Celebrating Pi (3.141592653) 3/14/15 at 9:26:53
Today is super-pi day, a day that comes but once a century and extends to a specific time at 9:26:53 seconds (although when that occurs will depends on your time zone. While pi is an infinite non-repeating decimal, there are still mathematicians and scientists seeking to build computers that can run the computation and see how far they can plot the number. As Spock put it:
Here’s to those who choose to defy reality and instead envision a future world – a world that ventures beyond even Mr. Spock’s wildest dreams.
The sad news of Leonard Nimoy’s passing has spurred tributes to not only to his life and craft, but to Star Trek, and what it has meant to so many over the years. In talking with my friends and colleagues, it seems that regardless of age, most Trekkies are also techies.
But from this disappointment is born opportunity and a vision for the future world. Here is where Star Trek is a reality, where innovators take those every day frustrations and disappointments as ask themselves how things can be done better.
“I grew up watching Captain Kirk, Spock, and the Enterprise crew boldly go where no man has gone before. In the 1980s, Star Trek was big in India and it ignited our collective sparks of creativity and imagination. In fact, as school children, we learned to make “communicators” with matchboxes and rubber bands. When I grew up, I realized this type of voice-activated technology could be a reality, and I have dedicated my career to making that vision something that is accessible to everyone. I still wonder how close our technology today is to what Gene Roddenberry had imagined when he created Star Trek.”
- Vivek Kaluskar, Nuance Natural Language Processing Researcher
The show also got me interested in science fiction, which has proven to be an enduring affection. It’s amazing to step back and see many ideas that seemed outlandish, like tractor beams, talking computers, matter transmission, and warp drives, are either becoming a reality, or are being researched and developed. Science fiction, in many ways, has created a technological roadmap for the future. It reminds us to keep dreaming and keep asking ‘why can’t we do that?’”
- Ignace Van Caneghem, Nuance Customer Support Specialist
We are a lot closer to the Hollywood vision that’s been in our minds since 1967, creating innovative technology that continues to amaze us at an incredible pace. It was this sense of amazement, instilled by the creative mind of Gene Rodenberry, which helped open my eyes to the potential for healthcare technology to touch not just hundreds, but millions of patients through innovation.
This Saturday is Super Pi Day, a day that comes but once a century. While pi is an infinite non-repeating decimal, there are still mathematicians and scientists seeking to build computers that can run the computation, see how far they can plot the number. Here’s to those who chase the impossible. To those who know there is a better way to do things and dare to keep asking “how?” They choose to live between two worlds and they are building the future. Super-pi day is for you.
This post originally appeared in Whats Next
I spent some time at Medicine 2.0 and participated on the panel Bridging the Digital Divide and will presented: Speech and Medical Intelligence – Allowing Doctors to Focus on Patients Not Technology
This is an exciting time for mobile devices and while we know there is a discrepancy in the accessibility of mobile technology (I’ll be participating on the panel Bridging the Patient Digital Divide) some of this divide in access can be linked to the complexity of this technology. With ubiquitous technology comes ubiquitous complexity – adn this is especially true for doctors who face challenging User Interfaces – captured here in this post: How Bad UX Killed Jenny. As doctors we feel we are loosing touch with the Art of Medicine
Which for many of us was the reason we started on the journey to being a healer. Physicians don’t go to medical school because they want to document and code clinical information. Doctors choose their path because of their compassion and desire to deliver care to patients in need. There are increasing physician frustrations with technology and their struggle to keep the focus on patients and not data entry.
Medicine is part science, part art. The relationship between physicians and patients is at the core of healing. This begins with hearing and understanding but is followed by focusing on the patient not the technology. I will be presenting our prototype “Florence” that combines artificial intelligence and speech recognition to offer innovative new speech technologies that help capture and understand not just what the clinician says but what they mean. With new tools that speech enabled systems we simplify access and empower clinicians to capture information and thoughts as they occur. Through the innovative use of natural language tools, context awareness and the generation of high-value clinically actionable medical information clinical systems become efficiently integrated into care delivery process offering the opportunity for doctors to return to the Art of Medicine and focus on the patient.
