Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] Value-Based Care’s Data Problem

From the 22 May 2015 post at The Healthcare Blog

I believe the concept of value-based care is good for healthcare. VBC encourages providers to make changes that put the patient at the center of care, so that different services can be provided across providers in a collaborative way. If all went according to the VBC vision, there would be fewer redundant tests, more emphasis on preventative care, and an effort to keep high-risk patients out of the emergency room. It’s also better for costs, something we desperately need in the US, where healthcare spending per capita is more than twice the OECD average.

But Lisa’s story, at the leading edge of the value-based experiment, is not good at all. ACOs and most other value-based models are new, constantly changing, and unproven. ACOs report on 33 metrics that are supposed to represent the quality of care provided by their networks of providers. While still extremely limited in scope, any more than 33 metrics would have made Lisa’s job impossible. So far, few ACOs have reported any savings. Worse — the metrics are unproven. What if they overemphasize standardized process over patient outcomes? And what if efficiency measures result in neglectful and impersonal care? A lot is riding on Lisa’s testing ground.

Screen Shot 2015-05-23 at 5.34.50 AM


The administrative challenge

By engaging with and learning from people like Lisa, I have begun to understand the problems frontier administrators face — the same problems countless others will face if we don’t address the administrative burden early on. Here are a few of the top headaches being rolled out in the name of value:

Selecting metrics

For ACOs, 33 metrics are tracked today. Inevitably, these will expand and change as accountable care evolves. There are also countless other systems of metrics encouraged by other incentive programs: the Physician Quality Reporting System measures, Meaningful Use metrics, Agency for Healthcare Research and Quality Indicators, the Consumer Assessment of Healthcare Providers and Systems for patient experience metrics, indicators for each specialty (Stroke and Stroke Rehabilitation Physician Performance Measurement Set, Endoscopy and Polyp Surveillance Physician Performance Measurement Set, and the Heart Failure Performance Measurement Set, to name a few). The document outlining protocols for the Physician Quality Reporting System is 18 pages long, with a mouthful of a title to match: “The 2015 Physician Quality Reporting System (PQRS) Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures.” Got that? A new piece of legislation that passed the House of Representatives last week — the “doc fix” bill — is about to revamp many of these requirements once again.

Collecting data

Lisa had to fumble through different electronic systems and paper charts to extract the relevant data for each patient in her panel at dozens of different clinics. In many cases, it was clear that care had been provided (e.g. an unstable patient had been upgraded from a cane to a walker), but the documentation wasn’t there (to fulfill the “Screening for Future Fall Risk” metric, documentation must state whether the patient had no falls, one fall without major injury, two or more falls, or any fall with major injury.) Therefore, even though care was provided to prevent future falls, the documentation did not meet the CMS requirement and no credit was given.

For the next reporting year, Lisa is designing her own reporting mechanisms for clinics and doctors. She says that her first reporting experience “was invaluable in learning ways to improve the reporting for year 2015 and beyond,” and she is putting processes in place to facilitate reporting next year. But each clinic is different: some need a page at the front of their paper chart with check boxes, and some have templates in their electronic health records. Her new processes may improve the situation, but additional tracking could also cut into time doctors spend with patients and add to the squeeze they already feel.

Integrating data

Lisa integrated all the data from each clinic manually, and this is a problem for small institutions who are trying to communicate and coordinate with each other. Right now it takes a long time and is not very scalable. Even at larger institutions with leading electronic health record systems, the data is locked away within proprietary databases, often in incompatible formats. Clinical data is rarely integrated with financial and patient-reported data in the way required to tie outcomes and claims to reimbursements in a value-based model.

Reporting

After all of her data collection, Lisa still had to submit her data to a third part to produce reports, and she will wait many months for the results. The CMS websites are comically complex ; the instruction manual for using the CMS metric reporting interface is 127 pages long.


