Category: Uncategorized

Digital Health Experts Needed for Landmark International Forum

Jan 16, 2020

Why Do We Have Residency Training?

Jan 16, 2020• 3

By BRYAN CARMODY, MD

Surely every resident has had the experience of trying to explain to a patient or family what, exactly, a resident is. “Yes, I’m a real doctor… I just can’t do real doctor things by myself.”

In many ways, it’s a strange system we have. How come you can call yourself a doctor after medical school, but you can’t actually work as a physician until after residency? How – and why – did this system get started?

These are fundamental questions – and as we answer them, it will become apparent why some problems in the medical school-to-residency transition have been so difficult to fix.

In the beginning…

Go back to the 18th or 19th century, and medical training in the United States looked very different. Medical school graduates were not required to complete a residency – and in fact, most didn’t. The average doctor just picked up his diploma one day, and started his practice the next.

But that’s because the average doctor was a generalist. He made house calls and took care of patients in the community. In the parlance of the day, the average doctor was undistinguished. A physician who wanted to distinguish himself as being elite typically obtained some postdoctoral education abroad in Paris, Edinburgh, Vienna, or Germany.

“I Want Complete Labs Ordered Before My Physical”

Jan 14, 2020• 1

By HANS DUVEFELT, MD

Many patients make this or similar requests, especially in January it seems.

This phenomenon has its roots in two things. The first is the common misconception that random blood test abnormalities are more likely early warning signs of disease than statistical or biochemical aberrances and false alarms. The other is the perverse policy of many insurance companies to cover physicals and screening tests with zero copay but to apply deductibles and copays for people who need tests or services because they are sick.

It is crazy to financially penalize a person with chest pain for going to the emergency room and having it end up being acid reflux and not a heart attack while at the same time providing free blood counts, chemistry profiles and lipid tests every year for people without health problems or previous laboratory abnormalities.

A lot of people don’t know or remember that what we call normal is the range that 95% of healthy people fall within, and that goes for thyroid or blood sugar values, white blood cell counts, height and weight – anything you can measure. If a number falls outside the “normal” range you need to see if other parameters hint at the same possible diagnosis, because 5% of perfectly healthy people will have an abnormal result for any given test we order. So on a 20 item blood panel, you can pretty much expect to have one abnormal result even if you are perfectly healthy.

Healthcare Needs Some IHOPs

Jan 13, 2020• 1

By KIM BELLARD

The New York Times had an article that surprised me: Current Job: Award Winning Chef. Education: IHOP. The article, by food writer Priya Krishna, profiled how many high-end chefs credit their training in — gasp! — chain restaurants, such as IHOP, as being invaluable for their success.

I immediately thought of Atul Gawande’s 2012 article in The New Yorker: What Big Medicine Can Learn From the Cheesecake Factory.

Ms. Krishna mentions several well-known chefs “who prize the lessons they learned — many as teenagers — in the scaled-up, streamlined world of chain restaurants.” In addition to IHOP, chefs mentioned experiences at chains such as Applebee’s, California Pizza Kitchen, Chipotle, Hillstone, Houston’s, Howard Johnson’s, Olive Garden, Panda Express, Pappas, Red Lobster, Waffle House, and Wendy’s.

Some of the lessons learned are instructive. “It was pretty much that the customer is always right,” one chef mentioned. Another said she learned “how to be quick, have a good memory, and know the timing of everything.” A third spoke to the focus that was drilled into all employees: “Hot food hot. Cold food cold. Money to the bank. Clean restrooms,”

Top 3 Myths About Digital Identity in Healthcare

Jan 10, 2020• 1

By GUS MALEZIS

Healthcare is in the midst of a digital transformation, creating information security, compliance, and workflow challenges. The engagement of an increasingly decentralized workforce along with anytime anyplace healthcare and the proliferation of cloud-based applications, databases, and mobile devices have now (or soon will have) eroded the once well-defined network perimeter.

The healthcare industry remains one of the most highly targeted for cyber-attacks – a recent report from Beazley Breach Insights showed that, 41 percent of all breaches in 2018 occurred in the healthcare sector. This means that, going forward, healthcare organizations must pay particular attention to cybersecurity and do so without restricting or compromising access to the systems and services providers and patients are now using and may do in the future. A successful cybersecurity plan requires these organizations to focus on establishing and managing trusted digital identities for all users, applications, and devices throughout the entire extended digital healthcare enterprise – from the hospital, to the cloud, and beyond.

Why are modern hackers targeting healthcare? Because they can, and they have the opportunity to do so! Hackers also know the value of the data stored within provider systems. Today, medical records fetch up to ten times more money on the dark web than the average credit card.

