Wednesday, February 20, 2019
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For Your Radar — Huge Implications for Healthcare in Pending Privacy Legislation

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By VINCE KURAITIS and DEVEN McGRAW

Vince Kuraitis
Deven McGraw

Two years ago we wouldn’t have believed it — the U.S. Congress is considering broad privacy and data protection legislation in 2019. There is some bipartisan support and a strong possibility that legislation will be passed. Two recent articles in The Washington Post and AP News will help you get up to speed.

Federal privacy legislation would have a huge impact on all healthcare stakeholders, including patients.  Here’s an overview of the ground we’ll cover in this post:

  • Why Now?
  • Six Key Issues for Healthcare
  • What’s Next?

We are aware of at least 5 proposed Congressional bills and 16 Privacy Frameworks/Principles. These are listed in the Appendix below; please feel free to update these lists in your comments.  In this post we’ll focus on providing background and describing issues. In a future post we will compare and contrast specific legislative proposals.

Failing Healthcare’s ‘Free Market’ Experiment in US: Single Payer to the Rescue?

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By KHURRAM NASIR MD, MPH, MSc 

In the industrialized world and especially in United States, health care expenditures per capita has has significantly outgrown per capita income in the last few decades. The projected national expenditures growth at 6.2%/year from 2015 onwards with an estimated in 20% of entire national spending in 2022 on healthcare, has resulted in passionate deliberation on the enormous consequences in US political and policy circles. In US, the ongoing public healthcare reform discussions have gained traction especially with the recent efforts by the Senate to repeal national government intervention with Affordable Care Act (ACA).

In this never ending debate the role of government interventions has been vehemently opposed by conservative stakeholders who strongly favor the neoclassical economic tradition of allowing “invisible hands” of the free market without minimal (or any) government regulations to achieve the desired economic efficiency (Pareto optimality).

A central tenet of this argument is that perfect competition will weed out inefficiency by permitting only competent producers to survive in the market as well as benefit consumer to gain more “value for their money” through lower prices and wider choices.

Restrained by limited societal resources, in US to make our health market ‘efficient’ we need to aim for enhancing production of health services provision at optimal per unit cost that can match consumers maximum utility (satisfaction) given income/budget restraints.

Keeping asides the discussion on whether a competitive market solution for healthcare is even desirable as adversely impact the policy objective of ‘equity”, however from a pure ‘efficiency’ perspective it is worthwhile to focus on the core issue whether conditions in healthcare market align with the prototypical, traditional competitive model for efficient allocation of resources.

Health in 2 Point 00, Episode 70 | HIMSS Recap

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We almost forgot to do Health in 2 Point 00 at HIMSS—but don’t worry, here it is. On Episode 70, Jess and I give you a rundown of everything that happened at HIMSS. Jess asks me about the biggest gossip at HIMSS (anyone notice Atul Gawande wasn’t there?), all the talk about ONC rules, new and exciting things at the exhibit hall, and the best and worst parties of HIMSS.—Matthew Holt 

 

Radiology in Africa

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By SAURABH JHA MD SAURABH JHA

What are the challenges of getting imaging to Africa? In this episode of Radiology Firing Line, I convene a panel of experts in Africa. We discuss the challenges of bringing new technology to Africa, the new need for imaging driven by public health gains and increased longevity of Africans, the insalubrious practice of “equipment dumping”, amongst others.

Panelists:

  • Kassa Darge, MD PhD, is Professor of Radiology and Radiologist-in-Chief at Children’s Hospital of Philadelphia. He is also Honorary Professor of Radiology in the Department of Radiology at Addis Ababa University in Ethiopia.
  • Omolola Mojisola (Monica) Atalabi MBBS MBA, is Professor of Radiology and Chief of Pediatric Radiology at University College Hospital, Ibadan, Nigeria. She is President of both the Association of Radiologist in Nigeria and the World Federation of Pediatric Imaging.
  • William Sykes is the CEO of Tecmed Arica – a medical equipment, device, service and training provider in the Southern African region.

Listen to our conversation here.

Saurabh Jha is a contributing editor to THCB and host of Radiology Firing Line Podcast of the Journal of American College of Radiology, sponsored by Healthcare Administrative Partner

Medicine is Not Like Math

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By HANS DUVEFELT MD Dr. Hans Duvefelt, A Country Doctor Writes, physician burnout

We do a lot of things in our head in this business. Once a patient reports a symptom, we mentally run down lists of related followup questions, possible diagnoses, similar cases we have seen. All this happens faster than we could ever describe in words (let alone type).

And, just like in math class, we are constantly reminded that it doesn’t matter if we have the right answer if we can’t describe how we got there.