Here’s a video showing off Florence
One in eight U.S. women will develop invasive breast cancer over the course of her lifetime. In 2014 alone, an estimated 295,000 new cases of invasive breast cancer are expected to be diagnosed. That’s approximately 808 cases per day.
But these statistics don’t matter. Whether it’s one-in-eight or one-in-3 million, the impact of the illness is what matters—not the numbers. It immediately becomes a reality to you. We can never forget that healthcare is personal, something my colleague, Melissa Dirth, articulated beautifully in her recent post “When 1 in 8” was no longer just a statistic to me.”
As a physician, sharing unfavorable findings and test results is always a sobering moment, no matter how many times you’ve done it before. We all struggle to find the right words, and look for ways to be supportive as you allow your patient to handle the shock that accompanies such news. We all have different viewpoints and our perspective on the disease is colored by our own life experiences and the individual circumstances.
What never ceases to amaze me, however, is the strength of the human spirit. Despite the hard road stretching before them, so many of our patients face breast cancer with what the British would term “Dunkirk Spirit,” that inner strength that helps patients and their families overcome tremendous adversity.
It is, in my opinion, one of the reasons that make cancer sufferers and survivors such an important and compelling tableau of courage.
Unfortunately, one of the essential elements that quickly becomes lost in the morass of technology is the Art of Medicine, and our ability as doctors to spend the time focused on our patient and their relatives. As clinicians, we intuitively know the statistics associated with the disease and can interpret them to understand the impact the diagnosis we have just communicated with the patient is likely to have, but there is so much more to providing care. We don’t just treat the condition, the physical body—we are caregivers and healers, and we seek to help the whole patient.
Technology can help in healthcare, but it is not the goal nor should it ever be the focus. Yet, in some cases, it has detracted from our ability to provide care and compassion. To deliver on the promise of great healthcare we have to return to the Art of Medicine and enable, not disable, our clinicians with the technology we develop.
To learn more about the role technology plays in the Art of Medicine, read: “There’s no room in technology in end-of-life care decisions”
This article originally appeared on WhatsNext: Healthcare
Offers a timely reminder that the US Government delayed a second time the implementation of ICD10 coding system that is used in the rest of the world
There is no code for Ebola in ICD9 – just a non-specific 078.89: Other specified diseases due to viruses which covers:
Disease Synonyms Acute infectious lymphocytosis Cervical myalgia, epidemic Disease due to Alpharetrovirus Disease due to Alphavirus Disease due to Arenavirus Disease due to Betaherpesvirinae Disease due to Birnavirus Disease due to Coronaviridae Disease due to Filoviridae Disease due to Lentivirus Disease due to Lone star virus Disease due to Nairovirus Disease due to Orthobunyavirus Disease due to Parvoviridae Disease due to Pestivirus Disease due to Polyomaviridae Disease due to Respirovirus Disease due to Rotavirus Disease due to Spumavirus Disease due to Togaviridae Duvenhage virus disease Ebola virus disease Epidemic cervical myalgia Infectious lymphocytosis Lassa fever Le Dantec virus disease Marburg virus disease Mokola virus disease Non-arthropod-borne viral disease associated with AIDS Parainfluenza Pichinde virus disease Tacaribe virus disease Vesicular stomatitis Alagoas virus disease Viral encephalomyelocarditis Applies To Epidemic cervical myalgia Marburg disease
ICD-10 has one specific code for Ebola: A98.4 – Ebola Virus Disease Clinical Information A highly fatal, acute hemorrhagic fever, clinically very similar to marburg virus disease, caused by ebolavirus, first occurring in the sudan and adjacent northwestern (what was then) zaire.
