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flying cadeuciiYour correspondent is avidly learning about health apps for patients.

As described here, half of U.S adults now own a smartphone, half of them use them to obtain health information and approximately a fifth have at least one health app loaded on their device.

Regular  readers are well aware of the potential for health apps, including lay-person education, the promotion of consumer behavior change, increased consumer-provider connectivity with greater access to care, better medication compliance as well as medication reconciliation, increased self-care, greater quality and lower costs.

But as this author’s e-health experience grows, he has encountered two under-recognized features of apps that – in his opinion –  are sure to also drive their adoption:

1. The Provider App Arms Race:  As  competition for loyal patients grows, health systems, care organizations, insurers, buyers and provider networks are going to expect their apps to create greater consumer “stickiness.”  For example, offering a tablet with a pre-configured app may enable hospitals to not only reduce readmissions, but enhance their brand recognition.

2. The App Is the Outcome: It will take years for science to prove that apps cause better outcomes. While lingering skepticism will prove to be another bonanza for outfits like this, the luster of smart-device gadgetry will be too much to resist. As a result, it’s only a matter of time until Boards and their CEOs pressure their management teams to launch their own app.  While the electronic record and big data are important advances, let’s face it: they’re in the background. There’s nothing like a patient-facing app to remind customers, families and providers of the organization’s health tech chops.

Jaan Sidorov, MD, is a primary care internist and former Medical Director at Geisinger Health Plan with over 20 years experience in primary care, disease management and population-based care coordination. He shares his knowledge and insights at Disease Management Care Blog, where an earlier version of this post first appeared.

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John Haughom MD whitePhysicians have always been in the information business. We have kept records of patient data regarding the vital signs, allergies, illnesses, injuries, medications, and treatments for the patients we serve. We seek knowledge from other physicians, whether that knowledge comes from the conclusions of experts from research published in a medical journal or the specialist down the hall. However, a physician will always benefit from additional good information such as the analysis of pooled data from our peers treating similar patients or from the patients themselves.

Over the next few years, vast new pools of data regarding the physiologic status, behaviors, environment, and genomes of patients will create amazing new possibilities for both patients and care providers. Data will change our understanding of health and disease and provide a rich new resource to improve clinical care and maximize patient health and well-being.

Patient Data Used by the Patient

Instead of a periodic handful of test results and a smattering of annual measurements in a paper chart, healthdata will increasingly be something that is generated passively, day by day, as a byproduct of living our lives and providing care. Much of the data will be generated, shared, and used outside of the health system. It will belong to patients who will use it to manage their lives and help them select physicians and other healthcare professionals to guide them in their quest for a long and healthy life.

Based on a patient’s preferences and needs, the data will flow to those who can best assist them in maintaining their health. It will reveal important and illuminating patterns that were not previously apparent, and with the right system in place, it will trigger awareness and alerts for patients and other providers that will guide behaviors and decisions.

Continue reading “Three Ways Doctors Can Use Patient Data to Get Better Results”

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Paul KeckleySaturday, the U.S. Senate passed the House-sponsored Omnibus Appropriation Bill that funds the federal government through September 2015. In all likelihood, all eyes weren’t glued to these proceedings, perhaps otherwise attentive to holiday shopping or the events around nationwide protests about policing in our cities.

Healthcare is a huge part of the federal budget: combining spending for Medicare, Medicaid, Children Health Insurance Program (CHIP), military and veterans’ health, Indian Health Services and federal employee health benefits, it represents 35% of the total $3.9 trillion budget. For the decade prior to the economic downturn, total health spending increased 7.2% annually. During the downturn, it slowed to less than 4% but is expected to increase to 6% annually for the decade ahead. That means healthcare spending will be an even bigger part of federal budgets going forward.

Continue reading “The FY15 Budget: There’s More to it Than the Numbers”

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The Interview
On top of everything else, the Sony data breach revealed employees’ sensitive health information:  Top Sony executives saw lists of named employees who had costly medical treatments and saw detailed psychiatric treatment records of one employee’s son.

