Healthcare Bowl 2017: Atlanta vs New England

By Clive Riddle, February 3, 2017

The Atlanta Falcons and New England Patriots square off this Sunday in Houston during a Lady Gaga concert (the halftime show.) But another performance between this two cities is playing out on a daily basis – healthcare indicators. Let’s see how Atlanta vs. New England stack up in a healthcare bowl.

Instead of the venue for this comparison being NRG stadium in Houston, we find ourselves at The Big Cities Health Coalition, a “forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of the 54 million people they serve.” Their playing field is a Data Platform that features over 17,000 data points across 28 large cities.

Here’s the selected results from their data platform. Let’s score 7 points when one city’s indicator bests the US average and the other city is below the US average, and 3 points the better city when both or neither best the US average. Data is from 2013, and represents Fulton County for Atlanta and the Boston metropolitan area for New England.

• ·         Uninsured Rate: Atlanta 16.9%; Boston 4.4%; US 14.5%. New England takes a 7-0 lead.

• ·         Adult Obesity Rate: Atlanta 25.4%; Boston 21.7%; US 28.3%. New England extends their lead to 10-0.

• ·         Heart Disease Mortality per 100,000:  Atlanta 157.3; Boston 133.6; US 169.8. New England goes up 13-0.

• ·         Diabetes Mortality per 100,000: Atlanta 19.3; Boston 19.4; US 21.2. To close to call. The score at halftime remains New England 13, Atlanta 0.

• ·         Asthma Annual ER visits per 10,000: Atlanta 49.8; Boston 125.8%; No US average provided. Atlanta now trails 13-3.

• ·         Opioid related unintentional drug overdose mortality rate per 100,000: Atlanta: 9.4; Boston 16.8; US 4.2. Atlanta cuts further into the lead, now trailing 13-6

• ·         Smoking: Atlanta 16.0%; Boston 18.4%; US 17.9%. Atlanta ties the score 13-13.

• ·         All Cancer Mortality per 100,000: Atlanta 159.3; Boston 176.1; US 163.2. Atlanta wins 20-13.

There you have it – Atlanta wins the Healthcare Bowl 2017 by a score of 20-13.

Living in a Retro Health Care System

by Kim Bellard, January 26, 2017

Living in the 21st century is cool, right?  We've got smartphones, ultra-thin tablets, the Internet, wearables, Uber, self-driving cars, virtual/augmented reality, drones, digital currency, and all the TV/movies/music you could want available for streaming anytime, anywhere.  It makes Back to the Future II's 2015 look drab by comparison (except maybe for the hoverboards!).   

So why does it seem like so many people are entranced with the 1980's?

Take, for example, the resurgence of vinyl. Vinyl is back, set to become a billion dollar industry (again).  

People are falling in love with cassette tapes again.  Their sales rose 74% in 2016. People are even inventing new ways to listen to old formats.  The Verge reports on Love, "the first intelligent turntable.”  

Retro isn't confined to music.  One of the hottest Christmas presents was the Nintendo NES Classic. Hey, we've got the Today show doing a 1970 retro show, the NFL going crazy with throwback uniforms, and the predicted reemergence of flip phones.  People even want retro computers.  

If any industry would keep its eye relentlessly on the future, you might expect it would be health care.  Few of us would want to go back to what health care was like in the 1980's, and none of us would accept the health care of the 1950's (except maybe those house calls).  

No, in health care we expect the kind of futuristic -- or, at least, modern -- experience that tech-based start-ups are promising.  If health care went retro, why, we'd usually make appointments to see our doctors in their offices instead of seeing them on-demand 24/7, wait long periods in their bland waiting rooms, fill out lots of paperwork, have our white-coated doctor listen to us with their stethoscope, have lots of unnecessary or even harmful tests and procedures, even have our information sent by fax.  No one would want to go back to all that.

Oh, wait -- that is our health care system, for the most part.  It hasn't gone retro because we haven't yet moved past retro.  

Get this: fax machines remain the predominant form of communication in health care, with fax volume hitting new records.  That's not retro, that is insanity.  

Get this: physicians hate their EHRs so much that they are cited as a leading reason for physician burnout, and in their frustration with them physicians are turning to medical scribes to do the inputting.  

Get this: after seeing a consumer revolt in the 1990's against managed care's capitation, small provider networks, and restrictive medical management, they're all back in vogue, in one form or another.

I get retro.  But I do not want to get care in a retro health care system.  

EHRs are a perfect example of how we took something that should revolutionize health care, and turned it into something that not only no one is happy with but that many feel often impedes care, to the point some want to go back to paper records.  We didn't do the wrong thing with EHRs, we just are doing it wrong.

We should be thinking big and bold about how we want our health care system to work in the 21st century.   We should be looking forward, not backward. We have all the technology we need to make our health care experience, well, if not like magic, then certainly more like a 21st century health care should seem.  Let's get there first -- then maybe we can think about how we can do some cute retro to it.  

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Understanding Impact of Socioeconomic Data on Health Outcomes

By Claire Thayer, January 26, 2017

While advancements in medical technologies have contributed to improved health outcomes, health care systems are increasingly retooling their focus to understanding the basic socio determinants of health, the underlying factors of how socio and economic conditions are correlated to health outcomes of patient populations along with the role of local communities in addressing these issues.  As health care providers undertake more risk with population health management and value-based payment arrangements, health care providers are being held accountable not only health care costs, but also the health of their patient populations.

The CDC outlines some of the factors related to health outcomes as:

• ·         How a person develops during the first few years of life (early childhood development)
• ·         How much education a person obtains
• ·         Being able to get and keep a job
• ·         What kind of work a person does
• ·         Having food or being able to get food (food security)
• ·         Having access to health services and the quality of those services
• ·         Housing status
• ·         How much money a person earns
• ·         Discrimination and social support

This week, a special edition of the MCOL Infographic, co-sponsored by LexisNexis Health Care, highlights many of the key socioeconomic factors impacting health outcomes for patient populations:

 

Additional reading:

Tackling Patients’ Social Problems Can Cut Health Costs, Kaiser Health News, January 23, 2017

Socio Determinants of Health: Know What Affects Health, CDC

Healthy People 2020 – Socio Determinants of Health, Health People.gov

Using Social Determinants of Health Data to Improve Health Care and Health: A Learning Report, Robert Wood Johnson Foundation, May 2016

Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Kaiser Family Foundation, November 4, 2015.

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

No Thanks, I Already Have Number

By Kim Bellard, November 17, 2016

Health care has a problem.  Well, of course, it has many problems, but one of them is that the various parties involved in the health care system can't agree on who we are.   Twenty years ago HIPAA called for creation of unique patient identifiers to accomplish this task, but within two years Congress put this on hold until further notice, and we're still waiting.