Accurate tracking and reporting stop at the border of the United States
This is one of many examples of codes “missing” in ICD9 for conditions and care we are already delivering and dealing with
I attended the Connected Healthcare Conference in San Diego yesterday Accelerate mHealth Adoption: Deliver Results through Data Driven Business Models for End-User Engagement
You can find the agenda here and the organizers will be publishing the presentations – there were many interesting insights
Andrew Litt, MD (@DrAndyLitt) (Principal at Cornice Health Ventures, LLC) opened the conference with a great overview of the industry and a slew of challenges and opportunities.
He sees our industry in Phase 1 – the Capture and Digitization of records and we have yet to really move and explore Phase 2:
Move and Exchnage Data AND Analyze and Manage Data that is linked to Information Driven decision Making
And Phase 3:
Managing Patient Health
In our need to move from data to analysis and information he cited a statistic from a white paper: Analytics: The Nervous System of IT-Enabled Healthcare that sadly puts 80% of data in the EMR unstructured. This is a fixable problem today with Clinical Language Understandingand we are seeing some results and a change in the industry to stop looking to doctors to be data entry clerks He also cited Hospitals:
Technology offers tremendous scope to not only fix these problems but get ahead of the problem (as is done in other industries like the Airline industry that has rebooked your flights before you even land and miss your connection). As he suggested could we use data to understand who is likely to develop a heart attack in the next 2 hours and try and change this outcome
But integrating mHealth into our workflow requires an mHealth Ecosystem:
mHealth needs an ecosystem that improves workflow and integrates data to reduce clinicians workload. This is why doctors and clinicians are resisting mHealth – they don’t like the change to the workflow that has little if any positive effect (for the doctor – they may have a positive effect for the individuals health) of reducing clinicians workload
Interesting comment on wearables and the perspective of doctors on these devices:
What bothers the doctor – mostly the people who are buying and using wearable fitness/activity trackers are the people that are young healthy fit and want to prove to (themselves/others) that they are young fit and healthy?
His graphic on Security and privacy was on the money:
Essential to balance Privacy of Health with interoperability but trust is the imperative The stats he presented were troubling (at best)
- 96% – Percentage of all healthcare providers that had at least one data breach in the past two years
- 18 Million – Number of patients whose protected health information was breached between 2009 and 2011
- 60% – Proportion of healthcare providers that have had 2 or more breaches in the past 2 years
- 65% – Proportion of breaches reported involving mobile devices
- $50 – Black market value of a health record
The healthcare industry is under attack and is the most attacked industry today:
You might find these figures of the value of Healthcare data as it is valued on the black-market
Another interesting data point:
HIMSS records a total of 11,000 Healthcare Technology companies – less than 100 are large size and the balance of 10,900 are small business that are essentially capturing and scattering your data across many systems and data repositories…
Multiple other presentations and panelists that were all insightful. As always Jack Young (@youngjhmb) from Qualcomm Life Venture fund had some great insights – impossible to capture all of them but here are some:
Healthcare is moving out of the hospital into the home for many reasons but cost is a big driver:
and he suggested there was at least $1.5 Trillion in economic value as the industry shifts (shifting vs replacement?)
Many were surprised by his stat that users check their smart phone at least 150 times per day (just looking around my world this seems low) – in fact a quick check online suggests this is no longer valid and it is probably 221 times per day. Given this device is the one thing we will not leave home without and it now contains a range of sensors including:
- Finger print
We have the potential for more passive compliance with our patients (and as many stated in their presentations likely more accurate as self reported data is notoriously inaccurate) He predicted a a 10x growth in wearables from 2014 – 2018 with 26% of this growth attributable to smart watches (I know hard to believe at this point but I think if you looked back 4 years ago the iPad had nothing like the level of penetration it does today) iPad Growth Rate
I liked his assessment of the werable market place by researching the eBay Discount against the price of the new device:
and even worse for Smart Watches
I also presented “mHealth Reimbursement – Who Will Pay: You can see it here at Slideshare or below:
Like many people the death of Robin Williams
was sad on so many levels and while my connection with him was limited to the exposure I had through his canvas of work, I like others felt I knew him.
