The Health Care Blog – Page 463 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Should Docs Prescribe Data?

Sep 23, 2014• 7

LESLIE KERNISAN, MD

I’ve always been a little skeptical of the push to get doctors to prescribe apps.

To begin with, it would be awfully easy for us to replicate the many problems of medication prescribing. Chief among these is the tendency for doctors to prescribe what’s been marketed to them, rather than what’s actually a good option for the patient, given his or her overall medical situation, preferences, and values.

Then there are the added complexities peculiar to the world of apps, and of using apps.

A medication, once a pharmaceutical company has labored to bring it to market, basically stays the same over time. But an app is an ever-morphing entity, usually updating and changing several times a year. (Unless it stops updating. That’s potentially worse.)

Meanwhile, the mobile devices with which we use apps are *also* constantly evolving, and we’re all basically forced to replace our devices with regularity.

PiPS: When Less Is More

Sep 23, 2014• 8

By DEBORAH GROSE

The search for an antidote to the ills of our ailing healthcare system inevitably bumps up against the pervasive mindset that more is better. Each year we develop and prescribe more drugs, more tests, more technology. Yet, despite these investments, more treatment doesn’t always result in better outcomes. Procedures can be invasive or have unintended consequences, medications can have side effects, and tests can be unnecessary. But what is the alternative? As we look to improve quality and reduce cost, less can actually be more.

Results of recent research indicate that there is much to tap into beyond reliance on drugs and other interventions when helping patients heal. For example:

The doctor’s connection with a patient can improve clinical outcomes

In a treatment experiment where the only variable was the quality of the clinician’s engagement with the patient, those in the “higher engagement” group reported much greater relief. 1

Seeing a treatment administered increases effectiveness

Morphine injected directly by syringe has greater pain-killing effects than when added, out of view, to a patient’s IV.

Sugar pills can work as well as “real” medicine 2

In a study concerning migraine, patients reported as much relief after taking a dummy pill labeled as a proven medication as patients who took the proven medication that was labeled as a dummy pill. 3

These occurrences tend to be aggregated under the rubric of the “placebo effect.” Once pigeonholed as a nuisance factor in clinical drug trials, the placebo effect is now the subject of a promising list of studies and experiments in the fields of neurophysiology, psychology, neuroscience, molecular biology, and genetics.

What Happened at Yorkville Endoscopy?

Sep 23, 2014• 1

KAREN SIBERT, MD

The ear, nose and throat specialist who treated comedian Joan Rivers on August 28 has been identified as Dr. Gwen Korovin, a prominent New York physician who is known as a voice doctor to many entertainers and Broadway stars including Hugh Jackman and Julie Andrews.

With a physician who is an expert in airway anatomy at her side, and all the technologic advantages of a modern clinic in Manhattan’s upper east side, the 81-year-old Ms. Rivers must have anticipated an uneventful procedure. Instead, she stopped breathing and suffered cardiac arrest. The question remains: What went wrong?

Credentials questioned

Several sources have reported that Dr. Korovin had not completed usual credentialing procedures at Yorkville Endoscopy, and did not have privileges to do anything but observe on the day Ms. Rivers was treated.

In fairness, the credentialing process at a hospital or ambulatory surgery center (ASC) simply reviews documentation that the physician is qualified to perform procedures, and grants the physician privileges to practice there. Physicians choose where they want to work, and don’t necessarily maintain privileges at more than one hospital or ASC. A lack of privileges doesn’t imply a lack of experience or training; it simply means that the physician hasn’t gone through credentialing steps at that facility.

The Political Economy of Hackathons

Sep 22, 2014

DAVID DO, MD

Two thousand hackers from 50 universities around the world came to the University of Pennsylvania last weekend, where they were fed, housed, given toothbrushes, Red Bull drinks, and proceeded to create the most innovative and creative software and hardware hacks to date. The event was PennApps, the nation’s largest and longest-running collegiate hackathon. In 48 sleepless hours, people built new ways to interact with iPhones, smart watches, and flying drones. Microsoft and Google were recruiting engineers. Intel even released a new electronics board for the event.

