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Health 2.0 announces Launch! and Traction Finalists

Health 2.0

Big news for the Health 2.0’s upcoming 9th Annual Fall Conference!

Launch!

Our annual Launch! competition is on the last day of the conference, Wednesday, October 7th. Ten digital health companies will demo their products for the first time. The audience votes for their favorites. Previous Launch! winners have included Castlight Health, Basis, and OM*Signal. This year’s finalists:

Bloom Technologies will debut their discrete, wireless wearable for expecting mothers to track contractions and other changes to improve maternal and neonatal outcomes.

Flow Health connects consumers, providers and payers around shared patient data including Patient Check-In, an iPad app replacing the standard medical clipboard.

Sensentia is a fully-automated inquiry using natural language processing and more to empower patients to make better health care decisions.

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Diagnostic Error: The IOM Talks Trash (But Not Cash)

flying cadeuciiTo understand how a landmark new report on diagnostic error breaks the mold, go past the carefully crafted soundbite ­(“Most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences”) and rummage around the report’s interior.

You can’t get much more medical establishment than the Institute of Medicine (IOM), also called the National Academy of Medicine, author of the just-released Improving Diagnosis in Health Care. Yet in a chapter discussing the role played in diagnostic accuracy by clinician characteristics, there’s a shockingly forthright discussion of the perils of age and arrogance.

“As clinicians age, they tend to have more trouble considering alternatives and switching tasks during the diagnostic process,” the report says. Personality factors can cause errors, too: “Arrogance, for instance, may lead to clinician overconfidence.”

Wow. Sure, both those assertions are extensively footnoted and hedged later with talk of the importance of teams (see below). Still, given the source, this practically qualifies as “trash talking.”

Of course, those quotes didn’t make it into the press release. There, inflammatory language was deliberately avoided so as not to give opponents any easy targets. (Disclosure: I was an advocate of an IOM report on this topic while consulting to an organization that eventually helped fund it. After testifying at the first committee meeting, I had no subsequent involvement.)Continue reading…

A Small EHR Vendor’s Emotional Open Letter to Users

flying cadeuciiOver the last few years, we have seen large EHR vendors purchase the moderate size EHR vendors, while moderate-size EHR vendors acquire smaller EHR vendors. We can expect to see a further decline in the number and diversity of EHRs as the IT mandates of Meaningful Use 2 and 3 are technically unachievable for all but the most well-endowed EHR vendors.

Along with the decreasing diversity of EHR options, an increasing number of physicians have lost the ability to choose the most important tool in their black-bag, their EHR, as many are now employed by large organizations which tell the physicians which EHR/HIT tools they are allowed to use.

If there was data that “Certified” EHRs, “Meaningful Use,” ICD10 and PQRS mandates had an impact on the cost or quality of healthcare which was commensurate with the IT costs and logistical disruptions, I would be the first to encourage physicians to use the new and proven technology. Unfortunately, we still do not know if “more” HIT is good for the healthcare system and society in general, or if it is only good for the IT industry.

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This Is Your Brain On Wellness

flying cadeuciiAs a CEO of a company in a competitive industry, I cross my fingers that my competitors will implement wellness programs.

Indeed, the more comprehensive their programs, the better it is for me. Those competitors will suffer increased healthcare costs, compounded by declines in productivity. Best of all, these programs’ negative morale impact may lead some employees to quit, thus facilitating our own recruiting efforts. (This is especially true for overweight employees, whom wellness vendors really seem to dislike. We, on the other hand, find employee weight makes no difference in either productivity or health spending.)

So hopefully my competitors will disregard the rest of this posting.

As background for those readers who are mercifully still unfamiliar with workplace wellness programs, they generally consist of four components (called “pry, poke, prod and punish” programs as shorthand):

1. A “health risk assessment,” or HRA, that pries into your employees’ personal lives, often asking about their drinking habits, marriage etc.

2. A “biometric screen” where technicians in white coats come to your workplace and poke your employees with needles to test them for diseases that in many cases, the government’s clinical guidelines say they shouldn’t be tested for. A small but increasing number of programs demand employee DNA, which isn’t in any clinical guideline.

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Why Chris Borland’s Retirement Makes Sense, And Does Not Make Sense


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Being an ardent football fan I was quite surprised by Chris Borland’s announcement that he would retire from the NFL. He is 24. I was still a fledgling medical student at 24.

