By THCBist

There is no doubt there are some obnoxious people throwing around arrogant/naive ideas. However, the “creative destruction” and “disruptive innovation” that has been most impactful has come from physician-entrepreneurs. Often, they are the most provocative and hard-hitting in their language. It seems loosely similar to how the most virulent anti-smokers are former smokers. They want others who they can relate to experience the liberation they’ve experienced.

I wouldn’t assume ill-intent from these MD-entrepreneurs using direct language. They simply were fed up with what they experienced as “broken” and stepped up with approaches that have out-performed. I’m thinking about the MD-entrepreneurs and innovators who have led CareMore, Nuka Model of Care, Qliance, Iora Health, MedLion, Healthcare Partners, etc. Sometimes to catalyze change, one must use stark, hard-hitting language. That doesn’t seem like a foreign concept to the many excellent MDs I’ve known over the years. I have enormous respect for any entrepreneur, especially one coming from tradition-bound professions who are willing to stick their neck out and endure enormous personal financial risk. Bob Margolis shared how his colleagues referred to him as a “communist” and his team-based model as “communism” yet Bob’s org achieved far better outcomes. He had the last laugh when that “communist” sold his business for $4.4B last year.

The comments from these MD-entrepreneurs is they feel they aren’t doing their MD friends any favors by candy-coating what is widely recognized as a system that isn’t close to reaching its full potential. In contrast, the orgs those MD-entrepreneurs are running are the reigning “Triple Aim Champs” that we should celebrate — colorful language or not. Often the most impactful entrepreneurs aren’t particularly “polite” in their language — Steve Jobs, Bill Gates, Larry Ellison et al called it like they saw it. What’s wrong with that?

By DAVID SHAYWITZ, MD

Since 2011, I’ve written extensively about digital health in this column, motivated by my excitement for the subject and my conviction around its potential. Going forward, I anticipate writing far less about digital health – paradoxically, due to its very growth. I simply lack the bandwidth to continue to follow digital health developments while remaining gainfully employed in a role unrelated to this space.

I remain profoundly optimistic about the future of digital health, and I am convinced it can play a transformative role in shaping the future of healthcare. I suspect we will come to discover that technology’s most important role in healthcare lies not in replacing humans with computers, but rather through motivating, enhancing, and supporting vital, health-promoting relationships between people.

Meanwhile, here are several recently-published books that readers interested in digital health may want to check out:

Big Data: A Revolution That Will Transform How We Live, Work, And Think

Authors: Viktor Mayer-Schönberger (Oxford Professor) and Kenneth Cukier, Data Editor of The Economist.

One-liner: Big data: how the world changes when you start to think about N=all.

Why read? Approachable and engaging overview of important, often-intimidating subject.

Caveat: Discussions of health implications tend to conflate promise with demonstrated results – though a small quibble in context of a wonderful read.

Continue reading…

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Governments around the world have started to rely on more digital government services. Ideally these new websites offer fast and efficient solutions. But the shaky rollout of HealthCare.gov served as a prime example of how digital government is not always good government. A new report from the Boston Consulting Group describes how different countries are approaching digital government. The authors surveyed over 12,000 users about their experiences and satisfaction with using online government services. The survey collected results from 12 different countries, including the U.S., the U.K., Australia, and France. The report finds that satisfaction varies throughout the world.

Throughout both the developed and developing world governments are expanding their online offerings. The average respondent had access to 10 different digital government services. These services include more frequently used services like community consultation, employment services, and health care. Developed countries reported higher levels of satisfaction with these digital services than developing nations. Across the spectrum of developed and developing nations, four out of five users believe that online services provided by the government have improved.

Satisfaction varied across countries. 56 percent of Malaysians and 52 percent of Indonesians perceived online government services to be far worse than private services. 60 percent of users in the United Arab Emirates and 53 percent of those in Saudi Arabia were most satisfied with online government services.  Americans favor private services by a large margin (42 to 22).

The report also describes areas where users believe governments can improve. One third of users reported having no problems or issues with the online services. Those surveyed were most interested in easy to access services rather than new ones. Users want simpler and easier-to-use websites (51 percent), greater reassurances on the privacy of information (47 percent), and more personalized or tailored services (34 percent).