Everyone used to use social security numbers for this purpose, until we finally figured out the folly of that (especially since that number was never intended to be used as a national identification number).

News flash; we already have a unique, non-government-issued identifier: it's called a cell phone number.

It's obvious why we want a universally accepted patient identifier.  Providers and insurers have to agree on who you are to exchange claims and payments.  Different providers have to agree on who you are if we're ever going to get to interoperability of health information.

We can't/shouldn't use social security numbers, and not everyone has a drivers license number.  Health insurance numbers change whenever you change insurers, or even stay with the same insurance company but change employers.  What to do?

Thus the cell phone number.

According to the Pew Research Center, in 2015 92% of U.S. adults had a cell phone. That's not everyone, but not everyone has a social security number either.  When you do business with almost any organization these days, you are likely to be asked to provide your email and cell number number.

The New York Times reported on how the cell phone numbers have already become a widespread identifier.  As a security consultant told them, it has become "kind of a key into the room of your life and information about you."

As The Times pointed out, there are no legal requirements for companies who have your cell phone number to keep it private, unlike protected health information (PHI).  To be fair, they also noted how poorly protected social security numbers have been as well, leading to billions of dollars in annual fraud losses.  With cell phones, though, hackers have shown that, once they have your number, not only can they link you to various databases, but they can also listen to your phone calls, read your texts, even track your location.

However, it's not all bad news.  You can lock your phone or change your number if you think your cell phone number has been breached.

Like it or not, our cell phones are becoming our lifelines to the world, including but in no way limited to health.  Health care might as well acknowledge that fact, the way that most other industries are already starting to.  You can send money to someone using just their cell phone number; why not file a claim or link electronic records?

Don't want to use your cell phone number as your identifier?  OK, get a free Google Voice number, or use an app like Sideline to add a free second number to your existing mobile phone.

Meanwhile, most systems even in health care already can and probably do store our cell phone numbers.  It'd be just like health care to develop an expensive new solution to a problem.  For once, could we go the obvious route?

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Will Anyone Notice?

By Kim Bellard October 13, 2016

There's an interesting verbal battle going on between two prominent tech venture capitalists over the future of AI in health care. Marc Andreessen asserted that Vinod Khosla "has written all these stories about how doctors are going to go away...And I think he is completely wrong."  Mr. Khosla was quick to respond:  "Maybe Mr. Andreessen should read what I think before assuming what I said about doctors going away."

It turns out that Mr. Khosla believes that AI will take away 80% of physicians' work, but not necessarily 80% of their jobs, leaving them more time to focus on the "human aspects of medical practice such as empathy and ethical choices."  That is not necessarily much different than Mr. Andreessen's prediction that "the job of a doctor shifts and becomes a higher-level, more important job that pays better as the doctor becomes augmented by smarter computers."

When AIs start replacing physicians, will we notice -- or care?

Personally, I think it is naive to expect that only 20% of physicians' jobs are at risk from AI, or that AI will lead to physicians being paid even more.  The future may be closer than we realize, and "virtual visits" -- telehealth -- may illustrate why.

Recently, Fortune reported that over half of Kaiser Permanente's patient visits were done virtually, via smartphones, videoconferencing, kiosks, etc.  That's over 50 million such visits annually.  

Sherpaa, a health start-up that is trying to replace fee-for-service, in-person doctor visits with virtual visits.  Available with a $40 monthly membership fee, the visits are delivered via their app, tests or emails.  Their physicians can order lab work, prescribe, and make referrals if needed.

How many people would notice if virtual visits were with an AI, not an actual physician?  

Companies in every industry are racing to create chatbots, using AI to provide human-like interactions without humans.  And health care bots are on the way.

Not everyone is convinced we're there yet.  A new study did a direct comparison of human physicians versus 23 commonly used symptom checkers to test diagnostic accuracy, and found that the latter's performance was "clearly inferior."  The symptom checkers listed the correct diagnosis in their top 3 possibilities 51% of the time, versus 84% for humans.  

However, consider the symptom-checkers may be the most commonly used, but may not have been the most state-of-the-art.  And the real test is how the best of those trackers did against the average human physician. Humans still got the diagnosis wrong is at least 16% of the cases.  They're not likely to get much better (at least, not without AI assistance).  AIs, on the other hand, are only going to get better.  

It used to be that physicians were sure that their patients would always rather wait in order to see them in their offices, until retail clinics proved them wrong.  It used to be that physicians were sure patients would always rather see them in person rather than use a virtual visit (possibly with another physician), until telehealth proved them wrong.  And it still is true that most physicians are sure that patients prefer them to AI, but they may soon be proved wrong about that too.

AI is going to play a major role in health care.  Rather using physicians to focus more on empathy and ethical issues, as Mr.  Khosla suggested (or paying them more for it, as Mr. Andreessen suggested), we might be better off using nurses and ethicists, respectively, for those purposes.  So what will physicians do?

The hardest part of using AI in health care may not be developing the AI, but in figuring out what the uniquely human role in providing health care is.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Out With the Old...Wait, Not in Health Care

By Kim Bellard, August 16, 2016

The last company still manufacturing VCRs announced it has ceased their production.  VCRs had a good run, most households had one, but their time has passed.  Meanwhile, the stethoscope is celebrating its 200th birthday, and is still virtually the universal symbol for health care professionals.  

There has got to be a moral in there somewhere. VCRs are a classic example of how technology (usually) moves on.  Except in health care.

Like stethoscopes.  Digital advocate Dr. Eric Topol recently tweeted: "The stethoscope's 200th birthday should be its funeral. That's all well and good, but -- to paraphrase Mark Twain -- reports of its death are greatly exaggerated.

It's not like stethoscopes do all that good a job, or, perhaps, that physicians use them all that well.  A 2014 study found that participants only detected all tested sounds 69% of the time.  As the authors diplomatically concluded, "a clear opportunity for improving basic auscultations skills in our health care professionals continues to exist."   

Oh, and stethoscopes also help carry germs.

And it's not like there aren't alternatives.  As one might expect in the 21st century, there are electronic/digital stethoscopes.  There are also handheld ultrasounds that provide another strong alternative.

And now, of course, there are smartphone apps for stethoscopes.  Apple was claiming 3 million doctors had downloaded its $0.99 stethoscope app as long ago as 2010, with Android versions also available.  

And yet stethoscopes hang in there.  

We might like to think that physicians continue to use traditional stethoscopes because they are simply being thrifty, since electronic stethoscopes and handheld ultrasounds are much more expensive, but that seems a reach.  They've certainly not been reluctant to adapt other types of newer, more expensive technology -- at least, not as long as they can charge more for it.  

