Year: 2014

Commentology: The Creative Destruction of Healthcare

Mar 26, 2014• 3

By THCBist

THCB reader and occasional contributor Dave Chase had this to say about Bill Crounse, MD’s recent post “Why the Creative Destruction of Healthcare May Not Be a Good Idea.”

“There is no doubt there are some obnoxious people throwing around arrogant/naive ideas. However, the “creative destruction” and “disruptive innovation” that has been most impactful has come from physician-entrepreneurs. Often, they are the most provocative and hard-hitting in their language.

It seems loosely similar to how the most virulent anti-smokers are former smokers. They want others who they can relate to experience the liberation they’ve experienced.

I wouldn’t assume ill-intent from these MD-entrepreneurs using direct language. They simply were fed up with what they experienced as “broken” and stepped up with approaches that have out-performed.

I’m thinking about the MD-entrepreneurs and innovators who have led CareMore, Nuka Model of Care, Qliance, Iora Health, MedLion, Healthcare Partners, etc. Sometimes to catalyze change, one must use stark, hard-hitting language.

That doesn’t seem like a foreign concept to the many excellent MDs I’ve known over the years. I have enormous respect for any entrepreneur, especially one coming from tradition-bound professions who are willing to stick their neck out and endure enormous personal financial risk.

Bob Margolis shared how his colleagues referred to him as a “communist” and his team-based model as “communism” yet Bob’s org achieved far better outcomes. He had the last laugh when that “communist” sold his business for $4.4B last year.

The comments from these MD-entrepreneurs is they feel they aren’t doing their MD friends any favors by candy-coating what is widely recognized as a system that isn’t close to reaching its full potential.

In contrast, the orgs those MD-entrepreneurs are running are the reigning “Triple Aim Champs” that we should celebrate — colorful language or not. Often the most impactful entrepreneurs aren’t particularly “polite” in their language — Steve Jobs, Bill Gates, Larry Ellison et al called it like they saw it.

What’s wrong with that?”

Will eClinicalWorks Win the Race to “Engage” the Patient?

Mar 26, 2014• 4

By Kim Krueger

Patient engagement, for better or worse, is one of those buzzwords that won’t be leaving us anytime soon.

A whole slew of companies use it to describe their products, platforms, and services, but we’re still knee deep in marketing jargon trying to figure out exactly what these tools do and how “effective” they really are.

We got a closer look at one such tool last month at HIMSS from a company that also finds itself knee deep in patient engagement.

eClinicalWorks debuted in 1999 as the Southwest Airlines of electronic health records (EHR). They offered a relatively low cost combined EHR/practice management system, which quickly made them significant players in the small practice market, adding more than 3,000 doctors in just three years.

It wasn’t until 2007 though that eClinicalWorks really broke through when then Assistant New York City Health Commissioner and future National Coordinator for Health Information Technology Dr. Farzad Mostashari selected them for installation with more than 1,300 New York City physicians as part of Mayor Bloomberg’s Primary Care Information Project (PCIP).

Now, eClinicalWorks counts more than 100,000 physician users in over 50,000 facilities in addition to another 14 million users on their patient engagement tool, Healow.

Actually, It’s a Great Time to Be a Doctor

Mar 26, 2014• 8

By Jeffrey Weisz, MD

Is this a good time to be a physician? Absolutely! In fact, I believe there has never been a better time to practice medicine. I hold this belief despite the barrage of negative comments and predictions from doomsayers remarking on the sorry state of health care in its current state.

Before I tell you why I’m so optimistic, I’d like to acknowledge one fact: practicing medicine is more complex and difficult than ever, however, this fact doesn’t dampen my enthusiasm. There is no doubt that over the past two decades a great many changes in the health care environment have consumed doctors’ time, distracted us from our core task of providing care, and impacted our incomes.

Meanwhile, patients’ expectations of the health care industry and of their physicians are changing. An increasing number of people want more involvement in their own health care and want to partner with their physician. So it is not hard to understand how practicing medicine can feel more challenging than ever.

For example: results from a national survey reported in the Archives of Internal Medicine in 2012 indicated that US physicians suffer from more burnout than other American workers.

Burnout, in this report, was defined by “loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment”; 45.8% of responding physicians had at least 1 of these symptoms.

So why am I so optimistic?

Because when I read these survey results, and others like them, bureaucracy and complexity are often cited as the reasons why physicians are unhappy. Not patient care.

While these factors (bureaucracy and complexity) can momentarily take physicians away from their passion of practicing medicine, it is the passion of a physician, precisely, that fuels my optimism for the state of health care today.

