Category: Uncategorized

Climate Change and the Migration of Infectious Disease

Apr 13, 2016• 3

By WILLIAM B MILLER JR., MD

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Zika is all over the news. Zika is surely dangerous, but it has its limitations and is likely to be well contained. However, its greater significance extends beyond any current spread. Instead, it exemplifies the crucial emerging trend of a novel infectious agent that has swiftly become a global threat.

The common phrase, ‘this time is different’, is almost always wrong. Yet, our modern circumstances are distinctly unlike any previous era. Humans possess a unique ability for rapid travel and we choose to journey with our favorite pets and plants. This unprecedented degree of mobility extends across every planetary habitat. Further yet, it now occurs during a phase of a rapidly shifting climate. Certainly, species migration or global climate change are not new but it is only in this present moment that these factors can amplify through instantaneous global travel in a singular manner.

In fact, the results of this unusual conjunction are already apparent. For example, Zika’s advance across Europe and to the Americas has been extremely rapid. This is such an extraordinary event that at the beginning of this year, the World Health Organization declared Zika a global emergency in recognition of its rapid spread from continent to continent. Its rising incidence mirrors our prior concerns about the global scope of other recent epidemics such as Ebola or SARS.

What Is Patient-Centered Care? What Isn’t Patient-Centered Care?

Apr 13, 2016• 10

By ROBERT LAMBERTS, MD

Rob Lamberts My last post discussed the wide gulf between healthcare and the rest of the world in the area of customer service. To sum up what took over 1000 words to express: customer service in healthcare totally sucks because the system promotes that suckiness and does nothing to penalize docs who make people wait, ignore what they say, rush through visits, and over-charge for their care. We get what we pay for.

But shouldn’t we judge the system for what it was build for: the quality of the care we give? Sure, the service is overwhelmed with serious suckitude, but that can be forgiven if we give good quality care for people, right?

Even if that was the case, there is no excuse for the lousy service people get from our system. The lack of respect we, as medical “professionals” show to our patients undermines the trust our profession requires. Why should people believe we care about their health when we don’t care about them as people? Why should they respect us when we routinely disrespect them? No, the incredibly poor service we have all come to expect from hospitals and doctors is, and never should be overlooked or forgiven.

Still, I already wrote a post about that. Go back and read it if you missed it. This post isn’t going anywhere. Now I want to cover the actual care we give, and how it too has moved away from the needs of the people it is supposedly for. The people question how much providers care (verb) mainly based on the (lousy) service they get. The care (noun) we give is all about the quality of the product purchased by whoever pays for that (be they third-party or the patients themselves). The real question I am asking here is not if this care is good or bad (the answer to that is, yes, it is good and bad), but whether it is patient-centered.

Eric Dishman, Intel & Randy Swanson, Care Innovations

Apr 12, 2016

Eric Dishman has been at Intel forever, and has been a cancer survivor for even longer. At HIMSS16 I met with him and Randy Swanson, another Intel veteran who is now CEO of their subsidiary Care Innovations. Yesterday Eric left Intel to become Director of the Precision Medicine Initiative Cohort Program. You’ll figure out why he’s so perfect for the job listening to this interview. You’ll also figure out why Intel cares about health care overall, and where Care Innovations is heading in the remote monitoring world. —Matthew Holt

Video recording provided by Greg Masters at Health Innovation Media
(FD–I am on the advisory board for the Validation Institute which is funded by Care Innovations.)

All Providers Are Not Equal

Apr 12, 2016• 9

By STEVEN FINDLAY

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Giving consumers information and data on providers’ quality of care and clinical results is one important path to enhanced transparency, patient engagement, and better health care.

Two publications out this month add significantly to the dialogue on this issue. The journal Health Affairs devotes most of its April issue to the theme of “patients’ and consumers’ use of evidence to inform health care decisions.” And the cover story in the May issue of Consumer Reports is entitled “What You Don’t Know About Your Doctor Could Hurt You.” Accompanying that story online is Consumer Reports’ latest ratings of doctors in six states and two metro areas.

(Disclaimer: I contributed an article to the April issue of Health Affairs and was involved in one element of the Consumer Reports piece.)

Among observations in the Health Affairs papers:

Star-based provider ratings, summarized information (instead of details) and well known signifiers of quality such as blue ribbons work best to compel consumers to both pay attention and make wise choices among health plans and providers.

Getting consumers to consider quality and cost (and the concept of value) remains a challenge. A survey of some 2,000 people found that most don’t think cost and quality of care are necessarily related. That’s good and bad. Good because previously published research indicated that most people leaned to believing that higher price means better quality. Bad because the new survey signals that people are still disconnected from pursuing value in health care by consciously choosing lower-cost/high-quality providers. Continue reading…

Are Your Health Cost Savings an Illusion?

Apr 12, 2016• 1

By TOM EMERICK AND DAVID TOOMEY

flying cadeucii The New England Journal of Medicine carried an excellent article by David Casarette, MD, on the topic of health care illusions and medical appropriateness. Click here to read the full article. Hats off to Bob Stauble for a heads up on this article.

