The Health Care Blog – Page 665 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Now you have healthcare data. So where does it go?

Jan 27, 2012• 4

By Paul Grundy, MD

In the next 10 years, data and the ability to analyze the data will do for the doctor’s mind what x-ray and medical imaging have done for their vision. How? By turning data into actionable information.

For instance, take Watson, IBM’s intelligent supercomputer. Watson can analyze the meaning and context of human language, and quickly process vast amounts of information. With this information, it can suggest options targeted to a patient’s circumstances. This is an example of technology that can help physicians and nurses identify the most effective courses of treatment for their patients. And fast: in less than 3 seconds Watson can sift through the equivalent of about 200 million pages, evaluate the information, and provide precise responses. With medical information doubling every 5 years, advanced health analytic systems technologies can help improve patient care through the delivery of up- to-date, evidence-based health care.

Demonizing The Demonization Of Physician-Industry Relationships

Jan 27, 2012• 3

By DAVID SHAYWITZ

Monday’s WSJ (online now) features an exceptionally important and courageous op-ed by Harvard professor (and frequent co-author of mine, although not in this case) Tom Stossel, discussing a rule within recently enacted healthcare legislation with the Orwellian title, “The Physician Payment Sunshine Act,” focused on physician/industry relationships.

Taking its name from the assertion that “sunshine is the best disinfectant,” the Act apparently aims to help disinfect physicians who might be contaminated by industry contact, an interaction the Act seems to assume is intrinsically corrupting — in stark contrast, one suspects, to the many other activities in which physicians engage, and the many other factors in their environment that might influence their behavior, as Stossel and I previously discussed here and here; see here and here as well.

To restore physicians to their baseline state of virginal professional purity, the Act mandates a stultifying series of reporting requirements, impacting amounts as little as $10. While such reports may be a Pharmascold’s wet dream, they are a logistical nightmare for the physicians involved, and serve to create an enormous compliance bureaucracy for everyone.

My recent experience at an innovation symposium at Duke University, as well as my frequent informal conversations with academic physicians at other leading institutes, suggest the increasing bureaucratic hurdles confronting university physicians seeking to strengthen the essential translational relationship between academia and industry are a particularly unfortunate problem, and are having the presumably intended effect of stifling these interactions. Young physicians worry that the burdensome requirements are overwhelming, while senior leaders seek desperately to avoid the inevitable media takedowns predictably led by the NYT, public radio, and the rest of the usual suspects. (Not infrequently, these stories seem to originate with material selectively provided to a sympathetic journalist by a plantiff attorney — but of course, nothing cozy or sketchy here….)

What I Learned from Listening to a Patient

Jan 26, 2012• 8

By Peter Pronovost, MD

I was reminded again recently of how important it is to sometimes just sit back and listen to what our patients have to say. Every month, as part of our hospital-wide patient safety efforts, I meet with staff and interview patients, seeking to learn how we can improve the care we provide to them.

A young patient shared two stories with me, one telling me how we get it right and one reminding me how we sometimes get it wrong, even without realizing it. She was nervously awaiting a procedure in Interventional Radiology when a nurse sensed her anxiety and called in a child life specialist. The specialists came and significantly helped relieve the patient’s suffering. She listened to the patient, offered a comforting touch, and provided her age-appropriate reading material and Sudoku puzzles, a brilliant though infrequently used intervention. If anything could take your mind off of your illness, it is Sudoku.

What was amazing was that after all the patient had been through―weeks in the hospital, countless procedures, scores of clinicians―what she remembered was the nurse’s act of kindness by caring enough to call the specialist. The patient reminded me that though we can cure disease sometimes, we can relieve suffering always, often with nothing more than a kind word, a gentle touch or a warm smile.

As I listened, the patient, along with her mother, went on to tell me more. They told me how the patient has complex allergies and that her mom knew her disease better than any clinician. They had lived with the disease for a decade. Yet at times, neither the patient’s mother nor the patient felt they were being heard by the doctors. The mom expressed frustration that clinicians often dismissed her concerns and discredited her knowledge.