Like last year’s revelation by AOL’s CEO, it shows US corporations look at employees’ health information and costs. By ‘outing’ the fact that 2 of AOL’s 5,000 employees had premature infants whose treatment cost over $1 million each, the CEO violated the employees’ rights to health information privacy.

Trusted relationships simply cannot exist if individuals have no right to decide who to let in and who to keep out of pii. Current US technology systems make it impossible for us to control personal health data, inside or outside of the healthcare system.

Do you trust your employer not to snoop in your personal health information?  How can you trust your employer without a ‘chain of custody’ for  your health data? There is no transparency or accountability for the sale or use of our health data, even though Congress gave us the right to obtain an “Accounting for Disclosures (A4D)” for disclosures of protected health data from EHRs in the 2009 stimulus bill (the regulations have yet to be written).  And we have no complete map that tracks the millions of places US citizens’ health data flows. See: TheDataMap.

Continue reading “Sony Hack Reveals Health Details on Employees and Their Children”

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ONC Plans for the Future

The ONC releases an updated five-year strategic plan that stresses interoperability, patient engagement, and the expansion of IT across the care continuum. The document updates the previous strategic plan released in 2011that focused heavily on the Meaningful Use program. Maybe the ONC is not quite dead yet after all.

McKesson Ventures Into Startups

McKesson announces the creation of McKesson Ventures, a venture capital fund that will invest in early-stage and growth-stage healthcare companies attacking healthcare business challenges. Tom Rodgers, who was most recently with Cambia Health, was named managing director of the fund’s investment portfolio.

Stage 2 Attestations Still Lagging

Fewer than four percent of eligible physicians and 35 of hospitals have attested to Stage 2 Meaningful Use, according to the newly released numbers from CMS. The AMA, CHIME, HIMSS and MGMA quickly reiterated the call to shorten the reporting period for 2015 to 90 days. As of November, 2014 CMS has paid $16.6 billion in EHR incentives since the program’s inception. Continue reading “HIT Newser: The Doctor Will Facetime You Now”

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flying cadeuciiDon’t let the name fool you—registries are important. Here are three powerful functions they can enable:

1). Collect data on real-world patient outcomes.
2). Create a feedback mechanism for health care providers—how well are patients faring under treatment?
3).Facilitate changes in care, and improvements in outcomes, based on that feedback.

Imagine this: You’re feeling sick and decide to go see the doctor. You receive a treatment, and in short order, you’re feeling much better. You’re a walking testimonial to the effectiveness of that treatment.

But where is this outcome recorded? Your doctor follows up and is aware that the treatment worked for you. But this is not a clinical trial, and these outcomes are not being systematically observed. So your experience becomes an anecdote—not a data point—which is to say, it doesn’t count. This is where registries come in.

Continue reading “Health Care Registries: Powerful Tool, Narcoleptic Name”

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flying cadeuciiI’ve been looking at the latest CMS national healthcare expenditure data and the accompanying commentary by CMS staff. The 2013 numbers are a pleasant surprise, showing for the fourth straight year minimal increase in healthcare spending relative to economic growth. The CMS staff commentary, however, suggests that such good news may not be repeated:

The key question is whether health spending growth will accelerate once economic conditions improve significantly; historical evidence suggests that it will.

Not everyone agrees. Apparently disliking such a pessimistic view, the New York Times followed its initial analysis of the CMS data (“Good News Inside the Health Spending Numbers”)  with a piece by David Leonhardt  (“The Health Cost Slowdown Isn’t Just About the Economy”)  challenging the CMS staff’s assumption that much of the spending slowdown was due to the recession. He suggests instead that the slowdown is due primarily to changes in the healthcare system—notably those resulting from the Affordable Care Act.

So, should we be cheering? Or not?

