Author Archives

John Irvine

Larry Weed’s Legacy and the Next Generation of Clinical Decision Support

Sep 22, 2017• 2

BY LINCOLN WEED, JD

The following originally appeared as a guest post at the blog of the director of National Library of Medicine (NLM) and NIH Interim Associate Director for Data Science, Dr. Patti Brennan.

“Patients are sitting on a treasure trove of data about their own medical conditions.”

My late father, Dr. Lawrence L. Weed (LLW), made this point the day before he died. He was talking about the lost wealth of neglected patient data—readily available, richly detailed data that too often go unidentified and unexamined. Why does that happen, and what can be done about it?

The risk of missed information

From the very outset of medical problem-solving, LLW argued, patients and practitioners face greater risk of loss and harm than they may realize. The risk arises as soon as a patient starts an internet search about a medical problem, or as soon as a practitioner starts questioning the patient about the problem (whether diagnostic or therapeutic).

Ideally, these initial inquiries would somehow take into account the entire universe of collectible patient data and vast medical knowledge about what the data mean. But such thoroughness is more than the human mind can deliver.

This gap creates high risk that information crucial to solving the patient’s problem will be missed. And whatever information the mind does deliver is not recorded and harvested in a manner that permits organized feedback and continuous improvement.

In Which We Wonder Where the Graham-Cassidy Bill Came From and What It All Means

Sep 21, 2017• 9

By STEVEN FINDLAY

The latest Republican attempt to repeal and replace the ACA looks a lot like what they were trying to do in May, June and July—and failed to do.

But actually, the framing of the current effort—the Graham-Cassidy bill—is much more deeply grounded in the perennial debate over where political power resides in the U.S.: the federal government or the states. Graham-Cassidy also more starkly reflects what many conservatives are trying to achieve in health care policy. And what they are trying to achieve is, to put it euphemistically, not nice.

On both counts, this renewed debate resonates politically beyond health care. It’s no coincidence that the two Senators behind this new push, Lindsey Graham and Bill Cassidy, are from southern states—South Carolina and Louisiana, respectively. Before the Civil War, during the Civil War, and up to the present day, southern conservatives like Graham and Cassidy—more passionately than their northern counterparts—have pushed to devolve power to the states and weaken the federal government.

What Does an Ideal Healthcare System Look Like?

Sep 20, 2017• 5

By ASHISH JHA, MD

Austin Frakt and Aaron Carroll recently approached me about a New York Times UpShot piece aiming to rank eight healthcare systems they had chosen: Australia, Canada, France, Germany, Singapore, Switzerland, the United Kingdom, and the United States. This forced me to think about a pretty fundamental question: what do we want from a healthcare system?

I would argue that most people want a healthcare system where they can get timely access to high quality, affordable care and one that also promotes innovation of new tests and treatments. But underlying these sentiments are a lot of important issues that need unpacking. First, what does it mean to be able to access care when you need it? A simple way to think about this is being able to see a doctor (or other healthcare professional) quickly and easily and in cases where there are follow-on tests, procedures, and treatments, you can get them without much delay. This brings up one important point: while experts often discount the importance of timeliness, regular people generally don’t: anyone who has waited weeks or months for a follow-up after an abnormal test result or to get a needed surgery knows that waiting times are not just an inconvenience. Delayed access can be stressful, agonizing and in some instances, downright harmful.

How Consumers Are Shaping the Next Gen Wellbeing Experience

Sep 20, 2017

BY MADHAVI VEMIREDDY, MD SPONSORED CONTENT

Our day-to-day interactions with technology are changing expectations and aspirations for almost every touch point in modern life. We want instant feedback and action at the push of a button, from the digital shopping cart to the doctor’s office. That is part of why there is a constant stream of new apps and tech services being released across every industry, including wellness. But the barrage of options can be a problem of its own nature.

To better understand what people want and how to deliver resources that resonate and stick, we spent time studying how real people engage (or don’t) with personal health and well-being. What we found was instantly familiar yet full of deeply personal insights that made the struggle real and the solution obvious.

So often we design towards an end-goal or finish line. As we were reminded through our research, health is not static. For the healthy, those with chronic conditions, those actively managing to avoid serious health issues, the issues are all the same: it’s a challenge to live your healthiest life every day. It’s a daily struggle to avoid the foods we shouldn’t eat; it’s a daily struggle to exercise; it’s a daily struggle to live in the “white space” between doctor appointments.Continue reading…

Forget Trump. The 2020 Election Will Be About Single Payer.

Sep 19, 2017• 4

By PAUL KECKLEY

Last week, the Senate Health, Education, Labor and Pensions Committee wrapped up hearings focused on stabilizing the individual insurance market leaving unresolved an issue that separates Dem’s and Rep’s on the committee: just how much freedom states should have in managing their insurance markets. At issue are the Section 1332 waivers which allow states to reduce essential benefits in health insurance policies, thus allowing insurers to sell policies that cover less with lower premiums.

Also last week, Republican Senators Lindsey Graham and Bill Cassidy offered what they called the “last chance” for Republicans to repeal and replace the Affordable Care Act. Their bill would repeal the individual and employer mandates and replace the ACA’s tax credits, Medicaid expansion, and cost-sharing payments with block grants to states so governors would have more flexibility and authority in managing their Medicaid programs and insurance markets.