Putting patients at the center

If these problems aren’t addressed, we’re in for a long and painful healthcare reform. Administrative costs will continue to rise, along with another generation of frustrated physicians and admins. Moreover, value-based care could be deemed a failure not because it’s a bad idea but because of poor implementation. Instead of putting patients at the center of care, it could breed more bureaucracy and force doctors to spend more time reporting on metrics and less time with patients.

We can address these issues and we must — to give value-based care a chance at moving the US toward more patient-centered, less exorbitant healthcare.

 

May 23, 2015 Posted by | health care | , , , , , , , , , | Leave a comment

[Research article] High value health IT: Policy reforms for better care and lower costs

From the 16 March 2015 Brookings news release

Achieving better health outcomes at a lower cost and succeeding with payment reforms that shift from volume to value is difficult without health information technology (IT). Health IT can engage and support health care providers, patients, and consumers with access to timely and accurate clinical information from electronic health records (EHRs) and other sources. It can also provide access to cost and coverage information that avoids burdensome administrative processes and unexpected costs. Health IT can achieve these benefits through interoperability across information and data exchange platforms – avoiding duplicative parallel systems and additional data entry. Engaged patients and providers, supported by flexible, usable and useful health IT, can make informed shared decisions about testing and treatment which can lead to more timely, efficient, and higher-value health care.

 

Download the issue brief.

March 21, 2015 Posted by | health care, Medical and Health Research News | , , , , | Leave a comment

[Reblog] Could mHealth Apps Be a Reprise of the EHR? The Need For Clinician Input

From the 14 February 2014 item at The Health Care Blog

……

“…. many app developers have little or no formal medical training and do not involve clinicians in the development process and may therefore be unaware of patient safety issues raised by inappropriate app content or functioning.”

Without the insights of seasoned real-world doctors and nurses, apps could end up with the same safety issues that are plaguing electronic health records, many of which were also developed with little regard to physician or nurse input.

In other words, just because it’s a “health” app doesn’t mean its necessarily so.

February 15, 2015 Posted by | health care | , , , , , , , | Leave a comment

[Reblog] What’s Next For Physician Compare? | The Health Care Blog

What’s Next For Physician Compare? | The Health Care Blog.

From the 22 January 2015 post

Screen Shot 2015-01-23 at 9.33.17 PMOf the many hidden gems in the Affordable Care Act, one of my favorites is Physician Compare.  This website could end up being a game changer—holding doctors accountable for their care and giving consumers a new way to compare and choose doctors.  Or it could end up a dud.

The outcome depends on how brave and resolute the Centers for Medicare and Medicaid Services (CMS) is over the next few years.  That’s because the physician lobby has been less than thrilled with Physician Compare, and, for that matter, with every other effort to publically report measures of physician performance and quality.

I’d give CMS a C+ to date.   Not bad considering it’s the tough task.  The agency has been cautious and deliberate.  But after the many problems with Hospital Compare, Nursing Home Compare, Home Health Compare, and Dialysis Facility Compare—not to mention the shadow of healthcare.gov’s initial rollout—that’s understandable.  They want, I hope, to get this one right from the get-go.  And competition from the private sector looms.

Congress mandated that CMS establish Physician Compare by Jan. 1, 2011 and that an initial content plan be submitted by Jan. 1, 2013.  CMS met those deadlines, albeit with a rudimentary site that launched in late December 2010.  The agency updated its plans in 2013 and 2014, even as it added more content and functionality to the site.

The law requires the site to have “information on physician performance that provides comparable information on quality and patient experience measures.”  That’s to include measures collected under the Medicare Physician Quality Reporting System (PQRS), Medicare’s main quality reporting vehicle, and assessments of:

  • patient health outcomes and the functional status of patients
  • continuity and coordination of care and care transitions, including episodes of care and risk-adjusted resource use
  • the efficiency of care
  • patient experience and patient, caregiver, and family engagement
  • the safety, effectiveness, and timeliness of care

Notably, Congress set no deadline for the site to meet those specifications or be fully operational.