This event was also the debut of PennApps Health, which will hopefully be a part of this event from now on. The turnout was impressive. Epic Systems, Independence Blue Cross, and Mainline Health each presented specific healthcare challenges and rewards. Their presence motivated at least 35 teams to compete in health challenges. Here are the main takeaways from this event:

1. Healthcare hacking is less sexy than device hacking

At open-ended hackathons, the “popular” crowd usually pursues high tech hacks e.g. virtual reality and other cutting edge devices. One group, for example, wired up a motorized skateboard so it could be controlled wirelessly with gestures. Another group created a Google Glass app for the blind that recognized, and spoke aloud, the names of objects in front of the wearer.

Will 2015 be mHealth’s Coming Out Party?

Sep 22, 2014• 11

JOSEPH KVEDAR, MD

I’ve been toiling in the field of connected health for 20 years now, watching for signs of adoption that will move us into the steep part of the curve. I have to wonder, with announcements from several huge consumer companies recently, if that time is coming.

By now you’ve heard about Apple’s HealthKit announcement , which involved not only Apple, but Mayo Clinic and Epic.

Maximizing Healthcare Connectivity and the Bottom Line

Sep 22, 2014• 2

By SURESCRIPTS in MARKETPLACE

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.

EHR Design: It’s a Matter of Time

Sep 22, 2014• 23

EDMUND BILLINGS, MD

As reported last year at HIMSS and by many online news and opinion sources since, physician dissatisfaction with EHRs is growing. Indeed, while this blog post doesn’t focus on the broader picture, general physician career dissatisfaction is disconcertingly high.

The breakneck push for more and better EHR use as a component of regular medical care is a significant part of that malaise, but it is insufficient as an explanation. For the most part, doctors really don’t like what the health IT industry is giving them to work with. The HIMSS survey proves it, showing that around 40 percent of physicians would not recommend their EHR to a colleague.

One would expect an industry to develop better products and improve usability, acceptance and satisfaction over time. In health IT, the opposite has occurred, with most pointing fingers at Meaningful Use as the culprit for awkward workflows and Rube Goldberg solutions cobbled together so everyone can get paid in a timely manner.

It seems EHRs are taking more time to use rather than less, which was the original goal.

What Does Big Data Actually Mean?

Sep 22, 2014• 1

JOSHUA BLEIBERG

The term Big Data is ubiquitous and enigmatic. It’s so overused that it has practically morphed into a meme for using fancy math to make technology better. In a recent Center for Technology Innovation analysis of Big Data in education the term was defined as a, “group of statistical techniques that uncover patterns.” But, others disagree, so what is Big Data?

To answer that question Jenna Dutcher, Community Relations Manager for datascience@berkeley, the UC Berkeley School of Information’s online masters in data science, asked subject matter experts from industry, academia, and the public sector how they define Big Data. All of the answers are fascinating but there were several worth highlighting.

THCB Marketplace

Sep 22, 2014

By THCBist

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THCB welcomes our latest corporate sponsors:

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Help the Doctor

Sep 21, 2014• 7

CHARLES KENNEY and JACK COCHRAN, MD

In recent weeks and months a number of articles have delved into the issue with a sense of seriousness and purpose that the doctor crisis deserves. Progress on reducing unnecessary pressures on physicians is painfully slow, but the broadest possible recognition of the problem is an important step toward dealing with it effectively.

We hold a basic belief about the future of health care: Solving the doctor crisis is a prerequisite to transforming our delivery system to improve access, equity, quality, and affordability. How can we possibly achieve the overall excellence and affordability in health care if large numbers of doctors are alienated and burned out?

Let’s be very clear: This is not about coddling doctors.

It is about preserving the ideals of the physician as healer and enhancing the professional experience – essential elements to optimizing care for patients and families. It is about acknowledging an honorable profession whose members deserve an environment in which they can serve patients to the best of their ability; an environment in which physicians can aspire to continuous improvement as engaged learners who embrace their role as active members of the Learning Coalition.

Traced Back to Medical School

The problem begins as early as medical school. Richard Gunderman, MD, recently authored an article in the Atlantic arguing that medical students:

are suffering from high rates of emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. College students choose careers in medicine because they care, because people matter to them, and because they want to make a difference. What is happening to the nearly 80,000 U.S. medical students to produce such high rates of burnout?

Dr. Gunderman argues that we “need to understand not only the changes taking place in medicine’s external landscape but the internal transformations taking place in minds and hearts. … In what ways are we bringing out the best elements in their character — courage, compassion, and wisdom — as opposed to merely exacerbating their worst impulses — envy, fear, and destructive competitiveness?”