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Transparency: Houdini’s last trick
I recall a talk on imaging biomarkers for Alzheimer’s disease (AD). “Take this with a pinch of salt. I have a financial conflict of interest (COI) in the success of these markers,” the speaker warned. I glanced at the audience – MDs and PhDs with a cumulative IQ higher than the French intake of wine. I looked for pinches. I searched for salt. I found neither.
I wondered what a speaker’s disclosure is supposed to trigger. Should we say “Stop, don’t advance your power point, until we regroup?” Demand that the statistics be re-run in front of us. Challenge, “You say p is 0.04. No, you lying Gordon Gekko, it’s actually 0.06.” Or ask “did you submit ANOVA to Tukey?” If we must ask these questions, must we not ask routinely? Skepticism is a habit, not an episodic righteous angst.
No really, I’m not being facetious, what should transparency make us do differently? His disclosure, paradoxically, made him a saint for his honesty, and gave the audience an excuse to switch off their skeptical neurons, which I suspect had been switched off all along.
Giving Software Engineers a Seat at the Table
Increasingly, research is becoming available that reveals the weaknesses and strengths of health information technologies. Everything from infusion pumps to EHR systems have been subjected to analysis. The new flow of information is wonderful to behold because it wasn’t too long ago that little in the way of actionable HIT research was available.
Research on usability, interoperability, and patient safety can lead to better clinical care software. From these studies, we are learning important information about workflow disruptions, clinician information needs, user interface issues, errors, etc. Now that we have more research, how do we use it to produce better products, to address the needs of HIT users?
Who actually builds HIT products? Software engineers. They turn feature requests and requirements lists into working software making software engineers a rate-limiting component of any process leading to new products. Therefore, at some point, research must make it into the hands of software engineers who then covert it into objects, methods, APIs, and data store specifications. Continue reading…
Health System Conflict 101
Ok. You know the story. The work we do here at THCB would not be possible without the generous support of our corporate underwriters. Like Castlight Health and Evolent, Health Catalyst are widely rumored to be bound for an IPO in the near future. They’re a really interesting company, with roots that go back to the fabled IT department at InterMountain Healthcare. They’ve also been wonderful enough to sign on to support the community here at THCB as Flagship level sponsors. If you love what we do at THCB, take a few minutes to show you support by taking a look at what they’re up to. Today’s free online session on adaptive leadership in a change of healthcare system conflict is a great introduction.
As you possibly may have noticed, there is a lot of conflict in healthcare. Doctors vs. Nurses. Patients vs. Doctors. Doctors vs. Computers. This online bootcamp will help you deal with it – or at least understand it – and should be required viewing for healthcare leaders, doctors, nurses and other healthcare providers. You will learn effective strategies for leading healthcare system change that will help address resistance to quality improvement, the drivers of negative attitudes, and the way to manage our own personal barriers to change. Well worth your time IMHO. Bring a friend. ; )
The M Word
Insurance carriers large and small have started submitting premium hikes for the next 12 months for approval by federal and state officials. The picture is not pretty particularly for companies that sell the new plans designed under the Affordable Care Act. Those premiums are destined to climb 40 percent or more in some states in 2016.
Health insurance companies are getting squeezed as spending goes up and not enough young, healthy people enroll and pay premiums. As result, healthcare premiums, co-pays, deductibles and out-of-pocket co-insurance costs for individuals, employers and taxpayers will continue to soar ever-higher.
Estimates are that the ACA will add between $140 billion and $500 billion to the deficit over the first decade of the law’s existence. That’s because more will be spent on Medicaid and subsidies than is found in cost savings to healthcare. All truth be told, the ACA did nothing substantive to ensure healthcare cost savings.
The Dark Age of Meaningful Use
A lesson from the future:
We look back at the years between 2010 and 2016 (The lifespan of Meaningful Use) as a dark age in healthcare software.
It was an era where software companies bound by government mandate to churn out horrible software tried to pretend their products increased productivity. “Eligible” providers were brow-beaten to click buttons and fill forms, print things and perform medical decision making without being paid.
Some software companies were successful, in a financial sense, as their armies of sales experts and market segmenters conquered their unassuming customers, brandishing the sabre of “ONC-ACB certified”. Those companies unwittingly managed to stamp out the potential of small physician offices, increasing consolidation to hospitals – and healthcare costs. Eventually, the ONC crest once emblazoned proudly on their chests, became a warning: “This software was designed for Meaningful Use, not Actual Use”.
