My daughter is an accountant. She took a statistics class in high school, and another as a requirement for her major. My son has taken a statistics course, and he is an English Literature major. I was a chemistry major in college and have an an MD and have never taken a statistics course. I don’t even recall a lecture on statistics in medical school. Mark Twain quoted Disraili as saying, “There are three kinds of lies: lies, damned lies and statistics.” Reading medical journal articles reporting on the benefits and lack of benefits when reported statistically can be really challenging. Reading a report of these, or worse listening to an interested party, like a sales rep or sponsored speaker talk about a study, requires being a skeptic. Here are some examples of how true statistics can be worse than a lie, and how what would seem to be common sense does not pay off.
Above the Fold
Half full. Half empty.
By PAUL LEVY
At a recent presentation, a respected doctor expressed some frustration with the criticism that is sometimes directed towards the medical profession. He pointed out that the medical community has actually done a very good job taking care of serious illnesses in the population. He noted that this is because doctors really devote their lives to improving patient outcomes.
To support this point, he presented the chart above from the AHRQ Center for Delivery, Organizations and Markets (full study here) that demonstrates improvement in hospital risk-adjusted mortality for important diagnoses and procedures. Whether you have a heart attack or pneumonia, or whether you have an aneurysm repair or a hip replacement, your chance of dying in a hospital has gone down over the years. (I know this data ends in 2004, but I would be confident that the trends have held.)
The Practical Consumer vs. The Illogical Deb Peel
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So it’s time for a little rant about everyone’s favorite privacy advocate, and the way she gets treated in the press—including by people who should know better (yes, I mean you, Inga at HERTalk, even though I am your favorite booth babe). I won’t overdo my previous statements about the illogical inconsistencies of Peel’s positions, and more to the point the utter one-sidedness of the utility of only caring about privacy breeches and nothing else. But it is time to remind everyone who’s rational and who’s the fruit loop.
Three different articles in recent days brought this up. Xconomy (the TechCrunch of Boston) had a long article about new “ich bin keine blogger” and modern linguist Jonathan Bush (CEO, athenahealth). In a good article, mostly about how athenahealth was spending more money on marketing and therefore making lower profits, Ryan McBride had a throwaway para at the end about a new athenahealth (still-under-wraps-and-likely-to-stay-there-for-a-while) product called athenacommunity. Here’s the offending para (and note that McBride annoys the athena PR gods by using a capital A when the name is lowercase!):
Athena might be able to halve the amount that physicians pay to use its EHR if they participate in what is now a nascent effort at the company called “AthenaCommunity.” Athena’s EHR customers who opt to share their patients’ data with other providers would pay a discounted rate to use Athena’s health record software. Athena would be able to make money with the patient data by charging, say, a hospital a small fee to access a patient’s insurance and medical information from Athena’s network. For a hospital’s part, this might be cheaper than paying its own staff to gather a patient’s information through standard intake procedures. Hallock, Athena’s spokesman, says the community is in development and is slated to launch later this year
Inga at HERTalk spied an opportunity to get Deb Peel some rant time. And based on that one snippet Peel went off:
When Medicare “Cuts” are Medicare “Savings”
In a post titled “Slowing Down that Revolving Readmissions Door” the New America Foundation’s Joanne Kenen writes about avoidable readmissions. “I once interviewed a patient who literally could not remember how often he had been hospitalized within just a few months,” Kenen recalls, referring to a story published in the Washington Post last year.
There, she reported that “one of five Medicare hospital patients returns to the hospital within 30 days–at a cost to Medicare of $12 billion to $15 billion a year—and by 90 days the rate rises to one of three, according to an analysis of 2007 data by Stephen Jencks.” Within a year, two out of three are back in the hospital—or dead—says Jencks who consults on this issue for the Institute for Healthcare Improvement (IHI).
This is money that health care reformers could use as we expand care to the uninsured. It’s worth noting that what many call “Medicare cuts” are really “Medicare savings”—billions that could be reclaimed if we rescued patients from that revolving door.
Under reform legislation, hospitals with particularly high rates of avoidable readmissions will have Medicare payments reduced, beginning in 2011. I would guess that some private insurers will follow Medicare’s lead.
A 21st Century Health Care Roadmap: The Path from Peril to Progress
By SUSAN BLUMENTHAL, MD and DENIS CORTESE, MD
A Commission of national health care experts convened by the Center for the Study of the Presidency and Congress (CSPC) has unveiled a roadmap and integrated approach that will help to put “health” back into our nation’s health care system as well as address key opportunities following passage of health care reform legislation.
The CSPC Commission on U.S. Federal Leadership in Health and Medicine: Charting Future Directions is releasing its second report, A 21st Century Roadmap for Advancing America’s Health: The Path from Peril to Progress, emphasizing a comprehensive spectrum of actions to build a 21st century system that will make America the healthiest nation in the world. Already, the CSPC Health Commission’s proposals have helped shape new Federal initiatives and are reflected in recent health reform legislation.
Now that historic health care reform legislation has been passed, it is critical to examine the next steps necessary to ensure that all Americans gain maximum value out of our current health care system, and that all of the key elements necessary to improve the health of the nation are addressed. While the United States spends over 17 percent of GDP on health care—nearly twice as much as any other nation—it ranks only 49th on life expectancy, and Americans get the right treatment just 55 percent of the time.
Is HITECH Working? #6: HITECH and Health Reform Objectives are Synergistic
By VINCE KURAITIS JD, MBA and DAVID C. KIBBE MD, MBA
….or to be more specific, HITECH is synergistic with payment reform that could come from the recently passed national health care reform legislation — the Patient Protection and Affordable Care Act (PPACA).
