Category: Uncategorized

Why Data Handoffs Matter

Mar 9, 2015• 12

By JORDAN SHLAIN, MD

Chief information officers (CIOs) and chief medical information officers (CMIOs) have spent the better part of two decades on a quest for interoperability; yet, their Achilles heel lies in the “information” part of their titles. If information is the sole beacon of efficiency and value, the invaluable contours of human suffering, personal preferences and humanity itself are lost.

Information is the first step to developing knowledge and understanding, but what physicians and patients rely on in the real clinical setting, rife with changes, are knowledge, understanding and empathy. The cold, hard calculus of a=b does not always apply when dealing with people because they are much more complex and complicated than binary machines with screens. If it were so easy, there would be no problem reaching 100% compliance with medication or a plan of action.

Sadly, all data lives in a database; which might as well be called a wait-a-base; after all, the data just sits there and waits for someone to look at it.

The fundamental problem with today’s information architecture is that all data are not created equal. Data, information and knowledge degrade with each new doctor that becomes involved. In addition, systems design lacks an understanding of how the human computer works in the context of illness, anxiety or uncertainty. Healthcare is a people business in need of data, not a data business in need of people. Data are the means; people are the beginning and the end.

Open Sourcing What Works in Health & Wellness

Mar 9, 2015

By DAVID CHASE

Few argue that we have a fully optimized healthcare system. In fact, many argue the opposite. I have good news for you. All of the components of a high achieving health ecosystem have not only been created — they have been proven with solid evidence backing them up.

The future is here. It is just unevenly distributed. — William Gibson

Mr. Gibson could have been speaking about healthcare when he made this oft-cited quote. Unfortunately, while we have the components to fix health and healthcare, they are scattered all over the country and world. Healthcare, in it’s present state, is a design failure given the money, smarts and compassion that we invest. Put simply, it rewards the wrong activities. We pay for illness and treatment, and we get more illness and treatment. Even if we had a perfectly designed health ecosystem, the emerging convergence of new genomic insights, smartphones and mobile Internet, the Internet of Things, sensors, wearables and changed reimbursement models creates an enormous new challenge.

Does the ACA Actually Mandate Free Checkups?

Mar 8, 2015• 88

By CHRISTIAN GLASON

“Where in the Affordable Care Act (ACA) does it mandate that every health insurance policy must include a free annual checkup?”

I posed this question to Al Lewis and Vik Khanna in the comments of their recent post entitled: The High Cost of Free Checkups, where they argue against the Affordable Care Act (ACA) provision that requires “free checkups for everyone.” They cite a recent New York Times Op-ed authored by ACA co-architect, Dr. Ezekiel Emanuel, that essentially debunks the link between annual checkups and overall health outcomes. For Lewis and Khanna the solution is simple, we need to “remove the ACA provision that makes annual checkups automatically immune from deductibles and copays.” But for me there’s an enormous problem with their argument: The ACA doesn’t actually have any such provision.

After raising the issue in the comments section of the post, Mr. Lewis responded informing me that: “It’s definitely there” and “You’ll have to find it on your own, though — I unfortunately have to get back to my day job.” What Mr. Lewis doesn’t consider with his quick dismissal, is that I have already looked. I’ve combed through the law and other policy guidance, rules and regs; searching for any mention of this required annual wellness exam, physical, visit, or any other linguistic derivative. It doesn’t exist.

It turns out that while the law does require that an annual wellness visit be covered (sec. 4103. “Medicare coverage of annual wellness visit providing a personalized prevention plan”), this requirement is specific to Medicare beneficiaries and does not apply to individual or group plans. Beyond this particular section you won’t find any mention of a requirement within the ACA.

So what gives? Lewis and Khanna aren’t the only ones who’ve mentioned this “free” Obamacare benefit. Even when researching this piece I had to engage in a lengthy discussion with a friend who is a healthcare policy advisor, unexpectedly defending my position. This claim has to be coming from somewhere, surely people smarter than me have gotten it right?

