The Health Care Blog – Page 322 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Patient Expert: Healthcare’s Untapped Workforce

Mar 9, 2017• 3

By KYM MARTIN

One of my favorite patient ~~advocates~~ consultants–that’s Kym Martin (far right) on a panel I ran at Health 2.0–has a new job at one of the most interesting patient consultant companies. Here’s her story!–Matthew Holt

Let me ask you two questions.

On a scale of 1 to 10, how would you rate the quality of the “real-world” patient insights your team gathers to inform your mission-critical, life-altering work?

Are you clear on the needs, trends, and challenges facing the patients you’re trying to serve?

Why Listen to Me?

For the past four years, I’ve listened to hundreds of healthcare leaders discuss patient issues from their perspective as clinicians, technologists, researchers, academics and administrators.

While I’m grateful to these leaders for working feverishly on my behalf as a patient, I question the completeness of their patient view.

The reason shouldn’t come as a surprise. Patients are too often left out of the conversations about the services and products designed to improve their care. Continue reading…

The Rust Belt Is Burning: Republicans Lay Waste to their Base on Health Reform

Mar 8, 2017• 45

By JEFF GOLDSMITH

William Tecumseh Sherman, who laid waste to the South at the end of the Civil War, famously said, “War is Hell”. So, too, is health reform. And like Sherman’s infamous March to the Sea, where he burned town after Confederate town, the Republican War on Obamacare entered its attrition phase with the introduction on Monday in the House legislation to repeal and replace ObamaCare. Except that Ryan is marching in the wrong direction; his troops are marching “north” and burning towns behind their own lines.

Ryan’s bill released Monday was greeted with a chorus of derision from the newly empowered Republican base; some conservative wags dubbed the bill “RINOCare”. Thoughtful conservative analysts savaged it. Michael Cannon, the hard core libertarian Cato Institute health analyst, called it “a trainwreck waiting to happen” and suggested that “ it will create the potential for the sort of wave election Democrats experienced in 2008” In Reason.com, Peter Sunderman wrote, “it’s not clear what problems this particular bill would actually solve.”

Ryan’s draft neither repeals nor replaces ObamaCare. Continue reading…

The House Republicans’ Terrible, Horrible, No Good, Very Bad Obamacare Replacement Plan

Mar 7, 2017• 2

By ROBERT LASZEWSKI

It won’t work.

Obamacare works for the poorest that have affordable health insurance because all of the program’s subsidies tilt in their favor.

Obamacare doesn’t work well for the working and middle class who get much less support––particularly those who earn more than 400% of the federal poverty level, who constitute 40% of the population and don’t get any help.

Because so many don’t do well under the law, only about 40% of the subsidy eligible have signed up and, with so many insurers losing lots of money, the scheme is not financially sustainable because not enough healthy people are on the rolls to pay for the sick.

To fix it, House Republicans are proposing a very attractive program for the better off and, with the Medicaid rollback, gutting the program for the poor to be able to pay for it.

Healthcare Insurance: America’s Collective Action Nightmare

Mar 7, 2017• 6

By CHARLES SILVER

Across the country, ugly confrontations are occurring between Republican lawmakers who pledged to repeal Obamacare and Americans who are afraid of losing their healthcare coverage. The protesters’ fears are understandable. The cost of medical services can be devastating. The chief selling point for Obamacare was that, between the guarantee of coverage on the exchanges and the expansion of Medicaid, the vast majority of Americans would be protected. And the main difficulty that Republicans face in repealing Obamacare is the widespread concern that tens of millions of people might be tossed off the rolls.

The confrontations are the unavoidable consequence of a collective action dilemma. The dilemma is this: To achieve good collective outcomes, government must often prevent people from doing what they think is best for themselves. Individually, I might like to be free to dump trash in the most convenient place, to pollute the waterways and skies, to fish and hunt without limit, to drink and drive, or to use other people’s property and possessions without their permission. Millions of other people might want these liberties too. But collectively, we’re all vastly better off when everyone’s freedom to do these things is constrained. One of the benefits of government is that it can prevent people from acting in ways that are individually rational but that, when practiced widely, make us collectively worse off.

In healthcare, the collective action dilemma stems from the fact that comprehensive coverage—by which I mean all forms of third-party payment, including Medicare and Medicaid, as well as private insurance—is the main driver of the healthcare cost spiral that gone unchecked since the mid-1900s.

The problem is a vicious circle.

Interview: Robert Armstrong, CEO, Appstem

Mar 6, 2017

By MATTHEW HOLT

Continuing my series of interviews from HIMSS17, is one with Robert Armstrong, CEO of Appstem. Appstem is one of the companies that quietly builds most of those ubiquitous mobile apps branded by health plans, pharma companies and a large number of product companies too. It’s an example of the hyper-specialization going on within technology, as even well funded product companies start to use companies like Appstem to build onto their partner APIs and build out their portfolios. An interesting niche and one that’s a lot more important that you’d think–it’s well worth a listen to Robert to find out more.

Hey, Machine Learning

Mar 6, 2017

By LEONARD D’AVOLIO

Hey Machine Learning,

I heard what Forbes said about your “setback” at MD Anderson. I also heard rumors going around HIMSS that maybe it’s “too soon” for you to be in healthcare. At first I thought, “serves you right.” There was so much hype that I could barely recognize you.

Then I realized that, in a way, we’re all to blame. The journalists, vendors, researchers, and data scientists – all of us that tried to make you popular in healthcare. I guess things just sort of got out of hand.