So what’s posted so far?   The centerpiece of the site is a searchable directory of some 850,000 Medicare providers.  That includes most of the practicing doctors in the U.S. with the exception of pediatricians and other physicians who don’t treat Medicare patients.  This database predates the ACA and Physician Compare but its functionality, reliability and accuracy (a big complaint from physician groups) is being gradually enhanced.

Each doctor has his or her own profile page—a significant foundation that could accommodate quality and patient experience data in the future.

Consumers can also search three additional databases on the site.  They identify doctors and other clinicians who participate in (a) PQRS; (b) the Electronic Prescribing Incentive Program; and (c) the electronic health record (EHR) incentive program (also called the meaningful-use program).  About 350,000 physicians and other clinicians participate in the latter.

The bad news: these databases are separate and their content is not integrated.  That makes searching for information on a particular group practice or individual doctor cumbersome and time consuming.  And the databases aren’t user-friendly.  On the plus side, for researchers and health administrators, the databases are downloadable.

January 26, 2015 Posted by | health care | , , , , , , | Leave a comment

[Reblog] From a physician: A plea to big medical corporations

Next time my physician urges a screening, I’ll wonder if it is because of his concern for my health (most likely- knowing my physician) or his corporation’s interest in profit…
As this article outlines is that physicians in corporations are often

English: A doctor examines a female patient.

English: A doctor examines a female patient. (Photo credit: Wikipedia)

in Catch-22 positions.

From a November 2014 post at KevinMD

thought more highly of business folks until I started working for them.  I thought CEOs and boards of directors of companies had a vision, whether to maximize shareholder profit, or to produce a stellar product or provide a singular service, etc.  Once the vision was elucidated, everyone worked together like a team to make it happen.

Then I became employed by a large corporation as a family physician to provide medical care.  And it’s been one eye opening experience after another ever since.  To me, it’s quite simple.  The vision of a medical practice should be to provide good medical care while being cost conscious, and maintaining strong patient satisfaction.  That’s how all the money gets generated, right?  The patient pays his/her premium, part of which gets funneled to our large corporation, who is then tasked to provide care for that patient.  How is care provided to that patient?  By having a doctor see, talk to, examine and treat that said patient.

OK.  So we all know that it’s not quite that simple.  Enter primary care 2014, the world of risk adjustment factor (RAF) scores (which entail the corporation getting paid more for sicker patients), electronic health records (EHR), and quality metric incentive payments (the corporation gets more money from insurance companies by meeting certain goals in screening, like colonoscopies, mammograms, etc.).  Now health care has become more complicated.  But it’s still all based on that interaction we physicians have with our patients.  We can’t meet quality metric goals if we don’t see the patients, we can’t determine if they are sicker and therefore require more funds to care for if we don’t see them, and we can’t use EHR if we don’t see the patient.  There’s just a bunch of road blocks and distractions added in….

November 9, 2014 Posted by | health care | , , , | Leave a comment

IT maybe be helpful for your health! – Clinical decision support, CPOE get thumbs up from academics

Clinical decision support, CPOE get thumbs up from academics 

From the 22 January 2014 news article at EHRIntelligence

Formal academic studies about the implementation of clinical decision support (CDS) and computerized provider order entry (CPOE) are generally positive, according to a study of studies targeting the meaningful use of EHRs and associated technologies.  The report, published in the Annals of Internal Medicine, found that for the most part, health IT implementations were successful in reducing adverse events and increasing efficient and effective processes of care.  However, many key aspects of IT adoption have been underreported, including the reasons why implementations go awry, leading to significant gaps in the ability to study the industry’s progress.