When Good Patient Engagement Goes Bad

Mar 8, 2015• 7

By HOLLY KORDA

The rush to implement patient portals to meet Meaningful Use Stage 2 deadlines has focused most attention on getting the technology up and running, and convincing patients and providers to move to shared communication online. Hospitals and health systems have implemented portals with the help of incentives from the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, and patients and providers have been migrating to them at a slow but steady pace.

I am one of the patients eager to see this move to transparency, and have been a user of my health system’s portal from the start. But I’m far from a happy customer and my experience leaves me scratching my head. Sure, I can get online without a problem, and I can read my results.

Recently, I read online that my results were “probably benign (not cancer)” and it would be important to follow up with retesting in six months. This news, delivered with no phone call or follow up from the hospital or my primary care provider, was disconcerting. The specter of cancer was anxiety producing, as it would be for many, especially with no clinical context for interpreting my test results.

I never received human follow up. When finally I reached someone at the hospital to set up an appointment for a retest, I asked about the portal and the message and was referred to the hospital IT Department. Hmmm…I wondered. What does this mean? Is this what patient engagement is all about?Continue reading…

Race, Ethnicity and Patient Engagement

Mar 7, 2015• 6

By MICHAEL MILLENSON

A few years ago, I was upgraded to First Class on a flight from California back to Chicago. Not long after I settled in, a tall, muscular man easily four inches taller than me walked up to my aisle seat in the first row and prepared to sit by the window.

I envisioned him spending hours hemmed in by the bulkhead and offered to switch places. We began to talk, and soon he shared that his seatmates often hesitate to engage him in conversation. Women and even some men will turn or stiffen in their seats in order to send a clear body-language message.

That’s what happens when you’re a large, physically imposing black guy. People make assumptions. When it comes to patient engagement, we often make assumptions, too.

We minimize the influence of race, gender and ethnicity, or we confuse it with socio-economic status. We assume that “people like us” have communication preferences like us. We downplay the doctor-patient relationship and overemphasize technology.

Race and Ethnicity Matter

In truth, race and ethnicity matter as much in medicine as in the rest of the society. For example, whites, African-Americans and Latinos share the same expectations of their physicians, a study in Health Services Research found, but “patients from different racial and ethnic groups report differing experiences…when using well-validated measurement tools.” Translation: the perception reflects reality.

The FDA & Me (or How to Explain Your Test Isn’t a Game)

Mar 6, 2015• 2

By CORI LATHAN

So you have a great idea for an app. Not so fast: it took two years and over half a million dollars to get ours cleared for marketing by the US Food and Drug Administration (FDA).

Our app, DANA uses a mobile phone to records peoples’ reaction time during game-like tests. It also provides questionnaires that help clinicians evaluate brain health. Commissioned from AnthroTronix by the Department of Defense, the app will help diagnose concussion, depression and Post-Traumatic Stress Disorder (PTSD).

For something so important, a serious investment of time and money for clearance may not sound extravagant, but few small companies can afford a two-year go-to-market delay, not to mention the significant investment and heartache that goes with it. And although the FDA has tried to facilitate regulation by providing guides like the Mobile Medical Applications Guidance Document and the Mobile Medical Applications website, the regulatory process remains confusing.

Here are five simple lessons from our own experience that will help other entrepreneurs to do the right thing and engage with the FDA:Continue reading…

Anthem Arrogantly Refuses Audit Processes. Twice.

Mar 6, 2015• 2

By FRED TROTTER

Recently, I took a bunch of heat for writing that Anthem was right not to encrypt. My point was that the application encryption is just one of several security measures that add up to a security posture, and that we needed to wait until we got more information before condemning Anthem for a poor security posture.

A security posture is the combination of an organization’s overall security philosophy as well as the specific security steps that the organization takes as a result of that philosophy. Basically the type of posture taken shows whether an organization takes security and privacy seriously, or prefers a “window dressing” approach. I argued that simply knowing that the database in question did not have encryption was not enough detail to assess the Anthem security posture.

Well we have more evidence now, and its not looking good for Anthem.

Iconoclasts and Healthism

Mar 6, 2015• 45

By SAURABH JHA, MD

An iconoclast must not only have abundant common sense but the gift of the gab to state the obvious. Simply stating won’t do. You must rub it in.

