Category: Uncategorized

An Open Letter to Sheryl Sandberg

May 10, 2015• 1

By KATIE HAFNER

My heart aches for you, even more because the same thing happened to me. You will get through it. But you never will get past it.

I was so very sorry to hear about your husband’s death. You must be inundated with condolence letters and here I am, adding one more to the pile.

I write from a position of knowing, which makes me unspeakably sad for you. My own husband, Matthew Lyon, died in 2002, while on a business trip. He died suddenly, on a treadmill in the gym of a Seattle hotel. He was 45. Our daughter was eight.

Nobody plans for this. We would all go insane if we did. Because we live life as if we have time.

Here is what I can tell you: From now until forever — a forever your husband will not get to share with you, which contributes to the pain of this — you will question everything you thought was true about your life. Your trust in everyone’s ability to get from A to B without incident will never be the same. We all know that nothing is certain, but we know it in a vague, theoretical, I’ll-think-hard-about-that-tomorrow way. You now know it as established fact, and this changes the way you see everything.Continue reading…

Real Meaningful Use? Curing Healthcare’s Digital Divide

May 9, 2015

By JAAN SIDOROV, MD

For better or worse, policymakers, politicians and health leaders in the United States are committed to achieving paperless healthcare environment. Even if there is lack of high quality research and reasonable skepticism over the ultimate cost and quality merits of “e”care, there is no going back.

As a result, visitors to ehospitals and eclinics are increasingly surrounded by monitors that, in turn, are surrounded by providers. To gain their attention, patients need to have internet access to make appointments, update medications, obtain education and communicate with their doctor.

And what if they don’t have that access? For the last decade, that worry has been characterized as “the healthcare digital divide. ” As recently as 2014, it’s been documented that the lack of computer hardware and access can have important healthcare implications for persons with low socioeconomic status.

For the doctors and nurses staring at screens all day, the millions of Americans who are living paycheck to paycheck risk being out sight and out of mind.

But it turns out that that it doesn’t need to be that way.

Check out this telling report from the Federal Deposit Insurance Corporation on the “unbanked” and “underbanked.” Not having a bank account (unbanked) or using any financial services (underbanked) are linked to persons with low income, being of color, disability and being unemployed.

In other words, these are the very persons at risk of being on the losing end of the health care digital divide.

While there’s interesting data on how close to 8% of U.S. households are unbanked and just over 20% were underbanked, there were also these stunning observations:

“Relative to fully banked households (86.8%), underbanked households were somewhat more likely to have had access to mobile phones (90.5%) and smartphones (64.5% of underbanked households compared with 59.0 percent of fully banked households).”

It’s Time to Stop Calling Them EHRs

May 9, 2015• 3

By JACOB REIDER, MD

It’s time to stop calling them EHRs. Yes – we also need to stop calling them EMRs. In 2011, ONC discussed the difference between the two terms, but I think that conversation missed the point: whether it’s “medical” or “health” that is the focus, these aren’t (shouldn’t be) RECORD systems at all. We need to expand our expectations from CRUD to something that we really need: smart tools that help us collaborate toward improving health for individuals. In November, when I floated this concept, I was teased (corrected?) for focusing on terminology and missing the point that we need EHRs to do more than just store data.

But it’s more than just terminology. Our words mean a lot. A “record” system is for storage of records. It saves information. Our expectations will always focus on storing and retrieving information.

A Second Look at the Two Midnight Rule

May 6, 2015• 10

By ANWAR OSBORNE, MD

“You gotta change us to inpatient!”

Mrs. Mack’s daughter was referring to me changing her mother’s status from “inpatient” to “outpatient.” If Mrs. Mack was discharged as an outpatient, she wouldn’t be able to afford to go to the nursing home she needed to make a full recovery, and her daughter couldn’t care for her at home.

Physicians and hospital are all too familiar with this scenario. When a patient stays inside a hospital building, they can be either an inpatient or an outpatient. A patient can be either in an inpatient status or an outpatient status, yet stay in a hospital bed overnight and receive identical care. The ‘2 Midnight Rule’ serves to put this determination of status in the hands of doctors, but somehow, physicians like those in the Society of Hospital Medicine and the American Hospital Association dislike this new responsibility.

