We think that Joe’s work is not known widely enough outside of the academic community, so we are using our blog to let you know what you have been missing and, in the process, perhaps change the way you think about healthcare spending.

We think that Joe’s work is not known widely enough outside of the academic community, so we are using our blog to let you know what you have been missing and, in the process, perhaps change the way you think about healthcare spending.

We share a common view that the best way to prevent an epidemic from occurring may lie in dramatically reframing how we approach the problem. This is exactly what Extending the Cure has done with ResistanceMap, a web tool that presents scientific data in a user-friendly way, allowing policymakers and researchers to quickly identify regions in urgent need of better infection control, enhanced surveillance, more vigilant antibiotic stewardship, and comprehensive methods to curtail the spread of resistant microbes.Continue reading… “,” By RAMANAN LAXMINARAYAN and HELLEN GELBAND  Why should the United States care about health problems in distant, poor countries when there are pressing priorities here at home?  It’s a classic question.  People trying to influence policy have never trusted humanitarianism to carry the day and have instead appealed to the self-interest of U.S. citizens.   When it comes to health, U.S. travelers heading to foreign lands for tourism or work need protection from disease or at least the promise of a cure when they return home.  Of utmost concern, the military sends large numbers of troops where they are in danger not only from armed conflict, but also from exotic (and often dangerous) diseases.  But no tropical disease can make as clear a case for U.S. self-interest as antibiotic resistance can:  witness the furor over NDM-1—the resistance gene that seems to have arisen in patients on the Indian subcontinent. Was the furor over a health problem in India and Pakistan?  No.  The news that hit U.S. and European newspapers was over the report about NDM-1 in Lancet Infectious Diseases that identified people in England who had had surgery in India—“medical tourists”—as victims, and warned that the UK National Health Service might suffer financially because patients coming home had to be hospitalized and treated with expensive antibiotics to cure their infections.

  These just as easily could have been Americans—and now they are:  NDM-1 was found in three U.S. medical tourists (and one Japanese man) on their return from India. Continue reading… “,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/tag/salesforce-com/”,”200″,”OK”,” By Albert Santalo For the majority of my career I have been obsessed with creating technologies to modernize our largely dysfunctional U.S. healthcare system.  To me, it is very clear that the emergence of cloud computing has finally created the opportunity to truly address this daunting problem. Cloud-based solutions are the only viable option for effectively getting providers, patients and other key stakeholders online so that the necessary efficiencies find their way into the system.https://harmoniqhealth.com/ To the rest of healthcare IT, however, it is not so clear, as witnessed by the lack of truly cloud-based companies in the marketplace. Most of the large, established players in this industry continue to rely on the outdated client/server or older technologies, such as MUMPS.  Some of these companies’ products trace their roots as far back as 1969.  These companies and their software were built before the world wide web, before Facebook, the iPhone and iPad, salesforce.com – and even email, for God’s sake!  There also exists a tremendous amount of confusion related to the morass of small, bootstrapped EMR companies, which number in the hundreds.  People do not understand the difference between buying a monolithic single-purpose app to utilizing a robust, cloud-based platform approach. This lack of understanding has made me realize that we need a better way to explain what the cloud has the power to do, and what true cloud-based technology even is.

Easier said than done! I was recently afforded a breakthrough, though unfortunately at the expense of an ancient treasure.  Allow me to explain: Continue reading… “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/tag/ecg/”,”200″,”OK”,” By Kenny Lin, MD Doctors of my generation have experienced dramatic changes in the way we access the information we need to care for patients. As a medical student 15 years ago, my “peripheral brain” consisted of fat textbooks sitting on office bookshelves or smaller, spiral-bound references stuffed into the bulging pockets of my lab coat. As a doctor-in-training, I replaced those bulky references with programs loaded onto PDAs. Today, smartphone apps allow health professionals at all levels to access the most up-to-date medical resources such as drug references, disease-risk calculators, and clinical guidelines—anytime, anywhere. Apps have several advantages over traditional medical texts. First, the information is always current, whereas many textbooks are already dated by the time they hit shelves.