Funded by the ONC, the research team found that at least 78% of studies focused on medication safety found positive effects from CPOE use.  The automated dose calculation features of the software helped reduce dosage errors anywhere between 37% and 80%.
Fifty-eight of the articles reviewed by the researchers addressed efficiency questions, and found that health IT was able to reduce costs in 85% of cases, even though a large number of studies also reported increased time and effort spent on electronic documentation.  Clinical decision support was associated with a 30% increase in adherence to infection prevention guidelines in one study, and a “substantial decline” in venous thromboembolism for patients in another.
Overall, positive findings from CDS and CPOE projects included shorter emergency department turnaround times, more time for clinicians to interact with patients, and better chronic disease management.  However, when individual studies reported negative or mixed findings, there were few clues in the literature as to why the problems manifested themselves or how to correct them.
Read the entire article here

 

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March 13, 2014 Posted by | health care | , , , , , | Leave a comment

5 Trends For Health CIOs In 2014 – InformationWeek

5 Trends For Health CIOs In 2014 – InformationWeek.

From the 23 December 2013 article at Information Week Health Care

Patient portals, direct messaging, and medical identity theft will keep healthcare execs on their toes in the new year.

Hackers Outsmart Pacemakers, Fitbits: Worried Yet?

Hackers Outsmart Pacemakers, Fitbits: Worried Yet?

(click image for larger view)

As healthcare CIOs are well aware, 2014 promises to be the year of “the perfect storm.” The potential impact of ICD-10 and Meaningful Use Stage 2, coupled with the transition to value-based reimbursement and new-care-delivery models, promise to overwhelm their budgets and burn out their already overworked staffs.

Nevertheless, there are some other trends healthcare CIOs should pay attention to in 2014, partly because of their bearing on the main events. Here are five significant trends.

1. Patient portals
Because of rising consumer interest in health IT, the industry transition to accountable care, and most of all, Meaningful Use Stage 2, patient portals are hot. Nearly 50% of hospitals and 40% of ambulatory practices already provide patient portals, according to a Frost & Sullivan report. The firm predicted that the value of the portal business would soar to nearly $900 million in 2017, up 221% from its worth in 2012.

[ What Obamacare sites can learn from online retail stores: Health Insurance Exchanges Struggle To Charm Customers. ]

KLAS Research, in a poll of 200 healthcare organizations, found that MU Stage 2 had made patient portals a “must-have” technology for doctors and hospitals. The government EHR incentive program requires providers to allow patients to access their health records electronically. In addition, providers must send care reminders and education materials to at least 10% of their patients. All of these tasks are most easily done through portals attached to EHRs. But there’s also some interest in untethered, standalone portals that can help patients assemble their records from multiple providers in one place.

 

….

Read the entire article here

 

January 2, 2014 Posted by | health care | , , , , , , | Leave a comment

NLM Director’s Comments Transcript Care Benefits from EHRs: 10/28/2013

English: MedlinePlus logo

English: MedlinePlus logo (Photo credit: Wikipedia)

 

From the 28 October 2013 Director’s Comments Blog

 

Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I’m Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what’s new this week in MedlinePlus.listen

Emergency room use and hospitalization rates for diabetes patients declined after a large California medical provider introduced an electronic health records system, finds a five year study recently published in the Journal of the American Medical Association.

The study of 170,000 Kaiser Permanente Northern California diabetes patients (from 2004-2009) found an average of 501 emergency department visits per 1000 patients declined to 490 after Kaiser’s clinics began to use an electronic health records system (EHR) for outpatient treatment.

The study found an average of 252 hospitalizations per 1000 diabetes patients declined to 238 per 1000 after Kaiser Permanente’s clinics used the health care provider’s EHR. The specific hospitalizations for ambulatory care-sensitive conditions also fell from a mean of 67 per 1000 to about 60 per 1000 diabetes patients after the use of an EHR for diabetes outpatient treatment.

The comparative, overall declines in emergency department visits and aforementioned hospitalizations among Kaiser Permanente’s diabetes patients were statistically significant, or did not occur by chance. There was no overall difference in the frequency of patient visits to a physician’s office after Kaiser’s clinics began to use the health system’s EHR.