It is a conundrum that has bedeviled economists: why in health care does new technology almost always increase costs, unlike most other industries?  E.g., DVRs were much better than VCRs, but quickly became comparably priced.  Professor Kentaro Toyama cites what he calls technology's Law of Amplification: "Technology’s primary effect is to amplify, not necessarily to improve upon, underlying human inclinations."

And in health care, those underlying inclinations don't drive towards greater value.

When it comes to stethoscopes, it's not about the money.  Many physicians believe that the stethoscope helps foster the patient-physician relationship.  In a recent article in The Atlantic, Andrew Bomback admitted that, "Indeed, for many doctors (myself included), the stethoscope exam has become more ceremony than utility."  

Physician/engineer Elazer Edelman argues that a stethoscope exam can help to create a bond between patients and physicians.  He worries that technology may be fraying the "tether" between doctors and patients. Still, if the relationship depends on which device a physician uses to listen to our chest, that relationship is in bigger trouble than we think.

So, R.I.P. VCRs, and thanks for the memories.  As for stethoscopes, and for health care more generally, though, maybe the moral is that we should focus less on status symbols and more on what is best for patients.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

What Pokémon Go Means for Health Care

By Kim Bellard, July 21, 2016

In recent days there have been a flood of stories trying to explain the Pokémon Go craze.  
Many -- e.g., The New York Times and Fast Company -- believe that Pokémon Go is finally going to make augmented reality mainstream, as well as showing AR's advantages over virtual reality, since the latter typically requires at least a headset plus a high powered PC.  It makes AR quick, easy, and free, teaching players how AR can seamlessly fit into the real world.

The game has players wandering around their neighborhoods, their eyes torn between their phones and the real world, visiting places they never stopped at before and meeting people they might never have talked to before.  People are already talking up the game's health benefits.  The New York Timesreports that it "has kids on the move."  More importantly, when people are playing the game they are not sitting passively behind a screen in their house.

Pokémon Go is not, by itself, going to lead to dramatic improvements in the nation's health.  Nor was it intended to.  It is, however, yet another example about we can use games, or at least gamification, can help us with our health.

However promising gamification in health care may be, it is the AR that may well hold the most promise for health care.  Google was not wrong to pursueGoogle Glass, just premature.  Pokémon Go may be signaling that we're now finally ready for AR, and that it will be consumers as well as professionals who can benefit from it.

The potential uses in health care are virtually endless, but here are a few examples:

• Ever been lost in a hospital, meandering haphazardly despite various signs and color-coded arrows?  How much better would an AR map be?  
•  Ever feel like your doctor spends too much time staring at your chart or a screen?  Instead of looking there for information about you, how much better would it be if he/she was looking at you, with AR notations for key information about you?  
•  Ever not understand what your doctor is telling you about your diagnosis or treatment?  It is well documented how few patients leave their doctors office/ER/hospital understanding what they were told.  How much better it would be if your phone could listen to the conversation, and provide AR "translations" into layman's terms of what is being said?  
• Ever been told you needed a prescription, a test, or other treatment, and wondered how much it might cost?  You might have even asked your doctor, who most likely doesn't know either.  How much more powerful transparency efforts would be if those prices showed up as AR in the place of service at the time of the discussion about them, again with both the patient and the doctor seeing them?
• Ever make "bad" food choices, despite calorie and nutritional information more omnipresent on labels and menus?  How much better would an interactive AR display of the information be?

Health care has no shortage of information.  Its problem is more making that information accessible to the right people, at the right time.  This is the real potential of AR, and figuring out how to do so in as impactful yet unobtrusive way will be the challenge for developers.

Pokémon Go is not the model for the future of health care, but it offers a model for it we should be paying attention to.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Millennials Are (Not) So Different

By Kim Bellard, June 24, 2016

If we believe conventional wisdom about them, they like to live with their parents, at least until they can move into their urban-center condo.  They hate to drive.  They're maddening in the workplace, demanding lots of frills and constant praise yet returning little loyalty.  They're hyperconnected through their various digital devices.  And, when they deign to think about health care, which isn't often, they want all digital, all the time. 

There's some truth to the conventional wisdom, but not as much as you'd think.  A new study from Credit Karma flatly asserts that "everything you thought you knew about Millennials may be wrong," finding that they still have aspirations to much of the same "American Dream" as previous generations.   

The hyperconnected part is certainly true.  Millennials are much more likely to have a smartphone,  and -- jawdroppingly -- on an average day they interact with it much more than with anyone else, even their parents or significant other.  

Things get really interesting when it comes to health.  Millennials are often viewed as not very interested in health care, but it is the second most important social issue for them, right after education and ahead of the economy. 

A deep dive on millennials and health care by the Transamerica Center for Health Studies had some results that also don't necessarily fit the stereotypes. Taking care of their health was tied with getting/keeping a job as their top priority. 70% have been to a doctor's office within the last year, although for minor issues they're more likely to head to urgent care/a retail clinic. When it comes to getting health information, this supremely digital generation still relies most heavily on health care professionals and friends/family (especially their mothers!).

There has been a dramatic drop in being uninsured -- 11% versus 23% as recently as 2013 -- but millennials don't like much about health insurance.  They feel much more informed about their health and how to improve it than they do about how to find health care services or their health insurance options.  

Perhaps that is why two-thirds have never comparison shopped for health insurance.

Lastly, TCHS found that millennials rate affordability as the most important aspect of the health care system, but many don't find it affordable.  About 20% can't afford routine health expenses, even though millennials' median health expenses are under $100 per month.  Nearly half have skipped care to reduce their expenses. Similarly, most millennials view monthly premiums over $200 as unaffordable.

If there is a key difference with millennials' health care, it may be in their emphasis on technology.  A report from Salesforce.com found that 76% of millennials valued online reviews in choosing a doctor, and 73% want doctors to use mobile devices during appointments to share information. 60% are interested in telehealth options in lieu of office visits.

It is perhaps no wonder millennials are turning to technology when it comes to their health.  They highly value face time with their doctor, but they may not be getting it.  According to the Salesforce report, 40% of millennials don't think their primary care doctor would recognize them on the street. 

Many of us might suspect the same thing, and that should trouble us all.

When it comes to health care, as with many other aspects of life, it may be less that millennials are different in what they want as it is that they're quicker to adopt newer options for getting it.  The rest of us should learn from that, not shake our heads at it.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Two Thirds of Healthcare Stakeholders Have Faith in Consumers Using Online Tools to Engage With Their Doctor

By Clive Riddle, June 16, 2016

MCOL has conducted an e-poll, co-sponsored by Keenan, of healthcare business stakeholders regarding their opinion on consumer tools involved with healthcare costs or quality. Key questions were asked regarding consumer healthcare cost and quality tools; and ranking of applicable items with respect to overall effectiveness.