Linguistically, the term “Meaningful Use” became entwined with “Electronic Health Record”. People forgot that medical software could improve patient care and not tout it’s Meaningful Use certification. An effort was made to ridicule those who believed that government regulations were legitimately harmful to the healthcare industry. The sky was lassoed and we were pulling it down.
A healthcare IT Renaissance:
The tides did turn, however. Visionaries and industry leaders came to realize how harmful Meaningful Use was to innovation. Lawmakers were educated on how destructive constantly changing software and workflow requirements are to software development and medical workflow management.Continue reading…
From the People Who Brought You ACOs: A New Model For Healthcare Transformation
When my co-founder Mat Kendall and I launched Aledade last June, I wrote that our mission was simple: empowering doctors on the front lines of medicine to put them back in control of health care—and rewarding them for the unique value they create. Today, a few days shy of our first birthday, we are announcing that we have raised $30 million in a funding round led by ARCH Venture Partners, and including our Series A funding partners at Venrock. This investment is a testament to the growing demand for our technology-enabled services, and to the rapid progress we have made in creating a platform for doctors to manage the new value-based healthcare economy. But most importantly, it’s a commitment to long-term thinking.
First, we have tapped into a huge unmet need and a growing demand for our healthcare technology services. We hand-picked and signed up 26 practices within weeks of starting the company, and have now established unique partnerships with over 100 primary care practices in 9 states.
Obamacare Set To Spike? Um…
So it’s all over the news space and the shrieking blogosphere, with headlines like, “Obamacare Rates To Spike Up To 51%,” “Obamacare Hell…” and “Obamacare Inflationary Deluge…”
And online friends are commenting about “Obamacare premiums set to rise next year as much as 51% in some states…”
Hey, hey, hey. No need to panic. “Set to rise.” Stated as an actual set-in-stone future. See, kids, this is why I tell you not to try this at home. Being a real futurist takes a professional.
You might remember in spring of 2014 we saw headlines about how 2015 rates would “skyrocket.” And I said, “Nope.”
So what’s really happening this year? Do we each have to imagine our present rates suddenly rising by 40 or 50 percent? Here’s my reasoning.
First, these are rate hike requests, not actual rate hikes. They are not “set” at all. Think of them as opening bids by individual companies in the current round of rate adjustments, which have to pass muster in their particular states. Like any group of numbers, they fall on a bell curve. The headlines are about the extreme outliers in a few markets.
HIT Newser: We Need Interoperability, Says HELP
Judy Faulkner pledges to donate her wealth
Epic founder and CEO Judy Faulkner announces plans to give away 99% of her estimated $2.3 billion wealth to charity. Faulkner joins 136 other individuals and families in the Giving Pledge, which was launched by Warren Buffett and Bill and Melinda Gates to encourage billionaires to give the majority of their wealth to philanthropic causes.
What’s not to like about that? Good to know that if Epic wins the $11 billion bid for the VA’s EHR system, some of the government’s money will eventually trickle back down to charity.
Are EHRs creating disparity in care?
A study from Weill Cornell Medical College looks at “systematic differences” between physicians who participated in the Meaningful Use program and those who did not, noting that the differences “could lead to disparities in care.”
The researchers suggest that providers participating in the MU program may provide higher quality care to their patients as physicians using paper records “have less reliable documentation and weaker communication” between providers and won’t benefit from EHR-enabled quality improvements.
I suspect that physicians relying on paper records would balk at the suggestion that the care they provide is inferior to their more digitally-equipped peers. However, it’s hard not believe that the overall care process would be enhanced if all providers could electronically share critical patient information.
News Flash: Government is wasteful in its spending
The Government Accountability Office releases a report calling for urgent action on federal IT Continue reading…
What Went Wrong?
It’s been a very slow week in my office. Today we almost pitched a no-hitter, having only one patient come in toward the end of the day. Overall, we’ve been quiet in nearly every way – few phone calls, few patients stopping by, few appointments, few secure messages.
What’s wrong?
That was a trick question. This is exactly what should be happening when things are going right. My patients are happy. My patients don’t need me now. My patients are satisfied with my care. This would be a problem in most offices, as revenue depends on people having problems, having questions about their care, or anything else that would fill the schedule. In practices like mine, however, this is what we want; after all, I am paid just as much for an empty office as a full one.