Employers 2.0

Mar 25, 2014

By PAUL KECKLEY

The most significant force for health system transformation in the United States is employer activism.

This month’s decision to delay the Affordable Care Act’s employer mandate until 2016 coupled with dramatic increases in health insurance premium costs assures employers will play a stronger role going forward.

The facts:

57% of all companies provide health insurance covering 149 million in the population. But participation varies widely by industry and size of company.

Participation: Manufacturing (72%), Services (65%), Transportation/Utilities/Communications (62%), Agriculture/Mining/Construction (60%), Wholesale (54%), Healthcare (51%), Financial services (49%), Retail (29%) (Kaiser/HRET Survey of Employers)

Size: Smaller companies under 199 are less likely to provide health benefits than larger companies, though premiums they pay to insurers are slightly lower than their larger counterparts.

Declines in employer sponsored coverage declines are due to costs, not the Affordable Care Act. Consider: the percentage of non-elderly workers with employer-sponsored coverage decreased from 68% in 2000 to 61% in 2009 before the law passed.

Employers pay 82% of health costs for singles and 71% of costs for those in their family health plans. Over the past decade, they have shifted more financial responsibility to their employees.

Premiums for employers from 2003-2013 increased 80% but employee contributions increased 89%.
At the same time, employers have reduced coverage for retirees and dependents, and in many industries, kept wages low to offset health cost increases.

How a Washing Machine Inspired Me to See the Future of a Safer ICU

Mar 25, 2014• 5

By KEVIN WANG

Berg, the company the brought along fun internet-connected concepts and products such as the Little Printer released this interesting video recently.

[vimeo=87522764 W=900&H=325]

The amazing part of this is that Cloudwash is foundational and will just be built on. It shows where the current state of the Internet of Things is and where it can go in the future. What Berg did was amazing to me.

It took a regular “dumb” appliance with software and electronics that were trapped in and made the interaction richer and its meaning and value richer.

In a way, they radically changed the way I viewed how devices could be connected and created the possibility for a new class of devices in our daily lives.

And in a way, I saw so many parallels to healthcare.

In the video, Berg mentioned how the action of washing clothes can be quite complicated. There are baroque symbols on how clothes should be treated and this in turn is reflected by different sets of complicated icons on machines

Healthcare delivery can be far more complex though.

“In any given hospital, as many as 15 medical devices, including monitors, ventilators and infusion pumps, are connected to an ICU patient, but because they are made by different companies, they don’t “talk” with one another. Patient-controlled analgesic pumps that deliver powerful narcotics, where a known side effect is respiratory depression, aren’t linked to devices that monitor breathing, for example.”Today’s ICU is arguably more dangerous than ever,” says Peter Pronovost.

Just last week, I had the privilege of shadowing the pain service team at work. The team had to go one by one to each patient while rounding throughout the hospital. At each patient, a nurse practitioner checked their PCA. These are supposed to the safest ways to deliver analgesics and are self-containing boxes that are locked except for their interface.

No one except the pain service team is supposed to even touch those boxes due to the level of training needed to even interface with them. But it relies on human systems to ensure that the correct concentration of drug is put in with the right dosage according to each patient.

Yet like Dr. Pronovost mentions, these pumps aren’t linked to devices that monitor breathing so that IF a wrong dosage is placed in the PCA, there is no way of stopping it before its too late.

What If Your Employer Gets Access to Your Medical Records?

Mar 25, 2014• 22

By Vik Khanna & Al Lewis

T was never a star service tech at the auto dealership where he worked for more than a decade. If you lined up all the techs, he wouldn’t stand out: medium height, late-middle age, pudgy, he was as middle-of-the-pack as a guy could get.

He was exactly the type of employee that his employer’s wellness vendor said was their ideal customer. They could fix him.

A genial sort, T thought nothing of sitting with a “health coach” to have his blood pressure and blood taken, get weighed, and then use the coach’s notebook computer to answer, for the first time in his life, a health risk appraisal.

He found many of the questions oddly personal: how much did he drink, how often did he have (unprotected) sex, did he use sleeping pills or pain relievers, was he depressed, did he have many friends, did he drive faster than the speed limit? But, not wanting to rock the boat, and anxious to the $100/month bonus that came with being in the wellness program, he coughed up this personal information.

The feedback T got, in the form of a letter sent to both his home and his company mailbox, was that he should lose weight, lower his cholesterol and blood pressure, and keep an eye on his blood sugar. Then, came the perfect storm that T never saw developing.

