The Health Care Blog – Page 603 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Can Banks Offer the ‘Digital Key’ to Healthcare?

Oct 5, 2012• 3

By John Casillas

Recognition of medical banking, or the convergence of banking and health IT, is gaining ground. Yet, of the many ideas evolving from this unique and growing cross-industry area, none may have more impact than using banking identity and access management systems for healthcare. By using “digital keys” offered by banks, the patient could gain a solution for securely accessing his or her electronic health records and much more. I want to share four compelling reasons for why I think banks can offer digital keys for healthcare:

1. Innovations in Banking and Health IT Are Ripe for Collaboration

Cost and convenience is driving new forms of efficiency in payment processing and this is driving banks further into the health IT arena. For example, medical banking innovations have helped one healthcare system move 4 million “explanation of benefits” (EOBs) from paper to digital processing, providing a conservative annual savings of $2 per form, or $8 million. Both providers and consumers have less paper to manage when following the digital approach.

2. Banks Have Addressed Identity Theft; Healthcare Desperately Needs a Solution for Medical Identity Theft

In 2006, the World Privacy Forum declared medical identity theft as the fastest-growing form of identity theft. Move ahead to 2010 when, according to the Ponemon Institute , more than 1.4 million people were victimized by medical identity theft, and the average cost to resolve their cases totaled about $20,000. Over half reported having to pay for medical coverage they did not receive to restore their health coverage. In fact, nearly one third indicated their health premiums increased after they were victimized.

State of Disruption

Oct 5, 2012• 12

By Jonathan Bush

Disruptive leadership. That’s a thing now? I’m told that this is a kind of leadership—I thought it was a market dynamic.

Hmmm…

What does it take to be a “disruptive” leader?

Does it mean talk like a pirate when explaining how the company will be cutting benefits?

Does it mean dress like Ali G and try to imitate him but only muster a WASP accent?

I suppose it does…but that’s the easy part.

Job #1 in leading a true market disruptive: FIND AND FERTILIZE THE HIDDEN RAGE AT THE STATUS QUO THAT LIES WITHIN ALL OF US. Find it in yourself and feed it and then find it in others and attract them to work with you.

I’m constantly looking for change in my personal life. For example, I just bought a Tesla. My other car is a 1983 Land Rover. Why? Because in 1983 you didn’t need to sell cars with a seatbelt dinger and airbags in the front seat andD because Tesla is the first ATTACKER disruptive car maker to make it past the fetal stage in my entire life. I must feed them. I HATE the established car industry! I have been trapped inside a small number of culturally (and occasionally financially) bankrupt brands that have lost any interest in fighting the over-regulated morass that constraints.

The Data Entry Paradox

Oct 4, 2012• 16

By William Hersh, MD

Everyone, including this blog writer, has been touting the virtues of the vast troves of data already or soon to be available in the electronic health record (EHR), which will usher in the learning healthcare system [1, 2]. There is sometimes unbridled enthusiasm that the data captured in clinical systems, perhaps combined with research data such as gene sequencing, will effortlessly provide us knowledge of what works in healthcare and how new treatments can be developed [3, 4]. The data is unstructured? No problem, just apply natural language processing [5].

I honestly share in this enthusiasm, but I also realize that it needs to be tempered, or at least given a dose of reality. In particular, we must remember that our great data analytics and algorithms will only get us so far. If we have poor underlying data, the analyses may end up misleading us. We must be careful for problems of data incompleteness and incorrectness.

There are all sorts of reasons for inadequate data in EHR systems. Probably the main one is that those who enter data, i.e., physicians and other clinicians, are usually doing so for reasons other than data analysis. I have often said that clinical documentation can be what stands between a busy clinician and going home for dinner, i.e., he or she has to finish charting before ending the work day.

I also know of many clinicians whose enthusiasm for entering correct and complete data is tempered by their view of the entry of it as a data blackhole. That is, they enter data in but never derive out its benefits. I like to think that most clinicians would relish the opportunity to look at aggregate views of their patients in their practices and/or be able to identify patients who are outliers in one measure or another. Yet a common complaint I hear from clinicians is that data capture priorities are more driven by the hospital or clinic trying to maximize their reimbursement than to aid clinicians in providing better patient care.

