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Dr DuvefeltMedical errors happen every day. Few make the headlines, but when they do, almost everyone who chimes in to comment offers the same type of solution for avoiding them. Three of the most common are guidelines, decision support and checklists.

From my vantage point as a primary care physician I agree that checklists, in particular, can enhance clinical accuracy, but some of the lists I have to work with in today’s healthcare environment are more likely to bog me down and distract me than focus my attention on the essentials. I call them choke lists.

Re-reading “The Checklist Manifesto” by Atul Gawande, published in 2010, the year before my clinic implemented their first EMR, I am reminded of how much has changed since then.

How I work and where my attention is drawn has changed because of the minutia of Meaningful Use, Patient Centered Medical Home, Accountable Care and all the other new philosophies and forces that define primary health care.

Continue reading “The Great Checklisting of American Medicine”

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Kognito VA screen

A new online and mobile app released this week called Together Strong is helping U.S. veterans and service members learn what to say and do when a peer is struggling with post-deployment stress and readjustment to civilian life. Through interactive role-play conversations with 3D and emotionally responsive virtual humans, the user prepares to have real-life conversations that will motivate a friend to access help if needed, build resilience, and lead a healthier life. The app is available for free online and on iOS and Android.

Continue reading “A Virtual Buddy System For Soldiers Returning From War”

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Accountable care demands that the system sync with the preferences and choices of the consumer purchasing the services.  In order to get to real health value, consumer-patients must make the health care decisions that improve personal health and do not derail personal bank accounts.  It was hard to piece these together for the last 15 years.  Now, with high deductible plans, more transparency for costs, and on-time digital connectivity, there is less difficulty.

Information technology can deliver the needed information to the patient and the physician to improve not only the likelihood of improved care but also the time-to-achieve the outcomes.  Most patients want and need to be involved in their care.  There is evidence that giving patients access to their information results in higher levels of engagement and adherence to recommendations.  In fact, the latest evidence shows that patients have been signing up for access to their health system portals at a rate of 1% per month for over 30 months.

Continue reading “Health Value: IT and the Rise of Consumer Centricity”

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Yesterday XPRIZE announced the 11 finalists for the second phase of the Nokia Sensing XCHALLENGE. This is a $2.25m prize competition to advance the ability to use sensors to measure and manage health, and it’s something that we’re fascinated by at Health 2.0. You may recall that the first round’s winners were unveiled live on stage at the 2013 Health 2.0 Fall Conference by our friends at XPRIZE and Nokia.

To find out a little more, please come to a Google Hangout at 10 am Pacific/ 1pm EST Wednesday where I’ll be chatting with Dr. Erik Viirre, Medical and Technical Director of the Qualcomm Tricorder XPRIZE and the Nokia Sensing XCHALLENGE; Jonanthan Linkous, Chief Executive Officer of the American Telemedicine Association; Jon Dreyer, President of Health IT Strategic Partners; Dr. Manas Gartia from team MoboSense, a Distinguished Award winner in the Nokia Sensing XCHALLENGE Competition #1; and Dr. Marc Bailey from Nokia Technologies.

You can also see videos of the finalist teams and their breakthrough technologies can be viewed and voted on beginning today through October 30 at http://www.nokiasensingxchallengevoting.org. More on the teams below the fold:

Continue reading “SENSING XCHALLENGE, with Google Hangout Wednesday at 10 PST”

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flying cadeuciiSome years ago I was in Australia’s Northern Territory. The intrepid explorer that I was, I was croc-spotting from the comfortable heights of a bridge over the East Alligator River. The river derives its name because it is east of something. And because it’s croc-infested.

I was reading a story about a German tourist (it’s usually a German) who was attacked by a saltwater crocodile in the vicinity (1). The story concluded to reassure that one is more likely to be killed by a vending machine than a saltwater crocodile.

I imagined what the apotheosis of a left brain thinker, the data-driven Renaissance man, might have done with that statistic. Might he have peeked in to the East Alligator River looking for a vending machine and seeing none, jumped right in?

This empirical fact is useful if you suffer from croc-phobia and live in the Upper East Side of Manhattan, and the biggest voyage you ever plan to undertake is to the Hamptons. But it’s not terribly useful, and marginally harmful, if you’re deciding whether to kayak rivers in Northern Australia.