We’ll keep this post fairly short and try to avoid many of the more divisive aspects of this topic. The need for healthcare payment reform is well understood on both sides of the aisle:
Realizing the full potential of health IT depends in no small measure on changing the health care system’s overall payment incentives so that providers benefit from improving the quality and efficiency of the services they provide. Only then will they be motivated to take full advantage of the power of electronic health records. Dr. David Blumenthal, New England Journal of Medicine
, April 9, 2009
Even with Incentives, Docs May Forgo EHR Adoption
By JOHN MOORE
Yes, hospitals will adopt and meet meaningful use requirements as the future CMS penalties will simply be too painful to do otherwise. Private practices, however, may just forgo adoption and decide to not serve CMS (Medicare/Medicaid) patients. It remains to be seen what direction this will take but as I stated in a recent keynote at the PatientKeeper User Conference, the focus of EHRs and their successful deployment, adoption and use needs to be based on what is the value that is delivered to the end user, the physician/clinician. For too long and even today, all the grand talk of EHRs and adoption thereof focuses on the broader public good. Yes, there will be a broader public good but if we don’t get back to focusing on delivering true, meaningful value to the end user all this talk, incentives and promotion will fall on deaf ears and many a tax dollar will be wasted.Continue reading…
A Painful Story
This is a painful story to write.
A close friend of mine, in his 40’s, had a persistent light cough for many months. Finally, when he had an X-ray taken, it showed a large tumor on his lungs. He was diagnosed with stage 4 lung cancer. As a non-smoker and strapping, physically fit man, he was shocked, as you can imagine.
He went to his non-Boston-based medical practice, and he was told the prognosis was 12 to 18 months before he would die. They offered him, though, the chance to enroll in a clinical trial, based on a cocktail of chemotherapy agents.
Why You Ought To Be On Twitter
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Today we’re introducing a new feature on THCB. Every two weeks I’ll be broadcasting a brief segment with the folks at ReachMD, the radio station for doctors that broadcasts on XM satellite radio. If you like, you can have a listen to the inaugural broadcast here. (You’ll need to sign up first, but the process is quick and painless.) You’ll also probably want to take a minute to contribute to the quick web-based poll tied to the broadcast. Today’s, which can be found at the foot of this post, asks how healthcare professionals are using Twitter.
More than 100 million people now have a Twitter account and millions of Tweets are sent daily. The Library of Congress is archiving every tweet ever sent!
If you need catching up, Twitter is a service that lets you send very short messages called “tweets”. Anyone can “follow” your tweets, that is subscribe to your messages, and you can subscribe to anyone else’s Tweets.
Some hospitals have already started tweeting, including a few sending minute by minute updates from the OR. That may generate publicity, but it’s not the most worthwhile use of Twitter.
But what’s the use of tweeting? Should you be doing it?
The magic of Twitter is that it extends your reach. There are two ways to use Twitter – one is inbound. One of the things you can tweet is a web link. Almost all journals, media companies, and medical leaders tweet links to their articles and opinions. And other people and organizations you’re following are also tweeting articles and opinions from people and organizations they’re following. …. Now you’re seeing what a whole community of experts is looking at —with virtually no effort.
Gimme My Damn Data!
By DAVE deBRONKART, MD (e-PatientDave), VINCE KURAITIS, AND DAVID C. KIBBE, MD
So far in this series has looked at HITECH participation by hospitals (grumbling but in the game) and physicians (wary, on the sidelines), kudos for ONC’s three major policy points, and how HITECH is already moving the needle on the vendor side. Today we’re going to look at the reason the whole system exists: patients.
It’s possible to look at the patients issue from a moral or ethical perspective, or from a business planner’s ecosystem perspective. In this post we’ll simply look at it pragmatically: is our approach going to work? It’s our thesis that although you won’t see it written anywhere, the stage is being set for a kind of disruption that’s in no healthcare book: patient-driven disruptive innovation.
We’ll assert that in all our good thinking, we’ve shined the flashlight at the wrong place. Sure, we all read the book (or parts), and we talk about disruption – within a dysfunctional system.
If you believe a complex system’s actual built-in goals are revealed by its actual behavior, then it’s clear the consumer’s not at the core of healthcare’s feedback loops. What if they were?
We assert that to disrupt within a non-working system is to bark up a pointless tree: even if you win, you haven’t altered what matters. Business planners and policy people who do this will miss the mark. Here’s what we see when we step back and look anew from the consumer’s view:
- We’ve been disrupting on the wrong channel.
- It’s about the consumer’s appetite.
- Patient as platform:
- Doc Searls was right
- Lean says data should travel with the “job.”
- “Nothing about me without me.”
- Raw Data Now: Give us the information and the game changes.
- HITECH begins to enable patient-driven disruptive innovation.
- Let’s see patient-driven disruption. Our data will be the fuel.
1. We’ve been disrupting on the wrong channel.
The disruptive innovation we’ve been talking about doesn’t begin to go far enough. It’s a rearrangement of today’s business practices, but that’s not consumer-driven. Many pundits, e.g. the ever-popular Jay Parkinson, note that today’s economic buyer isn’t the consumer, which is screamingly obvious because consumer value isn’t improving as time goes by.
When we as patients get our hands on our information, and when innovators get their hands on medical data, things will change. Remember that “we as patients” includes you yes you, when your time comes and the fan hits your family. This is about you being locked in, or you getting what you want.
I (Dave) witnessed this in my first career (typesetting machines) when desktop publishing came along. We machine vendors were experts at our craft, but desktop publishing let consumers go around us, creating their own data with PageMaker, Macs and PostScript. Once that new ecosystem existed, other innovators jumped in, and the world as we knew it ended.
(Here’s a tip from those years: this outcome is inevitable. Ride with it, participate in it, be an active participant, and you can “thrive and survive.” Resist and within a generation you’ll be washed away.)
