Category: Uncategorized

The Digital Doctor: Automation, Aviation and Medicine

Feb 26, 2015• 13

By ROBERT WACHTER, MD

The story of Chesley “Sully” Sullenberger – the “Miracle on the Hudson” pilot – is a modern American legend. I’ve gotten to know Captain Sullenberger over the past several years, and he is a warm, caring, and thoughtful person who saw, in the aftermath of his feat, an opportunity to promote safety in many industries, including healthcare.

In my continuing series of interviews I conducted for my upcoming book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, here are excerpts of my interview with Sully, conducted at his house in San Francisco’s East Bay, on May 12, 2014.

Bob Wachter: How did people think about automation in the early days of aviation?

Sully Sullenberger: When automation became possible in aviation, people thought, “We can eliminate human error by automating everything.” We’ve learned that automation does not eliminate errors. Rather, it changes the nature of the errors that are made, and it makes possible new kinds of errors. The paradox of cockpit automation is that it can lower the pilot’s workload in phases of flight when the workload is already low, and it can increase the workload when the workload is already high.Continue reading…

A Master Class In Health Policy with Kavita Patel

Feb 26, 2015• 3

By MATTHEW HOLT

The HxRefactored Conference kicks off April 1st in Boston and we are excited to have Kavita Patel giving a Master Class in U.S. Health Policy.” Kavita is a Managing Director at The Brookings Institution in Washington, DC and has a long history working in health reform for both Ted Kennedy and at the Obama White House. I interviewed Kavita to talk health care reform impact, insight, technology and and timing.

Matthew Holt: What are the most important changes that you are currently seeing due to Health Care Reform as well as in the health care system as a whole?

Kavita Patel:I would say the most important change is everybody is now intensely focused on transforming every aspect of health care, not only the consumer experience or people who are not already inside the health care system, but also for patients and then for their family members–whether it’s an insurance company that had massive numbers of enrollees, as a result of the Affordable Care Act and the last wave of 11 million people who signed up, or if it’s the one person’s primary care physician who is now looking at whether or not he or she should be part of the patient centered medical home, because he or she is kind of thinking through what the future of medicine will look like, as well as patients and consumers.Continue reading…

Why Can’t We All Just Get Along?

Feb 25, 2015• 14

By KAREN SIBERT, MD

American anesthesiology reached a significant milestone last year, though many of us probably missed it at the time.

In February, 2014, the number of nurse anesthetists in the United States for the first time exceeded the number of physician anesthesiologists. Not only are there more nurses than physicians in the field of anesthesia today, the number of nurses entering the field is growing at a faster rate than the number of physicians. Since December, 2012, the number of nurse anesthetists has grown by 12.1 percent compared to 5.8 percent for physician anesthesiologists.

The numbers—about 46,600 nurse anesthetists and 45,700 physician anesthesiologists—reported in the National Provider Identifier (NPI) dataset for January, 2015, probably understate the growing disparity. Today, more and more physicians are leaving the front lines of medicine, many obtaining additional qualifications such as MBA degrees and embarking on new careers in hospital administration or business.

Physician anesthesiologists can expect that fewer of us every year will continue to work in the model of personally providing anesthesia care to individual patients. Clinical practice is likely to skew even more toward the anesthesia care team model, already dominant in every part of the US except the west coast, with supervision of nurse anesthetists and anesthesiologist assistants.

The Tao of Wearables

Feb 24, 2015• 18

By JOE KVEDAR, MD

The hype around wearables is deafening. I say this from the perspective of someone who saw their application in chronic illness management 15 years ago. Of course, at that time, it was less about wearables and more about sensors in the home, but the concept was the same.

Over the years, we’ve seen growing signs that wearables were going to be all the rage. In 2005, we adopted the moniker ‘Connected Health’ and the slogan, “Bring health care into the day-to-day lives of our patients,” shortly thereafter. About 18 months ago, we launched Wellocracy, in an effort to educate consumers about the power of self-tracking as a tool for health improvement. All of this attention to wearables warms my heart. In fact, Fitbit (the Kleenex of the industry) is rumored to be going public in the near future.

So when the headline, “Here’s Proof that Pricey Fitness Wearables Really Aren’t Worth It,” came through on the Huffington Post this week, I had to click through and see what was going on. Low and behold this catchy headline was referring to a study by some friends (and very esteemed colleagues) from the University of Pennsylvania, Mitesh Patel and Kevin Volpp.

A Shout Out to Our Sponsors

Feb 24, 2015

By THCBist

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Weight Loss Fines Are Discriminatory and Counterproductive

Feb 23, 2015• 69

By LEWIS, KHANNA and ROBISON

One year ago in these pages, Harvard Medical School’s Stephen Soumerai wrote a scathing essay arguing that employer fines on overweight employees were ineffective. We’re here to tell you that Professor Soumerai is a cockeyed optimist. A new review in the American Journal of Managed Care shows that these fines transcend ineffectiveness. They are counterproductive.