68.5% of stakeholders believe it is likely or very likely that a typical consumer will use online data/comparisons to discuss options and costs with a provider. Stakeholders not involved with online tools have a greater belief that consumers are very likely to do so (34.8% compared to 18.6% of stakeholders that are involved with online tools). However, stakeholders involved with tools have an overall greater belief that consumers are likely to do so – combining likely plus very likely responses (72.1% for involved stakeholders compared to 65.2% for stakeholder not involved with tools.)

44.4% of stakeholders feel a smartphone is the optimal vehicle to deliver such tools, while 34.7% feel a computer desktop is the optimal vehicle, and 13.9% listed a tablet such as an iPad as the optimal vehicle. Stakeholders not involved with online tools were less likely to list a computer desktop (21.7% compared to 38.1% for stakeholders involved with tools and 57.1% for stakeholders not sure if they are involved). However smartphones were the top choice for both stakeholders involved with online tools, or not involved with online tools.

Given five types of tools to rank for effectiveness, stakeholders preferred health insurance out-of-pocket costs calculators and healthcare service price estimator/comparisons. Given seven issues to rank by level of concern, relating to consumer tools, stakeholders were most concerned by accuracy/credibility of data sources, and consumer ability to understand/use tool correctly.

58.9% of stakeholders indicated they are involved with consumer tools, while 31.5% responded they are not involved, and 9.5% were not sure. The online survey of healthcare business stakeholders was conducted during May 2016 by MCOL.  Survey participants received a detailed report on the survey results.

As Tim Crawford, a Vice President from Keenan puts it, “if we want to bend the healthcare cost trend downward by making patients and their families more effective consumers, we will need to equip them with the information they need to make informed decisions. Consumers of medical services will need to know about the quality of their providers and understand the total costs involved. More than two-thirds of those responding to the survey believe that consumers will use tools that give them this information and will use the knowledge to discuss options and costs with their providers. Ideally, such tools can provide the common ground needed for patients and physicians to have a transparent dialog about medical decisions.”

Practicing in an Age of Uncertainty

By Kim Bellard, May 27, 2016

If you've ever had a hard time trying to decide what's best for your health, perhaps you can take comfort in the fact that physicians often aren't so sure either. 

Or perhaps not.

A new study in Annals of Surgery, and nicely reported on by Julia Belluz inVox, focused on surgical uncertainty.  The researchers sent four detailed clinical vignettes to a national sample of surgeons, seeking to get their assessment on the risks/benefits of operative and non-operative treatment, as well as their recommendations. You'd like to think there was good consensus on what to do, but that was not the case.

In one of the vignettes, involving a 68 year-old patient with a small bowel blockage, there was fairly universal agreement -- 85% -- that surgery was the best option.  In the other three vignettes, though, the surgeons were fairly evenly split about whether to operate or not, even on something as common as appendicitis. 

So, there may be a "right" answer but you might as well flip a coin in terms of getting it, or there may just not be a right answer.  Both options are troubling.

The authors believe that surgeons are less likely to want to operate as their perception of surgical risk increased and the benefits of non-operative treatment increased, and more likely to want to operate as their perception of surgical benefit increased and non-operative risk increased.  The problem is that surgeons vary dramatically -- literally from 0 to 100% -- on their perceptions of those risks.

Most surgeons based their estimates of risks/benefits on their experience, their training, and -- if you're lucky -- on whatever literature might be available, but it is doubtful that we can usually expect an objective, quantifiable assessment. 

The American College of Surgeons has developed a "surgical risk calculator" to help surgeons better gauge these risks, using data from a large dataset of patients.  However, an earlier related study from the same team of researchers found that it doesn't make much difference.  The calculator did narrow the variability of surgeons' assessment of risk, but: "Interestingly, it did not alter their reported likelihood of recommending an operation."

Oh, well.

It is not just surgeons who aren't always sure of the right course of action, of course.  A study in the American Journal of Managed Care found that 62% of physicians reported that they found the "uncertainty involved in providing patient care disconcerting."  The discomfort with uncertainty did not vary appreciably between type of specialty.

Then there is the example of PSA tests.  In 2008 the US Preventive Services Task Force recommended routine PSA tests not be given to men over 75, and in 2012 broadened that recommendation to all ages.  Yet data suggest that the group least likely to need the tests -- men over 75 -- had the smallest declines in rates of testing.  Almost 40% of this age group are still getting the test, which is not far from the previous rates. 

As one researcher told The New York Times,   "That’s just insanity...bad medicine, poor use of health care resources and poor decision-making.”

There's all too much of that in our health care system.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Getting on the Blockchain Bandwagon

By Kim Bellard, April 28, 2016

Face it: health care IT infrastructure is a mess.  After spending tens of billions of dollars to "incent" providers to move to EHRs, they're using them but are not very happy with them. We now have millions of electronic records that are still way too siloed, and all too often incomplete.

Enter blockchain.

To the extent most people think of blockchain at all, it is in relation to one of its most prominent users, Bitcoin.  Bitcoin, which has its passionate advocates and equally passionate skeptics, is not synonymous with blockchain.  Blockchain is the technology that allows Bitcoin to operate, but they are no more one and the same than Salesforce.com and Oracle are.

In layman's terms -- and, trust me, when it comes to this I definitely am a layman -- blockchain is a set of distributed records, or databases, that are shared by multiple parties and which can only be updated by a majority of those parties.  There is no central authority, no central database.  It reminds me of the Internet's distributed networks, which help assure its robustness. 

Equally important, in blockchain once a record is stored (or "transcribed"), it can't be tampered with.  For better or for worse, Bitcoin has demonstrated that blockchain does, in fact, assure anonymity, privacy and security. 

Blockchain is starting to become more visible even outside of Bitcoin.  Businesses are being told they need a "blockchain czar.  Wall Street is starting to embrace it.  Britain looking into using it for manage the distribution of public money
 
Some people think it is the greatest thing since sliced bread -- or, in modern terms, since the Internet.  IBM's Jerry Cuomo says: "Blockchain has the potential to become the technological foundation for all electronic transactions conducted over the Internet."

If they are even remotely right, blockchain is something that we better be paying attention to, and what industry needs its advantages more than health care?

We're already beginning to see blockchain show up more in health care.  For example, Gem just announced Gem Health, As they say: "We need a modern infrastructure that unlocks new channels for services to connect, while balancing the need for strong data privacy and security.  Blockchain technology is that infrastructure."

Philips is onboard, with the Philips Blockchain Lab joining the Gem Health network.