He was not only prolific in his work with a list of films, interviews and shows (and if you have NetFlix – here’s all the movies available there), but could often be found adding color and charisma in the most unusual places – in this story related by Christopher Reeve talkingabout his friendship as they walked past a lobster tank in a restaurant
One evening we went out to a local seafood restaurant, and as we passed by the lobster tank I casually wondered what they were all thinking in there. Whereupon Robin launched into a fifteen-minute routine: one lobster had escaped and was seen on the highway with his claw out holding a sign that said, ‘Maine.’ Another lobster from Brooklyn was saying, ‘C’mon, just take da rubber bands off,’ gearing up for a fight. A gay lobster wanted to redecorate the tank. People at nearby tables soon gave up any pretense of trying not to listen, and I had to massage my cheeks because my face hurt so much from laughing.”
Bet you wish you had been there to listen in!
The outpouring of grief, sadness and accolades was no surprise and while he may not be everyone’s favorite actor or character it is hard to imagine people feeling dislike for him.
He was a serious actor who’s work included playing characters with flaws Good Will Hunting
And a personal Favorite (for the teacher we all wanted to have – Captain, My Captain) The Dead Poet’s Society
But is best known for his comedic genius and unstoppable energy that could light up any room or interaction and turn even the most somber of moods into smiles and laughter
And his comedic view of what Lobsters were thinking in a tank as he demonstrated when he visitedhis longtime friend Christopher Reeve and making him smile for the first time after his accident
“As the day of the operation drew closer, it became more and more painful and frightening to contemplate,” wrote Reeve. “In spite of efforts to protect me from the truth, I already knew that I had only a fifty-fifty chance of surviving the surgery. I lay on my back, frozen, unable to avoid thinking the darkest thoughts. Then, at an especially bleak moment, the door flew open and in hurried a squat fellow with a blue scrub hat and a yellow surgical gown and glasses, speaking in a Russian accent. He announced that he was my proctologist, and that he had to examine me immediately. My first reaction was that either I was on way too many drugs or I was in fact brain damaged. But it was Robin Williams. He and his wife, Marsha, had materialized from who knows where. And for the first time since the accident, I laughed. My old friend had helped me know that somehow I was going to be okay.”
The friend we all want to have…?
With that in mind it can be hard to reconcile that character with someone who would take his own life:
- How is it possible that someone with what appeared to be so much joy and happiness who was surrounded by friends and family find themselves in such a state of despair to take an irreversible path and commit suicide?
- How is it possible that someone who outwardly seemed to have such a sharp insight into people and laughter who could make us all laugh at the most unlikely of issues or discussions could take his own life?
- How is it possible that someone with such a storied and successful career could drop into a state of depression with so much to live for and so many people who loved him and end his own life?
- How is it possible that a smart, intelligent and gifted individual with so many positive aspects to his life could see no alternative to ending his life and commit suicide?
In what seems eerily insightful he talked about this in his “report to Orson” in the show Mork and Mindy in 1981 where Mork meets a famous celebrity (in this case it the famous celebrity is Robin Williams): “Mork Meets Robin Williams”. You can watch part of it here Mork learns about the nature of fame on Earth and the toll it takes on those who get swept up in it, or try this link
There has been some mention of Parkinson’s Disease and this may have had a contributing role. But the underlying challenge was his battle with depression. On many occasions he had shared his struggle with depression and substance abuse and the ongoing challenge he personally faced dealing with his disease.