When I work as an emergency physician or an internist, I used to have to explain to patient families that this status designation is not in my hands.

Mrs. Mack’s daughter was in a precarious situation, but not an uncommon one; I’ve heard similar requests from patients and their families, and with good reason.

Why Cancer Patients and Clinicians Need a Decision Aid Upgrade

May 6, 2015• 2

THOMAS SMITH, MD

We have learned a lot about how to treat cancer in the past 30 years, yet patients still experience significant symptoms, pain, and stress from cancer and its treatments. And we are nowhere near curing patients of some of the most debilitating forms of this disease.

The outlook for lung cancer can be particularly poor because it is often diagnosed at a late stage, tends to occur in older people who often have other medical conditions, and remains one of the most difficult cancers to treat. The average survival has increased a few months with new treatment, but is still only to about a year – way too short.

However research has shown that palliative care – which addresses the emotional, physical, practical, and spiritual issues of serious illness – can help lung cancer patients live better, longer lives.

So, how do we incorporate palliative care into our conversations with patients and families who expect us to tell them about the latest treatment, downplay its side-effects and demonstrate the tenacity with which we will fight for them and with them against this scourge? It is especially tough when 70% of people (and some of their doctors) don’t know what palliative care is, or think of it just as “end of life care” or hospice.Continue reading…

Doctors Should Own Up to Creating the Mark Cuban Problem

May 4, 2015• 13

By ADAMS DUDLEY, MD

Much has been made of Mark Cuban’s medical knowledge since he tweeted, “If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health”. Charles Ornstein shared the tweet and many physicians and others, myself included, weighed in on the costs and potential for harm from unnecessary testing.

I’ll admit that, when I tweeted to him, I expected Cuban to agree. But he didn’t. In fact, he grew increasingly resistant. I stopped responding when he announced that the opposition to his idea his had convinced him he needed to take his proselytizing to his TV show.

Instead of poking the sore, I began to wonder about the origins of Cuban’s conviction. I remembered that he is not alone in wanting tests that clinicians who worry about value, cost, and harm think he shouldn’t have.

But where do these attitudes come from? Is it possible that clinicians are contributing in any way to this situation? Quite the contrary: most Americans want tests, even when you tell them that nothing can be done with the information. Furthermore, Americans are more convinced of the benefits of tests like mammograms than people in other countries, and then go out and get more of them.

I think that we are. My team has studied why patients get so many electively placed coronary stents, when cardiologists readily admit that randomized trials have demonstrated that there are few situations in which such stents improve survival or reduce the risk of heart attacks.

Studies of the beliefs of patients who have just received an electively placed stent give a big clue: 80% thought stenting would reduce their risk of death, even though their cardiologists knew that this was not the case.

ONC Awards $300K in Funding to 6 Digital Health Pilot Projects!

May 4, 2015• 1

By ADAM WONG

The Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) today announced the six winners of the inaugural ONC Market R&D Pilot Challenge. The six winners will live-test new health information technology (health IT) applications in health care settings administered by their challenge partners.

The winning innovator-health care organization teams will each receive $50,000 to fund their pilot programs which will become operational in August are:

ClinicalBox and Lowell General Hospital
CreateIT Healthcare Solutions and MHP Salud
Gecko Health Innovations and Boston Children’s Hospital
Optima Integrated Health and University of California, San Francisco, Cardiology Division
physIQ and Henry Ford Health System
Vital Care Telehealth Services and Dominican Sisters Family Health Service

The ONC Market R&D Challenge launched on October 20, 2014 with the goal of finding early stage health care startups from across the country and connecting them with health care organizations and stakeholders with whom they could potentially run a pilot program to test the application.