It's not going to be easy.  Health care has had a hard time agreeing to things like ICD-10 or HL7, much less interoperability standards.  In CIO, Peter B. Nichol points out the need for foundational protocols, such as the Linux Foundation's Hyperledger project is working on  If we thought getting providers to use EHRs was hard, picture trying to get the health care industry onto a entirely new technology platform like blockchain. 

True to form, the "HIT standards mandarins" are already showing resistance to blockchain.

However, Mr. Nichol also enumerates a number of companies already jumping on the blockchain bandwagon for healthcare uses, including not just Gem but also Tierion, Factom, HealthNautica, and Guardtime.  It is something that any organization involved in health care can ignore only at their own risk.

Look, I'm no technology seer.  I don't know if blockchain is going to totally revamp how we store and update data, as its proponents claim.  What I do know is that, when it comes to health care, our current approaches are not getting us to the interoperability that we need, or are doing so only at glacial speeds, and that they allow our electronic data to be increasingly vulnerable.   

If not blockchain, what?

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Identity Crisis: The Need for Improved Healthcare Identity Management

by Clive Riddle, April 8, 2016

This week, Kathy Bardeen from LexisNexis spoke in a HealthcareWebSummit webinar on Mastering Identity Management in Healthcare.  The issue with that inaccurate and missing demographic information and inadequate authentication systems and processes threaten business integrity and success, financial outcomes, and member engagement. On top of that, there is the looming specter and fear of hacking, healthcare identify theft and fraud.

Kathy cited recent medical identity theft breaches with OPM data, UCLA Health and Anthem, along with these concerns:

• Nearly 40% of consumers would abandon or hesitate using a health organization if it is hacked
• 50% if consumers agreed they would find another healthcare provider if their medical records were stolen
• Between 8-14% of medical records have erroneous information tied to an incorrect identity
• Only about ten percent of health insurers use two-factor authentication and encryption to protect data
• Individual can spend an average of $13,500 to resolve applicable medical identity fraud cases
• Insurers spend $2pmpm or more for multiple years of credit monitoring for members affected by data breaches

Kathy tells us healthcare organizations need to handle identities as a journey that starts with Identity Checks, progresses with Identity Management and then Identity Insights. Here’s her definitions:

• Identity Checks involve facilitating the authentication, verification and resolution of identities engaging with the organization, identifying possible fraud risks, and allowing for point of need identity information searches.
• Identity Management leverages a systematic approach to maintaining, enhancing and augmenting member identity profiles with current, correct and previously unavailable information.
• Identity Insights involves understanding individuals and their relationships within and outside of the healthcare ecosystem and gaining insight into socioeconomic factors impacting health outcomes, costs and overall risk.

Kathy shares these best practices in Risk Mitigation in Identity Checks, Identity Management and Identity Insights:

• Risk Mitigation in Identity Checks should involve: evaluating systems and process to minimize the transmission and storage of PHI/SPII data whenever possible; executing a robust algorithm for unique ID assignment that will maintain consistency and persistence over identity evolution; and deploying a multi-layered approach for identity management that grows with business objectives as well as an ever changing identity landscape.
• Identity Management should involve: implementing an ongoing maintenance program to ensure integrity of identity records as this data erodes; executing the identity management program with a frequency and focus that matches the business processes and programs leveraging this data; and leveraging an authoritative, reliable data source(s) to augment and update identity information.
• Identity Insights should drive analytics from identity insights to solve for large complex problems as well as target improvements to existing programs; and maximize the value of the identity management data asset across different areas of the business.

This webinar is now available for free on an on-demand basis for qualified applicants.

Oh, And It Is Also An EHR

By Kim Bellard, December 18, 2015

You wouldn't -- I hope -- still drive your car while trying to read a paper map.  Hopefully you're not holding up your phone to follow directions on its screen either.  Chances are if you need directions while you are driving, you'll be listening to them via Bluetooth.  Or maybe you're just riding in a self-driving car.

But when it comes to your doctor examining you, he's usually pretty much trying to do so while fumbling with a map, namely, your health record.  And we don't like it.

A study in JAMA Internal Medicine found that patients were much more likely to rate their care as excellent when their physician didn't spend much time looking at their EHR while with them; 83% rated it as excellent, versus only 48% for patients whose doctors spent more time looking at their device's screen.  The study's authors speculate that patients may feel slighted when their doctor looks too much at the screen, or that the doctors may actually be missing important visual cues.

Indeed, a 2014 study found that physicians using EHRs during exams spent about a third of the time during patient exams looking at their screen instead of at the patient. 

As one physician told the WSJ, "I have a love-hate relationship with the computer, with the hate maybe being stronger than the love." 

The problem is that we forget that the record is not the point.  Figuring out what is wrong with a patient and what to do about it is the point.

Let's picture a different approach, one that doesn't start with paper records as its premise.  Let's start with the premise that we're trying to help the physician improve patient care by giving him/her the information they need at point of care, when they need it, but without getting in the way of the physician/patient interaction.

Let's talk virtual reality.

Picture the physician walking into the office not holding a clipboard or a computer or even a tablet.  Instead, the physician might be wearing something that looks like Google Glass or OrCam. There might be an earbud.  And there will be the health version of Siri, Cortana or OK Google, AI assistants that can pull up information based on oral requests or self-generated algorithms, transcribe oral inputs, and present information either orally or visually. 

When the physician looks at the patient, he/she sees a summary of key information -- such as diabetic, pacemaker, recent knee surgery -- overlaid on the corresponding portion of the patient's body.  Any significant changes in blood pressure, weight, and other vitals are highlighted.  The physician can call up more information by making an oral request to the AI or by using a hand gesture over a particular body part.  List of meds?  Date of that last surgery?  Immunization record?  No problem.

The physician can indicate, via voice command or hand gesture, what should be recorded.  It shouldn't take too long before an AI can recognize on its own what needs to be captured; the advances in AI learning capabilities -- like now recognizing handwriting -- are coming so quickly that this is surely feasible.

Building better EHRs is certainly possible.  Improving how physicians use them, especially when with patients, is also possible.  But it's a little like trying to make a map you can fold better while driving.  It misses the point. 

We need a whole different technology that subsumes what EHRs do while getting to the real goal: helping deliver better care to patients.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Consumers and Physicians and Technology in 2015

by Clive Riddle, October 9, 2015

 

The Deloitte Center for Health Solutions has just released a survey report, Health Care Consumer Engagement: No One-Size-Fits-All Approach, which they say shows 'that Americans are increasing their use of technology to improve their health, navigate the health system and flex their shopping muscles in acting like consumers instead of passive patients."

 

Overall, how "techy" are American healthcare consumers? They found "22% used technology to access, store and transmit health records in the last year, up from 13% in 2013. Use was higher for those with major chronic conditions: 32% compared to 19% in 2013."