The word depression is used frequently by people to describe their feelings and emotions but it has a very specific meaning in medicine and is used to describe a mood disorder:
Not to be confused with sadness which is a temporary feeling that is normally associated with some negative aspect of our lives or surroundings and passes
Our understanding of depression is still limited – our treatment of this disease is still in its infancy and mostly limited to broad-brush therapies that impact neurotransmitters that are implicated but not exclusively associated with depression. We have (mostly) moved past separating and isolating people from the general population (although some would argue that our prison system is the new version of the sanatorium). But our ability to treat or cure depression remains stubbornly missing.
Our understanding of the brain is limited and despite laudable attempts to jumpstart the process The NIH BRAIN Initiative. progress however remains frustratingly slow and leaves our society with a subset of the population suffering from varying degrees of debilitating diseases of our brain including depression, mania and schizophrenia and many others.
So what did Robin Williams teach us in Life
Laughter is the best medicine
It is hard to pick a single moment from his incredible repertoire, so I picked 3: Mrs Doubtfire Explaining Golf Or this medley tour of cultures and accents all done in less than 2 minutes Laugh and laugh loudly
Being different is not just OK its what makes life worth living
and the real Patch Adams
What did Robin Williams Teach us in Death
We need empathy, compassion and tolerance in our society Empathy: The Human Connection to Patient Care Social Media can help link people but even with these digital connections humans may still feel disconnected and alone despite outward appearances to the contrary and connecting, engaging and reaching out is even more important today in our “connected” world
Suicide is painful – not only for the unnecessary loss of life but for the trail of despair it leaves behind for all the people wondering what if…. should have…. could have done….
I’ve experienced it with friends and still think about them. In fact I was reminded when I read about two more suicides in New York: Suicides At NYU And New York Presbyterian–2 Physician Interns Jumped To Their Deaths of two promising lives brought to a final and sad end.
Don’t let that be your legacy and reach out to someone today and remind them and yourself why life is great for both of you
Come join me in the conversation with my colleagues at the SpeechTek 2014 conferencein Marriott Hotel in Time Square, Manhattan New York.
The Panel: C103 – PANEL: The Digital Healthcare Revolution at 1:15 p.m – 2:00 p.m. The panel moderator Bruce Pollock, Vice-President, Strategic Growth and Planning at West Interactive and on Social Media @brucepollock
I will be joined by Daniel Padgett, Director, Voice User Experience at Walgreens and on Social Media at @d_padgett and David Claiborn, Director of Service Experience Innovation at United Health Group.
We will be discussing the opportunities and challenges associated with the current digital healthcare revolution and of course how speech plays an essential role in integrating this technology while maintaining the human component of medicine that we all want. Rather than Neglecting the patient in the era of health IT and EMR
We have progressed from the world of Sir Lancelot Spratt
And the Doctor need to look at the patient not the technology perhaps in a cooperative Digital Health world like this
Is this future of Virtual Assistant Interaction good, desirableDemo Video 140422 from Geppetto Avatars on Vimeo.
We will be discussing
- What are the biggest obstacles to digital healthcare becoming a reality?
- Where do speech technologies bring the most value to healthcare?
- How will health providers, insurers, and payers provide patient support in the world of digital healthcare?
Perhaps the emerging Glass concepts improve this interaction as they are exploring in Seattle
Join us for analysis of the state of digital healthcare today and predictions for its future.
In the end
Come join the discussion as we explore the digital technology and how it should be used in healthcare and how speech can help
I attended a Wearble Technology conference today in Pasadena California: Wearable Tech LA
One of the more interesting concepts takes the challenge we have all faced mastering the mechanics of walking, exercise, running and in some cases rehabilitation by placing sensors in the sole of shoes – Plantiga who have taken force analysis for our feet to a whole new level
The technology takes the static Force Plate sensor and turns into a continuous assessment 3-D tool offering an opportunity to apply this in specific sports and to help rehabilitate people who have been injured or have mechanical challenges (the side effect of capturing all this data is actually creating more comfortable shoes as they now have built in suspension and springs).
It might take a while to arrive in healthcare but in the meantime may well show up as another input device for the X-box or PS3 for a more realistic interface.