The study’s nine authors estimate Kaiser’s cost savings from reduced emergency department and hospitalizations were about $158,478 per 1000 patients each year. Overall, they write (and we quote): ‘the estimated reductions in emergency department (ED) visits and hospitalizations that we identified for patients with diabetes may have potential to affect ED and hospitalization costs’ (end of quote).

The authors acknowledge future research needs to provide a more comprehensive assessment of the cost savings after the implementation of an EHR. They add the findings are limited to diabetes patients within one large health care provider (within one U.S. state) and may not be generalizable to other states and different medical systems. For example, the authors explain the reductions in emergency department use and reduced hospitalizations were not uniform among all of the 17 Kaiser Permanente clinics where the five year study was conducted.

On the other hand, the authors note the study is the most comprehensive to date about the impact of outpatient EHR use on adverse health outcomes. The authors explain they assessed diabetes patients in order to observe the impact of EHR use on an outpatient basis among adults with a chronic (or ongoing) medical condition over time.

The authors conclude (and we quote): ‘We extend the evidence of EHR-related improvements in care delivery by further describing statistically significant modest reductions in downstream adverse health outcomes measured by ED visits and hospitalizations’ (end of quote).

Meanwhile, MedlinePlus.gov’s personal health records health topic page provides information about the physician adoption of EHRs in the ‘statistics’ section. Information about the adoption of EHRs within residential care communities and office-based physicians also is provided within the same section.

A overview that explains how and why EHRs are implemented in medical centers is available in the ‘MedlinePlus Magazine’ section of MedlinePlus.gov’s personal health records health topic page.

A helpful explanation (from the National Institutes of Health) about how to protect the privacy and security of your health information is available in the ‘related issues’ section of MedlinePlus.gov’s personal health records health topic page.

MedlinePlus.gov’s personal health records health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about personal health records (and EHRs) as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s personal health records health health topic page, type ‘personal health records’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘personal health records (National Library of Medicine).’

 

Before I go, this reminder… MedlinePlus.gov is authoritative. It’s free. We do not accept advertising …and is written to help you.

To find MedlinePlus.gov, just type in ‘MedlinePlus.gov’ in any web browser, such as Firefox, Safari, Netscape, Chrome or Explorer. To find Mobile MedlinePlus.gov, just type ‘Mobile MedlinePlus’ in the same web browsers.

We encourage you to use MedlinePlus and please recommend it to your friends. MedlinePlus is available in English and Spanish. Some medical information is available in 43 other languages.

Your comments about this or any of our podcasts are always welcome. We welcome suggestions about future topics too!

Please email Dr. Lindberg anytime at: NLMDirector@nlm.nih.gov

That’s NLMDirector (one word) @nlm.nih.gov

A written transcript of recent podcasts is available by typing ‘Director’s comments’ in the search box on MedlinePlus.gov’s home page.

The National Library of Medicine is one of 27 institutes and centers within the National Institutes of Health. The National Institutes of Health is part of the U.S. Department of Health and Human Services.

A disclaimer — the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider.

It was nice to be with you. I look forward to meeting you here next week.

 

 

 

 

November 3, 2013 Posted by | Consumer Health, health care | , , , , , , , , , | Leave a comment

[Reblog] Forms do not keep patients out of hospitals

A patient having his blood pressure taken by a...

A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)

 

From the 21 October 2013 KevinMD.com article by Kathy Neider, Physician

 

Over one year ago my office implemented an EHR (electronic health record). I’ve not done a note on paper since.

Last week, a Transition of Care (TOC) document was placed on my desk with a sticky note stating: “Dr. Nieder please fill out this form so we can bill a 99496 for your visit with Mrs. Jones yesterday.”

