The Health Care Blog – Page 269 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

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My Triple Aim of Medication Assisted Treatment for Opioid Addicted Patients

Jul 11, 2018• 1

by HANS DUVEFELT, MD

My second foray into Suboxone treatment has evolved in a way I had not expected, but I think I have stumbled onto something profound:

Almost six months into our in-house clinic’s existence, I have found myself prescribing and adjusting treatment for about half of my MAT patients for co-occurring anxiety, depression, bipolar disease and ADHD as well as restless leg syndrome, asthma and various infectious diseases.

Years ago, working in a mental health clinic, we had strict rules to defer everything to each patient’s primary care provider that wasn’t strictly related to Suboxone treatment. One problem was that many of our patients there didn’t have a medical home or had difficulty accessing services. Another problem was that primary care providers unfamiliar with opioid addiction treatment were uncomfortable prescribing almost anything to patients on Suboxone.

Medicare Holds Out Promise of Health Record Access Revolution

Jul 10, 2018• 8

By MICHAEL MILLENSON

This is the second of two posts from the Society of Participatory Medicine about the important policy issue regarding portability of our medical records. The first provided background, with link to a PDF of the comments SPM submitted, largely authored by Michael Millenson, who provides this essay for context.

The Trump administration is proposing to use a powerful financial lever to push hospitals into making the patient’s electronic medical record interoperable – that is, readable by other care providers – and easily available to patients to download and organize via an app.

The possible new mandates, buried in a 479-page Federal Register “Notice of Proposed Rule Making” from the Centers for Medicare & Medicaid Services (CMS), could become part of hospital “conditions of participation” in Medicare. That means if you don’t do it, Medicare, which accounts for about a third of an average hospital’s revenues, can drop you from the program.

In a comment period that closed June 25, we at the Society for Participatory Medicine registered our strong support for taking the administration rhetoric heard earlier this year, when White House senior advisor Jared Kushner promised a “technological health care revolution centered on patients,” and putting it into practice. The American Hospital Association (AHA), on the other hand, while professing its support for the ultimate goals of interoperability and patient electronic access, was equally strong in telling CMS it was going too far, too fast and with too punitive an approach.

Health in 2 Point 00, Episode 37

Jul 10, 2018

Jessica DaMassa asks me about the American Well mega funding round, Cerner investing in Lumeris, and the new NHS England app. Which naturally descends into a conversation about England’s chances in the world cup semi-final tomorrow!–Matthew Holt

SPM’s comments on important proposed CMS interoperability rules

Jul 9, 2018• 1

By E-PATIENT DAVE DEBRONKART

This is the first of two posts from the Society of Participatory Medicine about an important policy issue regarding portability of our medical records. The second part will be published tomorrow and is written by Michael Millenson, who did the lion’s share of this work, as noted below.

Our Society’s Advocacy and Policy chair Vera Rulon @VRulon has submitted our comments on the proposed rules that have been discussed at great length on social media.

These regulations are a big deal for participatory medicine – they’re the successor to the Meaningful Use rules that have governed patient access to their chart, among other things. The regulations do this by altering how a hospital gets paid based on how well their data moves out of their computers. We want this; we believe it is essential in enabling patients and families to achieve the best possible care. (More on this in Millenson’s companion post.)

Not surprisingly, some hospitals don’t like new rules that affect how they get paid, and have lobbied heavily to NOT be required to give us our data. Some observers say there are ulterior motives – for instance see these 30 seconds of Yale cardiologist Harlan Krumholz at Connected Health 2016, on how a health system CEO told him flat out:

Social determinants on becoming a physician

Jul 6, 2018• 2

By SAURABH JHA

Poverty is known to be an important determinant of a person’s health and longevity. A person’s zip code is more relevant than genetic code. Does a physician’s zip code – that is where they were born and raised – have an effect on where they practice? Specifically, do rural born and raised physicians return to their rural roots? The story of Prashant, a physician raised in rural Bihar, India, is instructive.

When I first met Prashant, he was a second-year medical student in Patna Medical College and Hospital. Patna is the capital of Bihar, and Bihar is one of the poorest states in India.

Prashant brimmed with idealism and vigor. “I’ll practice in Purnea one day and serve the poor villagers,” he told me in broken English.

Prashant comes from a family of Bihari farmers who are also affluent landowners. He grew up near Purnea, a fourth-tier town in Bihar surrounded by villages. Visiting these villages is like stepping into a time machine – you can see people travelling by bullock carts but using mobile phones.

Health in 2 point 00, Episode 36

Jul 6, 2018

Back in the US of A to celebrate the nation’s birthday, Jessica DaMassa asks about Amazon buying Pill Pack, GE spinning off its health division, and what Rock Health and Startup Health’s numbers say about health tech investment–Matthew Holt

The Past, Present and Future of Health Care

Jul 6, 2018

OK, so it’s a tad of an ambitious title… but it was a talk that I gave in Finland last month. I had fun looking at the development of health and technology and suggesting a structure for the future. Plus I got to tell my Neil Armstrong joke. The talk was part of the Upgraded Life Festival in Helsinki and you can see some of the other speakers videos on their channel—Matthew Holt

Why I Tattooed My Health Data Over My Heart | WTF Health with Casey Quinlan

Jul 5, 2018

By JESSICA DAMASSA

WTF Health – ‘What’s the Future’ Health? is a new interview series about the future of the health industry and how we love to hate WTF is wrong with it right now. Can’t get enough? Check out more interviews at www.wtf.health.