There is clear evidence that users want to see online services continue to grow and develop. For example despite the rocky launch of Healthcare.gov, Americans reported the highest rates of satisfaction (55 percent) with searching for, registering for, or accessing health care services. American users also reported the highest levels of satisfaction in other categories such as participating in community consultation/online surveys (58 percent), accessing cultural, heritage, or similar facilities (66 percent), and searching, registering, or accessing health care records (57 percent).

The report argues that governments should focus on adding and maintaining the value of those services constituents need and use most, rather than building content that may go to waste. Furthermore, there is a strong emphasis on building tools that incorporate concerns about the user experience into the design.  In the future as technology in the private sector improves, pressure on governments to deliver digital services will only increase.  Governments must develop the capacity to develop and maintain new service delivery websites and applications.

Find the full report here.

By

It was with much distress that I read the recent New York Times front page article by Benedict Carey about the heart wrenching plight of the Serpico family in their journey to get proper psychiatric treatment for their two sons. As a child and adolescent psychiatrist who has served children and families for more than 30 years, trained many child psychiatrists, and served as President of the American Academy of Child & Adolescent Psychiatry (2001-2003), I am deeply disturbed by the current psycho-pharmacologic practice of psychiatry.

Over the past decade, there have been amazing advances in medicine that have pushed the profession in the direction of utilizing more evidence-based practices.  This is easy to see in most specialties, such as cardiovascular medicine, where implementing the latest surgical best practices results in proven, tangible positive outcomes. Unfortunately, it is not that clear cut in the field of psychiatry.

Every other medical specialty claims an organ of interest – cardiologists have their heart, nephrologists have their kidneys, hepatologists have their livers, yet the brain remains a medical orphan.

In the “mental health” field we treat diseases of the brain, yet we shy away from claiming the brain as our organ of interest. The brain is the only organ that cannot be transplanted, nor can a person survive without it. People actually survive with mechanical hearts while awaiting heart transplants. The idea that a child can go into an inpatient unit with emotional and behavioral problems and simply be treated in five days with reckless medication trials, without any diagnostic tests that guide an understanding of the genesis of the problems, is preposterous. There is no evidence-based science to support such treatment. The “health” (misnomer?) insurance industry has been the driver of such treatments, and, unfortunately, psychiatry has capitulated instead of pushing back and advocating for appropriate time to evaluate, diagnose, and properly treat our patients. I do not think there is a nephrologist in the world that would accept fewer dialysis sessions for a patient in renal failure, or a cardiologist who would deny critical diagnostic testing simply because the insurance company decided they would not pay for it. Medical necessity should drive assessments—not the insurance industry.

Most inpatient units fail to do any psychological testing.  They typically do no testing to probe for language and communication problems, learning disabilities, or other cognitive challenges that may be at the root of the problem. Children with early traumatic experiences are not being diagnosed appropriately; instead behaviors associated with such trauma are targeted for treatment with medications. If the diagnosis is incorrect, then so is the treatment intervention.

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By SURESCRIPTS

Health information exchange. Connectivity. Interoperability. For the health IT crowd, these words have become staples in our vocabulary. Data exchange and accessibility are critical to improving care delivery and increasing efficiency, especially when patients move from one provider to another.

Patients’ digital expectations are growing too, their health records must be easy to share with other care providers in a secure manner. To keep up with industry demands, regulations and the pace of innovation, the entire healthcare ecosystem must continue to take steps forward in their respective – and collective – interconnectivity journeys.

According to a recent article from Health Affairs, 78 percent of office-based physicians reported adopting some form of EHR system in 2013, however only 14 percent electronically shared data with care providers or hospitals outside their own organization, which is one of the most critical pieces of the interoperability puzzle. The secure transfer of information between each stakeholder group is no longer nice to have, but a necessity – not only for the assurance of high quality care, but also for the improvement of healthcare overall.

But the journey isn’t easy, the challenges are great, and the questions are plentiful. How are hospitals going beyond compliance to take Meaningful Use from a regulation to a framework for connected success? How can you achieve seamless connectivity between disparate entities? How can tracking immunizations drive down costs for patients, providers and pharmacies, while improving population health?

To tackle these questions and more, please join Surescripts and a panel of experts – from Kaiser Permanente, Mt. Sinai and Walgreens – tomorrow September 23rd at the Health 2.0 fall conference, as we address “How a Connected Health Infrastructure and Data-Driven Solutions are Improving Quality, and Your Bottom Line.” Be sure to follow us @Surescripts on Twitter!