You have to believe me when I say we meant well. We wanted people to see how special you really are. And the whole “30+ years of clinical research and thousands of published studies” wasn’t working. Apparently, evidence is only cool with your research buddies.

So you got a makeover. The cool kids in marketing gave you new nicknames. People started rumors about all these crazy things you were up to. Suddenly, after years of being invisible Machine Learning was the talk of the town. Did you hear, Machine Learning is now going by Artificial Intelligence! Artificial Intelligence will cure cancer! I heard Big Data will replace doctors! Do you mean Machine Learning? I don’t know but I heard Cognitive Computing just created the latest fashion craze!

Really, it was all just too much for any one set of methods to live up to.

But that doesn’t change who you are and what you’re capable of. Yes, Queries and Dashboards are more popular. But you don’t get caught up constantly dwelling on the past like they do. And sure, Traditional Statistics have prestige. But we both know they can be a bit myopic at times. And Risk Scores…don’t even get me started on Risk Scores.

You are different. And that’s a good thing.

I personally have seen you consider millions of different data points – even free text notes – to spot falls in hospitals, prevent admissions of elderly patients, and route people with serious mental illness to appropriate care sooner. You don’t need to be a doctor. Because you can make doctors better at doctoring.

Can Community Health Organizations Pave the Way for Local Technology Adoption?

Mar 6, 2017

By ALEXANDRA CAMESAS

It’s 6 AM and Anna’s alarm clock goes off. She has a busy day ahead of her, starting with getting her children to school, heading to her doctor’s appointment and taking on a double shift at her part time job. Anna is on a tight budget and has difficulty juggling work and her kids. On top of her often stressful situation at home, Anna suffers from Type 2 diabetes and has been inundated with medical bills. Although Anna doesn’t own a computer, her doctor introduced her to a smartphone application that helps her to monitor her glucose levels and communicate with her care team if she needs medical assistance.

Millions of individuals across the U.S. have experience with at least one aspect of Anna’s situation. As a country, the U.S. spends less money on social services and more on healthcare.^1,² Yet, a large majority of what makes us sick can be attributed to the social determinants of health (SDOH)—factors such as socioeconomic status, availability of resources, employment and access to healthcare. While using technology to address social factors in underserved regions has generated momentum, it’s an area of healthcare and digital health that is emerging with the shift from reactive to proactive healthcare.

In (Gasp) Defense of the Coronary Stent

Mar 6, 2017• 25

By ANISH KOKA, MD

A kerfuffle ensued recently when an oncologist and expert on evidence based medicine took the field of cardiology to task over the evidence for placement of the ubiquitous coronary stent. What started with a lengthy article in Propublica that included coronary stenting for stable coronary disease as a prime example of a procedure done without evidence to back it up turned into this fiery twitter exchange between Drs. Kirtane (cardiology) and Prasad (oncology).

The crux of the debate revolves around placement of coronary stents in patients with stable coronary artery disease. Stable coronary artery disease refers to narrowing of the arteries by a build of plaque that has occurred slowly over time. Unstable coronary artery disease refers to eruptions that occur within the coronary vessel when a plaque ruptures, quickly leading a patent vessel to become completely occluded or nearly occluded. Unstable coronary artery disease, otherwise referred to as an acute coronary syndrome is regarded as an emergency that requires urgent intervention by skilled operators (interventional cardiologists) who must race against time to abort a process that if left unchecked may lead to death or severe damage of the heart muscle.

Figure 1. Stable angina/Acute Coronary syndromes

Stable coronary artery disease on the other hand is not considered an emergency, but can result in patients being symptomatic because of diminished blood flow through the culprit artery. Angina pectoris is the descriptor one uses to describe chest pain that relates to a mismatch between the blood flow the heart muscle needs and what it receives. It is almost always the case that angina in stable coronary disease is triggered by activities such as physical or emotional stress that require more blood flow than the narrowed artery can supply.

A Great Leap Forward (Or Backward) For the National Health IT Agenda?

Mar 5, 2017• 2

By JOHN HALAMKA, MD

At HIMSS, I listened carefully to payers, providers, patients, developers, and researchers. Below is a distillation of what I heard from thousands of stakeholders.

It is not partisan and does not criticize the work of any person in industry, government or academia. It reflects the lessons learned from the past 20 years of healthcare IT implementation and policymaking. Knowing where we are now and where we want to be, here are 10 guiding principles.

1. Stop designing health IT by regulation

Through its certification program, ONC directs the specific features, functionality, and design of electronic health records. As a result, technology developers devote the majority of their development resources to fulfilling government requirements instead of innovating to meet market and clinician demands. The certification program has established a culture of compliance in an industry ready for data-driven innovations. ONC’s role in the health IT industry made sense eight years ago when IT adoption in healthcare lagged considerably behind all other sectors, but today the certification program impedes a functioning market and must be reformed.

Imagine Ransomware, For Your Body

Mar 3, 2017• 2

By JOE FLOWER

Wired has an article up, “Medical Devices are the Next Security Nightmare.” It’s all about how vulnerable almost all of these implantable devices and hospital telemetry devices are, with old, unpatchable operating systems, open ports, all that.

Let’s just think about this. Imagine someone hacking your implanted defib or insulin pump.

Wait. No need. Imagine just getting an email telling that they have hacked into it. They have the keys to your body’s engine. And they want something in return for not turning it off.

“Give us your credit card and bank account information — all of it. Now. Or we will start screwing up your body, a little bit or a lot, whenever we feel like it, dumping all the insulin into the bloodstream at once. Or just giving you a heart attack. You have until 5pm EST.