His dealership started cutting employees a month later. In the blink of an eye, a decade of service ended with a “thanks, it’s been nice to know you” letter and a few months of severance.

T found the timing of dismissal to be strangely coincidental with the incentivized disclosure of his health information.

An Obamacare Fine on Overweight Americans: Discriminatory and Ineffective

Mar 25, 2014• 50

By STEPHEN SOUMERAI

Amid the rancorous debates over the Affordable Care Act, one provision deserves to be getting serious discussion.

It’s a provision that allows employers to increase the amount that they may fine their employees for “lifestyle” conditions, such as being overweight or having high blood pressure or high cholesterol.

Almost 37% of Americans are overweight or obese. The supposed goal is to use financial penalties to reduce obesity, the health costs of which exceed $200 billion per year. But this idea, while well intended, will not help Americans suffering from obesity, a medically defined disease and disability. In fact, it will likely make their situation worse.

For years, the country’s “wellness” industry has offered health-enhancement and obesity-reduction programs to corporations, from gym memberships to dietary counseling. For obesity, this approach has not worked. Research on these programs shows that they have not significantly reduced weight or cholesterol levels, or improved any other health outcomes.

Even the most successful programs, such as Weight Watchers, achieve an average two-year weight loss of only about 3% for their members— and even that tiny weight loss often returns later.

TED 2014: Flip the Clinic!

Mar 25, 2014• 1

By Michael Painter, MD

First, let’s get the plug out of the way, shall we? Here’s the deal: The Robert Wood Johnson Foundation has a new initiative, Flip the Clinic—and we want you to join us.

We’re launching the new Flip the Clinic site this week. Here’s the trailer. Please take a look, and then let me know what you think:

[vimeo=89722532]

So, what’s with all this flipping business? What’s all this talk about health conversations?

The Note Taker’s Dilemma

Mar 25, 2014• 7

By Saurabh Jha, MD

The year is 2020, or sometime in the future when the healthcare system is better, much better. Patients have access to their medical notes, are encouraged to read the notes regularly and ask physicians relevant questions. This is to facilitate patient-centered participatory medicine (PCPM), previously known as shared decision making. In fact, note reading by patients is now a quality metric for CMS.

The CEO of the Cheesecake Hospital Conglomeration, one of the hospital oligopolies, has set up a Bureau for Transparency and Protection of Patients from Complex Medical Terminology. The goal is to risk manage troublesome medical writing that could result in poor satisfaction scores, complaint or a lawsuit.

Mr. Upright (MU) is the Inquisitor General for the bureau. He has called the author (SJ), a repeat offender, to his office to discuss elements of his medical record keeping.

Disclaimer: Any resemblance to future events is purely coincidental. The narration is merely a reflection of the author’s paranoid affect and a tendency to believe in conspiracy theories.

MU: Dr. Jha, you’ve been summoned because your open medical notes do not meet the standards for empathy and compassionate care and seem devoid of a reflection on the complex interplay between social determinants of health.

SJ: Has a patient complained?

MU: No. But that’s what the bureau is trying to prevent. We protect patients from physicians. Actually, we protect physicians from their most dangerous enemy: themselves.

An Open Call for the PCORI Matchmaking App Challenge

Mar 25, 2014

By via The Health 2.0 Network

PCORI is pleased to announce the PCORI Matchmaking App Challenge. This initiative seeks to create research partnerships that allow innovators and patients to work together. Developers are invited to make a full functioning, ready-to-publish app that has the capability to connect patients with researchers.

The Initiative

We are inviting developers to create an app that brings together patients, stakeholders, or researchers, and move toward collaborative research. These apps must integrate with already established research networks, and preferably integrates social media and robust user profiles. The developer is also encouraged to include an advanced search option and customizable displays.

Reviewers will include technology experts, PCORI staff members, and members of PCORI’s multi-stakeholder Advisory Panels. Reviewers will consider how well each developer facilitates connections that allow equal access to people from different backgrounds and with varying health interests and research experience, as well as considering creativity and the past experience of the developers.

The rewards are substantial, with PCORI awarding first place with $100,000, second place with $35,000, and third place will take home $15,000.

How to Apply

To enter your team for the Challenge, please go to the pre-registration form.

PCORI and Health 2.0 will host an hour-long informational webinar on Wednesday, April 30, at 1 p.m. (ET) to present the challenge goals and guidelines. We will describe the motivation behind and purpose of the Matchmaking App Challenge; explain the submission guidelines, judging criteria, and other conditions of the challenge; and answer questions from potential applicants. Registration for the webinar is now open. Questions and answers will be posted after the event.