The vending machine has reared its deadly head again. It seems that more Americans have been killed by vending machines than have died from Ebola. Well let’s head to Liberia for the winter, because there are fewer vending machines there.

Sorry, I jest. But this is not a joke. Some actually think this is a relevant statistic to put Ebola in perspective. And some are actually reassured by it!

Continue reading “The Antifragile CDC”

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In an exclusive interview with Matthew Holt, American Well President and CEO Roy Schoenberg, MD shrugs off the threat of emerging competitors, predicts that United Healthcare will own a telehealth company within the next 12 months, and reveals that his company has “turned the corner” in terms of generating revenue from telehealth services. Schoenberg also shares details of the company’s recently announced integration with Apple HealthKit and the growing use of scheduled telehealth visits to treat chronically ill patients.

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Given what is now known about how the case of Thomas Eric Duncan at Texas Health Presbyterian was handled, the attempt to blame the hospital’s electronic health record for the missed diagnosis sounds pretty lame.

But people are still doing it:

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Critics of electronic medical records have found a case they will be talking about for years.

Consider this argument from Ross Koppel and Suzanne Gordon:

While it is too early to determine what precisely happened in this case, it is not too early to consider the critical issues it highlights. One is our health care system’s reliance on computerized technology that is too often unfriendly to clinicians, especially those who work in stressful situations like a crowded emergency room. Then there are physicians’ long-standing failure to pay attention to nurses’ notes. Finally, there is the fact that hospitals often discourage nurses from assertively challenging physicians.

Long promised as the panacea for patient safety errors, electronic health records, in fact, have fragmented information, too often making critical data difficult to find. Often, doctors or nurses must log out of the system they are on and log into another system just to access data needed to treat their patients (with, of course, additional passwords required). Worse, data is frequently labeled in odd ways. For example, the results of a potassium test might be found under “potassium,” “serum potassium level,” “blood tests” or “lab reports.” Frequently, nurses and doctors will see different screen presentations of similar data, making it difficult to collaborate.

Continue reading “Throwing the EHR Under the Bus …”

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We have some questions for you—questions, that is, about health information. What is it?  Can you get it when you need it? What if your community needed important information to make your town or city safe or keep it healthy? How about information about your health care? Can your doctors and nurses get health care information about you or your family members when they need it quickly?

I came across a recent Wall Street Journal article about a remarkable story of health, resilience and survival in the face of an unimaginable health crisis—a Liberian community facing the advancing Ebola infections in their country got health information and used it to protect themselves. When the community first learned of the rapidly advancing Ebola cases coming toward them, the leaders in that Firestone company town in Liberia jumped on the Internet and performed a Google search for “Ebola”.

Continue reading “Data for Health: Coming to a Town Near You …”

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When Thomas Eric Duncan first came into the hospital, he arrived with an elevated temperature, but was sent home.

On his return visit to the hospital, he was brought in by ambulance under the suspicion from him and family members that he may have Ebola.

Mr. Duncan was left for several hours, not in isolation, in an area where other patients were present.

No one knew what the protocols were or were able to verify what kind of personal protective equipment should be worn and there was no training.

Subsequently a nurse supervisor arrived and demanded that he be moved to an isolation unit– yet faced resistance from other hospital authorities.

Lab specimens from Mr. Duncan were sent through the hospital tube system without being specially sealed and hand delivered. The result is that the entire tube system by which all lab specimens are sent was potentially contaminated. Continue reading “Statement from the Dallas Nurses”

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Texas Health Presbyterian

A group of nurses at Texas Health Presbyterian has come forward with a very different picture of what happened when Liberian Ebola patient Thomas Duncan arrived at the hospital with Ebola-like symptoms on September 28th.  If true, the allegations are certainly unsettling.

In an unusual move, the nurses spoke anonymously to the media, conducting a blind conference call in which none of the participants were identified.

After arriving at the emergency room with a high fever and other symptoms of the disease , the nurses said the patient was kept in a public area, despite the fact that he and a relative informed staff that he had been instructed to go to the hospital after contacting the Centers for Disease Control in Atlanta to report a possible case of Ebola.

Continue reading “Angry Nurses Tell of Ebola Patient’s arrival at Texas Hospital”

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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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