But arguably more media attention was directed at Sen. Bernie Sanders’ proposal to replace the current employer-sponsored health insurance system with “Medicare for All” which would be phased on over four years and be funded by increased employer payroll taxes and higher taxes for those earning more than $250,000. What appeared to garner the media’s attention was the cadre of 15 Democrats in the Senate and 117 in the House who endorsed his proposal, though its price tag is unknown.

DACA Repeal is Bad for Medical Students, Healthcare, and the Public

Sep 16, 2017• 5

BY SUHAS GONDI

The Trump administration’s recent announcement to end the Deferred Action for Childhood Arrivals (DACA) program instilled fear and outrage in communities across the country. As a medical student with friends and classmates with DACA status, I am particularly disappointed in the poor and compassionless judgment of our nation’s leader. I fear for my peers who have worked incredibly hard and overcome the most daunting of obstacles to get where they are today, and who now could see it all taken away from them. Their now tenuous situation is unimaginable to me. But I also fear the impact of this decision on my non-DACA classmates, on our training, and on our futures. There is certainly a moral case to keep DACA alive, but the effects of its repeal on the healthcare system writ large make apparent that it’s also a bad idea for all Americans.

The American Medical Association (AMA) letter to Congress spells out many of the reasons why. Study after study has shown that, due to multiple demographic changes, physician demand will far outpace supply over the next decade. By 2030, the US will face an estimated shortfall of up to 104,900 physicians. Even now, we are witnessing how a lack of doctors in rural and other federally designated Health Professional Shortage areas results in inadequate access to care for too many, and directly contributes to worse health. As AMA CEO James Madara wrote in the letter, “the DACA initiative could help introduce 5,400 previously ineligible physicians into the U.S. health care system in the coming decades,” and work towards alleviating this persisting issue.

Why a Silicon Valley Approach Can’t Work for Health Tech

Sep 15, 2017• 4

By AMELIA EDWARDS

Imagine if I told you that there was a pool of close to 600,000 individuals in New York City who were ripe for innovative health technology integration. You probably wouldn’t believe me and say that it sounded too good to be true. This said pool does in fact exist and can be found concentrated within the city’s public housing.

While entrepreneurs, governmental leaders, and healthcare officials constantly speak of innovation and disruption, there seems to be a major disconnect between these words and actual creativity. This large, untapped pool of individuals who fall under the New York City Housing Authority’s (NYCHA) umbrella is one example of the lack of creative, and truly disruptive practices, that I see in today’s early stage ecosystem.

In health tech, we have all too readily accepted the Silicon Valley model of startups and attempted to force healthcare to fit within this mold. Startup mythology has encouraged us to look at disruption as a four step model:

Develop a pitch deck and product
Raise Money
Experience success, a TechCrunch article, and wealth
Exit out with acclaim and glamour

7 Ways We’re Screwing Up AI in Healthcare

Sep 14, 2017• 8

BY LEONARD D’AVOLIO

The healthcare AI space is frothy. Billions in venture capital are flowing, nearly every writer on the healthcare beat has at least an article or two on the topic, and there isn’t a medical conference that doesn’t at least have a panel if not a dedicated day to discuss. The promise and potential is very real.

And yet, we seem to be blowing it.

The latest example is an investigation in STAT News pointing out the stumbles of IBM Watson followed inevitably by the ‘is AI ready for prime time’ debate. If course, IBM isn’t the only one making things hard on itself. Their marketing budget and approach makes them a convenient target. Many of us – from vendors to journalists to consumers – are unintentionally adding degrees to an already uphill climb.

If our mistakes led to only to financial loss, no big deal. But the stakes are higher. Medical error is blamed for killing between 210,000 and 400,000 annually. These technologies are important because they help us learn from our data – something healthcare is notoriously bad at. Finally using our data to improve really is a matter of life and death.

Dear Republicans, There Are Second Acts In Washington

Sep 12, 2017• 1

By STEVEN FINDLAY

Nazis and white supremacists. Charlottesville. Immigration policy and DACA. Climate change. In the context of these issues, there’s been much discussion of late about moral and ethical principles and American values.

There is, of course, no moral equivalency between white supremacists and those who oppose and protest them. People who advocate white supremacy are just plain wrong, on moral grounds.

And the Trump administration is clearly pursuing a path on immigration policy and climate change that is contrary to the ethical standards and values of the vast majority of Americans. I would add to this list the expansion of health insurance coverage. If anything is clear after this summer’s failed attempt by Republicans to repeal the ACA it’s that almost all Americans now support universal coverage.

And, more to the point, people see this increasingly in moral terms. They get it. It took many years—decades—to get to this point. But this summer’s debate clarified what our values are as a nation on access to health care via the structure of insurance, private and public.

Is It time For Physicians to Unionize?

Sep 12, 2017• 4

By NIRAN AL-AGBA, MD

Since the birth of our nation, labor unions have existed in one form or another in the United States. Unions are a force to protect the ‘working population’ from inequality, gaps in wages, and a political system failing to represent specific industry groups. Historically, unions organize skilled workers in a specific corporation, such as a railroad or production plant, however unions can organize numerous workers within a particular industry. Known as “industrial unionism”, the union gives a profession or trade a collective and representative voice. The existence of unions has already been woven into the political, economic, and cultural fabric of America; recent events suggest that it may be time for physicians and surgeons to unionize.

A labor union, is a body of workers who come together to achieve common objectives, such as improved safety, higher pay and benefits, and better working conditions. Union leadership bargains with employers on behalf of union members to negotiate labor contracts (collective bargaining.) This may include the negotiation of wages, work rules, complaint procedures, and regulations governing hiring, firing and promotion, or workplace policies.