Three in-person matchmaking events were held in January, 2015, focused on connecting health care organizations with innovator companies looking to pilot test their products. Almost 500 organizations expressed interest in finding partners through the matchmaking program. More than 300 in-person meetings were held in New York, New York; San Francisco, California; and Washington, D.C., with many more conducted virtually. These “speed-dating” events allowed startups to meet face-to-face with health care organizations to identify common interests and goals. ONC and the organizer of these meetings, Health 2.0, intended for the events to have additional benefits, including facilitating the exchange of ideas that might lead to new partnerships and relationships.

To be eligible to serve as a host, organizations were required to operate in clinical, public health and community, or consumer health environments while also serving enough consumers or patients to conduct a pilot study. The innovators had to be an early-stage health information technology company with less than $10 million in venture capital funding and a readily available technology solution.

Wikipedia: Homeopathy and Evidence for Unpatentable Medications

Apr 30, 2015• 5

By FRED TROTTER

Recently, I have had some interesting conversations with doctors and medical students of Naturopathic Medicine. I am slowly getting involved in editing Wikipedia medicine articles, and I was approached by several proponents of Naturopathic Medicine, who were upset about the following phrases from the Wikipedia article on Naturopathy:

Naturopathic philosophy is based on a belief in vitalism and self-healing, and practitioners often prefer methods of treatment that are not compatible with evidence-based medicine. Naturopathic medicine is replete with pseudoscientific, ineffective, unethical, and possibly dangerous practices.

Of course, they felt this was unfair. In their mind, the Wikipedia article was “wrong” and needed to be fixed and they were frustrated by the tendency for Wikipedia editors to thwart their efforts to “fix” the article.

This put me in an uncomfortable position. I had the option of remaining entirely silent, or informing these followers of Naturopathy of several issues:

Wikipedia has become a “court for facts”. The Wikipedian community focuses on what has become verifiable scientific consensus.
There is very little scientific consensus supporting Naturopathic methods while there is is a substantial amount of scientific consensus opposing some Naturopathic methods.
Naturopathic methods tend to layer “placebo effects” (Ben Goldacre is the inevitable reference for how that works).
These layered placebo effects tend to make the patients of naturopaths and the naturopaths themselves, believe that their methods are way more effective than they actually are.
I have to admit that I fully expected to have a serving of Tim Minchin’s Storm. But what the hell. Why not?? So I jumped and put the basic issues forward.

Opening the Care Conversation Through Open Notes

Apr 28, 2015

By SUSAN DENTZER

It’s a memory aid.

It’s truth serum.

Using it can transform relationships forever.

These may sound like come-ons for the type of product typically hawked on late-night television. But in fact, they’re some of the things people are saying about OpenNotes.

OpenNotes isn’t a product, but an idea: That the notes doctors and other clinicians write about visits with patients should be available to the patients themselves. Although federal law gives patients that right, longstanding medical practice has been to reserve those visit notes for clinicians’ eyes only.

But Tom Delbanco and Jan Walker, a physician and nurse at Beth Israel Deaconess Medical Center in Boston, have long seen things differently.

Their personal experiences with patients, and inability to access care records for their own family members, persuaded them that the traditional practice of “closed” visit notes had to change. So, with primary support from the Robert Wood Johnson Foundation, they launched what has now become a movement.

In 2010, Delbanco, Walker and colleagues led a study in which more than 100 primary care doctors from three health systems began sharing notes online with patients. Patients got secure messages prompting them that the notes were available, and reminders to read notes before their next appointments.

HIT: Where We Stand and Where We Go From Here

Apr 27, 2015• 3

By KAREN DeSALVO

This post is adapted from DeSalvo’s talk at the annual meeting of the Health and Information Management Systems Society in Chicago last week.

I am optimistic about the bright future we have to leverage health information technology to enable better health for everyone in this country.

One year ago, we called upon the health IT community to move beyond adoption and focus on interoperability, on unlocking the data, so it can be put to the many important uses demanded by consumers, doctors, hospitals, payers, and others who are part of the learning health system.

ONC spent the year listening to the health IT community to understand the challenges and opportunities and developing strategic roadmaps to guide our way. Our goal was to evolve to be best able to lead where appropriate, and partner wherever possible, as we all shift the national strategic focus towards interoperability. I hope you all have felt that shift.