If I have a question, I can look up the answer on my smartphone without leaving my patient’s side. And unlike textbook chapters, many medical apps have interactive features that help doctors choose appropriate screening tests for patients, recognize when immunizations are due, or calculate a patient’s risk of developing heart problems. Lastly, apps can enable remote monitoring of high-risk patients and reduce the need for office visits. In a small study published in PLoS ONE, for example, researchers found that patients hospitalized for heart vessel blockages were able to complete “supervised” rehabilitation exercise sessions in their homes with a portable heart monitor and GPS receiver that transmitted real-time data to doctors via smartphone. Continue reading… “,” By Dr. Wes Doctors wanting to determine a patient’s atrial fibrillation burden have a myriad of technologies at their disposal: 24-hour Holter monitors, 30-day event monitors that are triggered by an abnormal heart rhythm or by the patient themselves, a 7-14 day patch monitor that records every heart beat and is later processed offlineto quanitate the arrhythmia, or perhaps an surgically-implanted event recorder that automatically stores extremes of heart rate or the surface ECG when symptoms are felt by the patient. The cost of these devices ranges from the hundreds to thousands of dollars to use. Today in my clinic, a patient brought me her atrial fibrillation burden history on her iPhone and it cost her less than a $10 co-pay.

 For $1.99 US, she downloaded the iPhone app Cardiograph to her iPhone. Every time she feels a symptom, she places her index finder over the camera on the phone, waits a bit, and records a make-believe rhythm strip representing each heart rhythm. With it, comes the date and time. Continue reading… “,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2010/09/16/thcb-recommends-2/”,”200″,”OK”,” Spread the love Categories: Uncategorized “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/tag/tpn/”,”200″,”OK”,” By MICHAEL KIRSCH, MD Recently, nine patients died in Alabama when they received intravenous nutrition that was contaminated with deadly bacteria. This type of nutrition is called total parenteral nutrition, or TPN, and is used to nourish patients by vein when their digestive systems are not functioning properly. It is a milestone achievement in medicine and saves and maintains lives every day.

What went wrong? How did an instrument of healing become death by lethal injection? What is the lesson that can emerge from this unimaginable horror? This tragedy represents that most feared ‘never event’ that can ever occur – death by friendly fire. No survivors. Contrast this with many other medical ‘never events’ as defined by the Centers for Medicare and Medicaid Services, such as post-operative infections, development of bed sores in the hospital or wrong-site surgery. Under the ‘never events’ program, hospitals will be financially penalized if a listed event occurs. Many physicians and hospitals are concerned that there will be a ‘never events’ mission creep with new outcomes added to the list that don’t belong there. Medical complications, which are unavoidable, may soon be defined as ‘never events’. Do we need a new category of ‘never ever ever events’ to include those that lead to fatal outcomes? The facts of the Alabama deaths have started to emerge.

  Apparently, a water faucet in the pharmacy was contaminated. Protocols and processes are violated every day in all spheres of professional life; and we usually get away with them. The absence of serious consequences breeds complacency, which is shattered by an occasional tragedy. Isn’t it after a horrible traffic accident that a local government decides to erect street lights that were requested by local residents for years? I read earlier today that the Federal Aviation Administration is requiring extensive inspections of a few hundred airplanes when small cracks were discovered in a few of them. This followed a near disaster when a 5 foot hole burst open in the roof of an airplane during flight. The plane landed and all survived. Of course, a very different outcome was possible.

Continue reading… “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/tag/joe-doyle/”,”200″,”OK”,” By DAVID DRANOVE & CRAIG GARTHWAITE Two weeks ago, the Kellogg School of Management was privileged to host Joe Doyle, an outstanding economist from MIT. In a broad research portfolio, Joe has focused on the effects from differing intensity of medical treatments. This research is shattering some long held beliefs about the relationship between health spending and outcomes. We think that Joe’s work is not known widely enough outside of the academic community, so we are using our blog to let you know what you have been missing and, in the process, perhaps change the way you think about healthcare spending. It is well known that the U.S. far outspends other nations on healthcare, yet the outcomes for Americans (in terms of coarse aggregate measures such as life expectancy, infant mortality, and other dimensions) are quite average. Of course, these outcomes are not the only things that we value in health care. A lot of our spending is on drugs and medical services that improve our quality of life and won’t show up in these aggregate outcomes. For example, more effective pain management can decrease pain and improve quality of life – often with important economic benefits. Despite this fact, most health policy analysts have concluded that we can cut back on health spending, without harming quality on any dimension. This is not a new idea, of course.

