonder that Americans are perpetually on diets.

It is only in the last 20 years that eating, a task we do quite naturally, has become so complex that you apparently need professional spin from nutritionists and dietitians, or worse, from doctors, on how to do it.

Spend a little time on the web (and especially social media) and your head will spin from all the contradictory healthy eating advice: eat organic…no, wait, don’t waste your money; eat less salt…wait, too little salt might be worse for you than too much salt; don’t eat fat…oh, sorry, eating too little fat will actually make you fat because you’ll eat too many poor quality carbs; eat foods that have a low glycemic index…wait, we meant a low glycemic load, er, well maybe eat foods that are both; eat breakfast every day because it will help you control your body weight except when it doesn’t.

We have the most productive food industry and the safest food supply in the world. Without us, the world’s food supply collapses and lots of people starve.  Food is cheaper now as a proportion of income than it was 100 years ago. Only in America could we look at our easy and cheap access to food and conclude that we have done something wrong.

Continue reading “Eat Less. Eat Less Crap.”

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Screen Shot 2014-10-31 at 8.40.52 AMThis week, I have had the pleasure of attending the CHIME Fall Forum event in San Antonio, Texas. What I like most about this event is being able to talk to CIOs and hear their thoughts on this rollercoaster world of healthcare IT – to hear first-hand what challenges they face, what keeps them up at night, and what they are doing to solve these issues. As a vendor, we always strive to provide the best solutions and the best services possible that meet the needs of our customers. In this hectic world of regulations, deadlines, and competing priorities, it’s easy to lose sight of what is important and why we all do this in the first place. Ultimately, it comes down to doing what is right for the patients.

Although not all of the vendors attending CHIME offer the same solutions, nor do the attendees from different hospitals have the same challenges, there is one common theme among healthcare IT vendors, hospital CIOs, government officials, etc. At some point in our life, either ourselves, or someone we know, will be a consumer of the healthcare system seeking care. You want to be assured that the hospital or healthcare provider has done everything they can to be efficient and give you or your loved one the care that is deserved

So how do we, as a vendor, play a role in this? By listening to our customers about the challenges they are facing, and working with them to solve them. The greatest reward as a leader in a healthcare IT company is when we can grow a relationship and collaborate with a CIO to come up with the right solutions to their problems which ultimately benefits the patients. This may include streamlining a process so the patient gets results faster, or safe-guarding their medical information, or making the jobs of the clinicians easier so they can focus on the patient. These results make all the hard work worthwhile.

Continue reading “Partnership, Collaboration, and Success Between Vendors and Hospitals — it is possible!”

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Let’s see a show of hands. Who among us, doctor, nurse, patient, family member, wants to give or get health care inspired by a factory—Cheesecake or any other?

Anyone?

I didn’t think so.

True confession: I have never actually eaten at a Cheesecake Factory (hereinafter referred to as the Factory). My wife, Mary, and I did enter one once. We were returning from a summer driving vacation. Dinnertime arrived, and we found ourselves at a mall walking into a busy Factory.

It seemed popular. The wait was long—really long. We got our light-up-wait-for-your-table device. We perused the menu. There was a lot there. Portions seemed gigantic. We looked at each other and, almost without speaking, walked back to the hostess, returned our waiting device and left.

You got me—I cannot say 100 percent that I wouldn’t love Factory food. We were so close that one time!

A young woman in our small New Jersey town recently opened a new restaurant here. We tried it the other night. She and her business partner tended us and all the other patrons with such attention and care. We waited some, true, but she seated us near the bar while we waited—brought over pieces of cheese (no light-up device) for us to enjoy. The menu was ample and varied—not enormous. It’s also true that two items on the menu—including my first choice—were no longer available that evening. The chef however crafted the dishes that we did select with flare and pride. Dinner was a delicious, wonderful, relaxing experience—made better because of the human touch.

It’s probably not fair to contrast my one near-Factory dining experience with this other. Big chain restaurants have clearly figured out a way to provide a consistent meal for millions of satisfied customers. But the Factory way is not for everyone. People, I think, crave customized, attention-to-detail service experiences—in their dining choices. And—I’ll go out on a limb—in their health care too.

Continue reading “Big (Box) Medicine”

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Ceci Connolly

If you’re wearing a wristband that counts your steps, a patch that monitors your vital signs or a watch that tracks your heart rate, you are in the minority. And if you paid $300 or more for any of those items, you are among the nation’s quantified self-health elites.

Judging by the chatter streaming across our social media feeds, one would think every man, woman, child is sporting a health “wearable.” But in reality, these are the early days of the devices that promise to help us live longer, healthier, more active lives.