To begin with, forced corporate weight loss programs don’t work. Of roughly 1000 wellness vendors promising weight loss, only one, the iDiet, has received validation. Literally no other corporate weight loss program can check three simple boxes that are standard in medical research:

The study was controlled the way grownups would define “controlled,” not using unmotivated non-participants as a control for motivated participants, which Health Fitness Corporation inadvertently invalidated
the program was sustained for 18 months, rather than eight weeks, which seems to be the new standard for get-thin-quick programs; and
The results showed both high persistence and significant weight loss.

Even that study had significant limitations: One could argue that the sample was small and even 18 months was not a long enough period to determine if weight maintenance was likely to be permanent.

What Do Women Know About Obamacare That Men Don’t?

Feb 22, 2015• 27

By SUSAN DENTZER

For the second year running, more women than men have signed up for coverage in health insurance marketplaces during open enrollment under the Affordable Care Act. According to the Department of Health and Human Services, enrollment ran 56 percent female, 44 percent male, during last year’s open enrollment season; preliminary data from this year shows enrollment at 55 percent female, 45 percent male – a 10 percentage point difference.

What gives? An HHS spokeswoman says the department can’t explain most of the differential. Females make up about 51 percent of the U.S. population, but there is no real evidence that, prior to ACA implementation, they were disproportionately more likely to be uninsured than men – and in fact, some evidence indicates that they were less likely to be uninsured than males .

What is clear that many women were highly motivated to obtain coverage under the health reform law – most likely because they want it, and need it.

It’s widely accepted that women tend to be highly concerned about health and health care; they use more of it than men, in part due to reproductive services, and make 80 percent of health care decisions for their families . The early evidence also suggests that women who obtained coverage during open enrollment season last year actively used it. Continue reading…

HIT Newser: Black Book Rankings Not So Unbiased?

Feb 22, 2015

By MICHELLE RONAN NOTEBOOM

Black Book: Not so Unbiased and Relevant?

Black Book Rankings announces that it will change its EHR survey methods and remove ballots cast by provider organizations that serve as resellers/VARs, and/or channel partners. The organization reviewed previous surveys and discovered that 33 hospital resellers had cast EHR satisfaction and loyalty ballots for 740 physician practices, and that 93% of the physician practices and small hospitals felt obligated to only select the EHR offered by their hospital.

Well, duh! I have always been a little suspect of Black Book’s survey method since their findings are often so different than the rankings from KLAS. If I were a vendor with a website that proudly displayed a high ranking from Black Book, I think I would quietly remove that reference, at least for now.

Epic Opening App Exchange

Epic Systems is launching its own app store, giving outside companies the ability to market applications that work with Epic’s EHR. According to former Nordic Consulting CEO Mark Bakken, the app store will “open the floodgates” for anyone who knows Epic and wants to get their products in front of Epic clients quickly.

Politically it’s a savvy move, since Epic wants to continue dispelling those rumors that its system is closed and lacks the interoperability of some of its competitors vying for the DoD’s $11 billion EHR contract.

Why Anthem Was Wrong Not to Encrypt

Feb 22, 2015• 27

By DAN MUNRO

Being provocative isn’t always helpful. Such is the case with Fred Trotter’s recent headline ‒ Why Anthem Was Right Not To Encrypt.

His argument that encryption wasn’t to blame for the largest healthcare data breach in U.S. history is technically correct, but lost in that technical argument is the fact that healthcare organizations are notably lax in their overall security profile. I found this out firsthand last year when I logged onto the network of a 300+ bed hospital about 2,000 miles away from my home office in Phoenix. I used a chrome browser and a single malicious IP address that was provided by Norse. I wrote about the details of that here ‒ Just How Secure Are IT Network In Healthcare? Spoiler‒alert, the answer to that question is not very.

I encourage everyone to read Fred’s article, of course, but the gist of his argument is that technically ‒ data encryption isn’t a simple choice and it has the potential to cause data processing delays. That can be a critical decision when the accessibility of patient records are urgently needed. It’s also a valid point to argue that the Anthem breach should not be blamed on data that was unencrypted, but the healine itself is misleading ‒ at best.

A Ray of Light at the Brigham

Feb 20, 2015• 5

By MARTIN SAMUELS, MD

I work at the Brigham and Women’s Hospital in Boston. We call it The Brigham. A month ago we were subjected to a tragic murder of one of our doctors. The winter has been brutal and unrelenting. Then, as I was walking to work the other day I was struck by a ray of light.

It was 7:30 AM and the morning light shone directly into what was the original main operating room of the Peter Bent Brigham Hospital, one of the parent institutions of what we now know as The Brigham. Peter Bent Brigham was a restaurateur who left an endowment for a hospital for the poor. It was decided to site the Peter Bent Brigham in the Longwood area just behind the Harvard Medical School which had moved to this location in 1904.

After a national search, Harvey Cushing was selected to be the founding Surgeon-in-Chief. Cushing, a native of Cleveland and graduate of Yale College and Harvard Medical School, had trained in surgery at the The Johns Hopkins Hospital and was in the process of creating the modern field of neurosurgery. Between 1910 and 1913, Cushing worked with the architects of the new hospital and sited the operating room such that the morning sun would shine into its large window, thereby allowing the surgeons to see well with natural light.