So the ninth doctor who observes a little girl with deteriorating neurologic functioning and after less than ten minutes says “your child has Rett Syndrome” could theoretically get paid less than the previous eight doctors whose explorations meandered for over an hour before they admitted they didn’t know what was going on.

Does anybody care how Mozart or Beethoven created their music? Or do we mostly care about how it makes us feel when we listen to it?

Obsessive Measurement Disorder: Etiology of an Epidemic

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By KIP SULLIVAN JD Kip Sullivan

Review of The Tyranny of Metrics by Jerry Z. Muller, Princeton University Press, 2018

In the introduction to The Tyranny of Metrics, Jerry Muller urges readers to type “metrics” into Google’s Ngram, a program that searches through books and other material published over the last five centuries. He tells us we will find that the use of “metrics” soared after approximately 1985. I followed his instructions and confirmed his conclusion (see graph below). We see the same pattern for two other buzzwords that activate Muller’s BS antennae – “benchmarks,” and “performance indicators.” [1]

Muller’s purpose in asking us to perform this little exercise is to set the stage for his sweeping review of the history of “metric fixation,” which he defines as an irresistible “aspiration to replace judgment based on personal experience with standardized measurement.” (p. 6) His book takes a long view – he takes us back to the turn of the last century – and a wide view – he examines the destructive impact of the measurement craze on the medical profession, schools and colleges, police departments, the armed forces, banks, businesses, charities, and foreign aid offices.

Foreign aid? Yes, even that profession. According to a long-time expert in that field, employees of government foreign aid agencies have “become infected with a very bad case of Obsessive Measurement Disorder, an intellectual dysfunction rooted in the notion that counting everything in government programs will produce better policy choices and improved management.” (p. 155)

Muller, a professor of history at the Catholic University of America in Washington, DC, makes it clear at the outset that measurement itself is not the problem. Measurement is helpful in developing hypotheses for further investigation, and it is essential in improving anything that is complex or requires discipline. The object of Muller’s criticism is the rampant use of crude measures of efficiency (cost and quality) to dish out rewards and punishment – bonuses and financial penalties, promotion or demotion, or greater or less market share. Measurement can be crude because it fails to adjust scores for factors outside the subject’s control, and because it measures only actions that are relatively easy to measure and ignores valuable but less visible behaviors (such as creative thinking and mentoring). The use of inaccurate measurement is not just a waste of money; it invites undesirable behavior in both the measurers and the “measurees.” The measurers receive misleading information and therefore make less effective decisions (for example, “body count” totals tell them the war in Viet Nam is going well), and the subjects of measurement game the measurements (teachers “teach to the test” and surgeons refuse to perform surgery on sicker patients who would have benefited from surgery).

What puzzles Muller, and what motivated him to write this book, is why faith in the inappropriate use of measurement persists in the face of overwhelming evidence that it doesn’t work and has toxic consequences to boot. This mulish persistence in promoting measurement that doesn’t work and often causes harm (including driving good teachers and doctors out of their professions) justifies Muller’s harsh characterization of measurement mavens with phrases like “obsession,” “fixation,” and “cult.” “[A]lthough there is a large body of scholarship in the fields of psychology and economics that call into question the premises and effectiveness of pay for measured performance, that literature seems to have done little to halt the spread of metric fixation,” he writes. “That is why I wrote this book.” (p. 13)

Everyone Has a Part to Play in Ending Vaccine Hesitancy

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Felicia D. Goodrum Sterling
Heidi L. Pottinger

By FELICIA D. GOODRUM STERLING, PhD and HEIDI L. POTTINGER, DrPH, MPH, MA

The measles outbreak in Washington state this week has brought new attention to the anti-vaccine movement.  In fact, the World Health Organization recently identified “vaccine hesitancy” as one of top threats to global health. In the US, the number of unvaccinated children has quadrupled since 2001, enabling the resurgence of infectious diseases long-since controlled.  In fact, the WHO claims a staggering 1.5 million deaths could be prevented worldwide by improved vaccination rates.

Amidst the media and public health outcry, a mystery persists:  Why has vaccine hesitancy continued, despite years of vigorous debunking of shoddy science?  The answer may lie in a deeply-rooted distrust of doctors and science.

One of the authors of this article, Dr. Pottinger, surveyed hundreds of Arizona parents, from schools with exemption rates greater than 10%, about their perceptions on vaccines. Pottinger and colleagues found the vast majority of the parents surveyed who delayed or chose not to vaccinate their children did so because of true personal beliefs and not convenience.  Specifically, they tended to distrust physicians and information about vaccines or held misperceptions about health and disease, including the idea that immunity by natural infection is more effective or that vaccine-preventable diseases are not severe.