Rethinking the Provider Certification Game

Oct 4, 2012• 3

By David Shaywitz, MD

Quality is the new watchword in healthcare; it’s what we seek – and increasingly, what we try to measure. Medications, devices, care delivery, hospital services – all are now scrutinized as we seek to gauge their benefit, and justify their cost.

The idea of using metrics to evaluate quality make sense, but only if we can trust the metrics themselves. Otherwise, we risk becoming party to an updated version of craniometry, systematized false-precision that focuses on easily-measurable parameters (such as head circumference) that may not represent meaningful proxies for the assessments we’re really after (i.e. intelligence).

The good news is that the science of testing, of developing evaluation instruments, has improved over time. We’re now better able to recognize the qualities and properties of good tests – and to identify where they’re likely to fall short.

We’re also getting more comfortable with demanding robust evaluation instruments. For example, the FDA’s approach to patient-reported outcomes places exceptional (and appropriate) emphasis on the assessment tool chosen, and requires that it demonstrates the appropriate properties before relying on its results.

Unfortunately, one critically important area within our healthcare system that seems to have escaped such careful review is the way the competence of care providers is typically assessed and certified.

Whether you are an X-ray technician, a physical therapist, a registered nurse, or a transplant surgeon, you are required to pass through a gauntlet of costly certification exams. These tests, already significant, are assuming an even greater importance as the healthcare system increasingly looks to them as proxies for quality. Certification can be required for employment and for admission privileges, and frequently impacts the reimbursement rate for healthcare providers.

All this makes complete sense – provided the certification tests themselves are sound.

Unfortunately, the world of healthcare worker certification remains a bit like the wild west, as medical organizations and professional societies approach certification testing with profoundly different degrees of rigor — and generally little-to-no transparency.

The Art of Diagnosis

Oct 3, 2012• 4

By Maggie Mahar and Clifton Meador, MD

A young doctor and his wife had just moved to the mountains of eastern Kentucky, near the border of West Virginia. The small town was nestled among the coal mines of the region. Nearly all of his patients would be coal miners or family members of a miner. Bill would practice family medicine. His wife, a veterinarian, hoped to build a small-animal practice.

Liz McWherther, the forty-seven-year-old wife of a miner, came to see the young doctor. Over several weeks, she had developed a curious set of complaints. Each morning she woke with a dry mouth and slurred speech. She also noted blurred vision and difficulty urinating. Within a couple of hours of waking, she was completely free of any symptoms. These symptoms had been occurring each morning and going away by afternoon.

Liz had had a series of tests done by the previous physician, but none of these tests were abnormal. The physical examination by Dr. Hueston was entirely normal. She denied drinking alcoholic beverages or using illicit drugs. Hueston had briefly considered some unusual response to marijuana or other drugs that were prevalent in the area. Liz had not been down in the mines, nor did her husband bring back anything unusual into the house.

Vinod Khosla Thinks I’m Narrow-Minded

Oct 3, 2012• 6

By Margaret Polaneczky, MD

There’s a (tiny) bit of a discussion going on in Twitter about a post I wrote responding to Vinod Khosla’s statement that 80% of the work that doctors do will one day be replaced by computer algorithms.

In my post, I talked a bit about the marketplace-driven IT innovations in healthcare, and medicine as seen through the eyes of the IT entrepeneurs. I questioned just how much of what doctors do today can really be replaced by algorithms, particularly the doctor-patient relationship.

I then asked if Khosla was right and answered myself – Maybe. I stated that we were in the midst of a huge disruption in healthcare, and reflected on how I was already seeing signs of that disruption in my current practice. And while I still did not see anything changing too much just yet, as far as the future Khosla predicted? I wasn’t so sure.

I then stated that if there is a revolution in healthcare, we docs needed to make ourselves a part of it now. I urged my fellow physicians to become involved, in order to be sure that what happens in the IT-driven healthcare future actually improves our patients’ health beyond what we are doing today.

