Categories

Year: 2014

Could the ‘Design Thinking’ that Led to the Apple Mouse Transform Health Care?

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In 1980, Apple gave a small California design firm (that later became IDEO) a simple yet incredibly complex task: do more with less. The challenge: take a computer mouse that cost $400 and make one that cost $25 while simultaneously improving the quality, functionality and user experience. The result: IDEO not only delivered an exceptional product, but also pioneered a design thinking approach that has allowed it to make innovation a regular occurrence.

This month, as part of the first Evolent Health Clinical Innovation Summit on high-value health care delivery, we visited IDEO at its Palo Alto headquarters. Twenty health care leaders from across the country visited the IDEO toy lab, heard the story of the first Apple mouse and marveled at a 3D-printer. The question on our collective minds: could the design thinking principles that produced the first Apple mouse be used to transform U.S. health care?Continue reading…

No Country for Old Smokers

flying cadeucii“Traditionally, doctors used to be called in when needed. But this is now changing. Increasingly it is the doctor who calls the person in by issuing an invitation. Healthy people are asked to visit the surgery for a ‘check-up’, or ‘screening’, when their computerized records show they are ‘due’. Non-attendance is known as ‘non-compliance’, indicating an element of recklessness and irresponsibility.”

Petr Skrabanek. The Death of Humane Medicine and Rise of Coercive Healthism.

If CMS endorses MEDCAC’s recommendations regarding low dose screening CT for lung cancer, we may see a coverage scenario that might be mistaken for an episode of Saturday Night Live.

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Primary Care Physicians Need To Be More Like Financial Advisors

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Man looks into the Abyss, and there’s nothin’ staring back at him. At that moment, man finds his character, and that’s what keeps him out of the Abyss. – Lou Mannheim (Hal Holbrook) in the movie “Wall Street”

We hear reform ideas all the time: primary care physicians need to work at the top of license, physicians need to work in teams, healthcare must deliver top-notch customer service, the focus needs to be on creating strong physician/patient relationships, and physicians need to be paid for delivering value.

The question then becomes: how does the healthcare industry implement such ideas?

I believe it would be smart to apply the lessons from other industries.

Specifically, the financial services industry.Continue reading…

ACOs Are Doomed / No They’re Not

A number of pundits are citing the systemic failure of ACOs, after additional Pioneer ACOs announced withdrawal from the program – Where do you weigh in on the prognosis for Medicare and Commercial ACOs over the next several years?”

Peter R. Kongstvedt

KongstvedtWhoever thought that by themselves, ACOs would successfully address the problem(s) of [cost] [access] [care coordination] [outcomes] [scurvy] [Sonny Crockett’s mullet in Miami Vice Season 4]? The entire history of managed health care is a long parade of innovations that were going to be “the answer” to at least the first four choices above (Vitamin C can cure #5 but sadly there is no cure for #6). Highly praised by pundits who jump in front of the parade and declare themselves to be leaders, each ends up having a place, but only a place, in addressing our problematic health system.

The reasons that each new innovative “fix” end up helping a little but not occupying the center vary, but the one thing they all have in common is that the new thing must still compete with the old thing, and the old thing is there because we want it there, or at least some of us do. The old thing in the case of ACOs is the existing payment system in Medicare and by extension, our healthcare system overall because for all the organizational requirements, ACOs are a payment methodology.

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Dear ACO General Hospital

Screen Shot 2014-11-05 at 10.08.09 AMDear ACO General Hospital:

Thanks for contacting me about my most recent blog post.  I’m sorry to scare your administration about HIPAA information, but I am equally concerned about that and will always do my best to respect the privacy of my patients.  At your request I hid even more of that information.

I know it’s kind of embarrassing to have that kind of thing made public, and I am overall grateful that you did not take it personally that I put the “transition of care” documents for all to see.  My goal was not to embarrass or ridicule, it was to point out what our healthcare system is driving us all toward: replacing patient care with documentation.  You are being encouraged by the system to produce those ridiculous documents, as they are part of the deal you accepted when you became “ACO General” in the first place.

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Solving the Primary Care Shortage

GundermanOne of the top students at one of the nation’s largest medical schools, Ishan Gohil has made an unusual – and to many of his colleagues – inexplicable decision.  Instead of seeking to train in one of medicine’s most highly specialized and competitive fields, he says, “I elected to pursue a career in family medicine.”  Many view his choice of primary care as ill-advised, largely because family medicine is one of the least competitive fields and ranks at the bottom for income of all medical specialties.