My favorite iconoclasts are Peter Skrabanek and Thomas Szasz. Skrabanek was a general practitioner who authored Death of Humane Medicine and Rise of Coercive Healthism. Szasz, a psychiatrist, who volunteered that he entered psychiatry to unveil its pseudoscience, is the Voldermort of psychiatry – he who must not be named (may be Voldermort is the Szasz of muggles). He wrote several books including “Myth of Mental Illness.”

Neither believed in nominative subtlety. The title of their books gave it away. Both Szasz and Skrabanek had a point. The point was simple. Be careful. Don’t allow the medical profession to medicalize the broad coastline of normality – the dog ears of the bell-shaped curve.

Skrabanek was a socialist, Szasz a libertarian. Neither was against medical care for the sick and poor. Skrabanek was urbane, Szasz went for the jugular. Both were prescient. They predicted modernism’s medical epidemic: overdiagnosis.

I’m a pseudo iconoclast. I look for real ones. I recognize them a mile off. They are straight shooters. They are humane but do not wear sentimentality on their sleeves. So it was not hard to spot Vikram Khanna, the author of Your Personal Affordable Care Act. Khanna is an ‘in the trenches’ foot soldier who has worked on the wards, worked with insurers and worked as a regulator. He has a mission, like Skrabanek who he worships. To fight healthism.

One of Those Patients

Mar 5, 2015• 12

By ROB LAMBERTS, MD

“I’ve been getting winded lately.”

He’s a middle-aged man with diabetes. This kind of thing is a “red flag” on certain patients. He’s one of those patients.

“When does it happen?” I ask.

“Just when I do things. If I rest for a few minutes, I feel better.”

Now the red flag is waving vigorously. It sounds like it could be exertional angina. In a diabetic, the symptoms of ischemia (the heart not getting enough blood) are atypical. It’s the pattern of symptoms that is the most important, and to have exertional shortness of breath which goes away with rest is a pattern I don’t like to hear.

What he needs is a stress test – more specifically in his case, a nuclear stress test (because his baseline EKG is abnormal). But there’s a problem: he has no insurance. A nuclear stress test will cost thousands of dollars.

I can refer him to the hospital, but I know the financial situation he and his wife face. They have no money because of a chronic pain problem he has. He hasn’t worked in several years, but hasn’t ever been able to get disability either (“I tried, but was denied three times”). Without insurance he’s not able to get his problem fixed, so he’s disabled. But he can’t get disability, so he can’t get insurance to get his problem fixed and no longer be disabled.

But the problem on hand is this: he needs a test he can’t afford.

There are many folks out there in this same situation. It may not just be the people with no insurance, and it may not even be people who don’t have money. In fact, my own family is facing this same problem. Multiple family members (myself included) need dental work done. Some need it done badly, yet we don’t yet have the money to pay for it. So we wait for the money to show up while the problems gets worse.

Killing Cancer

Mar 5, 2015• 3

By JOHN IRVINE

As you might expect from a blog, we’re big fans of HBO’s VICE, the cable giant’s slickly-produced answer to staid network news magazine shows like Sixty Minutes. Over it’s first two seasons, the show has established a small cult following with fast-paced, drop-you-down-in-the-center-of-the-action investigations of stories that are usually owned by the major television news organizations.

The recipe works and works surprisingly well as entertainment. It’s also pretty damn good journalism, much to the dismay of traditionalists.

VICE generally avoids slower-moving health care stories in favor of edgy, faster-paced, occasionally subversive pieces that send correspondents to far flung locations around the globe and put their lives in jeopardy as they go places the other guys generally won’t go.

The show’s first two seasons have seen correspondents sent to Afghanistan to report on teen suicide bombers, to Bangladesh to report on the illegal organ trade and to North Korea to a report on a basketball game attended by Dennis Rodman and North Korean Dictator Kim Jong Un.

Killing Cancer, Season Three’s season opening special report, an optimistic hour long episode that airs before the season premiere, is an encouraging exception to the no-healthcare rule that demonstrates that the show may be capable of much more than critics give it credit for.