How Doctors Are Trapped, Part II

Jan 26, 2012• 13

By JOHN GOODMAN

Of all the people in the health care system, none is more central than the physician. Fundamental reform that lowers costs, raises quality and improves access to care is almost inconceivable without physicians leading and directing the changes. Yet of all the actors in modern health care, none are more trapped than our nation’s doctors. Let’s consider just a few of the ways your doctor is constrained, unlike any other professional you deal with.

No Telephone. Sometime in the early part of the last century, all the other professionals in our society — lawyers, accountants, architects, engineers, etc. — discovered the telephone. It’s a handy device. Ideal for communicating with clients. Yet even today I find that I can rarely talk to a doctor by phone. Why is that?

The short answer is: Medicare doesn’t pay for telephone consultations. Medicare has a list of about 7,500 tasks it pays physicians to perform. And talking by phone isn’t on the list — at least in a way that makes it practical. Private insurance tends to pay the way Medicare pays. So do most employers.

At a time when doctors feel like they are being squeezed on their fees from every direction by third-party payers, most become very focused on which activities are billable and which are not. And most are going to try to minimize their non-billable time.Continue reading…

Listen to What Innovators Don’t Talk About

Jan 26, 2012• 6

By Michael Schrage

While working away on my laptop at a hotel breakfast, I couldn’t help but overhear the four gentlemen poring over an iPad two tables way. Their intense discussion revolved around rolling out their high-tech prototypes in a medical care complex. Since I’ve written about prototypes and prototyping, I couldn’t help but eavesdrop.

Forgive me.

The foursome represented a mix of medical care complex personnel and what was clearly an entrepreneurial innovator with a potentially high-impact idea. I’ll skip the technical details, but this was clearly a sophisticated group who were both smart and ambitious. The prototypes were their gateways to success. Their debates included whether it made more sense to field one or two more “finished” prototypes or whether they could get more information more quickly by fielding “roughs.” Were “staggered roll-outs” more cost-effective than “staggered builds”? They talked about the need to be able to “patch” quickly and whether their prototypes should optimize particular subsystems or overall system performance. They argued timelines and sequencing for test.

These questions are classic and it’s always fascinating to hear how — and what — decides them. Getting great value and insight from prototypes and pilots is more an art and craft than a science. Successful tech prototyping in health care contexts is particularly demanding.

That’s why the more passionately they spoke, the more nervous I got. Something was missing. Whenever innovators gather, I always listen for what’s not discussed. In almost 50 minutes of detailed discussion (yes, I am that kind of eavesdropper), I heard not a single mention, reference or allusion to the challenge of training the people onsite on how best to use or learn from the prototype. Details of prototype design and roll out were discussed as if the medical care personnel were irrelevant to the process. It reeked of “over the wall” technology transfer. OMG.

Our Cancer Journey – Week 6

Jan 26, 2012• 2

By John Halamka, MD

We’re halfway through the most challenging cycles of chemotherapy, Kathy has lost her hair, and her fatigue is getting worse but her mood is still very positive.

On Friday January 20th, Kathy received Cyclophosphamide (Cytoxan) 1200 mg, Doxorubicin (Adriamycin) 120 mg and her pre-chemotherapy supportive medications Fosaprepitant 150 mg, Dexamethasone 12 mg and Ondansetron 8 mg.

She tolerated it well.

Her Complete Blood Count shows that her Granulocyte Count has dropped from 6690 to 3610 since the chemotherapy affects her fast multiplying white cells as a side effect of targeting the cancer. Her hematocrit has fallen from 42 to 32. She tires more easily but her appetite is good. Small frequent meals enable her to overcome any GI symptoms.

We’ve been told that the Adriamycin/Cytoxan is the most difficult chemotherapy. Only two more cycles to go.

The photograph above shows Kathy and me at age 21 in our Stanford graduation photo. She’s always had long, luxuriant hair, even a waist length braid at one point.

