Screen Shot 2014-09-18 at 2.28.53 PMNot accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily. Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me – in my rumpled white coat, sheaves of dog-eared paper bulging from both pockets – feel out of place. Within a minute, an administrative secretary came out and escorted him into one of the offices. Exhausted from a long call shift and lulled by the quiet, I started to doze off. Soon roused by the sound of my own snoring, I started and looked about.

That was when I spotted the document on an adjacent chair. Its title immediately caught my eye: “How to Discourage a Doctor.”

No one else was about, so I reached over, picked it up, and began to leaf through its pages. It became apparent immediately that it was one of the most remarkable things I had ever read, clearly not meant for my eyes. It seemed to be the product of a healthcare consulting company, presumably the well-dressed man’s employer. Fearing that he would return any moment to retrieve it, I perused it as quickly as possible. My recollection of its contents is naturally somewhat imperfect, but I can reproduce the gist of what it said.

“The stresses on today’s hospital executive are enormous. They include a rapidly shifting regulatory environment, downward pressures on reimbursement rates, and seismic shifts in payment mechanisms. Many leaders naturally feel as though they are building a hospital in the midst of an earthquake. With prospects for revenue enhancement highly uncertain, the best strategy for ensuring a favorable bottom line is to reduce costs. And for the foreseeable future, the most important driver of costs in virtually every hospital will be its medical staff.

Continue reading “How To Discourage a Doctor”

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Robert W WahIf I had to capture the main shortcoming of electronic health record (EHR) technology in one word, this would be it: Usability.

As we’re observing National Health IT Week through Friday, I can’t think of a better time to call for EHR systems that better serve physicians and our patients. That’s why the AMA just released a new framework for improving EHR usability.

As a chief medical officer for a health IT company and a former deputy national coordinator in the Office of the National Coordinator for Health Information Technology, I understand the complexities of what’s required to make EHRs first and foremost usable systems for the medical practice. When I say “all” I want for Health IT Week is an EHR overhaul, I realize that’s no simple request.

But it is a basic request. Usability should be the driving quality of all health IT. Unless health IT functions in a way that makes our practices more efficient and facilitates improvements in our patient care, it isn’t doing what it was intended to do.

As my colleague Steven J. Stack, MD, AMA president-elect, has said, most physicians are stuck with technology that interferes with their ability to provide first-rate medical care. And that’s reflected in physicians’ professional satisfaction.

In the AMA’s study with the RAND Corporation released last fall, we identified that the primary driver of physician dissatisfaction was EHR technology that put up barriers to delivering high-quality patient care.

Continue reading “All I Want For Health IT Week Is An EHR Overhaul”

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Art Caplan 2Why are they so afraid of public health types who want to do something about the carnage caused by guns in America?

Vik Khanna is the latest man with a gun to write squealing in terror  before the kale crunching, fitbit wearing hordes of public health types who he is somehow sure are out to disarm him and, even more hilariously, have any chance of doing so.

Vik, buddy, no one and especially the roughly 28 folks in public health not completely distracted by their lack of funding and inability to secure tenure is capable of doing anything that will pry your gun from your warm-blooded grip. There is no political movement to take away anyone’s guns. The NRA is the mightiest lobbying outfit in these United States and the best Mike Bloomberg or Bill Gates are going to be able to do is to get the anti-gun lobby a few more op-eds and soundbites.

Vik stop being afraid of your critics. You hold all the bullets er … cards. Time to think harder. Do public health folks have anything to offer that might reduce the mayhem while letting you hunt deer or shoot partridge or blast targets or whatever it is you and your son like to do with your guns?

Well yes in fact there are some things from the minds of the unarmed weenies of public health worth your consideration and that of your open-carry pals.

Continue reading “What Is It With Gun Rights Proponents?”

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flying cadeuciiMillions of important pieces of health information are entered into systems of record daily. Without an information governance play book, we are asking our patients to take a trust fall with their health. How confident are you that this is the single source of truth and care is being accurately reflected?

Data has become the vital component against which all things are measured— from determining short-term efficacy to developing long-range strategies. As a result, a new role is emerging in many industries, the Data Quality Officer (DQO), who is entrusted with ensuring data health, analyzing trends, and deriving actionable insights from the information. While this role may be new to Fortune 500 companies, its core competencies have existed in healthcare for years, championed by health information management (HIM) professionals.

In healthcare, data has always been the lifeblood of better patient care — and accurate documentation is an essential first step to ensuring integrity. Data integrity not only helps improve patient care, it has downstream effects on regulatory compliance, case mix index (CMI), quality reports and your organization’s bottom line, as well.  But it won’t stand up today’s pressures and levels of scrutiny unless it all starts with an information governance strategy.