It’s a completely legitimate concern, and, I believe, an extremely important one. As an example, I cited the evolution of the EMR – a system that has created high hopes and caused huge disruption at enormous cost, even as we continue to struggle to find conclusive evidence that EMR use actually improves patient outcomes.

The Health Care Debate Within the Debate

Oct 3, 2012• 10

By David Merritt

In tonight’s first presidential debate, Governor Romney and President Obama will spend 15 minutes discussing healthcare. This is a perilous topic for both, but whoever wins this debate within the debate will take a big step to winning on November 6th.

The Affordable Care Act, or ObamaCare as both candidates now call it, will be center stage. The president will offer his standard defense, saying it helps middle-class families by making insurance more affordable and more secure.

But the president knows a full-throated defense will not work. A majority of Americans have consistently supported repeal since day one.

Rather than defend the indefensible – higher costs, higher taxes, Medicare cuts, government expansion – the president will attack.

First, he will tie together ObamaCare and the reform law Gov. Romney signed in Massachusetts, arguing that they are the same.

Gov. Romney should stipulate that there are some policy similarities between the two, but that the differences are what matter. He can deflect this attack and return the spotlight to the president’s unpopular law by clearly saying:

“I did not raise taxes. You raise taxes by $500 billion.

“I did not cut Medicare. You cut Medicare by more than $700 billion to pay for a new entitlement that the public opposed. Your cuts jeopardize seniors’ access to care.

The Health of Nations

Oct 3, 2012• 2

By David Katz, MD

If all of us were simply to make better use of our feet, our forks, and our fingers — if we were to be physically active every day, eat a nearly optimal diet, and avoid tobacco — fully 80 percent of the chronic disease burden that plagues modern society could be eliminated. Really.

Better use of feet, forks, and fingers — and just that — could reduce our personal lifetime risk for heart disease, cancer, stroke, serious respiratory disease, or diabetes by roughly 80 percent. The same behaviors could slash both the human and financial costs of chronic disease, which are putting our children’s futures and the fate of our nation in jeopardy. Feet, forks, and fingers don’t just represent behaviors we have the means to control; they represent control we have the means to exert over the behavior of our genes themselves.

Feet, forks, and fingers could reshape our personal medical destinies, and modern public health, dramatically, for the better. We have known this for decades. So why doesn’t it happen?

Because a lot stands in the way. For starters, there’s 6 million years of evolutionary biology. Throughout all of human history and before, calories were relatively scarce and hard to get, and physical activity — in the form of survival — was unavoidable. Only in the modern era have we devised a world in which physical activity is scarce and hard to get and calories are unavoidable. We are adapted to the former, and have no native defenses against the latter.

Then, there’s roughly 12,000 years of human civilization. Since the dawn of agriculture, we have been applying our large Homo sapien brains and ingenuity to the challenges of making our food supply ever more bountiful, stable, and palatable; and the demands on our muscles ever less. With the advent of modern agricultural methods and labor-saving technologies of every conception, we have succeeded beyond our wildest imaginings.

So now, we are victims of our own success. Obesity and related chronic diseases might well be called “SExS” — the “syndrome of excessive successes.”

Body 2.0 Health Tech Expo San Francisco

Oct 3, 2012

By Robin Friedlander, MD and Catherine Bostian

Get healthier at this year’s first ever Body 2.0 health tech expo on Sunday, October 7 in San Francisco.

Health 2.0’s first ever public event will showcase the companies at the forefront of innovation in consumer health. From biometric sensors monitoring everything from your heart rate, to the miles you’ve walked and the hours you’ve slept, technology and health have never interfaced at this level before.

Body 2.0 is for those curious about getting healthier and those already fanatical about health. Regardless of where you fall on the spectrum you will learn something new.

Try out the latest tech from companies like Azumio, ChickRx, Lark, LumoBack, Explorence, and SoloHealth.

Leaders in the field will guide you on creating a fitter, stronger and more sustainable life. Keynotes include Dr. Arlene Blum, who was the first female to climb Mt Everest and is now the head of the Green Science Policy Institute, and Linda Fogg-Phillips, the leader of the Mobile Health Family. Also, hear from the innovators themselves like Amar Kendale from MC10, and Keith D’Amelio from Nike SPARQ.