Borland has decided to retire sooner rather than later because of a medical issue. Not a medical condition he has. But a medical condition he may acquire should he continue playing football. Borland has made a judgment call. He has decided that the risks of repeated head trauma outweigh the benefits and $$$$ of being an NFL player.Continue reading…

Big PopHealth: Healthcare Analytics Summit 15

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THCB congratulates (FD: content partner and corporate supporter) HealthCatalyst in the wake of last week’s sold out Healthcare Analytics Summit (HAS15) in Salt Lake City.

The Utah-based startup widely-rumored to be headed for the Hot IPO List  drew a crowd of over a thousand attendees, including vendors, clients, c-suite healthcare types, data geeks and industry observers.    

If you want to wrap your brain around what sets Health Catalyst apart from the growing number of pretenders in the red-hot analytics space, you had only to look at the jaw-droppingly impressive client list: Partners Health Care, Stanford Health System, Kaiser Permanente Colorado, Texas Children’s, Allina Health,  and many, many more.

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Symptoms of Unknown Origin – The Prevalence of False Diagnosis of Disease


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Early in my career in the 1960s, I developed an interest in patients who had physical symptoms but no definable medical disease. I began to see a number of these patients referred from my colleagues. I asked myself, “If these patients do not have a medical disease, then what do they have?”

I defined “symptoms of unknown origin” as occurring when a patient had two or more symptoms for over a month, and whose symptoms remained unexplained after a thorough medical workup. I intended to study and follow these patients, hoping to uncover the underlying cause for their symptoms whatever they might be. I was surprised to discover that many such patients carried diagnoses of non-existent diseases – that is false diagnoses. I soon found that the presence of a false diagnosis created a barrier to uncovering the real cause for the symptoms.

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Lifetime Health Records For Patients?

flying cadeucii Leonard Kish and Eric Topol recently argued eloquently for patient control of a lifetime health record, adding their voices to the calls for patient ownership of health records, building on the foundational notion that ownership is necessary in order to assert control because “possession is nine-tenths of the law.”

I certainly agree that patient control of data is of paramount importance, but I am not convinced that we need to take the leap to patient “ownership” of data, and I am not quite sure what that even means in this day and age — or how it really differs from the status quo.

I’m less worried about the name we use for the bundle of rights a patient has with respect to his or her health data than I am about the vehicle available to exercise those rights.Continue reading…

The Wisdom of the Blogs

flying cadeuciiHave a prediction for 2016?

Send them in. There’s still time.

Want to know what the crystal ball holds in store? Register for athenahealth’s “The Future of Healthcare: Predictions for 2016.”

Saurabh Jha writes:

My predictions for 2016:

1. ICD-10 will not have caused a third world war centered in the middle east. However, it might have persuaded some physicians to consider a third career, may be as coders. Meanwhile, ISIS changes their torture tactics from decapitation to ICD-11.

2. We will still be discussing what is quality and what is value. Meanwhile, Propublica’s surgeon scorecard will have the same fate as Leo Tolstoy’s War and Peace – one is too ashamed to admit one didn’t read it.

3. Interoperability will finally be achieved by redefining interoperability. “Interoperability is when disparate electronic health records in disparate healthcare systems do not wage physical war against each other.”

John Irvine of THCB writes:

“In 2016 Donald Trump will propose a wild health reform plan combining free-market principles, the ritualistic destruction of most of Obamacare (except for the parts that quote “work okay”) with elements of the Swedish, French and Japanese systems and the deployment of “lots of attractive doctors.”

Pundits will spend most of year debating the insanity and surprising merits of the plan.”

Matthew Holt of THCB writes:

“In 2016 Health 2.0 technologies will add diagnostic tools to now mainstream virtual visits

ballsy prediction — Several big hospitals default on bonds as inpatient volume craters and they still have to pay for their EMR implementations

amusing prediction  — Epic tries to buy athenahealth, eClinicalWorks & Practice Fusion but is stopped by the DOJ”

B.S. writes:

1. ICD-10 will cause an explosion in fraudulent and abusive medical bills during a messy implementation

2. Health Catalyst will file for an IPO and IBM will preemptively buy them

3. Revenue Cycle Management companies, in the face of reimbursement changes, will attempt to morph into analytics companies.