 

Deloitte’s findings are that consumer engagement is increasing three ways:

1. "More consumers today prefer to partner with doctors instead of relying passively on them to make treatment decisions"
2. "Consumers’ trust in the reliability of information sources is rising"
3. Consumers are increasingly relying Relying on technology

Here's some of the numbers behind their report, regarding the oercentage of survey consumer respondents: 

• 28% have used technology to measure fitness and health goals, up from 17% in 2013 (45% of Millennials this year)
• 23% have used technology to monitor a health issue, versus 15% in 2013
• 40% of the surveyed technology users have shared their fitness or monitoring information with their doctor
• 39% with major chronic conditions use tech-based monitoring (22% in 2013)
• 63% of the surveyed technology users say their use of fitness or monitoring technologies has led to a significant behavior change
• 13% who take prescription drugs receive electronic alerts or reminders
• 48% prefer to partner with doctors rather than have them make decisions for them, up from 40% in 2008
• 34% strongly believe doctors should encourage patients to raise questions
• 58% feel that doctors should explain treatment costs to them before decisions are made
• 16% who received care report asking their doctor to consider treatment options other than the one initially recommended.
• 52% report searching online for health or care-related information; 
• 16% who needed care went online for cost information, up from 11% in 2013 (27% of Millennials this year)
• 71% of all those surveyed said they have not gone online for cost information but are "very" or "somewhat" likely to use a pricing tool in the future
• 25% used a scorecard to compare the performance of doctors, hospitals and/or health plans, up from 19% in 2013 (49% of millennials this year)

What do these numbers mean? Harry Greenspun, M.D.Director of the Deloitte Center for Health Solutions, tells us "not all consumers are alike in how they engage the system, and a large segment still remains disengaged. Companies likely won't take a one-size-fits-all approach in their marketing and operations, but a tailored strategy that considers the unique characteristics of the segments they are most interested in."

 

Greg Scott, Principal, Vice Chairman and national sector leader for Deloitte's health plans practice, adds "the specter of a more customer-driven industry is causing many health companies to transform into retail-focused organizations, impacting everything from strategy and scale to operations and human capital. For the enterprise, this is about more than a cool app – this is about making the end-to-end changes needed to better identify and engage a more empowered purchaser."

 

So at the other end of the stethescope, how do doctors feel about using technology in their practices? Geneia just released survey results on this topic - not addressing physician interaction with consumers as discussed above, but rather how physicians relate to EMR, data and analytics.

 

Heather Lavoie, Geneia's President & Chief Operating Officer, tells us that "seemingly, there is an inverse relationship between health IT spending and physician job satisfaction,..physician sentiment towards technology is surprisingly nuanced. Doctors are indicating that data and analytics tools have the potential to reduce time spent on recordkeeping, one of their primary frustrations, while also contributing to it."

 

24% of physicians said that EMR impact on practices was positive, 19% negative, 53% a little of both, and 5% said they do not use EMRs. 69% of physicians felt data and analytics tools positively impacted their ability to efficiently assess patient history and needs, 63% said they help them get value and improved outcomes from chart documentation, and nearly 60% felt they helped identify and triage the highest need patients and created greater efficiencies in office workflow.

 

But Geneia shares that "on the other hand, more than 60% of physicians say that data and analytics tools have negatively impacted recordkeeping time. In fact, when asked to identify the number one way data and analytics could improve their job, the most popular answer was to reduce the time spent on recordkeeping (41%) followed by more time with every patient (22%), better access to patients' complete medical profile and history (20%), and more time with the patients who require enhanced care (14%)."

Can Slick Trump Sick?

By Kim Bellard, September 24, 2015

Health insurance is getting some love from investors.  A lot of that money is going to companies that make it easier to deal with health insurance, but some is going to start-ups -- like Oscar, Clover Health, and Zoom+ -- that actually hope to reinvent the nitty-gritty, often grimy business of providing health insurance.

Oscar, of course, has long been a media darling.  Google just put in another $32 million that ups their valuation to $1.75b.  All this for a company that only has 40,000 members, is offered only in New York/New Jersey (with plans to expand to California and Texas), and which in 2014 lost $28 million on $57 million in revenue.  But never mind all that; they've got a nice website.

That's not really fair, of course.  They've focused on using technology to improve the customer experience, are ahead of the industry curve on use of technology like fitness trackers and telehealth, and are working to use data to match patients with the best physicians for their conditions.

Clover Health, which just raised $100 million in a funding round through some impressive lead investors, has a somewhat different strategy.  It focuses on the Medicare population, putting their primary emphasis on using data to improve patient outcomes.

Clover uses their algorithms to identify high-risk patients, sends nurse practitioners to their homes to develop personalized care plans, and continually loops in new data to update patient profiles. So far Clover (headquartered in San Francisco) is only available in six New Jersey counties, but they claim to have 50% fewer hospital admissions and 34% fewer readmissions than the average for Medicare patients in those counties.  Most of their competitors would claim to have similar efforts for high-risk patients, so we'll have to see if their model scales.

Then there is Zoom+, or, rather, "Zoom+ Performance Health Insurance."  It is the outgrowth of ZoomCare, a network of retail clinics in Portland (OR).    Zoom+ claims to be "the nation’s first health insurance system built from the ground up to enhance human performance," and thinks of itself as "Kaiser 4.0."

Hmm.

Zoom+ has focused heavily on the user experience, wanting "health care to be more like visiting an Apple store," according to Fast Company Design's profile of them.  Zoom+ features not just cool retail centers but also mobile capabilities, a Personal Performance Path, and a Zoom+ Guru, among other services.  It is not your mother's health insurance, and right now can't be yours either unless you happen to live in Portland.

I'm all for reinventing health insurance.  I'm all for making the customer experience much, much better in health insurance and in health care generally.  But I do worry that some of these upstarts may be taking advantage -- perhaps inadvertently -- of one of the underlying problems with health insurance: risk selection beats execution.

Health insurers can market features that are more likely to appeal to younger, healthier customers, like snazzy websites, fitness trackers, or training advice.  None of those are only of interest to "healthy" people, but, it doesn't take much of a shift in the risk profile to have noticeable impacts on costs.

Health insurance needs more consumer-focused technology, more effective use of data, and more focus on promoting health.  However, I'm not getting too excited until I see a health insurer that does away with provider networks, refuses to be complicit in outlandish provider charges, and offers a plan of benefits that consumers can actually understand.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

More About Us, Less About Them

By Kim Bellard, September 1, 2015

Something Amazon just did is worth those of us in health care paying attention to.  It was the layoff of "dozens" of engineers at Lab126, Amazon's hardware development center, as first reported by The Wall Street Journal.  These were the first layoffs in the division's history.