Create a playbook

A lot has been written about health IT and the vast amounts of patient data that is being entered into systems every day. How do we organize it, track it, analyze it, and leverage it to improve patient outcomes? Before we can execute against any of these initiatives, we first have to know that the information is accurate and uniform. Creating a playbook that includes protocols and processes, such as, who is allowed to enter clinical information into a record, what information is included and how it is presented, and a process for amending possible discrepancies is vital. Outlining these procedures and policies will help maintain dataintegrity.

Continue reading “Would You Take a Bullet For Your Clinical Data?”

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I remember the first time that I heard about an unexpected rise in unnecessary mastectomies in young white women, who were privately insured. About five years ago, I was at the largest cancer meeting of the year, the annual meeting of the American Society of Clinical Oncology. Speakers raised the issue; they’d speculate why; and within minutes, the speaker and the entire audience looked crestfallen and helpless.

For many, it was a devastating turnaround. The women’s health movement and progressive forces in medicine had vigorously fought for breast-conserving surgery because the best science long ago proved that total mastectomies were overkill. Not only has breast-conserving surgery been tested rigorously against total mastectomies, but the results have consistently shown, that for women with early breast cancer, there is no survival advantage to having more aggressive surgery. Compelling proof that breast-conserving surgery AKA lumpectomy and radiation should be the standard of care for early breast cancers goes back until about 1990. Simply put, for women with early breast cancers, if both breasts are removed, they will not reduce their chance of getting cancer again, nor will they improve their survival any more than if they had had a minimally invasive lumpectomy followed by radiation. Additionally, unnecessary hysterectomies were also questioned and they are far less common today.

Continue reading “Unnecessary “Preventive” Mastectomies are Surging in Young, White Women With Insurance”

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Ten new digital health companies will demo their products for the first time in the Launch! session during the Health 2.0 8th Annual Fall Conference being held in Santa Clara, CA on September 21-24. Launch! is a contest held at 12:00 p.m PDT on Wednesday, September 24th, where the technology is demoed in three and a half minutes. At the end, the audience votes for their favorites. Previous Launch! winners have included Castlight Health, Basis, and OM*Signal. This year’s finalists:

  • Symptify helps the user navigate a series of questions to narrow down the cause of their symptoms while also helping them find a nearby medical facility.
  • Open Source Health MyAVA, uses Open Source health IT for a collaborative patient – physician educational and informational sharing platform for women. Advocating everything from female health, fertility, to healthy aging.
  • Intake.Me is a communication and patient engagement product that allows patients to check-in for their doctor’s visit from anywhere and attach medical records stored in their own virtual private health cloud.
  • Livongo Health introduces the brand new InTouch, which is a diabetes monitor, advisory and coaching service, community, and communications tool—all rolled into one. The concept is so exciting that it’s got Glen Tullman out of his post Allscripts “retirement” and back into the startup game.
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Daniel GarrettLook at who is entering the New Health Economy: Amazon, with digital health applications; Intel, with a home health gateway; Google, with a fit platform, not to mention the news out of Cupertino last week.

Why? According to the 2013 PwC Global Innovation Survey, nearly half of drug and device companies are focusing on traditional product innovation rather than on breaking their efficacy and safety mold. And the stakes are high: As patients become value-seeking consumers, they want quick and easy technology connections to their health source.

It appears that the biggest barrier to transforming traditional healthcare business is culture. Most (89%) of the drug and device CEOs surveyed by PwC view technological advances as the global trend to follow. Yet three-quarters of these executives cite an inability to grasp new information technologies.

Many of these firms invested heavily in social media in 2012 and 2013, but then retreated, possibly awaiting further guidance from the FDA on what is acceptable conduct for “socializing” with consumers.

In fact, the FDA released draft guidance this spring outlining rules for interactive promotional media, including blogs, social networking sites, online patient forums, and podcasts. Some companies, such as Qu Biologics, already use social media to enhance trial recruitment. Companies can scan social media for information about adverse events related to their products. A recent study showed that social media had three times more adverse-event reports for 23 commonly used prescription medications than the FDA did during the same time period.

Any cultural transformation should begin at home. Although drug and device companies say they value social media as an important accelerator of innovation, the evidence is scant on how these firms use technology to promote internal communications that can better connect employees across traditional silos—from R&D to commercial business units.

Continue reading “Those New Neighbors”

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In less than one week, the Health 2.0 8th Annual Fall Conference will feature over 200 LIVE demos, 150 speakers, on over 60 panels and sessions focused on innovative solutions within health care technology.  Indu Subaiya, CEO & Co-Founder of Health 2.0 interviewed Adam Pellegrini, VP of Digital Health of Walgreens ahead of his appearance at the 8th Annual Health 2.0 Fall Conference. Adam will be participating in the Monday main stage panel “Consumer Tech and Wearables: Powering Healthy Lifestyles.” In this interview, Adam gives insight into Walgreens innovative API creating the seamless user experience.

