Category: Uncategorized

What’s Missing in the Debate Over Employer Wellness Programs

Dec 4, 2015• 5

By SUSAN DENTZER

By now, Americans are no doubt getting used to debates that put show over substance and skirt the genuinely profound issues the nation faces. But although we may have come to expect as much in this political season, we deserve better when it comes to contemplating the role of employers in improving employees’ health.

A recent “debate” sponsored by the Population Health Alliance about employer wellness programs – the various health promotion and disease prevention strategies that about half of U.S. employers offer, such as weight loss, smoking cessation and onsite gym classes – fell into the depressing pattern of highlighting the largely irrelevant at the expense of the important. The debate, which took place last November 2 at the alliance’s 2015 Forum in Washington, DC, pitted two frequent combatants:Al Lewis, founder of Quizzify and co-author of a book critiquing wellness programs, and Ron Goetzel, senior scientist at Johns Hopkins University’s Bloomberg School of Public Health and leader of the “Promoting Healthy Workplaces” program supported by the Robert Wood Johnson Foundation.

The ostensible topic was whether wellness programs benefited employees, companies, and society at large, but the debate never actually addressed this broad question. Most of the time, the session’s verbal jousting focused on a far narrower issue: whether companies saw any financial return on investment (ROI) on the dollars they plow into wellness programs.

The Ten Worst Wellness Programs and What They Do to Harm Employees

Dec 4, 2015• 4

By AL LEWIS and VIK KHANNA

If corporate wellness didn’t already exist, no one would invent it. In that sense, it’s a little like communism, baseball, or Outlook.

After all, why would any company want to purchase programs that damage morale,reduce productivity, drive costs up…and don’t work 90%-95% of the time? And that’s according to the proponents. What the critics say can’t be repeated in a family publication such as ours.

Still, those are the employers’ problems. However, the employers’ problems become the employees’ problems when employees are “voluntarily” forced to submit to programs that are likely to harm them. (As the New York Times recently pointed out, there is nothing voluntary about most of these programs.)Continue reading…

The Meaning of “Value” in Health Care

Dec 3, 2015• 15

By PAUL KECKLY

There are terms in healthcare circles that get thrown around as if there’s a common and widely accepted definition.

Consider “quality:” every hospital touts its quality, every physician confidently affirms their delivery of high quality care, and every trade and professional sector in healthcare has its own definition that aligns with attributes of quality they deem most important. “Quality” is touted on every website and in every boardroom, but rarely is it defined and measured consistently.

“Outcomes” is another. Most ascribe positive outcomes in their performance, but the indicators on which they’re based and the time periods over which they’re captured—days, weeks, months, or years—varies from user to user. Valid and reliable measures are ephemeral: process measures are used more frequently because they’re easier for regulators, policymakers and payers to monitor; i.e. “advising a patient to stop smoking or lose weight” but these may have little to do with the actual outcome.

On the Preventability of Lethal Errors: A Response to Dr. Koka

Dec 3, 2015• 3

By JOHN T JAMES, PhD

In my opinion, the title of Dr. Koka’s post (“Very Bad Numbers“) is far too inflammatory for a subject that needs to be taken seriously. Dr. Koka’s summary of the approach I took in my JPS study is a reasonable summary, minus a few key points. Preventability of lethal errors is the problematic issue. The nine authors of the Classen paper did postulate that virtually all serious adverse events they found are preventable; I did not pull this out of the air. Preventability is a highly subjective area. A few years ago everyone assumed that hospital acquired infections were simply the cost of doing business. Now we know that the majority of infections can be prevented. The major difference Dr. Kota and I have is that he wants to rely exclusively on the Landrigan study, which is an excellent and large study, but it is not representative of the nation. It represented hospitals in North Carolina. That state was chosen because it was much more aggressive in efforts to reduce medical harm than the average state in the nation. The OIG study (2010) was in fact an attempt to be representative of the Medicare population across the country, but it is just Medicare beneficiaries. As I noted in my paper, none of the four studies can stand alone, not even the Landrigan paper.Continue reading…

The Healthcare System Link in the San Bernardino Shootings

Dec 2, 2015• 14

By JOE FLOWER

Another day, another mass shooting. At this point the news reports say nearly 30 down, 14 or more dead, multiple perps, at a banquet for the San Bernardino, California, Department of Public Health.

And instantly the argument is all about the guns. I understand that, and I’m not even saying that it’s not about the guns.

And instantly we want to say these folks are crazy and of course that’s true. It doesn’t matter if they frame their reasons around Allah or “no more baby parts” or Obama’s impending takeover of the U.S. using ISIS fascist armies disguised as Syrian refugees pouring over the border from Mexico, doesn’t matter. Anyone who turns a gun on other human beings in a school, a clinic, a public street is we can safely say, nuts, if “nuts” has any real meaning any more.

But there are crazy people in every culture, and we have always had crazy people in ours. The percentage of people who are crazy does not scale across societies and across time with the number of people walking into theaters, malls, and bus stations with guns blazing.

Even the number of guns per capita, or the caliber and size of magazines people can buy, or the rules around buying them do not scale directly with mass violence. There is something else going on here.

Rethinking our Thinking about Diagnostic tests: There is nothing Positive or Negative about a Test result

Dec 1, 2015• 4

By ROBERT McNUTT, MD & NORTIN M HADLER, MD

Making a diagnosis is easy if the test we use to make the diagnosis defines the disease. These sorts of tests, called “reference-standard” tests, when present at any level of the test’s result, make the diagnosis. A spinal fluid culture growing listeria or opioids in the urine are examples.