Continue reading “Good News From CMS at Last? Maybe Not”

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Ezekiel Emanuel

In the October issue of The Atlantic, physician and medical ethicist Ezekiel (Zeke) Emanuel, brother of Rahm Emanuel (former official in the Clinton White House, then Congressman, then Chief of Staff for President Barack Obama, now Mayor of Chicago) published an article why he thinks we should all forgo advanced age and die at 75. As a 69-year-old moving toward 75, my response to that article is this blog post requesting a stay of execution from our newly appointed Czar of American longevity.

An Open Letter to Ezekiel Emmanuel.

Dear Ezekiel Emmanuel:

Please forgive me for taking so long to comment on your article in The Atlantic arguing that we should declare our lives to have reached their productive limit at age 75 and therefore gracefully exit this world before we move into an inexorable decline. Your article – “Why I Hope to Die at 75″ -- appeared in The Atlantic in October and here it is December and I have not joined the 3000 plus people who commented on it earlier. First, I confess, I did not read it until almost a month ago, and then, I had to stew in some juices before figuring out how to reply. You make many good points in your article. Americans do indeed consider themselves to be “immortals,” do prolong death rather than extend life when they push for futile treatments or agree when their physicians who too often recommend them (if they were not so enthusiastically recommended, would so many American patients so heartily sacrifice themselves on the altar of science?) But does the solution to the out of control medicine lie in declaring that 75 should be the age of exit?  See, for example, Shannon Brownlee’s Overtreated.

In your article, you carefully explain why you have picked 75 as the human sell by date. Continue reading “An Open Letter to Ezekiel Emanuel on Life and Death”

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Screen Shot 2014-12-12 at 2.27.00 PMI was enjoying drinks last week with Jody Holtzman (AARP)Terry Booker (IBC), and Doug Ghertner (change:healthcare) at a wonderful conference sponsored by Oliver Wyman. Jody was waxing eloquent about how every start-up needs a strategy for the senior population, when – after a few too many drinks – I emphatically told everyone at the table that I had the senior market cracked. I had experienced first hand the ills of the American health care system for seniors and had identified the perfect solutions.

My father-in-law grew up on a small, Kosher dairy farm outside of Pennsylvania (insert Jewish farmer joke here). He is 72 years old, he was about 40 pounds overweight, he has been widowed for about four years, and, about 30 minutes after my mother-in-law passed away, he started dating a woman that my wife never quite accepted, which is akin to saying that Russia is watching events unfold in the Ukraine from the sidelines (and to be clear, I don’t condone either position).

In January of this year, he was jumping from a backhoe onto a helicopter pad (don’t ask), fell 6 feet, and shattered his heel. The heel is a terrible bone to break in general (poor circulation) and, in particular, for someone who is older and a bit overweight (my goal is to not use the word “patient” once in this article because we aren’t patients, we’re people). Continue reading “Starvation: The Cure For the Obesity Epidemic. Or Will Esther Dyson Be My Next Mother-In-Law?”

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flying cadeuciiJust as the Bear Stearns implosion presaged the 2008 financial crisis, the events of the last few days, building on earlier events, are presaging the collapse of the “pry, poke, prod and punish” outsourced, vendored wellness industry.

For those readers still living in Biosphere 2, here is a brief review of how we got here.  First among the precursors was Honeywell’s completely voluntary self-immolation with the Equal Employment Opportunity Commission (EEOC).  We’re not sure how their benefits consultants failed to advise  that all they needed to do was offer a simple wellness program alternative that didn’t require medical exams, and there was no way they’d get hit with an  EEOC lawsuit. But, then again, no one ever went broke underestimating the ability of benefits consultants to misinform their clients.

Second, the Business Roundtable (BRT) decided to go to the mat with the President over this EEOC-wellness issue.  They are essentially demanding to retain their Constitutional rights to deplete their treasuries while harming and alienating their employees without intrusion from the pesky EEOC. Continue reading “The Wellness Industry’s Terrible, Horrible No-Good Very Bad Week”

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