How can patients help usher in a better future for healthcare? Start speaking up. LOUDLY.

In this WTF Health interview, meet one of health’s most outspoken patient advocates, Twitter voices (@mightycasey) and podcasters, Casey Quinlan of Mighty Casey Media, who talks about her patient journey as a cancer survivor — and why the awful experience led her to tattoo a QR code linking to her electronic medical record to her chest.

Casey’s ‘physical political protest’ is tied to her passionate views about the lack of data liquidity in healthcare and how patients suffer as a result. She’s launching a new “If-You’re-Selling-My-Health-Data-Cut-Me-In” Movement and weighs in on why more patients aren’t clamoring after their health data to push real change in the healthcare system.

Filmed at Health Datapalooza in Washington DC, April 2018.

Stay Out of my Wellness

Jul 2, 2018• 5

By VA WEST HAVEN COE CLINIC

On a sunny New England morning at a secluded guest house with a perfectly manicured lawn, medical residents, each with their own brightly colored yoga mat, were getting ready to assume the downward dog position. They were on an annual retreat organized by their residency program to promote wellness. One embraced the opportunity with delight, smiling through every pose. Another grimaced as his back spasmed. And yet another wandered off towards a lake to find his own kind of respite.

Physician wellness has become something of a buzzword in recent years, and rightfully so considering that the rates of burnout and suicide within medicine are rising. Individual residency programs have found burnout rates between 55% and 76%. Such burnout erodes well-being over time and may be contributing to suicide, which is now the second leading cause of death among residents nationwide. In 2014, the suicides of two medical interns in New York prompted the American College of Graduate Medical Education to take action. A series of initiatives to combat burnout were rolled out, including the consideration of wellness in its review of residency programs during site visits. In 2017, emergency medicine physicians convened the first Residency Wellness Consensus Summit to devise a module-based curriculum on wellness. Hospital systems have attempted to respond as well, through the hiring of chief wellness officers.

It is unsurprising that the medical community has taken such an analytical approach towards diagnosing burnout, much as we do with other diseases, in search for a cure. But perhaps such a prescriptive approach fails to capture the highly individualized and somewhat abstract concept of wellness. The reasons for resident burnout are personal and vast. Decreased wellness has been attributed to the lack of time for self-care, inadequate sleep, social isolation, negative work environments, excessive paperwork, long work hours, poor relationships with colleagues, and insufficient mentorship, among others in a lengthy list. Any attempt to standardize the definition of wellness should be met with caution.

So how do we as a society go forward in ensuring our resident physicians are well?Continue reading…

Sending the Questions to the Data

Jul 1, 2018

By John Halamka

As hospitals and practices form accountable care organizations, they will accelerate their efforts to build healthcare information exchanges and novel analytics that support community-wide lifetime care rather than siloed episodic care, This requires “freeing the data” from the EHRs, hospital information systems, and laboratories in which it resides.

There are two basic ways to analyze data for a panel or population.

1. Send the data from multiple sources to a central repository for analysis.

BIDMC has partnered with the Massachusetts eHealth Collaborative on such an approach to build a quality data center supporting its ACO strategy.

2. Send the question to the data.

The new federal Query Health initiative is a standards-based approach that enables standardized questions to be sent to multiple federated databases without moving the data itself.

In Massachusetts, we’ve implemented such an architecture in two ways.

I2B2/Shrine which links together the Harvard hospitals (and many other sites nationwide) with query tools supporting clinical trials and clinical research.

MDPHNet, an ONC funded Challenge grant which sends questions to data sources, answering public health questions.

MDPHnet is being developed under contract with the Massachusetts eHealth Institute to implement a secure web-based query tool which enables predefined and ad hoc queries to be sent to participating sites, including selected practices within the Mass League of Community Health Centers and potentially, Atrius Health.

Queries are executed locally, securely returned after optional review, and then presented to the requester and displayed in a variety of ways – heat map, histogram, table etc. Results contain no patient-identifiable data. Data holders control authorization of requesters and their specific query capabilities.

The current focus for predefined reports is syndromic surveillance (Influenza-like illness) and chronic disease surveillance (diabetes). It can also support other uses, such as pharmacovigilance and quality measurement.

MDPHnet uses PopMedNet open source software developed by the Harvard Medical School Department of Population Medicine at the Harvard Pilgrim Health Care Institute, with support from AHRQ and FDA. Lincoln Peak is co-developer.

There is great synergy among i2b2, PopMedNet and MDPHnet, since they use a common architectural approach. Query Health incorporates PopMedNet in its design.

MDPHnet uses the Electronic Health Record Support of Public Health (ESP) common data model. ESP was developed by the HMS/HPHCI Department of Population Medicine with support from a CDC Center for Excellence in Public Health Informatics.

The Massachusetts League of Community Health Centers transforms data from their clinical data warehouse into the ESP format. Commonwealth Informatics supports the process as needed. Additional participants will extract data from their EHR and put it into the same schema (ESP) with help from Commonwealth Informatics.

MDPHnet can be readily expanded to cover other datasources such as the I2B2 nodes which are hosted at over 60 sites nationwide.

Over the next few years I believe that for many use cases we will be sending questions to the data instead of sending the data to centralized registries. I2B2, MDPHnet, and Query Health will show us how.

John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chief Information Officer at Harvard Medical School, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician. He’s also the author of the popular Life as a Healthcare CIO blog.