Casarette observes that humans have a tendency to see success in what they do, even if in truth there is none. Casarette writes, “Psychologists call this phenomenon, which is based on our tendency to infer causality where none exists, the ‘illusion of control’.” This illusion applies in all walks of life, especially in politics and parenting, and it includes medical care as well.

In medical care, the phenomenon has been referred to as “therapeutic illusion“, and it impacts both doctors and patients. Undoubtedly, therapeutic illusion is why placebos can so effective.

Matthew talks, Fred listens

Apr 11, 2016

After years interviewing people at HIMSS, I got interviewed by a patient (as in putting up with me, not sick!) Fred Goldstein. My pearls of wisdom include the history of EMRs, eHealth, and how much money HIMSS makes by not buying food! Thanks to Greg Masters of Health Innovation Media for this and all he does!–Matthew Holt

LIVE from @HiMSS 2016 | Meet Matt Holt @boltyboy Co-chair @Health2con from Health Innovation Media on Vimeo.

The C Word

Apr 11, 2016• 29

By JEFF GOLDSMITH

flying cadeucii That we are experiencing a “consumer revolution” in healthcare is a durable meme in the media and in policy circles just now. When you hear the word “consumer”, it conjures images of someone with a cart and a credit card happily weaving their way through Best Buy. It is, however, a less than useful way of thinking about the patient’s experience in the health system.

A persistent critique of our country’s high cost health system is that because patients are insulated from the cost of care by health insurance, they freely “consume” it without regard to its value, and are absolved of the need to manage their own health. In effect, this view ascribes our very high health costs to moral failure on the part of patients.

Market-oriented policy advocates believe that if we “empower”patients as consumers by asking them to pay more of the bill, market forces will help us tame the ever rising cost of care. If patients have “skin in the game” when they use the health system and also “transparency” of health providers’ prices and performance, patients can deploy their own dollars more sensibly.

This concept played a major role in the otherwise “progressive” Affordable Care Act. The 13 million people who signed up for coverage this year through the Affordable Care Act’s Health Exchanges opted overwhelmingly for subsidized policies with very high deductibles and out-of-pocket cost limits. The “skin in the game” argument has also heavily influenced corporate health benefits decisions. More than 30 million workers and their families receive high deductible plans through employers.

Hacking Doctors

Apr 11, 2016• 1

By MARGALIT GUR-ARIE

flying cadeucii For decades and decades we have been counting the number of doctors in America. For decades and decades we have been coming up short compared to other developed nations, and some less developed ones as well. A poorly educated person may be tempted to suggest that we should “make” more doctors. After all, there is hardly a shortage of young people willing and able to undergo the rigors of a medical education. But luckily we are not poorly educated, so we devised much smarter solutions.

If people can’t get a doctor appointment, it must be the doctor’s fault. Hence, we put our foot down and mandated that doctors see people the same day they want to be seen, or shortly thereafter. It sounds great and it worked perfectly for the Veterans Administration (VA), so it should scale terrifically to everybody else.Taking a page from the highly respected Samuel Hahnemann, we decreed that physically “seeing” an actual doctor is not only completely unnecessary, but it may very well be detrimental to the healing process. A doctor effect is created by simply having an MD somewhere in the building, and as technology continues to improve, a virtual doctor presence should do the trick. Some have argued that Mr. Hahnemann’s homeopathic fantasy is no better than a placebo, but we have plenty of research showing that placebos are indeed effective.Continue reading…

Keep Calm and Save the NHS

Apr 9, 2016• 1

By SAURABH JHA, MD

Keep Calm and Save the NHS It was Boxing Day weekend. The consultant surgeon summoned the on-call team. “We face a calamity,” he said. The house officer had called in sick. The locum wasn’t going to arrive for another 12 hours. This meant that I, the senior house officer, would have to be the house officer. The registrar would take my place. The consultant, looking tense, would have to be the registrar—i.e. a junior doctor again.

“Junior doctor” is a misnomer because it implies a master and an apprentice. Running the National Health Service (NHS) are apprentices who become Jedis very quickly, and without a Ben Kenobi showing them the ropes.

I’ll never forget my first night on-call in the emergency room (ER). I was one of two junior doctors managing a busy inner city ER in London from midnight to 8 am. Just a year earlier, I was an errant medical student bunking lectures. Now I had to see people with heart attacks, strokes, and broken bones. Seeing the terror on my face, the senior nurse reassured me. “Just look as if you know what you’re doing. We’ll handle the rest.”

Forget Patient-Facing Apps. Yes, You Read That Correctly.

Apr 9, 2016

By ALAN PITT, MD

flying cadeucii Several years ago both Microsoft and Google invested millions of dollars on a flawed assumption: If they built a useful and free healthcare application, people would flock to it. In both cases, the effort failed. At its peak Microsoft HealthVault was only able to enroll a few thousand—largely inactive—users. Google Health was discontinued after a few years.

The problem was (and is) that unlike almost any other business, healthcare is a negative good.

Even if it’s “free,” as was the case with both the Microsoft and Google offerings, most people find tracking their health to be, in some sense, an admission of frailty, imperfection and mortality. Except for occasional blips related more to vanity (weight loss is the prime example), when it comes to our health most of us are in denial. So when people talk about technology for patient engagement, I tend to pause and wonder: Should we be building apps and services just for patients, or for the people who care about them too?