Lab126 is responsible for Amazon's consumer devices, including their very successful Kindle e-reader and the new Fire TV. What makes this is a cautionary tale for the rest of us is that even Amazon -- which is noted for their prowess with their online consumer experience -- can't necessarily get the physical consumer experience right.  I think Wired captured the problem best, asserting that Amazon's consumer devices would have been more successful "if Amazon focused more on consumers, and less on consuming."

Now perhaps the relevance to health care may be clearer.

Consumer devices are all the rage in health care.  The global mHealth market is predicted to be $49b by 2020, with some 73 million units shipped in 2015 and an eye-opening CAGR of 47.9% expected from 2013 to 2020 (although other analysts already see slowing demand).

At the core of Amazon's devices is the goal to, well, get consumers to buy more stuff from Amazon.  
So I wonder: what is the goal of consumer devices in health care?  Are they intended to help us achieve better health -- or to consume more health care services?  I hope for the former but I fear it may end up being the latter.

I was struck a couple of weeks ago by an opinion piece in JAMA: "Obstacles to Developing Cost-Lowering Health Technology."  It's authors, doctors Kellerman and Desai, note that:

The inventor’s dilemma is that creating a product that improves health is not enough; the product must also be able to generate a healthy return on investment. In the United States, the surest way to generate a healthy return on investment is to increase health care spending, not reduce it.

Think about the terminology used in health care.  It speaks volumes about the underlying culture and its attitudes towards us.  Health care providers call us "patients."  Health plans call us "members."  Medicare and Medicaid call us "beneficiaries."    The name for one of the newest fads -- "patient centered medical homes" -- serves to remind us that we're not normally considered the center of our health care, and that the focus is on our medical care, not our health.

At least "consumer-directed health plans" pay lip service to us being in charge.

I'm all for people and organizations making money in health care, but I don't like to be seen as some kind of ATM for them either.  The health care industry needs to realize that we don't really want to be its customers, don't want to need to consume their services, and certainly don't want to have to be unduly patient about it when we do. 

What we want is to be healthy.  Give us the devices, services, and experiences that make that as simple as possible and then you can call us whatever you want.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Nag On My Shoulder

By Kim Bellard, July 15, 2015

We seem to like to have help with our health.  In addition to doctors, we might have a case manager, a health coach, a pharmacist, a personal trainer, or a nutritionist, to name a few.  But we soon may be able to have all of their expertise whispering in our ear 24/7.

Whether that would be a good thing or a bad thing remains to be seen.

The Wall Street Journal recently profiled an interesting company called OrCam.  OrCam's origins were in helping visually impaired individuals.  A small wearable camera processes surrounding images -- faces, steps, even handwriting -- on the fly and informs the user, almost as if they were seeing the objects directly.  Now OrCam is testing what they bill as a digital personal assistant -- Casie -- to add even more value.

I can see all sorts of potential for health care.

The WSJ article gives the example of you walking down the street, and Casie recognizes the face of one of your Linkedin contacts.  

If OrCam can recognize your Linkedin contacts, I would bet that it can recognize a donut, or a cigarette, and remind you about the health risks before you get either in your mouth.  
Such a digital assistant might also notice you haven't taken your morning pills.  Lack of adherence to taking medication has been labeled a $300b problem.

Maybe it could be trained to look at that rash on your arm and offer an informed diagnosis, taking teledermatology to the next level.

Pack a portable ultrasound into the device -- this technology is already here -- and suddenly whole new worlds of things your digital assistant could help you with really open up, especially if paired with a Watson type of AI.

Ideally, one would like to be able to tell your digital assistant how you are feeling, much like you might tell your doctor or try to do with an online symptom checker, and get a diagnosis.

Fitness trackers are all the rage, but the attrition rate on the use is terrible; a third stop using after six months.  Perhaps something like Casie could have better luck keeping you engaged.  

Smart glasses have faced adoption resistance for a variety of reasons: people think current models look goofy, there are concerns about privacy when everything in sight is suddenly a picture/video, or perhaps it has just been lack of a perceived killer app. 

OrCam addresses the first objection by being a fairly inconspicuous clip-on, and the second by deleting audio and video content after it has been processed and analyzed, sort of like Snapchat does for messages.  

And maybe digital health assistant will be the killer retail app.

I think the concept of "augmented reality" raises the bar for digital assistants.  Instead of just warning you about eating that donut, the digital health assistant might flash a picture of you with an extra thirty pounds just to re-enforce the risks it poses. It'd be like the health care version of "scared straight."

OrCam is a reminder that our digital future doesn't necessarily lie in smart phones or smart watches or even smart glasses. This is why companies like Facebook and Google are pouring so much money into virtual reality -- not just to escape reality but to augment it.

People talk about "the digital doctor," but what really makes that concept interesting is that it may not involve a doctor at all.  I just hope my digital assistant knows when to be quiet and when to make me listen.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Vormetric Report: 48% of Healthcare organizations Had Data Breach or Failed Compliance Audit in Past Year

By Clive Riddle, April 16, 2015

Given the Anthem health plan hack in February, and other healthcare organizations that have fallen victim to breaches as of late, surveys offering threat assessments are certainly of interest. Vormetric just released the twenty-page 2015 Vormetric Insider Threat Report, which includes healthcare industry specific data.

How does Vormetric define Insider Threats? "Insider threats are caused by a wide range of offenders who either maliciously or accidentally do things that put an organization and its data at risk. The insider threat landscape is becoming more difficult to deal with as the range of miscreants moves beyond employees and privileged IT staff. It now includes outsiders who have stolen valid user credentials; business partners, suppliers, and contractors with inappropriate access rights; and third-party service providers with excessive admin privileges. Unless properly controlled, all of these groups have the opportunity to reach inside corporate networks and steal unprotected data."

Vormetric's 2015 Insider Threat Report was conducted online by Harris Poll during fall 2014, with 818 global respondents who work full-time as an IT professional with major influence in decision making for their company’s IT. In the U.S., 408 ITDMs were surveyed among companies with at least $200 million in revenue with 102 from the health care industries, 102 from financial industries, 102 from retail industries and 102 from other industries.

Vormetric reminds us that hacker attraction to healthcare is fueled by black market “healthcare records selling for tens to hundreds of dollars, while U.S. credit card records sell for 50 cents or less.” Alan Kessler, Vormetric tells us "healthcare data has become one of the most desirable commodities for sale on black market sites, yet U.S. healthcare organizations are failing to secure that data. An overreliance on compliance requirements and a cursory nod to data protection point to systemic failures that are putting patient data at risk. What's needed is for healthcare organization to realize that compliance is not enough, and to implement the controls and policies required to put the security of their data first."

