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flying cadeuciiThat pesky Ebola bug is not done with us yet.

Apparently not satisfied with inflicting havoc in Texas for two weeks and causing a major panic, the publicity-hungry Ebola virus set its sights on the media capital of the world on Thursday.

The latest Ebola case is a New York City Doctor. A specialist in international medicine at New York Presbyterian Hospital, Dr. Craig Spencer had been working with Ebola patients for the French relief agency Doctors Without Borders.

New York City health officials are conducting contact tracing to find people who may have had contact with Dr. Spencer.

The bad news?

New York City being New York City,  Spencer took the the subway from his apartment on West 143th street in Harlem to a Brooklyn bowling alley the night before his fever spiked.  That’s led to speculation that he may have inadvertently exposed a lot of people. Public health health officials are now tracing Spencer’s contacts to find potential “high risk” cases.

Our talking points:

Is It Possible to Catch Ebola on the Subway? 

No. Yes. Maybe.

Unfortunately,  in reality we don’t know, although we’re pretty sure we do.  Current CDC guidelines are based on the assumption that Ebola only becomes contagious when symptoms present and the patient enters the high fever stage.

Via Controversies at Hospital Infection Prevention:

Those at risk for Ebola are healthcare workers who have cared for Ebola patients (whether here or in West Africa). Not mall-goers, bowlers, subway riders, or those who might have been in an airport terminal on the same day as an asymptomatic Ebola patient. The greatest transmission risk is borne by those who provide direct care for Ebola patients during severe illness, when viral shedding is very high.

There’s a lot of evidence to support this argument. There have been cases of symptomatic Ebola patients traveling by airplane, bus and other modes of transportation without spreading the disease.  That’s somewhat reassuring.

On the other hand, it is not exactly compelling statistical evidence of anything other than that some people travelled with an Ebola patient and did not develop Ebola.

We need to work with  much larger numbers before we know for sure.  The good news?

Now that Ebola has arrived in a city of eight million people, we’re now going to have them.

Continue reading “Is It Possible to Catch Ebola From the Media?”

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By HEALTH 2.0

The Middle East Marketplace, Medical R&D, Investments, and Consumer: Kemal Malik, Head of Innovation at Bayer, and Tim Kelsey, National Director for Patient and Information for NHS England are slated to keynote the upcoming 5th Annual Health 2.0 Europe conference on November 10-12 in London, UK. The international digital health conference will feature a wide variety of sessions on some of the most important topics in digital health including:

Medical R&D: How medicine continues to grow with Health 2.0 tools which supports medical research and collaboration via open data reporting and collection through clinical trials. Featured demos include F1000, Lumos!, PxHealthCare, and TrialReach.

Big Data: A session that frames national, entrepreneurial, and patient-based efforts to create Open Data portals and access across the spectrum. See how HealthUnlocked, Healthbank, and Marand are turning big data into actionable change.

Wearable Technology: As the marketplace for consumer tech and wearables become more prevalent within digital health, Health 2.0 Europe features devices from Biovotion, Qardio, Empatica, and Sensoria which are taking new approaches to tracking, capturing, and analyzing personal health data.

Continue reading “Bayer’s Head of Innovation and Tim Kelsey of the NHS to Keynote Health 2.0 Europe”

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Karen DeSalvo, MD, the national coordinator for health information technology for HHS, is leaving her post to to address public health issues, including becoming a part of the Department’s team responding to Ebola. She took over as the ONC head in January, 2014.

The ONC’s COO Lisa Lewis will serve as the agency’s acting national coordinator.

HHS spokesman Peter Ashkenaz told THCB:

“HHS Secretary Burwell asked National Coordinator for Health IT Karen DeSalvo to serve as Acting Assistant Secretary for Health, effective immediately. In this role she will work with the Secretary on pressing public health issues, including becoming a part of the Department’s team responding to Ebola. Dr. DeSalvo has deep roots and a belief in public health and its critical value in assuring the health of everyone, not only in crisis, but every day.

Lisa Lewis, ONC’s chief operating officer, will serve as the Acting National Coordinator. However, Dr. DeSalvo will continue to support the work of ONC while she is at OASH.”

The transition comes at a time when critics are asking tough questions about the government’s Meaningful Use program and providers’ lackluster progress qualifying for Stage 2.

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It’s time to think carefully and look at the large systems (human and technical), institutions, and individuals that contributed to Mr. Duncan’s death. Systems should be designed to protect people and prevent human errors. Certainly we rely on the healthcare system to improve our health and to protect our privacy, especially our rights to health information privacy.

Looking at the death of Mr. Duncan, the poorly designed Epic EHR was a critical part of the problem: the lack of clarity, poor usability, hard to find critical information, and no meaningful quality testing to ensure the system prevents critical errors contributed to his death and endangered many others. Why wasn’t the discharge of a patient with a temperature of 103 from the ER flagged?

EHRs are one of several critical systemic problems.

Current US EHRs were not designed or tested to ensure patient safety or privacy (patient control over the use of PHI for TPO).  The Meaningful Use requirements for EHRs don’t address patient safety or ensure patients’ legal rights to control use of PHI. Let’s face it, the MU requirements were set up by the Health IT industry, not by a federal agency charged with protecting the public, such as NIST or the FDA. Industry lobbying resulted in industry ‘self-regulation’, which has failed to protect the public in every other sector of industry. Industry lobbying is another critical systemic problem.

Our public discourse also is a critical systemic problem.  The 24/7 US media drives us to play the ‘blame game’—and look at what happens: it’s a sham. A massive public and social media exercise substitutes for a crucial scientific and ethical oversight process by government and industry to face or examine the systemic causes and key actors—both people and institutions.  We end up with no responsibility being assigned or addressed.  Or the media hoopla and confused thinking leads to the opposite conclusion: everyone and everything is responsible and blamed, which has the same effect: it lets everyone and everything off the hook. Either way, no one and no institutions are to blame.

Continue reading “Ebola, EHRs, and the Blame Game”

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In response to several reader questions on the CDC post on safe handling of Ebola and recommended lab procedures, the CDC got back to us with this update:

In the Ebola guidance for healthcare workers and specifically for Specimen Handling for Routine Laboratory Testing  of  persons under investigation (PUI) for Ebola disease , CDC reminds all laboratory personnel to consider all blood and body fluids as potentially infectious.  The guidance further informs laboratory personnel that strict adherence to the OSHA bloodborne pathogen regulations and Standard Precautions protects laboratory workers from bloodborne pathogens, including Ebola. In this guidance, emphasis is placed on the OSHA regulation’s requirement for performance of site-specific risk assessments.  These assessments should consider the path of the sample throughout the laboratory, including all work processes and procedures, to identify potential exposure risks and to mitigate the risks by implementing engineering controls, administrative controls (including work practices), and appropriate PPE to protect laboratory personnel.  Implementation of these recommendations requires that there is designated staff that is trained, competent, and confident in performing risk assessments within their laboratories.

Continue reading “Update on CDC Guidelines on Ebola Specimen Handling + Lab Testing”

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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.

UPDATE–The hangout is embedded above. 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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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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