4. One or both of the mega health plan mergers will not be approved due to market concentration concern.

5. Centene/Health Net merger will get done and Centene’s stock will hit a post split $100 by year end 2016.

6. United Healthcare will lose to Humana and Health Net for the new TriCare contract as three regions are reduced to two- UHC will lose its appeal”

Andy Oram of O’Reilly writes: 

“The 1980s have returned, and the HMO battles with them. In the 1908s, capitation was used by insurers to deny necessary care. Now, instead, patients are forced to accept high deductibles and are told to control costs — while the institutions in health care withhold the necessary information. See http://bit.ly/1Mxb5zj

Unable to wait for standards to evolve in structured patient data, health care providers and payers will turn on a massive scale to natural language processing to extract structured data from free-text patient notes.

We’ll admit that genetic research, the great hope held forth by the Precision Medicine initiative and other futurists, will not solve most health problems. The interactions among genetic markers and between the markers and the environment are too complex to predict or alter.

Institutions will hold back on sharing patient data for research purposes because anonymization removes too much useful detail and interoperability remains almost insurmountable. Instead of the promised future of big data crunching on enormous data sets, we’ll see more focused research based on medium-sized, local data sets.”

Rob Lamberts writes:

“1.  ICD-10 will create increased physician distress and ennui – This not only increases the overall workload of medical offices, but it does so while putting their cash-flow at risk.  At a time where physician dissatisfaction and frustration is high, adding more work and potentially less income is a disaster waiting to happen.  EMR products, of course will pose as the guy in the white hat ready to rescue doctors, but this will only serve to associate these record system with one more distasteful thing.

2.  With this increase in angst, doctors and patients will increasingly seek alternatives.  Patients will continue demanding access to their records and an increase in their role in their own care.  Doctors will move in increasing numbers toward alternative models of care, be they retail, concierge, or direct care.  The number of inquiries I’ve had over the past few months from physicians wanting to change over has increased sharply, and their level of interest is much higher.”

Dick Quinn of QuinnsCommentary writes:

“We will continue on the road to destruction of employer-based health benefits no matter who controls Washington, and on the road to a single-payer system. Obamacare won’t work to manage costs, the Republican alternatives to date are just silly.  Individual state solutions make no sense. So what’s left?”

Ron Hammerle of Health Resources Ltd.

“Implementation of elective, medical aid in dying in Canada (and maybe California) will begin to have an impact on end of life care, “informed consent,” medical costs, patient-empowerment and the reduction of unwanted medical care in the U.S.”

IndustryYoda writes

“Uncertainty about the outcome of the 2016 election will lead to increasing fear and gridlock as large healthcare organizations elect to play a wait and see game. GOP attacks on the Affordable Care Act will spook many. Doc morale will continue to spiral as a consequence. If the Republicans win the White House, the shit is going to seriously hit the fan …

ICD-10 will (flip a coin) either be delayed yet again in a last minute reversal by red-faced administration officials or be pushed through incompetently, causing stress and economic chaos among providers. Those who prepared will survive. Those who did not will feel extreme pain. The real winner? The consultants.

At least one ineptly-run electronic health record vendor will flame out spectacularly (note: this is not the company mentioned above), with dire consequences for customers. Citing obscure contractual language, the vendor will attempt to monetize customer data in various sleazy ways. Outrage and vows of official action will follow in Washington but no substantive action will be taken.”

Salesforce.com will Eat the World writes:

“You want predictions? Okay. Fine. Here’s my totally-insane world-changing-prediction-that-could-change everything. Salesforce will win over at least one huge healthcare name, causing a major freakout among vendors. Several will see the writing on the wall and announce plans to launch compatible services. Will it actually happen? Who knows. Not a fan of Salesforce, but I almost hope it does. ”

The University of South Carolina’s Joan Creed writes: 

“We now have retail health care.  I’ve thought for years we’ll one day have drive-thru health care: stop at the first window with your symptoms, then stop at the second window to pick up prescriptions, whether for medications, tests, whatever.”

Terry Bennett of Clinic on the Commmons writes:

“I am strongly tempted to say ” More of SOS”

There do not appear to be any trending stories about the return to the classic model, wherein an individual physician is responsible for an individual patients’ care.

Ditto any nationwide look at the impact of nonprofit hospitals becoming for profit gigantic Taj Majals, dominating both the jobs market and the real estate market in their communities, and the redundant duplicating/reduplicating of the servicers and technologies offered at the just-down-the -road former community”not for profit hospital”

Add to that the “90 day contract”that most young docs are forced to sign upon landing a job at one of these centers, wherein the doctor may be fired without recourse and without any stated cause. This widespread ” hear no, see no, speak no evil policy does very little for constructive criticism/two way discourse as to the best way forward.

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