In a famous 1978 New England Journal article, Alain Enthoven coined the term “flat of the curve medicine” to describe how the U.S. had reached the point of diminishing returns in health spending. And for nearly 30 years the Dartmouth Atlas has documented how health spending dramatically varies across communities without any apparent correlation with outcomes. The question has always been, what health spending to cut? Garthwaite’s previous work has shown that broad regulations requiring longer hospital stays for new mothers and their babies have provided only limited benefits and that more targeted rules could save money without sacrificing quality. Beyond some wasteful regulations, we can always point to gross examples of overspending such as the rapid proliferation of proton beam treatments. But beyond those clear examples how can one identify what is waste and what is medically necessary?

In two important papers, Joe Doyle and co-authors ask a more fundamental question – is the often cited broad variation in health spending actually wasteful at all? They find that even in healthcare, there really is no such thing as a free lunch. His work should be mandatory reading for everyone who believes that broad spending cuts will have no adverse consequences. For those who lack the time to read these papers, we provide the “Cliff’s Notes” versions. Continue reading… “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2016/01/05/why-i-left-my-health-care-executive-role-to-join-a-startup/”,”200″,”OK”,” By CAROLYN BRADNER- JASIK, MD Six months ago, I made the decision to join a digital health startup, after directing the inpatient EHR roll-out at the University of California San Francisco (UCSF) Benioff Children’s Hospital. This may not seem that surprising: there is a lot of discussion lately of the growing dissatisfaction among doctors with the healthcare system, and “digital dropouts” leaving medicine to work in tech.

The difference is that I am neither 28 nor right out of residency. I’m a 40-year-old healthcare executive who is squarely mid-career, and I did not make the change for the usual reasons: the lure of money, job dissatisfaction, etc. I loved my job at UCSF, and in fact, I continue to see patients there. So why did I leave a promising academic career for a riskier role at a startup? Because we need more seasoned clinicians at the front lines of digital health to get us to scale. Our institutions have made huge financial investments, and now it’s time for us to make a more personal commitment. Every week, I receive an email from a colleague asking me to meet with a young physician who’s considering a career in tech, right out of training. We would not have digital therapeutics or a national physician network without innovators who left medicine early in their career to pursue a big idea. But this is not enough to induce mainstream adoption of digital health: we also need to hear the voices of physicians who have been in practice for a while or have held operational roles within large health systems. …institutions have made huge financial investments, and now it’s time for us to make a more personal commitment. I left my role at UCSF because I was disappointed as companies with great ideas were passed over. I often sat through pitches thinking, This is terrific, but we will never buy this because … The technology is great, but it doesn’t solve any pain point that we currently have. The product does not integrate well with our clinical workflows, including our EHR.

The startup has an A+ solution to our problem, but our EHR has a C+ solution that we already paid for and can implement with little cost. The technology budget has already been (over)spent on our EHR. Asking for additional resources is a heavy lift. Our staff have tech fatigue from large, complex EHR rollouts. The bandwidth to train and implement another tech solution is not there. Rock Health recently reported that digital health received $4.3 billion in funding this year.  But at the same time, 75% of this went to early-stage Series A and B rounds for innovations that may not stick. To take us to the next phase, we need more cross-pollination of perspectives, among both startups and enterprise organizations alike.

The seeds of this type of collaboration have already been planted, with innovation centers popping up at healthcare institutions, and startups hiring clinicians earlier. So why don’t more seasoned, executive physicians leave their posts to disrupt care? Most can be found on advisory boards or as innovation champions within their organization.