There was sensors to be placed all over the body for respiration, heart rate, muscle movement, acceleration/deceleration and even some to be ingested
A major challenge highlighted by several speakers facing all of the wearables genre was the issue of battery life
(and ironically it was the same problem I faced as I tried to capture and post social media)
The opening keynote was from Nadeem Kassam – CEO of BioBeats (Founder of Basis which is now an Intel company). His journey was one of classic rise from poor neighborhood in South Africa where he started his entrepreneur sporty selling oranges
He focused on three lessons – the first an essential learning point for everyone especially those facing healthcare challenges
He also suggested that those looking to succeed with innovation should:
- Look for innovation outside of your industry, and
- Don’t throw a big team or money at innovation
His story behind this was a classic one of engineers told to build a product who came back with his wearable watch that was a huge device that weighed down his arm and had a velcro battery pack under the arm!
He ended up finding his greatest engineers on Craigslist who’s references and Resume was a cardboard box full of devices that he had built.
The new concept of “Adaptive Media” which is bridging the divide between human emotion, data and the media we consume and should adapt to our mood based on our emotion. His new company has done some interesting research programs including an experiment with machines designed to allow people to hear their own heartbeat and have it set to music in Australia. When people heard their heartbeat for the first time it created a deeply emotional experience and many were moved to share very personal life stories.
They took this a step further and worked to gather heartbeats worldwide – a clever BIGData gathering exercise that amassed large quantities of rate, rhythm and details of millions of people around the world.
His overriding point was
There was a fascinating blend of the Entertainment industry and Hollywood and a slew of companies taking different approaches to these devices:
Epihany Eyewear tries to make wearables fashionable as well as functional (I’d say it not so much as fashion but blending into society)
Optivent with powerful wearable glass – but no mention of the interface They probably had the most fun concept videoLes lunettes d’Optinvent voient plus grand que les Google glass from Rennes, Ville et Métropole on Vimeo.
Enlightened design had the most impressive on stage display with a jacket that had lapels that constantly changing color
|Janet Hansen – Founder & Chief Fashion Engineer, Enlightened Designs|
Sporting her jacket with lapels that constantly changed color
Sports and Wearable
Given the excitement over the last month wight he World Cup it was fascinating to hear from Stacey Burr from Adidas who revealed that most if not all the teams were using technology to help them train and track in extensive detail – she suggested that there is not a single team or sport that is not using wearable technology in some form or another.
You can see some of the gear below
|GPS enabled ECG/EKG monitoring Units plug into the back around the neck area|
|Paired with watches to offer players feedback|
|Digital insides of a ball used to sense how well it is struck|
These are the professional versions used by major teams but Adidas is releasing commercial versions that will be available to the general public but lack the GPS capability and the analysis tools they offer
Surprisingly the leaders from a sports and country standpoint are Rugby and Australia and New Zealand who are “light years ahead” of wearable tech in sports
|They are ahead in Psyching out their opponents too!|
Sensoria demonstrated an exciting interactive future for sports and wearables where we challenge ourselves, other people and are coached by virtual assistantsSensoria Fitness Shirt with Heart Rate Sensors from Heapsylon on Vimeo.
One of the highlights:Seeing Dick Fosbury of the “Fosbury Flop” Olympic Gold Medal Winner from Mexico 1968 and it turns out he is a Cancer Survivor, has an aneurysm and fully engaged in the intersection between healthcare and wearable technology
Neil Harbisson – Co-Founder, Cyborg Foundation
who was born totally color blind was definitely at the edge of wearable technology. He has an implanted device that turns color into sound and this is directly fed into his brain. He described that it took 5 weeks for the headaches to stop with this sudden input of data and then 5 months before it just became part of him and he now sees in color. Here’s his TED Talk: I listen in Color http://embed.ted.com/talks/neil_harbisson_i_listen_to_color.htmlHe also has a permanent internet connection in his brain so people cane send him colors and images directly (he joked the address is private – but I did wonder given the ease with which spammers seem to find new addresses how he protects this destination from spam!)
