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“Going Digital: Behavioral Health Tech Conference” Matthew Holt & Jessica DaMassa’s Long, Exhaustive & Boring Overview

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Matthew Holt and Jessica DaMassa gave a talk at the “Going Digital: Behavioral Health Tech Conference” on June 17, 2020. They spoke about how technology is evolving the mental health space, along with their thoughts on where the future of the industry is headed.

Jess & Matthew first start off with their “Health in 2 Point 00” segment, discussing all of the funding deals in the mental health space, from Headspace to Mindstrong raising money in Q1, to Kaiser rolling out MyStrength to its members.

Then they jump into a deeper dive segment, where they discuss how the money is being distributed in the mental health space, and how startups are coming up with creative solutions to package their services. Some mental health companies are wrapping solutions into other digital health platforms that already manage chronic conditions, like Livongo & Omada, others are working to directly address and treat mental health issues, and some are developing digital therapeutic solutions to manage mental health problems. As this part of the industry grows, Matthew & Jess predict how the mental health tech space will change & develop with increasing demand, more investments, and a lot more innovative tools to serve the population’s needs.

Zoya Khan is the EIC of The Health Care Blog & a Strategy Manager at SMACK.health

Do Kaiser Cardiologists Need More Pharmacist Consults to Keep Their Patients Alive?

By AL LEWIS

A study by a team consisting mostly of Kaiser clinical pharmacists published in Pharmacotherapy[1] finds that a very inexpensive pharmacist consult for cardiac patients reduces the cardiac death rate by more than 80% and — even though it’s a cardiac-specific drug regimen consult — also reduces the non-cardiac death rate by more than 95% vs. what Kaiser’s doctors achieved with usual care.  Plus, even though it increases drug use, it earns a 56:1 ROI while reducing drug costs.

The implication: Kaiser’s doctors need Kaiser’s pharmacists to prevent their cardiac patients from dying, in general, but especially from non-cardiac causes…and that Kaiser is losing huge amounts of money if they don’t do this.

However, the study’s conclusions violate every “rule of plausibility” and are invalid. This study, unless its invalidity becomes more widely recognized, could also be used to justify expanded reimbursements for clinical pharmacist consults.   Clinical pharmacists may or may not deserve expanded reimbursement, but justification for that reimbursement cannot be made based on studies like this one.

Quite a number of findings deserve mention. First, not getting the $1/patient-day of clinical pharmacist support given to the study group had apparently cost 30% of the retrospective control group patients their lives, vs. 3% of the intervention group.

 

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More Work Is Needed on the Safety and Efficacy of Healthcare Information Technology

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By Stephen Soumerai & Ross Koppel

If one were writing about the improvement of gastronomy in America, one would probably not celebrate “over 300 billion hamburgers served.”  But that’s very much the type of success Dr. Ashish Jha is celebrating in last week’s piece on recent US healthcare IT sales. Unfortunately, the proliferation of Big Macs does not reflect superior cuisine, and healthcare IT (HIT) sales do not equate with better healthcare or with better health. Quantity does not equal quality of care.

To be sure, Dr. Jha acknowledges the challenges of rolling out HIT throughout US hospitals. And he should be strongly commended for his admission that HIT doesn’t capture care by many specialists and doesn’t save money. In addition, Dr. Jha points to the general inability of hospitals, outpatient physicians and laboratories to transfer data among themselves as a reason for HIT’s meager results.

But this is a circular argument and not an excuse. It is the vendors’ insistence on isolated proprietary systems (and the government’s acquiescence to the vendors) that created this lack of communication (non-interoperability) which so limits one of HIT’s most valuable benefits.

In our opinion, the major concern is that the blog post fails to answer the question we ask our PhD students:

So what? What is the outcome?

This entire effort is fueled by $29 billion in government subsidies and incentives, and by trillions of dollars spent and to be spent by hospitals, doctors and others [1].

So where is the evidence to back up the government’s and industry’s promises of lower mortality, improved health and lower health care costs?

Single studies tell us little. Sadly, as many as 90% of health IT studies fail the minimal criteria of the respected international literature syntheses conducted by the Cochrane Collaboration.

In other words, studies with weak methodology or sweetheart evaluation arrangements just don’t count as evidence.
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Brainstorming About the Future of Clinical Documentation

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By John Halamka, MD

In 2013, I’m focused on five major work streams:

· Meaningful Use Stage 2, including Electronic Medication Administration Records
· ICD10, including clinical documentation improvement and computer assisted coding
· Replacement of all Laboratory Information Systems
· Compliance/Regulatory priorities, including security program maturity
·Supporting the IT needs of our evolving Accountable Care Organization including analytics for care management

I’ve written about some of these themes in previous posts and each has their uncharted territory.

One component that crosses several of my goals is how electronic documentation should support structured data capture for ICD10 and ACO quality metrics.

How are most inpatient progress notes documented in hospitals today? The intern writes a note that is often copied by the resident which is often copied by the attending which informs the consultants who may not agree with content. The chart is a largely unreadable and sometimes questionably useful document created via individual contributions and not by the consensus of the care team. The content is sometimes typed, sometimes dictated, sometimes templated, and sometimes cut/pasted. There must be a better way.

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