On January 21st, her hair began falling out in clumps. It was not exactly painful, but felt very odd, as if her hair had not been washed in months and just did not lie on her scalp properly. In consultation with her cancer survivor friends, she decided to shave it off. Her hairdresser gave her a “GI Jane” cut realizing that the small hairs left will fall out soon, but in a more manageable and comfortable way. I seriously considered shaving my head in solidarity, but she asked me not to.

DSM-5: You’re Still Autistic. You’re Just Weird. You We’re Not Sure About. Call Us Tomorrow.

Jan 26, 2012• 95

By Anne Dachel

Reports of autism cases per 1,000 children grew dramatically in the US from 1996 to 2007. Source: Wikipedia.

It’s hard to imagine more chaos in the world of autism than what we see happening right now. Autism is more and more in the public spotlight. The numbers are huge and no one can explain them. Since 2009 we’ve been told that one percent of children have autism. Among boys alone, it’s almost two percent. Mainstream medicine can’t explain the stunning increase in a once rare disorder. For years health officials gave doctors credit for all the autism everywhere. They said it was the result of “greater awareness” and “better diagnosing.” Children who were mislabeled as something else were now correctly called autistic. The criteria for diagnosing autism was laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and a child with symptoms would be placed somewhere on the autism spectrum, as it came to be known. This included very high functioning autism and Asperger’s syndrome all the way over to the other end of the spectrum to those with severe intellectual impairment and all the signs of classic autism.Continue reading…

Care Innovations Summit Live Blog

Jan 26, 2012• 2

By Connie Chen and Laura Montini

Wrapping up the CI Summit with a Health Affairs Chat

By Laura Montini

The Care Innovations Summit wrapped up with a fireside chat, and moderator Susan Dentzer observed that there hadn’t been much discussion about the Medicaid population throughout the day, even though the summit was co-hosted by the Centers for Medicare and Medicaid Services. Dentzer asked Deputy Administrator Director of CMS Cindy Mann how innovation could play into the care of the Medicaid population.

Mann mentioned three major ways: experimentation (with payment rules and service delivery), peer to peer learning and data. Though she mentioned data last, she emphasized it the most.

“We need to be much more intentional about getting the data that we need to see what’s working, what’s not working,” Mann said.

Occupational Health In the Electronic Age

Jan 25, 2012• 1

By Sanjay Bansu, MD

When we say our products are made “in China”, what we really should say it that they’re made in Shenzhen–a city in Guangdong Province, just north of Hong Kong. Shenzhen is one of China’s “special economic zones” (SEZs)–754 square miles of industrial space in which foreign corporations are permitted unique rules and regulations, permitting them to run high-throughput factories that currently use 3.3 million people to make products for the Western consumer market. This is where Xboxes and cell phones come from, produced by Chinese contractors like Foxconn (which makes the new iPhone). There is an unusually high rate of suicide in Shenzhen, and in Foxconn factories in particular; behind these suicides are a broader set of public health issues among electronic workers–from those who make the new gadgets, to those who dismantle them after we throw them away.

The Rise of the Programmable Self

Jan 24, 2012

By Fred Trotter

Programmable self is a riff on the Quantified Self (QS). It is a simple concept:

Quantify what you want to change about yourself + motivational hacks = personal change success.

There are several potential “motivation hacks” that people regularly employ. The simplest of these is peer pressure. You could tell all of your co-workers every morning whether you kept your diet last night, for instance. Lots of research has shown that sort of thing is an effective motivator for change. Of course, you can make peer pressure digital by doing the same thing on Facebook/Twitter/Google+/whatever. Peer pressure has two components: shame and praise. It’s motivating to avoid shame and to get praise. Do it because of a tweet and viola, you have digital peer pressure motivation.

Several books have recently popularized using money, in one form or another, as a motivational tool. There is some evidence, for instance, that people feel worse about losing $10 than they feel good about earning $10. This is called loss aversion, and it can easily be turned into a motivational hack. Having trouble finishing that book? Give 10 envelopes with $100 each to your best friend. Instruct them to mail the envelopes to your favorite (or most hated) charity for each month that you do not finish a chapter. Essentially, you’ve made your friend a “referee” of your motivational hack.