I don’t wear technology I am technology, I can’t tell the difference between the software & my brain
The healthcare focused panel: Emerging Wearable 2.0 Health Platforms:
The furthest along and well know was probably Misfitwearables (Sonny Vu, CEO) who try and make sensors “disappear” but still simple sensors
OMSignal (Jesse Slade Shantz – Chief Medical Officer) was the most interesting as they are trying to change the monitoring from attached sensors to using fabric that can be loose fitting but can capture physiological information.
Breathometer(Charles Michael Yim – CEO) focus on analyzing your breath and have a range of products directed at health (over and above their simplistic alcohol breathalyzer available today) that assessed fat burning (using acetone) and asthma
NeuroSky(Stanley Yang – CEO) offer a system that other manufacturers can integrate into their wearables. Typically found in mobile phones or headsets
LUMO(Monisha Perkash – CEO & Co-founder) offering a discreet sensor that is designed to help improve your body posture and works as a tracker.
It’s an exciting future with some fascinating technology to come – one thing for sure – with ubiquitous technology comes ubiquitous complexity and your voice will become an essential tool for successfully managing and navigating. Dragon Assisatnt is one of several tools built to assist in using and navigating technology that is reinventing the relationship between people and technology
We have some Healthcare reform in the US but we are still challenged with a system that is failing to deliver results. This piece recently: America Ranks No. 1 for Over-Priced, Inefficient Health Care featured the chart from the Commonwealth fund
That ranks the US last in a group of 11 industrialized countries.
As he puts it:
There is one way America is clearly exceptional: we have a healthcare system that is dramatically more expensive than the rest of the industrialized world, but it doesn’t manage to make us any healthier.While the Affordable Care Act attempts to address access it does little to address the cost of the system and the inefficiencies. This does not require a reduction in premiums it needs to address the costs built in to the system that we are all paying for in on form or another
Dr Hans Duvefelt wrote this piece on the healthcare blog: A Swedish Country Doctor’s Proposal for Health Insurance Reform that draws on his personal experience in “socialized medicine, student health, cash-only practices and government-sponsored rural health clinic working for an underserved, underinsured rural population.”
His focus is as a primary care physician but most would agree this is one of the most challenging areas for reform with the shortage in clinicians and low reimbursement rates that is driving doctors out and certainly no encouraging our new generating of clinicians to dive into this essential area.
His main proposals center on basic services that are covered by a flat rate for populations
- Have the insurance company provide a flat rate in the $500/year range to patients’ freely chosen Primary Care Provider, similar to membership fees in Direct Care Medical Practices.
- Provide a prepaid card for basic healthcare, free from billing expenses and administration.
but importantly changing the responsibility and feedback on the cost from a central purchasing authority (the government for example) to the user themselves.
- Unused balances can be rolled over to the following years, letting patients “save” money to cover copays for future elective procedures.
And offers a pathway to specialty care with some appropriate oversight and appriroate levels of reimbursement.
- Keep prior authorizations for big-ticket items, both testing and procedures, if necessary for the health of the system.
- Keep specialty care fee-for-service.
These are clever suggestions and would do much to encourage the patient engagement that will be, as Leonard Kish stated
Patient Engagement is the Blockbuster drug of the century
He rightly points out that the current health “insurance” products are often poorly named – given that insurance that pays and copiers to identify diseases with screening but then stops short of paying to treat conditions and diseases when they are found through that screening. But most of all Insurance should be user driven and priorities and decision left in the hands of the individual and their clinician and not relegated to others who sit in offices emoted from clinical practice and focused on fiscal drivers not on care and quality fo life
Health insurance is not like anything else we call insurance; all other insurance products cover the unexpected and not the expected. Most people never collect on their homeowners’ insurance, and most people never total their car. Health insurance, on the other hand, is expected by many to be like a bumper-to-bumper warranty that insulates us from every misfortune or inconvenience by covering everything from the smallest and most mundane to the most catastrophic or esoteric.
