This year, my thoughts go to the way Christmas is a time of reconnection for many people. We reconnect with family and friends we may not see as often as we would like, and many of us reconnect with secular traditions dating back to our childhood. Many people also reconnect more deeply with their Christian traditions, the ancient celebration of Hanukkah or the newer one of Kwanzaa.
As a doctor, I think Christmas is a time when individuals are more open toward others, more willing to extend “good will toward men” (Luke 2:14). It can be an opener for future relationships to form or grow, a time to share our humanity in the context of experiencing something larger than ourselves and our everyday existence. It allows us to get a little more personal by sharing something of what we all have in common – the need for togetherness with those we love.
The question of how much time I spend in front of the screen has pestered me professionally and personally.
A recent topic of conversation among parents at my children’s preschool has been how much screen time my toddlers’ brain can handle. It was spurred on by a study in JAMA Pediatrics that evaluated the association between screen time and brain structure in toddlers. The study reported that those children who spent more time with electronic devices had lower measures of organization in brain pathways involved in language and reading.
As a neurologist, these findings worry me, for my children and for myself. I wonder if I’m changing the structure of my brain for the worse as a result of prolonged time spent in front of a computer completing medical documentation. I think that, without the move to electronic medical records, I might be in better stead — in more ways than one. Not only is using them potentially affecting my brain, they pose a danger to my patients, too, in that they threaten their privacy.
As any practicing physician can tell you, electronic medical records represent a Pyrrhic victory of sorts. They present a tangible benefit in that medical documentation is now legible and information from different institutions can be obtained with the click of a button — compared to the method of decades past, in which a doctor hand-wrote notes in a paper chart — but there’s also a downside.
Disruption of the healthcare payment model? We’re IN! Meet Ooda Health a two-year old startup that is working to change the way healthcare is paid for by changing WHEN it’s paid for: BEFORE the patient leaves the hospital or doctor’s office. How can we possibly live in a world without EOBs? We’re dying to find out. Seth Cohen, President & Co-Founder of Ooda Health, talks about the launch of the startup’s first service, Ooda Pay, which just went live with BCBS of Arizona, Blue Shield of California, and care provider, Common Spirit Health. How did it go? We may be closer to disrupting healthcare billing (and it’s paperwork and admin expense) than we thought.
I recently took care of Rosaria, a cheerful 60-year-old woman who came in for chronic joint pain. She grew up in rural Mexico, but came to the US thirty years ago to work in the strawberry fields of California. After examining her, I recommended a few blood tests and x-rays as next steps. “Lo siento pero no voy a tener seguro hasta el primavera — Sorry but I won’t have insurance again until the Spring.” Rosaria, who is a seasonal farmworker, told me she only gets access to health care during the strawberry season. Her medical care will have to wait, and in the meantime, her joints continue to deteriorate.
Migrant and seasonal agricultural workers (MSAW) are people who work “temporarily or seasonally in farm fields, orchards, canneries, plant nurseries, fish/seafood packing plants, and more.” MSAW are more than temporary laborers, though— they are individuals and families who have time and time again helped the US in its greatest time of need. During WWI, Congress passed the Immigration and Nationality Act of 1917 because of the extreme shortage of US workers. This allowed farmers to bring about 73,000 Mexican workers into the US. During WWII, the US once again called upon Mexican laborers to fill the vacancies in the US workforce under the Bracero Program in 1943. Over the 23 years the Bracero Program was in place, the US employed 4.6 million Mexican laborers. Despite the US being indebted to the Mexican laborers, who helped the economy from collapsing in the gravest of times, the US deported 400,000 Mexican immigrants and Mexican-American citizens during the Great Depression.
What separates successful digital health startups from the pack? John Sharp, Director of Thought Advisory for the Personal Connected Health Alliance (a HIMSS organization) has watched digital health ‘grow up’ over the years as an industry analyst focused on health IT, consumer health, and health tech. Want to know what it takes to win? Who does John think is poised to dominate the digital health space? (Hint: It’s a chronic condition management startup and it’s probably not the one you expect!)
Filmed at the HIMSS Health 2.0 Conference in Santa Clara, CA in September 2019.
Medical researchers and their groupies – early adopters, thoughtleaders, those easily influenced or whatever you want to call them – never seem to learn that when you try to outsmart Mother Nature or Our Heavenly Father, whichever appeals more to your world view, you usually get your hand slapped.
When I was a resident (1981-1984), I got penalized if I didn’t offer postmenopausal women estrogen-progesterone replacement therapy because it seemed obvious that if women with endogenous estrogen didn’t get many strokes or heart attacks and women without estrogen did, all we needed to do was make up for God’s or Mother Nature’s oversight in not keeping the estrogen coming after age 50.
Then the Women’s Health Study in 2000, almost 20 years later, showed that women on Prempro had more strokes, blood clots and heart attacks, and more breast cancer on top of that, than women who accepted the natural order of things – menopause with all its symptoms and inconveniences.
The same things has happened with osteoporosis – more subtrochanteric femur fractures after five years of Fosamax than in untreated women.
Keep your eyes peeled for OKKO Health, the startup that has created an AI-driven app game to make sure that your eyes are healthy. Founder-and-optometrist Stephanie Campbell explains how the game works to help clinicians to remotely monitor patients with eye diseases that would otherwise require frequent hospital visits to manage; think diabetic eye disease or age-related macular degeneration. Can we really look to gaming as a way for remote patient monitoring? OKKO certainly sees it that way!
Filmed at Bayer G4A Signing Day in Berlin, Germany, October 2019.
trend toward less invasive procedures, shifting from inpatient to outpatient, has
changed the face of surgery. Industry-changing leaps in technology and surgical
techniques have allowed us to achieve our treatment goals with smaller
incisions, laparoscopy and other “closed” procedures, less bleeding, less pain,
and lower complication rates. As a result, patients who used to require days of
recovery in the hospital for many common surgeries can now recuperate in their
procedures grew from about 50% to 67% of hospitals’
total surgeries between 1994 and 2016,1,2 and outpatient
volume is expected to grow another 15% by 2028,3 with advantages for
patients, surgeons, insurers, and hospitals. In my hospital, where bed space is at a premium, my colleagues and
I were able to make a significant impact by switching minimally invasive
surgery for enlarged prostate, also called benign prostatic hyperplasia (BPH),
from inpatient to outpatient.
Opportunity with an Advanced Technology
about half of men in their 50s, with the prevalence increasing with age to include
about 90% of men 80 and older.4As a result, BPH surgery makes up a significant
portion of urological procedures in any hospital.
have been performing BPH surgery for 11 years. There are several options,
including transurethral resection of the prostate (TURP) and suprapubic
prostatectomy, both of which require hospital stays and bladder irrigation with
a catheter due to bleeding. Another less frequently utilized surgical option for BPH is holmium
laser enucleation of the prostate (HoLEP). HoLEP causes fewer complications and
requires shorter hospitalization.5 Specifically, its postoperative
morbidity is the lowest among BPH surgeries.5,6,7 HoLEP has the
least bleeding, shortest catheter time, and low rates of urinary tract
infection, plus patients are less likely to require additional treatment for
BPH as they age compared to other available therapies.5,6,7