Indu Subaiya: So you are leading up a number of very exciting initiatives at Walgreens in terms of digital health. Let’s begin by talking a bit about the API program and the developer ecosystem that you’ve built.

Adam Pellegrini: Absolutely. So Walgreens has been offering a very robust API program for quite some time – this idea that our stores in the online space should be really an omni-channel user experience.  If you think about our stores, our stores actually have a lot of partners that actually have products in the stores.

So really, our API program is really about partners. It’s about bringing and facilitating the digital ecosystem together via API.  So for us in the Health API space, it’s about how do we help all of these different apps leverage the ingredient technologies that Walgreens has created to create a seamless friction as user experience.

IS: You mentioned that the Health API has drawn a lot of members within the Health 2.0 community.  Can you tell us a little bit about some partners there and how this is then connected to your Balance Rewards program?

AP: GenieMD is actually one of our partner apps that leverage our Refill by Scan, our personal health app that goes on both Androids and iPhones.  And some of that could be really convenient and add a value to their app by embedding the API that we have for refilling prescriptions, the Refill by Scan.

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Since the death of comedian and talk-show host Joan Rivers, more information has surfaced about the events on the morning of August 28 at Yorkville Endoscopy. But key questions remain unanswered.

News accounts agree that Ms. Rivers sought medical advice because her famous voice was becoming increasingly raspy. This could be caused by a polyp or tumor on the vocal cords, or by acid reflux irritating the throat, among other possible causes.

So Ms. Rivers underwent an endoscopy by Dr. Lawrence B. Cohen, a prominent gastroenterologist, to evaluate her esophagus and stomach for signs of acid reflux. At the same time, a specialist in diseases of the ear, nose, and throat (ENT) reportedly examined her vocal cords (also known as vocal folds).

We don’t know exactly how much or what type of sedation Ms. Rivers’ may have received, though several news sources have reported that she was given propofol, the sedative associated with the death of Michael Jackson. No physician who specializes in anesthesiology has been identified on the team taking care of Ms. Rivers, and we don’t know who was in charge of giving her propofol.

It seems clear that at some point during Ms. Rivers’ endoscopy and vocal cord examination, there was a critical lack of oxygen in her bloodstream.

Was laryngospasm the cause?

Giving sedation for upper endoscopy is tricky, as any anesthesia practitioner will tell you. A large black endoscope takes up space in the mouth and may obstruct breathing. Any sedative will tend to blunt the patient’s normal drive to breathe. But most patients breathe well enough during the procedure, and go home with no complaints other than a mild sore throat.

News reports have speculated that the root cause of Ms. Rivers’ rapid deterioration during the procedure could have been laryngospasm. This term means literally that the larynx, or voice box, goes into spasm, and the vocal cords snap completely shut. No air can enter, and of course the oxygen in the bloodstream is rapidly used up.

The most common situation that leads to laryngospasm is irritation of the vocal cords. Everyone knows that when a drop of liquid or a crumb of food goes down the wrong way, it’s highly irritating and provokes a fit of coughing. When the vocal cords are stimulated or even lightly touched, their natural protective response is to close up.

Every anesthesiologist is taught how to manage laryngospasm, because it can be a life-threatening emergency leading to brain damage or death if the patient is deprived of oxygen for too long. Sometimes the vocal cords relax and open up on their own, but often they don’t.

Continue reading “Anesthesiologist’s Review of the Facts in the Joan Rivers Case”

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I’ve always been a little skeptical of the push to get doctors to prescribe apps.

To begin with, it would be awfully easy for us to replicate the many problems of medication prescribing. Chief among these is the tendency for doctors to prescribe what’s been marketed to them, rather than what’s actually a good option for the patient, given his or her overall medical situation, preferences, and values.

Then there are the added complexities peculiar to the world of apps, and of using apps.

A medication, once a pharmaceutical company has labored to bring it to market, basically stays the same over time. But an app is an ever-morphing entity, usually updating and changing several times a year. (Unless it stops updating. That’s potentially worse.)

Meanwhile, the mobile devices with which we use apps are *also* constantly evolving, and we’re all basically forced to replace our devices with regularity.

Last but not least, how can we know the benefit of prescribing one app compared to another? Studies are few and far between. And by the time a study is published, everything – the app, people’s use of technology, the mobile devices, the sensors – will have gone through several phases of change. This means we generally won’t have much of an evidence base, when it comes to the prescribing of a given app.

All of this means that it would be a Herculean task for physicians to maintain enough current knowledge about apps, such that they could prescribe them in a thoughtful and informed matter.

Continue reading “Should Docs Prescribe Data?”

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FROM THE VAULT

The Power of Small Why Doctors Shouldn't Be Healers Big Data in Healthcare. Good or Evil? Depends on the Dollars. California's Proposition 46 Narrow Networking

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