 

I pick up two sheets of paper with multiple questions including:

  • discharge Medications: (list)
  • present Medications: (list)
  • diagnostic tests reviewed/disposition (list)
  • disease/illness education (discussion documentation)
  • home health/community services discussion/referrals: (list)
  • establishment or re-establishment of referral orders for community resources: (list)
  • discussion with other health care providers: (list)
  • assessment and support of treatment regimen adherence: (discussion documentation)
  • appointments coordinated with: (list)
  • education for self-management, independent living and activities of daily living: (discussion documentation)

Please remember, I am now on an EHR. So I am expected to document electronically first then manually fill out forms. I have no discharge summary yet from the hospital.  The medications when she left the hospital state “resume pre-admission meds.” In order for me to list what tests she had I log in to the hospital portal and look them all up. Some of them have been scanned into my EHR, some not. She had a straight forward admission for a small bowel obstruction. She declined to keep the surgeon’s appointment as she was told there was nothing he could do for her.

A TOC visit is paid at a higher rate than other visits if the patient does not return to the hospital in the following 30 days. Hence, we hold the billing until that time. My understanding of the purpose of this new code is to improve coordination of care as a patient transitions from the hospital to home. Coordination would imply that there are other individuals involved and thus there is improved communication between us.

However my staff and I bear the brunt of gathering information (which is what we normally do anyway, so I guess it’s nice because now we get paid for it).

At what point will it become incumbent upon the hospital to send me the necessary information for treating the patient now that he/she is home again? How does it follow that improving care means the primary care doctor fills out even more forms, ultimately reducing the time spent with the patient?

The form will not keep the patient out of the hospital. Communication can keep the patient out of the hospital. True coordination of care might keep the patient out of the hospital. More busy work for the patient’s primary care doctor will not. Since the order of the day is using hospitalists, it is imperative that we improve our communication systems at the time of discharge and before the patient is seen again in the primary care office. Systems must stop thinking that one more form is going to save the patient. Especially another form on my back.

Kathy Nieder is a family physician who blogs at Family Practice 2.0.

 

 

November 3, 2013 Posted by | health care | , , , , , | Leave a comment

Patient engagement: Going from email to secure messaging

From the December 7, 2012 post at EHR Intelligence

For providers apprehensive about increasing demands for patient engagement, a small dose of email could get them on their way toward becoming comfortable with the idea as well as the practice. “For the organizations who’ve pushed patient portals the furthest into their patient base, email is always the place where things started,” argues Avado CEO Dave Chase in a recent contribution toForbes. According to Chase, email is the equivalent of a gateway drug in the context of patient engagement able of easing providers’ concerns about additional work and responsibility that they fear having to undertake by making themselves more available to their patients.

“Physicians are understandably concerned about being overwhelmed by emails if they provide an option for secure messaging,” writes Chase. “Interestingly, the physicians who have given out their phone number or enabled secure email (without remuneration) haven’t found they are overwhelmed by any means.”
Given that so much of medicine is built on evidence-based studies, research findings should compel providers to at least acknowledge the benefits of engaging with patients electronically. Kaiser has continued to show that electronic patient engagement can lead to improve patient outcomes for those with chronic disease as well as maintain the loyalty of patients who will remain customers of the healthcare organization’s services………
…….

 

December 11, 2012 Posted by | health care | , , , | 1 Comment

Digital medicine: Patients are stuck in the precarious middle

Health Applications for Android Tablets

Health Applications for Android Tablets (Photo credit: IntelFreePress)

From the 15 October 2012 post by JOHN SCHUMANN, MD at KevinMD.com

The use of computers in everyday medical practice has finally reached the tipping point.

The HITECH Act, part of the 2009 federal stimulus bill, has been the final kick in the pants that U.S. health care has long needed to make the conversion to digital. The act states that, by employing electronic health records (EHRs) in a fashion known as meaningful use, doctors are individually eligible for Medicare subsidies of $44,000, paid out over five years. Before now, only early adopters and deep-pocketed institutions like hospitals and large medical groups could afford the investment to convert to EHRs.