Among healthcare organization respondents to their survey, 48% encountered a data breach or failed a compliance audit in the last year. 26% of healthcare respondents reported that their organization had previously experienced a data breach. 54% reported compliance requirements as the top reason for protecting sensitive data, and 68% rated compliance as very or extremely effective at stopping insider threats and data breaches.

63 percent of healthcare IT decision makers report that their organizations are planning to increase spending to offset data threats, which was the highest of any segment or region measured in the report.

When asked about the most important reasons for securing sensitive data, the top three responses from the healthcare sector were compliance (55%), implementing best practices (44%) and reputational protection (41%). In comparison to other business sectors the compliance response was 5 percentage points above other industry averages.

Looking for the Future in the Past

By Kim Bellard, March 25, 2015

I don't get smartwatches.

Yes, I know; they're all the rage. Apple unveiled its Apple Watch earlier this month, to generally good if not entirely ecstatic reviews. Not to be outdone, Google announced a collaboration with TAG Heuer and Intel for a "Swiss Smartwatch." Samsung and Sony are close behind with their own versions.

Poor Fitbit, which held the early lead in wrist wearables, is now desperately trying to broaden its product line, including the new Surge. They must feel a little like Garmin or Nikon did when mobile phones began to incorporate GPS tracking and digital phones.

I have to wonder why the focus on the wrist. It isn't the ideal place to track, say, your heartbeat, your sleep, or your steps, and as a result fitness trackers have been faulted about their accuracy.  I'm not sure who is clamoring to add more features to a watch.

It's as if Timex and Casio, not to mention TAG Heuer, are conspiring to create a demand so that they don't go the way of Kodak.

It's not that I think they are a bad idea. If you want to wear one, more power to you, and I hope it helps you with your health goals. My problem with them is that I think they are an example of our trying to create the future by looking in the past.

Shouldn't we be developing truly new technologies and uses for them?

I can't help but think about EHRs in this context. Health care providers insisted on being subsidized for what would be normal business process improvement investments for any other industry. What we got for all the federal spending were products that physicians don't really like, that more often hinder than help with patient care, that patients rarely have access to, and that can't easily share data.

We need tools that are more collaborative, more interactive, and more proactive.

Congress is already starting to ask what it has gotten for its $35b HITECH investment, even holding hearings to demand answers. EHRs used to have bipartisan support and now have fairly bipartisan disappointment.

We don't even have an agreed upon way to figure out if providers have the same patient, much less share their data about that patient. The financial services industry solved similar customer-identification problems decades ago. They did it because it made business sense.

In theory, that kind of change will happen once we make that big move to "value-based" care, but as long as our baseline is our current level of spending, I'm skeptical. We need approaches that attempt not just to reduce increases in spending but that aim to take big chunks out of spending. There's no shortage of waste, duplication and unnecessary care that could be eliminated.

Smartwatches, EHRs, or proton beam therapy, to name a few examples, are not likely to help accomplish that.

I want to see those kinds of new technologies in health care, not a smartwatch. Technologies that help change how we think about "health" and how we treat problems with it. I challenge health care technology gurus: show us something not just that we haven't seen before; show us something we hadn't even thought of before

As Alan Kay famously said: "The best way to predict the future is to invent it."

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Making the Old New Again

By Kim Bellard, January 22, 2015

I always love it when someone looks at something familiar in a completely new way.  I only wish health care had more examples of that.

The example of this kind of totally fresh thinking that caught my eye concerns traffic lights.  If researchers from Carnegie Mellon University, led by Professor Ozan Tonguz, have their way, those familiar yellow boxes with the lights could become unnecessary.

The CMU researchers have developed "virtual traffic lights" (not to be confused with the separate CMU "smart traffic signals" project).  Instead of using physical traffic lights, lights would show up on the driver's dashboard as needed.  As Professor Tonguz told CNN: "With this technology, traffic lights will be created on demand when [two cars] are trying to cross this intersection, and they will be turned down as soon as we don't need it,"

The researchers claim the virtual, on-demand signal could reduce commuting times by 40%, as well as reduce carbon emissions and accidents.  And, of course, we wouldn't need all those physical lights; think of the savings on new lights, poles, and wires, plus on ongoing maintenance.

All that would be required is that every car -- and that means, every car -- is equipped with the required vehicle-to-vehicle communications technology.  No small task!  Some think this could happen in a year or two, others a decade or two.  Either way, it's mind-blowing to think that such a familiar part of our driving experience could be so utterly transformed by what seems, in retrospect, such an obvious solution.

Let's contrast this kind of thinking with health care.  Yes, I know -- health care has plenty of new technology and many kinds of improved treatments, but I'm not sure we're getting a lot of reinventing.  Where are our virtual traffic lights?

One small -- well, maybe not so small at that -- health care example is a new patient tracking system called PatientStormTracker, developed by Lyntek Medical.  As the name suggests, PatientStormTracker borrows from weather tracking to present patient monitoring data as systemic color monitoring.  Instead of trying to follow the usual rows and rows of data, clinicians can actually see a patient's status -- color-coded -- and watch it progress in real time, including which body systems are currently being impacted and how much.  

Lyntek's founder and CEO, Dr. Laurence Lynn, told The Columbus Dispatch that traditional patient monitoring is like a fire alarm -- either on or off.  As he said: "We have this simple fire alarm idea that existed from the 1980s, and it didn’t evolve, it didn’t improve."  Dr. Lynn wants to monitor patterns and detect trends earlier, when interventions are more likely to be effective.  PatientStormTracker is in clinical trials.  

One proponent of radical changes in health care has long been Dr. Eric Topol, who happens to have a new book out (The Patient Will See You Now: The Future of Medicine Is In Your Hands).  I have not yet read his book, but I did read his related op-ed in The Wall Street Journal.  His version of virtual traffic lights, if you will, is the smartphone.

Dr. Topol outlines not just increasingly common functions like virtual visits or monitoring using a smartphone, but also apps that assist with testing and even diagnosis.  I especially like his prediction that wearable sensors will make it possible that "...except for ICUs, operating rooms and emergency rooms, hospitals of the future are likely to be roomless data surveillance centers for remote patient monitoring."  That would certainly upend how we view hospitals...finally.

Perhaps those remote patient monitors will use something like PatientStormTracker.

The smartphone technology options are cool, but what Dr. Topol sees as an even more important trend in putting all the newly-captured data in the cloud, mining it, and using it to target interventions.

Changes are going to come at us from seemingly left field.  We can never be quite sure where they will lead. It just takes some innovator to see the familiar in a different way -- and then manage to convince us, and the medical-industrial complex, to change.  

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting