Above the Fold

Moving Toward An Identity and Patient Records Locator

Mar 13, 2013• 13

By Rich Elmore

Last week, five health IT vendors came together to announce the CommonWell Health Alliance, a nonprofit focused on developing a national secure network and standards that will:

Unambiguously identify patients
Provide a national, secure record locator service. For treatment purposes, providers can know where a patient’s records are located.
Enable peer-to-peer sharing of patient records requested via a targeted (or directed) query
Enable patients and consumers to withhold consent / authorization for participation in the network

Unambiguous patient identity matters

In banking, without certainty about identity, ATM machines would not give out cash. And in healthcare without certainty about identity, physicians are working with one hand tied behind their backs.

This problem will never be solved by the Feds. In fact, Congress has restricted any spending on it by the government at all. Industry working together may be the only practical alternative.

How Should Apps Be Prescribed?

Mar 13, 2013• 13

By Leslie Kernisan, MD

Should I be prescribing apps, and if so, which ones?

I recently came across this video of Happtique’s CEO Ben Chodor describing his company to Health 2.0’s Matthew Holt. In it, the CEO explains that Happtique is creating a safe and organized space, to make it easy for doctors to prescribe apps and otherwise “engage with patients.”

Because, he says “we believe that the day is going to come that doctors, and care managers, are going to prescribe apps. It’s going to be part of going to the doctor. He’s going to prescribe you Lipitor, and he’s going to give you a cholesterol adherence app.”

He goes on to say that they have a special process to make sure apps are “safe” and says this could be like the good housekeeping seal of approval for apps.

Hmm. I have to admit that I really can’t imagine myself ever prescribing a “cholesterol adherence” app. (More on why below; also found myself wondering what it exactly meant for Happtique to say an app was safe. What would an unsafe cholesterol app look like?)

Why Patient Engagement Really Does Matter and Why So Many People Are Getting It Wrong

Mar 12, 2013• 64

By Rob Lamberts, MD

“Patient engagement.”

What is “Patient Engagement?” It sounds like a season of “The Bachelor” where a doctor dates hot patients. It wouldn’t surprise me if it was. After all, patient engagement is hot; it’s the new buzz phrase for health wonks. There was a even an entire day at the recent HIMSS conference dedicated to “Patient engagement.” I think the next season of “The Bachelor” should feature a wonk at HIMSS looking for a wonkettes to love.

Here’s how the Internets define “Patient engagement”:

The Get Well Network (with a smiley face) calls it: “A national health priority and a core strategy for performance improvement.”
Leonard Kish refers to it as “The Blockbuster Drug of the Century” (it narrowly beat out Viagra) – HT to Dave Chase.
Steve Wilkins refers to it as “The Holy Grail of Health Care” (it also narrowly beat out Viagra) – HT to Kevin MD.
On the HIMSS Patient Engagement Day, the following topics were discussed:

-How to make Patients Your Partners in Satisfying Meaningful Use Stage 2 Objectives; Case Studies in Patient Engagement, session #64;
-Review Business Cases for Implementing a Patient-Centered Communication Strategy and Building Patient 2.0, session #84;: and
-Engaging People in Health Through Consumer-Facing Devices and Tools, session #102.

So then, “patient engagement” is:

-a strategy
-a drug
-a grail (although I already have a grail)
-a “meaningful use” objective
-something that requires a business case
-something that requires “consumer-facing devices and tools” (I already have one of those too).

What Will Tomorrow’s Doctor Look Like? (12)

By LESLIE KERNISAN, MD

What skills will doctors need to survive and succeed in the future? At this point pretty much everybody gets that they’ll need to be good with technology. But beyond that? This is what we know: tomorrow’s doctor will need to be comfortable dealing with e-patients armed with information. They’ll need to efficiently communicate and coordinate care with colleagues using new-fangled means. And oh yeah, lest we forget: they’ll need to adapt quickly and to a changing world on a regular basis. Just like everybody else.

Not Knowing What You Don’t Know (25)

By DINOSAUR, MD

The new thinking among many experts is that nurse practitioners and physicians assistants should take over many mundane day-to-day tasks to free up doctors for more important work. But many doctors remain violently opposed to the idea. Dinosaur MD offers a cautionary tale.

The HIT Job (44)

By ROBERT WACHTER, MD

The New York Times investigation on the sketchy influence of federal money in health IT was inevitable from the moment Washington announced it would be paying incentives to drive electronic medical record adoption. Unfortunately, the newspaper’s hard-hitting reporting almost entirely misses the point, argues UCSF’s Bob Wachter.

The Other Scandal (47)

By MICHAEL MILLENSON

Sorry. The real scandal is the healthcare industry’s continued refusal to adopt electronic medical records and other new technologies that could revolutionize care and save tens thousands of lives every year. What’s really going on here? It turns out that the answer isn’t as straightforward as one might think.

Death of an Evangelist(33)

By ROB LAMBERTS, MD

An early adopter of electronic medical records says enough already. This has gone on long enough. Better technology is indeed the answer. But we have just isn’t good enough. It’s time to roll up our shirt sleeves and get to work, argues Rob Lamberts.

Choosing Alternative Medicine (57)

By JAMES SALWITZ, MD

Steve’s death was a hard one. Facing Stage 2 Hodgkin’s Lymphoma he fought for life using every weapon he could lay his hands on. Herbal teas. Acupuncture. Mysterious elixirs. The one thing he didn’t try? Chemotherapy. With a growing number of patients choosing alternative therapies, the story is a familiar one.

Praying For Obamacare to Fail (49)

By JD KLEINKE

The Affordable Care Act is now the law of land. Looking for ways to obstruct implementation of the new healthcare law is becoming a cottage industry in some circles. And that’s a crying shame.

CommonWell Is a Shame and a Missed Opportunity (28)

By ADRIAN GROPPER, MD

One of the big stories coming out of HIMSS this year is a new star alliance featuring some of the biggest names in health IT. Adrian Gropper argues the effort misses the mark. And that’s a damn pity when real innovation is desperately needed. Continue reading…

Death By Remote Connection

Mar 11, 2013• 1

By James Salwitz, MD

Not long ago the Atlantic published a provocative article entitled “The Robot Will See You Now.” Using the supercomputer Watson as a starting point, the author explored the mind-bending possibilities of e-care. In this near future, so many aspects of medicine will be captured by automated technology that the magazine asked if “your doctor is becoming obsolete?”

The IT version of health includes continuous medical monitoring (i.e. your watch will check all vital functions), robotic surgery without human supervision, lifelong personal database with genetic code core and intensive preventive care modeled for each person’s need; all supervised by artificial intelligence with access to a complete file of medical research and findings. The e-doctor will never forget, never get tired, never get confused, never take a day off and will give 24/7 medical care at any location, anywhere in the world, for a fraction of the cost. Perfect care, everywhere, at every moment, for a pittance.

While the transformation for doctors seems clear, a shift from being at the core of medicine to being what the article described as “super-quality-control officers,” what intrigues me is not how doctors will change (retire); the real question is how patients will adapt to this new healthcare world? Particularly when experiencing extreme or life threatening illness, will patients accept that family, friends and a pumped up Ipad are enough?

Sitting Is the Smoking of Our Generation

Mar 11, 2013• 16

By Nilofer Merchant

I find myself, probably like many of you, spending way too much time in front of my computer.

When I do face-to-face meetings, my colleagues and I typically met around some conference table, sometimes at an airport lounge (nothing like getting the most out of a long layover), and quite often at coffee shops (hello Starbucks!). But that means that the most common denominator across all these locations wasn’t the desk, or, the keyboard, or even the coffee. The common denominator in the modern workday is our, um, tush.

As we work, we sit more than we do anything else. We’re averaging 9.3 hours a day, compared to 7.7 hours of sleeping. Sitting is so prevalent and so pervasive that we don’t even question how much we’re doing it. And, everyone else is doing it also, so it doesn’t even occur to us that it’s not okay. In that way, I’ve come to see that sitting is the smoking of our generation.

Not Knowing What You Don’t Know

Mar 10, 2013• 67

By Lucy E. Hornstein, MD

“The more you learn, the more you realize you don’t know.”

You will hear this statement not just from physicians, but from lots of other folks engaged in scholarly work of all stripes. That’s because it is not merely true; it is a deep and universal truth that permeates all of mankind’s intellectual endeavors.

The implication of this for the practice of medicine is that a little knowledge can be very dangerous.

What do I, as a fully trained, extensively experienced primary care physician bring to the evaluation of patients who seek out my care that cannot be matched by so-called “mid-level providers” (PAs and NPs)? It is not (always) my knowledge, but rather the experience to know when I do not know something. In short, I know when to ask someone else’s opinion in consultation or referral.

I had a scary experience lately with a PA who didn’t even know what she didn’t know (and who still probably doesn’t realize it.)

The patient had been bit on the hand by a cat. I saw the injury approximately 9 hours after it had occurred. The patient had cleaned it thoroughly as soon as it had happened, and by the time I saw it, it was still clean, bleeding freely, not particularly red or swollen, and only a little painful. Still; cat bites are nasty, especially on the hands. Therefore I began treatment with oral amoxicillin-clavulanate, and told the patient to soak it in hot water several times a day.

Six hours later (after one oral dose of antibiotic) the patient called me back: the wound was now much more painful, red, swollen, and there were red streaks going from the hand all the way up to his elbow. Frankly, I was a little puzzled. He was already on antibiotics; the single dose probably hadn’t had enough time to make much of an impact. And yet the infection was clearly progressing.
Continue reading…

When Technology Understands What People Want From Healthcare, Our System Has A Chance

Mar 10, 2013• 13

By Jordan Shlain, MD

As a primary care doctor in San Francisco and Silicon Valley, I have been searching for the holy grail of patient engagement for over 15 years. My journey began with an alpha-numeric pager and a medical degree. I shared my pager number with my patients along with a pledge to call them back within 15-minutes, 24-hours a day. My communications evolved into email and texting, with the predicate that by enhancing communication, I could carefully guide my patients down the byzantine corridors of healthcare – with a high probability we could avoid mistakes – if they would agree to share the ownership of their treatment plan. My life’s work has been where the rubber meets the road; where doctors interface with patients: office, hospital or smartphone.

Technology has washed over almost every industry and transformed it, radically. Healthcare is on the precipice of destiny. The wave is here.

Over the past three decades healthcare has lurched from one existential crisis to another; often manifested by an acronym solution: HMO, ACO, PCMH, P4P, PQRS; each a valiant attempt to reign in costs and solve for aligning incentives. However, we can’t have hospitals, doctors, health systems and payers accountable to healthy outcomes if the 300,000,000 people are not paramount to the equation.
Continue reading…

Can Health Care Transparency Make A Difference?

Mar 9, 2013• 34

By Martin S. Gaynor

There’s been a lot of discussion of transparency in health care recently, e.g., a USA Today op-ed and a counterpoint by Paul Ginsburg. The appeal of transparency is obvious. As movingly documented by Steven Brill in Time, prices are high and often differ quite substantially, even across close by providers. However, we don’t know the prices for the health care that we consume, and it’s extremely difficult to find out what these things cost (e.g., this recent study in JAMA).

While the appeal of transparency is obvious, it’s important to realize that buying health care is not like buying milk at the grocery store. A key factor is health insurance. Health insurance is very important — people need to be insured against the catastrophic expenses that can occur with serious illness. Thus people with high health care expenses won’t be exposed to most of those expenses (and shouldn’t) and therefore will have no reason to respond to information about health care prices.

What Will Tomorrow’s Doctor Look Like?

Mar 8, 2013• 18

By Leslie Kernisan, MD

“What does the 21st Century Physician look like?”

Lisa Fields (@PracticalWisdom) cc’ed me on a tweet about this; it’s the featured question at www.tomorrowsdoctor.org, an organization founded by three young professionals who spoke at TEDMED last year.

I’ll admit that the question on the face of it struck me as a bit absurd, especially when juxtaposed with the term “tomorrow’s doctor.”

Tomorrow’s doctor needs to be doing a much better job of dealing with today’s medical challenges, because they will all be still here tomorrow. (Duh!) And the day after tomorrow.

(As for the 21st century in general, given the speed at which things are changing around us, seems hard to predict what we’ll be doing by 2050. I think it’s likely that we’ll still end up needing to take care of elderly people with physical and cognitive limitations but I sincerely hope medication management won’t still be a big problem. That I do expect technology to solve.)

After looking at the related Huffington Post piece, however, I realized that this trio really seems to be thinking about how medical education should be changed and improved. In which case, I kind of think they should change their organization’s name to “Next Decade’s Doctor,” but I can see how that perhaps might not sound catchy enough.