By LESLIE KERNISAN, MD

flying cadeuciiFor a while now, I’ve been working on an ebook about making digital health more useful and usable for older adults.

(Don’t hold your breath, I really have no idea when it will be done. I can only work on it for about an hour every weekday.)

In reflecting on the health innovation conferences and conversations in which I’ve participated these past few years, I found myself musing over the following two questions:

1. What is health?
2. What does it mean to help someone with their health?

After all, whether you are a clinician, a health care expert, or a digital health entrepreneur, helping people with their health is the core mission. So one would think we’d be clear on what we’re talking about, when we use terms like health and health care.

But in fact, it’s not at all obvious. In practical parlance, we bandy around the terms health and health care as we refer to a wide array of things.

Actually defining health has, of course, been addressed by experts and committees. The World Health Organization’s definition is succinct, but hasn’t been updated since 1948:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Three Components

A more recent attempt to define health, described in this 2011 BMJ editorial, proposed health as “’the ability to adapt and self manage’ in the face of social, physical, and emotional challenges.”

This left me scratching my head a bit, since it sounded more like a definition of one’s resilience, or self-efficacy. Which intuitively seem much related to health (however we define it), but not quite the same thing.

I found myself itching for a definition of health that would help me frame what I perceive as the health – and life – challenges of my older patients.

Continue reading “What Is Health?”

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Screen Shot 2014-11-24 at 9.33.22 AMYou may have seen some news regarding a study MyFitnessPal recently did with UCLA.

I wanted to take a minute to address this study, since we participated in it directly. We are excited that we got to work with some very smart people to answer a question we also wanted to know the answer to. We jumped at the opportunity to find out—is having your physician introduce you to the app and help you sign up enough to kickstart a health journey?

What we learned is that just introducing people to MyFitnessPal wasn’t enough. People have to be ready and willing to do the hard work.

The app itself does work—if you use it. Our own data and the data from the study show that the more you log on, the more you use the app, the more success you will see. Users that logged in the most lost the most weight. In fact, we already know that 88% of users who log for 7 days lose weight.

We make tools designed to make it as clear and simple as possible for you to see the path to achieving your fitness goals. We are not, however, making a magic bullet—because there is no magic bullet. Ultimately, you’re the one who has to do the work.

Continue reading “MyFitnessPal Works If You Use It”

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The CommonWell Alliance Gets More Common

Aprima and CareCloud join Allscripts, Cerner, McKesson, athenahealth, Greenway, and RelayHealth in the CommonWell Alliance, a nonprofit consortium of HIT vendors focused on fostering interoperability.

Coalition Says Stick to ICD-10 Schedule

CHIME, AHIMA, HFMA, and a dozen more industry organizations send a letter to Congressional leaders urging no further delays to the implementation of ICD-10.

CVS Health Ramps Up Digital Health Efforts

CVS Health will expand its efforts in digital healthcare with the opening of a 15,000 square foot innovation lab in Boston that will house up to 100 employees.

KLAS: NextGen Tops for RCM Services

KLAS names NextGen Healthcare the top provider of ambulatory 2014 RCM services in a report that ranks the best-performing HIT vendors for outsourced billing and RCM.

Continue reading “HIT Newser: The CommonWell Alliance Gets More Common”

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Long time (well very long time) readers of THCB will remember my extreme frustration with Patients Privacyflying cadeucii Rights founder Deborah Peel who as far as I can tell spent the entire 2000s opposing electronic health data in general and commercial EMR vendors in particular. I even wrote a very critical piece about her and the people from the World Privacy Forum who I felt were fellow travelers back in 2008. And perhaps nothing annoyed me more than her consistently claiming that data exchange was illegal and that vendors were selling personally identified health data for marketing and related purposes to non-covered entities (which is illegal under HIPAA).

However, in recent years Deborah has teamed up with Adrian Gropper, whom I respect and seemed to change her tune from “all electronic data violates privacy and is therefore bad”, to “we can do health data in a way that safeguards privacy but achieves the efficiencies of care improvement via electronic data exchange”. But she never really came clean on all those claims about vendors selling personally identified health data, and in a semi-related thread on THCB last week, it all came back. Including some outrageous statements on the extent of, value of, and implications of selling personally identified health data. So I’ve decided to move all the relevant comments to this blog post and let the disagreement continue.