Until his third year, Gohil had planned to pursue orthopedic surgery, which is considerably more difficult to get into than family medicine.  In 2014, the average score on Step 1 of the US Medical Licensing Exam for students entering family medicine was 218, while for orthopedic surgery it was 245 (the overall average is 230).  Average annual salary levels diverge even more widely, at $122,000 for family physicians and $488,000 for orthopedic surgeons.Continue reading…

The White Paper Isn’t Dead. It’s On Life Support.

flying cadeuciiThe original purpose of white papers as a B2B marketing tactic was to produce objective information, packaged as quasi-academic research, to validate a company’s or product’s value proposition. White paper sponsors sought to educate, inform, raise comfort levels and eventually initiate sales conversations with prospective customers.

White papers gained significant adoption as a content marketing tool concurrent with the rapid growth of new technologies that often required detailed explanation or context for non-technical buyers. Over time, however, the market education function was largely assumed by research firms such as Gartner and Forrester, whose opinions carry greater credibility than self-publishers of white papers.

Unfortunately, what began as a legitimate and sometimes helpful marketing tactic has morphed into poorly disguised sales promotion, packaged in a plain vanilla wrapper. The evolution of white papers from bona fide content into self-serving advertorials has been validated by vertical industry trade publications, in which companies, for a fee, are permitted to “feature” their white papers in a special section. White papers jumped the shark when they became paid content.

The outcome of widespread abuse of white papers – driven by marketers grasping for new ways to put lipstick on a pig, or too lazy to produce rigorous research that might empower customers to draw their own conclusions – is that the tactic has lost its franchise as an effective B2B marketing asset class. Increasingly, prospective customers do not believe white papers will be helpful or credible, and as a result, they often no longer play a critical role in their decision-making process for purchasing products or services.Continue reading…

Health IT Newser

flying cadeuciiHHS Clarification:
DeSalvo Will Retain Leadership of ONC

Five days after announcing that National Coordinator Karen DeSalvo’s appointment as Acting Assistant Secretary of Health, the ONC clarified that DeSalvo would still be the leader of the ONC; she would also continue to chair the HIT Policy Committee, lead the development and finalization of the Interoperability Roadmap, and remain involved in MU policymaking.

HHS said that when DeSalvo’s new appointment was originally announced, DeSalvo’s bio had mistakenly indicated that she had “previously” held the role of National Coordinator.

HIT NEWSER’S TAKE: Did HHS simply do a poor job communicating or did someone recognize a little too late that DeSalvo’s removal might heighten concerns about the ongoing turnover among ONC leadership?

No More CCHIT

The Certification Commission for Health Information Technology (CCHIT) announced it was shutting down its operations November 14. CCHIT was created in 2004 to provide certification services for HIT products and to educate providers and IT developers; in January CCHIT announced it would no longer provide testing and certification services for the MU program. In a press release CCHIT Executive Director Alisa Ray said that “the slowing of the pace of ONC 2014 Edition certification and the unreliable timing of future federal health IT program requirements made program and business planning for new services uncertain.”

HIT NEWSER’S TAKE: Coupled with the recent turmoil at the ONC (leadership changes, underwhelming Stage 2 MU attestations numbers), one can’t help but wonder what it all means for long-term viability of the MU program and whether the industry remains committed to its objectives.

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What Do I Do If I Don’t Have a Template?

Screen Shot 2014-11-03 at 11.49.29 AMElectronic medical records (EMRs) now play a part in the daily documentation routine for most physicians. While improvements in access to patient data, legibility of notes, and ease of order entry are welcome enhancements, there is a significant downside to EMRs as well. Although I’ve blogged about my frustrations with nonsensical, auto-populated notes and error carry-forward, there is a more insidious problem with reliance on EMRs: digital dependency.

The idea of digital dependency first occurred to me during a conversation with a young medical resident at a hospital where we share patients. I was bemoaning the fact that I was being forced to use hospital-designed templates for admission notes, rather than a dictation system or carefully crafted note of my own choosing. She looked at me, wide-eyed and said:

“You’ve worked without templates? How do you even know where to begin? Can you really dictate an entire note off the top of your head? I couldn’t live without templates.”

As I stared back at her with an equal amount of bewilderment, I slowly realized that her thinking had been honed for drop-down menus and check boxes.

Continue reading…