These beliefs, stoked by a fraudulent 2010 study, have proven almost impossible to shake—despite the fact that the debunked study, based on 12 children, was retracted due to serious ethical violations and scientific misrepresentation; authors cherry-picked and fabricated data, and the first author had undisclosed business interests in the vaccine industry.

The failure of many interventions to dispel misinformation demonstrates the power of a complex interaction of confirmation bias, cognitive dissonance, distrust in data sources, and personal experiences and narratives.  Taking them on requires that the healthcare community effectively spread the following messages.

HIPAA RFI Comments: Patient Privacy Rights

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By ADRIAN GROPPER and DEBORAH C. PEEL

Adrian Gropper
Deborah C. Peele

Among other rich nations, US healthcare stands out as both exceptionally privatized and exceptionally expensive. And taken overall, we have the worst health outcomes among the Western Democracies.

On one hand, regulators are reluctant to limit private corporate action lest we reduce innovation and patient choice and promote moral hazards. On the other hand, a privatized marketplace for services requires transparency of costs and quality and a minimum of economic externalities that privatize profit and socialize costs.

For over two decades, the HIPAA law and regulations have dominated the way personal health data is used and abused to manipulate physician practice and increase costs. During these decades, digital technology has brought marvels of innovation and competition to markets as diverse as travel and publishing while healthcare technology is burning out physicians and driving patients to bankruptcy.

Health in 2 Point 00, Episode 69 | Pre-HIMSSanity!

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Today on Health in 2 Point 00, Jess and I are pregaming HIMSS at WSJ Tech Health. In this episode, Jess asks me about my biggest takeaways from WSJ Tech Health—and what we’re looking forward to at HIMSS. We’ll be at booth #5594 with SMACK.health, along with WTF Health, our new podcast Hardcore Health and ten exciting tech companies including: Tag.bio, BlueStream Health, Happego, Ouchie, SurveyorHealth, Dot.Health, SAFE App, InPharmD, CaptureProof and Visolyr. Get a rundown of them here. We also have a guest question from Katie McGraw from W2O about predictions for big topics at HIMSS. –Matthew Holt

 

HIMSSanity Preview

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By MATTHEW HOLT

It’s time for my favorite busman’s holiday of the year, the HIMSS global conference, held this year in the cultural wasteland of Orlando, Florida (which given its cultural competition is Las Vegas is saying something!). But there are only 2 places in the US with enough hotel rooms to deal with 45,000 hungry and thirsty Health IT people and they’re it!

I think this is my 22nd HIMSS. First was in 1994, but I missed one when I was sick in the 90s, and 2-3 when I was taking a long post-dotcom bust sabbatical in the early 00s. Suffice to say I know my way around and have a decent party invite list. But this year is different. I’m both a HIMSS quasi-staff member, since Health 2.0 is now a HIMSS brand doing VentureConnect this year, AND I’m a vendor client with a booth for my SMACK.health advisory service program, which will be featuring several of our clients and a couple of special guests (or clients in waiting?).

So who will you see in booth #5594 at HIMSS?

First up the incomparable Jessica DaMassa will be interviewing all and sundry for her WTF Health specials. I’ll be stealing her camera for some THCB spotlights and we’ll also be recording segments for our forthcoming podcast HardCore Health. Then there’ll be a whole gang of super exciting tech companies and in no particular order with my (and not their quick summaries) here’s who they are:

  • SurveyorHealth — Super clever AI that optimizes medication management by fixing complex drug regimens, saving $$ and lives
  • BlueStream Health — Revolutionary, always-on telehealth network
  • CaptureProof — A visual medical record changing the game in ortho, derm, + + +
  • SAFE App — an STD lab test system hidden behind the coolest consumer app that will really help bring transparency to “dating” by sharing your STD status
  • Happego — Have you heard of psychological priming to create behavior change? This app does it at scale with no effort on the users part. Mindfulness made easy!
  • Ouchie – An app and community to help patients track, manage & beat chronic pain
  • Dot.Health — The home of the “.health” domain extension (come get yours!)
  • Tag.bio — Putting the power of data science into the hands of clinicians and researchers
  • InPharmD – “Siri for pharmacists,” bringing the most important lit searches to the end user
  • Visolyr — Interoperability-as-a-service for health care organizations

4 of these companies will be demoing at any one given time. Plus we will have the most fun furniture in the exhibit hall, and the only booth featuring a Unicorn Straddling during interviews. Come see us at booth 5594!

If you want to know more, the ringmaster is Zoya Khan.

Matthew is the Founder of The Health Care Blog and is the President of SMACK.health