What started the conversation was a throwaway paragraph at the end of a comment I left in which I basically told Adrian to rewrite what he was saying in such a way that normal people could understand it. Here’s my last paragraph

As it is, this is not a helpful open letter, and it makes a bunch of aggressive claims against mostly teeny vendors who have historically been on the patients’ side in terms of accessing data. So Adrian, Deborah & PPR need to do a lot better. Or else they risk being excluded back to the fringes like they were in the days when Deborah & her allies at the World Privacy Forum were making ridiculous statements about the concept of data exchange.

Here’s Deborah’s first comment Continue reading “Is Deborah Peel up to her old tricks?”

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Unlucky in Coverage writes from the Southwest:

I am self-insured. I was quite pleased last year when I had a chance to purchase health insurance through the Federal Marketplace because my new plan was significantly less expensive and more comprehensive than the coverage I had previously. However, I just learned that my (Gold Plan) insurance is jumping from $399 to $508 a month – that’s 29%! I’ve been reading reports that the average rate increases are only a few percentage points but all of those studies are based on the lowest-priced Silver Plans.

Continue reading “Unlucky In Coverage”

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flying cadeuciiSo you spent millions to billions of dollars on information systems over the past few years, right?

How’s that working out for you?

For a large percentage of you, whether or not you admit it, not so well. What you bought needs some serious tweaks, re-engineering, re-thinking, re-vamping.

For an even larger percentage, maybe most of you, the best advice is: Junk it. Throw it out and start over.

Poorly designed and poorly implemented information systems are worse than useless, worse than a waste of those millions and billions of dollars. As we go through rapid, serious changes in health care, poor information systems will strangle your every strategy, hobble your clinicians, kill patients and actually threaten the viability of your organization.

A lot of health care executives dismiss the complaints about the new systems as the carping of stubborn technophobic doctors and nurses who should just get with the program. If you are tempted to do that, you need to take a step back. You need to get real. The complaints and concerns are too widespread, too deep and indeed too frightening for that kind of blithe denial. And they are not just coming from disgruntled docs.

Dr. Clem McDonald of the National Institutes of Health, a true pioneer in pushing for electronic medical records (EMRs) over the last 35 years, has called the current implementations a “disappointment,” even a “tragedy.” He is far from alone in this assessment.

Continue reading “Why You Should Ditch Your IT System”

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Screen Shot 2014-11-20 at 6.38.27 AM

     Each year, over 20,000 US students begin medical school.  They routinely pay $50,000 or more per year for the privilege, and the average medical student graduates with a debt of over $170,000.  That’s a lot of money.  But for some who pursue careers in medicine, the financial cost has been considerably greater.  Melissa Chen, 35, a final-year radiology resident at the University of Texas San Antonio, calculates that her choice of a medical career has cost her over $2.6 million in lost wages, benefits, and added educational costs.  And yet in her mind, the sacrifice has definitely been worth it.

Continue reading “Is Becoming a Doctor Worth $2.6 Million?”

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JOE wrote THCB with an interesting question that could be an outlier or could be significant:

Do you know of a consulting firm or advisory firm that can assist me in applying for insurance through Covered California? When I applied for insurance through the Covered California website, they gave me a list of places where I can get assistance. The phone numbers go to dead voice mail boxes or don’t work at all.  I am willing to pay for assistance from somebody that understands the system.

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Gruber OptimizedIn the giddy days after the passage of ACA, I was chatting to a PhD student in health economics. He was in love with the ACA. He kept repeating that it would reduce costs, increase quality and increase access. Nothing original. You know the sort of stuff you heard at keynotes of medical meetings; ‘Healthcare post Obamacare’ or ‘Radiology in the new era.’ Talks warning us that we were exiting the Cretaceous period.

He spoke about variation in healthcare, six sigma, fee-for-value and ‘paying doctors to do the right thing.’

‘How?’ I asked.

‘I just told you, we need to pay doctors for value and outcomes.’ He smugly replied.

‘How?’ I asked again.

He did not answer. Instead he gave me the look that one gives an utter imbecile who doesn’t know the difference between a polygon and a triangle. Continue reading “Grubernomics”

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