Using reference-standard tests in clinical medicine, however, is not the norm. The reason for this is that reference-standard tests often don’t exist and if they do they may be dangerous, difficult to obtain, and costly. Hence, we use most often non-reference standard tests that can only raise or lower the likelihoods of diseases. There is nothing particularly new in these comments. Every reader will know such concepts as, the “sensitivity and specificity” of a test. Every reader will remember hearing about, or be able to construct, 2X2 tables showing the sensitivity of a test; the corresponding false negative percent; the specificity of the test; the corresponding false positive percent.

But, despite the ever-present teaching of how tests ‘work”, it is my experience that physicians and patients have difficulty using the measures of a test’s value in clinical care. This difficulty is manifest in the observation that diagnosis mistakes may be common and the perceived mistake is the inciting event in up to 40% of malpractice cases. If the conceptual ideas for appropriate test characteristics are so clear and well taught, why is there so much difficulty in using tests to make a correct diagnosis? I contend that the way we teach and understand testing has not allowed us to advance an ideal, numerate approach to accurately making a diagnosis. I claim, also, that the concept of a single “sensitivity and specificity” for a test is actually suspect, even incorrect.

Very Bad Numbers

Nov 30, 2015• 51

By ANISH KOKA, MD

The date is July 17th, 2014. It is 10am in the Dirksen Senate building, and the congressional subcommittee on health and aging is about to focus on patient harm. The educating will be done by some of the leaders in the medical field, Ashish Jha and Tejal Gandhi from Harvard, Peter Pronovost from Johns Hopkins. The star of the proceedings is John James, a toxicologist, a PhD from Texas, and the founder of Patient Safety America.

The tone is set from the beginning by none other than Bernie Sanders. In somber tones, he relays that hospitals can make patients worse, and that a recent study suggests medical errors is America’s third leading cause of death behind only heart disease and cancer. Hospitals are killing patients, and something needs to be done about it. The panelists then go on to speak strongly about the ongoing epidemic of patients dying in hospitals, and re-enforce the staggering numbers introduced by Bernie Sanders.

Headlining the proceedings is an unassuming gentleman named John James. He has a Ph. D in pathology, and he worked as a Chief Toxicologist at NASA. He is at the congressional proceedings, and is one of the lead activists in patient safety because of personal tragedy. His 19 year old son died in the summer of 2002 due to “uninformed, careless, and unethical” care by cardiologists. He proceeded to write a book, “A Sea of Broken Hearts” that details the errors he believes cardiologists made in his son’s care that lead to his death. Of note 2 cardiologists that were sought by Dr. James’ lawyers believe the care his son got did not violate the standards of care. A further 2 appeals to the Texas Medical Board also rendered two opinions from two other separate cardiologists that the standards of care in this case were not only met, but exceeded. Dr. James, armed with information he has carefully selected from a number of different sources, strongly disagrees.

A Home for Orphan Wearables

Nov 30, 2015

By PAUL LEVY

How many people do you know who’ve bought a Fitbit or similar device to track their exercise patterns–who have then let the whole venture lapse? The Fitbit now resides comfortably and peacefully in their drawer!

Well, there’s a useful way to recycle them, offered by Tufts University professor Lisa Gulatieri. As noted in this article:

Gualtieri started RecycleHealth in April with the goal of giving unused activity trackers — mostly Fitbits so far, but RecycleHealth accepts all devices — a second life. The company has collected about 20 devices so far and has plans to donate them to the Montachusett YMCA in Fitchburg, Massachusetts, where they will be used to help older and lower income individuals have access to devices, as well as to learn about how those populations interact with activity trackers.

Check out the Facebook page for stories on how the idea is spreading, plus more information, including how to get free mailing labels.

Paul Levy is the former CEO of BIDMC and blogs at Not Running a Hospital, where an earlier version of this post appeared.

A Usability Conundrum: Whether it is EHRs or Hospital Gowns, One Size Never Fits All…

Nov 30, 2015• 2

By JEROME H CARTER, MD

Building clinical care systems that intimately support clinical work has to begin with the acknowledgement that clinicians perform many tasks within the context of a patient encounter, and those tasks very in type, number, and sequence. Everyone knows this. So, one might ask, if this is common knowledge, why are there so many problems with EHR usability? The answer is very simple. EHR systems are designed to be one-size-fits-all.

One-size-fits-all (OSFA) is such a fundamental precept of EHR design that no one even questions it. Instead, there is a pursuit of every possible means of fixing EHR systems, while allowing them to remain OSFA. Why? Because it is a design assumption carried over from past software design/development limitations. Achieving the highest possible level of usability requires dumping deeply-ingrained OSFA thinking.

How did OSFA become so entrenched in EHR designs? Here are the main reasons.

Poor choice of design metaphor
Paper charts are the inspiration for current EHR systems. Charts are OSFA. No clinician was allowed to customize the chart to fit his/her personal work habits or information needs. Every hospital or practice has strict rules about chart organization and use. There are legal rules that dictate how charts must be stored and what they must contain. There is an entire profession dedicated to charts. Charts are designed to be standardized information repositories; they are not designed to aid in care delivery. Paper charts are a means to an end, and I have never heard anyone gush over how wonderful a paper chart was or how it made their lives so much better. However, since paper charts are (were) a fact of life, one simply adapted to them, like it or not.

Venrock headlines Health 2.0’s Digital Health Investor Conference, WinterTech 2016

Nov 30, 2015

By DEEPA MISTRY

Health 2.0’s WinterTech conference on January 13, 2016 at the Julia Morgan Ballroom in San Francisco, CA showcases the latest in digital health investing featuring leaders from Venrock, Canvas Venture Fund, Helix, Doximity, Grand Rounds, Livongo, Omada Health, and more. Learn about the latest financing and market trends of digital health and hear directly from the start-ups creating the biggest waves in the industry.