In general, EHRs are secure digital repositories of patient information–doctors’ notes, lab and X-ray reports, and letters from specialist physicians. They are an electronic version of the paper chart. Newer, more advanced EHRs are integrated systems and allow doctors to order tests, generate bills, communicate with patients, and run analyses on aggregate patient data. In hospitals, nurses use EHRs to administer and record medication dosing and document other patient care activities.

Though medical practices have a high burden of proof to claim their bonus–the Department of Health and Human Services is still in the process of fully defining just what constitutes ‘meaningful use’–there is now conclusive evidence that the carrots are working. Recent data demonstrates that solo and two-doctor offices, which still comprise over half of all medical practices in the U.S., have seen the biggest jump in EHR adoption over the last six months. These small shops are reaching the conclusion that they must.. participate, as they risk being left behind technologically and financially…

..

No one describes this more elegantly than doctor and author Abraham Verghese, who has lamentedthe rise of the “iPatient.” For Verghese, the iPatient symbolizes the adoption of technology to a level that is eroding the foundational elements of the profession, like the physical examination. He decries trainees spending vastly more time at computer stations looking over their ‘virtual’ patient [the collection of progress notes plus lab and x-ray data, not an avatar] than giving face time to the sick person down the hall. Other commentators describe the sloppy habits of ” copy and paste” medicine, in which doctors (especially trainees) perpetuate the same patient histories from one hospital admission to the next without applying fresh thinking. [Human nature is no different among doctors: Where possible, we take the path of least resistance.]

Further, doctors and nurses are now tethered to computer appliances. To perform any basic hospital function (e.g. admission, lab test, x-ray, pill delivery, discharge), an order needs to be sent via the computer system. The good in this is that all doctors’ orders go through one standardized entry point: It eliminates issues with poor physician penmanship. However, the technology inhibits doctors and nurses from actually talking to one another…

There is hope, however. Bryan Vartabedian, a pediatric gastroenterologist and social media enthusiast in Texas, gives voice to the possibilities of doctor-patient collaboration using technology. In a blog post about his visit to an orthopedic surgeon for back problems, Vartabedian writes (italics mine):

…through the course of my visit he never touched me. We spent an extraordinary amount of time examining my MRI. Together in front of a large monitor we looked at every angle of my spine with me asking questions. I could see firsthand what had been keeping me up at night. I could understand why certain positions make me comfortable. What we drew from those images could never be determined with human hands. In my experience as a patient, I consider it one of my most thorough exams.

Vartabedian is describing a new paradigm, in which he plays the role of empowered patient and demands an explanation to his level of satisfaction. In the parable offered, the technology is the medium, not the message….

 
  • e-patient Dave de Bronkart was successfully treated for kidney cancer at a very late stage. He credits his recovery to using the Internet to find trusted medical information as well as to get advice from patients via support groups.

His video Let Patients Help outlines how and why patients should empower themselves.
Some video highlights

    • Patients are presently the most underutilized part of the health team
    • The e-patient movement is at least partly based on hippie ideals of self-reliance and self-care (think Whole Earth Catalog)
    • e-patients are empowered, engaged, equipped and enabled through finding information to use in discussions regarding treatment options with their health care providers
    • Support groups often are useful in providing information not available at other sites (as which doctors specialize in certain treatments)
    • Patients not only need quality information, but also access to their raw medical data

October 16, 2012 Posted by | health care | , , , , | Leave a comment

Better medicine, brought to you by big data through new types of data analysis

 

A good overview of how improved data analysis and presentation is improving health care delivery.

I especially liked the slideshare presentation found below in Related Articles.
The 42 slides in Big data – a brief overview outlines what big data is, its sources and processes, how it is analyzed, current “players”,examples, market analysis, future, and opportunities.

From the 15 July 2012 blog post at Gigaom

Slowly but surely, health care is becoming a killer app for big data. Whether it’s Hadoop, machine learning, natural-language processing or some other technique, folks in the worlds of medicine and hospital administration understand that new types of data analysis are the key to helping them take their fields to the next level.