Despite the buzz, just 21% of Americans own a health wearable, according to a new consumer survey by PwC’s Health Research Institute, and only 10% of them use it daily. Even fewer consumers – 5% of respondents — expressed a willingness to spend at least $300 for a device. Many wearables today are a passing fancy – worn for a few months then tucked away in a drawer awaiting a battery charge or fresh inspiration to get up and get moving again.

As Genentech CEO Ian Clark recently put it, health wearables are “a bit trivial right now.”[1] And it seems even the folks claiming to be wearing the devices can’t be trusted – reports have begun circulating of employees enlisting their more active coworkers to wear the device and collect fitness points on their behalf.

Yet wearables present remarkable opportunities for a nation and industry grappling with the twin challenges of improving health and controlling healthcare spending. Across the board, consumers, clinicians, insurers and employers express high hopes for the power of these new devices.

Continue reading “The Self-Health Era”

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Screen Shot 2014-10-29 at 10.05.05 AMHealth 2.0 announces the inaugural event, WinterTech: The New Consumer Health Landscape on January 15th, 2015 during JP Morgan Week in San Francisco, CA. Industry leaders Walmart, Samsung, Target, Qualcomm Life, MyFitnessPal and many others will discuss major digital health themes in the marketplace such as: investing in consumer health, the new role of retail environments in health care, new platforms and interfaces for personal health, the informed health care consumer, and how consumer data is contributing to new clinical insights.

Participating organizations and speakers at WinterTech include:

Ben Wanamaker (Walmart)
Bakul Patel (United States Food and Drug Administration)
Rick Valencia (Qualcomm Life)
Tara Montgomery (Consumer Reports)
Karan Singh (Ginger.io)

Agenda highlights include: Continue reading “Health 2.0 Announces Agenda Highlights for WinterTech”

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Screen Shot 2014-10-28 at 9.34.48 AMThe Ebola crisis in Texas has tested our nation’s health care system in many ways, exposing weaknesses and potential breakdowns. In particular, the incident with the first diagnosed Ebola patient at Texas Health Presbyterian underscores a fundamental issue with information liquidity between providers, their care teams, and across the continuum of care. The ability to share information effectively is critical not just in responding to health care crises like Ebola — but also in delivering great, cost-effective care.

As athenahealth CEO Jonathan Bush said in an interview with CNBC earlier this month: 

“The worst supply chain in our society is the health information supply chain. It’s just a wonderfully poignant example, [a] reminder of how disconnected our health care system is. … The hyperbole should not be directed at Epic or those guys at Health Texas. The hyperbole has to be directed at the fact that health care is islands of information trying to separately manage a massively complex network.”

Continue reading “Ebola and the Information Flow Challenge”

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InterSystems. Our technologies enable healthcare organizations to rapidly connect processes, applications and people – and clinicians to make decisions with complete information.

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IntersystemsLike far too many women, I know what it means to confront the prospect of breast cancer. I spent the better part of a year in watchful waiting for what eventually proved to be a benign lump. Some of my friends participate in randomized clinical trials in hopes of being among the first to benefit from a promising new therapy. Some have passed away.

All have faced agonizing challenges sorting through options and confusing medical jargon, poring over statistical data they may or may not understand, and trying to reach a treatment decision in the midst of their fear.

A recent observational study reported in The Journal of the American Medical Association (JAMA) compared survival rates for several different treatment approaches to breast cancer. The primary finding picked up in the press was that the long-term survival rate for women undergoing bilateral mastectomy was not statistically different than that for women who chose lumpectomy and radiation.

I’m not going to outline the entire study – there are a number of good summaries available elsewhere. What particularly caught my interest was the way the study was conducted.

What excited me about the new study is that it is a terrific example of the secondary use of data for informatics-based clinical research. That is, information captured as part of the normal care process for a single patient is combined with information from an entire population segment in order to compare clinical alternatives. Continue reading “The Promise of Informatics-Enabled Research: The California Mastectomy Study”

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flying cadeuciiThe recent Ebola cases and fatality have triggered a collective process of finger pointing as we struggle to understand events and hold someone accountable.

Hence, the television footage of health officials hauled off to Congress, accusatory headlines (“Alarming stumbles by the C.D.C.”) and appointment of czars. In the desire to pin the blame somewhere, notably the Centers for Disease Control and Prevention (CDC), we overlook the essential fact that in the United States public health responsibilities are fragmented among federal agencies, and decentralized throughout state and local government. The laws and regulations governing public health activities at federal, state and local levels is truly wonky terrain, but understanding these details is critical to being able to improve our response to public health emergencies. We need to know who actually has the authority to deal with specific public health functions and who should be held accountable (spoiler alert – it is not the Czar, nor the Secretary at DHHS, nor the Surgeon General, nor the Director of CDC). Often, it is a state health official, local health official or professional organization. Continue reading “Who Do We Blame Now?”

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FROM THE VAULT

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