Health in 2 Point 00, Episode 104 | OneMedical, KRY, ClassPass, Komodo Health & LeanTaaS

Jan 9, 2020

Today on Health in 2 Point 00, Jess and I have a million deals to talk through. My Softbank rumor from last week hasn’t been announced yet, but there’s still plenty to discuss before JP Morgan. In this episode, get key takeaways from OneMedical’s S1, Swedish company KRY raising $155 million, ClassPass reaching unicorn status with a $285 million round, Komodo Health raising $50 million, and LeanTaaS raising $40 million. Be sure to follow along with all the JPMadness next week. —Matthew Holt

Doctoring in 2020: Why is the Patient Here? Whose Visit is it Anyway?

Jan 9, 2020

By HANS DUVEFELT, MD

A new decade and a new EMR are making me think about what the best use of my time and medical knowledge really is. The thing that stands out more and more for me is the tension between what my patients are asking me for and what the medical bureaucracy is mandating me to do. This is, to be blunt, an untenable, crazy-making situation to be in.

Many of my patients with chronic diseases don’t, deep down, want better blood sugars, BMIs or blood pressures – nor do they want better diets or exercise habits. People often hope they can feel better without fundamentally changing their comfortable, familiar and ingrained habits – that’s just human nature.

I went to medical school to learn how to heal, treat and guide patients through illness, away from un-health and toward health. I didn’t go to school to become a babysitter or code enforcement officer.

For all who hate computers in medicine: here’s what we got before.

Jan 8, 2020• 3

By e-Patient Dave DeBronkart

The photo below shows what “visit notes” from a doctor appointment might look like in the era before computers. Just two days before my first speech where I said “Gimme my damn data,” I had an ENT visit, and on the way out I asked for a copy of the doctor’s notes. The clerk snickered out loud and showed it to me, saying, “If you really want it….”

No joke; this is what the doctor had recorded.

Visit notes from my ENT appointment, Sept 15, 2009

Disrupting Medicare Advantage for Data Access, Better Outcomes | Vivek Garipalli, CEO Clover Health

Jan 7, 2020• 1

BY JESSICA DAMASSA, WTF HEALTH

Vivek Garipalli, CEO and Co-Founder of Clover Health initially set out trying to create a high-tech healthcare company aimed at improving clinical decision making, while leveraging the best of tech and data science in the process. Sounds about right for a guy who previously founded a health system (CarePoint Health), so…how did he end up with a high-tech Medicare Advantage plan instead? Isn’t clinical disruption hard enough? In this very candid chat about the larger issues thwarting tech and the healthcare business model, Vivek explains how he HAD to turn Clover into a health plan in order to get “reliable access” to the longitudinal set of information that would truly help patients and providers achieve better health outcomes. Can this kind of thinking ever be applied to the under 65 market? How does Clover perpetuate this model? Founded in 2012, this late-stage startup has big plans for scaling up and they’re centered on winning over physicians.

Filmed at the HIMSS Health 2.0 Conference in Santa Clara, CA in September 2019.

9 Healthcare Companies Who Changed the 2010s

Jan 7, 2020

By ANDY MYCHKOVSKY

In order to celebrate the next decade (although the internet is confused whether its actually the end of the decade…), we’re taking a step back and listing our picks for the 9 most influential healthcare companies of the 2010s. If your company is left off, there’s always next decade… But honestly, we tried our best to compile a unique listing that spanned the gamut of redefining healthcare for a variety of good and bad reasons. Bon appétit!

1. Epic Systems Corporation

The center of the U.S. electronic medical record (EMR) universe resides in Verona, Wisconsin. Population of 13,166. The privately held company created by Judith “Judy” Faulkner in 1979 holds 28% of the 5,447 total hospital market in America. Drill down into hospitals with over 500-beds and Epic reigns supreme with 58% share. Thanks to the Office of the National Coordinator for Health Information Technology (ONC) and movement away from paper records (Meaningful Use), Epic has amassed annualized revenue of $2.7 billion. That was enough to hire the architects of Disneyland to design their Google-like Midwestern campus. The other amazing fact is that Epic has grown an average of 14% per year, despite never raising venture capital or using M&A to acquire smaller companies.

Over the years, Epic has been criticized for being expensive, non-interoperable with other EMR vendors, and the partial cause for physician burnout. Expensive is probably an understatement. For example, Partners HealthCare (to be renamed Mass General Brigham) alone spent $1.2 billion to install Epic, which included hiring 600 employees and consultants just to build and implement the system and onboard staff. With many across healthcare calling for medical record portability that actually works (unlike health information exchanges), you best believe America’s 3rd richest woman will have ideas how the country moves forward with digital medical records.