Here are some of the interesting use cases we’ve written about over the past year or so, and a few others I’ve just come across recently. If you have a cool one — or a suggestion for a new use of big data within the healthcare space — share it in the comments:

Genomics. This is the epitomic case for big data and health care. Genome sequencing isgetting cheaper by the day and produces mountains of data. Companies such asDNAnexusBina TechnologiesAppistry and NextBio want to make analyzing that data to discover cures for diseases faster, easier and cheaper than ever using lots cutting-edge algorithms and lots of cloud computing cores.
BI[definition of business intelligence] for doctors. Doctors and staff at Seattle Children’s Hospital are using Tableau to analyze and visualize terabytes of data dispersed across the institution’s servers and databases. Not only does visualizing the data help reduce medical errors and help the hospital plan trials but, as of this time last year, its focus on data had saved the hospital $3 million on supply chain costs….
..Semantic search. Imagine you’re a doctor trying to learn about a new patient or figure out who among your patients might benenfit from a new technique. But patient records have been scattered throughout departments, vary in format and, perhaps worst of all, all use the ontologies of the department that created the record. A startup called Apixio is trying to fix this by centralizing records in the cloud and applying semantic analysis to uncover everything doctors need, regardless who wrote it…
..Getting ahead of disease. It’s always good if you figure out how to diagnose diseases early without expensive tests, and that’s just what Seton Healthcare was able to dothanks to its big data efforts…
and more!

July 17, 2012 Posted by | health care, Medical and Health Research News | , , , , , , , , , , , , , , , , , , | Leave a comment

Wale Based “Do Lectures” Presented by People Who Do so the Rest of us can be Inspired Inspire Others

From the About Page

The idea is a simple one— that people who Do things can inspire the rest of us to go and Do things, too. So each year we invite a set of people down here to come and tell us what they Do. They can be small Do’s or big Do’s or just extraordinary Do’s. But when you listen to their stories, they light a fire in your belly to go and Do your thing, your passion, the thing that sits in the back of your head each day, just waiting, and waiting for you to follow your heart.

A number of the lectures are health related .  Good approaches through the Do Lecture home page include the Well-Being and Challenging links.

GIVING PATIENTS CONTROL OF THEIR HEALTH RECORDS was very persuasive in explaining patients naturally should not only have access but control because they are the only ones going to all the consultations. I also was astounded by a few facts previously unknown to me. For example 95 % of UK doctors use electronic records as compared to only 5% of US doctors. And UK patients use the internet more so than US patients.
This site was found via The Scout Report (https://scout.wisc.edu),a service of the  University of Wisconsi-Madison  finding, filtering, and presenting online information and metadata since 1994.

May 30, 2012 Posted by | Educational Resources (High School/Early College(, Health Education (General Public) | , , , , | Leave a comment

E-health Records Should Play Bigger Role In Patient Safety Initiatives, Researchers Advocate

From the 20th July Medical News Today article

Patient safety researchers are calling for the expanded use of electronic health records (EHRs) to address the disquieting number of medical errors in the healthcare system that can lead to readmissions and even death. Their commentary is in the July 6 issue of JAMA, The Journal of the American Medical Association.

“Leading healthcare organizations are using electronic health records to address patient safety issues,” said Dean Sittig, Ph.D., co-author and professor at The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics. “But, the use of EHRs to address patient safety issues hasn’t hit the mainstream yet and we think everyone should be doing this.”

One way to fast-track the use of EHRs to address patient safety issues would be to incorporate the annual patient safety goals of The Joint Commission, a healthcare accreditation organization, into the criteria for the certification of EHRs, said co-author Ryan Radecki, M.D., who is scheduled to join the UTHealth faculty Aug. 1….

Click here to read the rest of the news article

July 22, 2011 Posted by | Medical and Health Research News | , , , , | Leave a comment

   

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