His point about setting of priorities is important – no matter how you cut it there is no unlimited pot of money o resources to treat everything and everybody. These are difficult conversation and ripe for abuse by those with their own agenda’s through fear mongering and use of emotive terms like “Death Panels”.
None of this aspect of reform is simple but it needs to be addressed and included.
The United Kingdom’s National Health Service (NHS) may not be perfect but they have started this process of addressing the challenge of allocating resources in an open manner. They developed the the quality-adjusted life years measurement (QALY) out of the National Institute for Health and Care Excellence (NICE). There has been criticism and push back as there will always be but the concept and methodology use is not limited to the UK. While imperfect as Laozi (c 604 bc – c 531 bc) stated: A journey of a thousand miles begins with a single step
There is lots of detail in this piece and I would encourage you to go over and read it
Previously posted on HITConsultant
On a recent flight, I had my headphones on and the Rolling Stones’ “Satisfaction”
began to play.
It’s a song I have heard hundreds of times over the years, but I was struck by the difference listening to it with headphones made. With no distractions, I noticed the bass line, in time with the percussion, provides the perfect offset to Mick Jagger’s distinctively strained voice. It was a completely different experience than hearing the track play in the background of a movie or while at a restaurant. Being fully-immersed and listening only to that song allowed me to pick out and appreciate subtle details I had never noticed previously. It’s no surprise that things sound differently when you’re able to concentrate your full attention on what is being said, but as I was sitting there, I became acutely aware of the function headphones serve—they enable the wearer to listen, blocking out distractions.
That is exactly what we are seeking in healthcare and it has proven to be difficult to achieve – in part because of pace, complexity of care, and technology. For centuries, physicians have listened to their patients and relied on their senses— their powers of observation— and matched these insights with clinical experience to heal. Clinicians need to be able to listen and concentrate on what their patient is telling them and noticing those distinctive symptoms he or she may be exhibiting. As Sir William Osler
Being able to dedicate your undivided attention to anything these days is a rarity, but in healthcare, it is a crucial but frequently missing element. The last thing you want to feel when you are at your most vulnerable is that your physician is multi-tasking. Patient satisfaction scores will suffer, but more concerning are the clinical risks and missed opportunities of distracted physicians.
Distracted clinicians are the result of what Dr. Steven Stack of the American Medical Association refers to as an “over-designed” health IT system.” In a recent discussion with industry leaders, he explained that we seem to have become victims of our own ambition. We have devised structures that don’t work for everyone and policies that create very real, very expensive consequences for those who don’t abide. And this has left physicians stretched too thin, trying to do more in less time without any direct impact on improving their ability to care for their patients.
So, maybe it’s time we scale back. Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center and co-chair of the nation HIT Standards Committee, noted that while we are in this period of transition and growth, we need to focus on parsimony, or determining the smallest number of moving parts that need to be adjusted in order to create seamlessness in HIT. Quite simply put, while the cart has been upset, there is no reason to trample all over the apples.
The MIT Technology Review recently interviewed Sarah Lewis, a doctoral candidate at Yale, about her recent book that explores how different unlikely circumstances or paths, like failure, have often spurred innovation. Citing creative geniuses such as Cezanne and Beethoven to Nobel laureates, she defines failure as the gap between where one is and where one would like to be. Confronting this gap, she asserts, is important because it “lets people go deep with their failure while letting it be an entrepreneurial endeavor if they like, or an innovative discovery.” We, in health IT, are currently at that gap where there is a disparity between where we are and where we would like to be.
The recent ICD-10 delay has provided the perfect opportunity for us to find Halamka’s parsimony, leveraging solutions that work for physicians and creating consistency and impact wherever possible. Like medicine itself, there will be no one perfect solution for every physician or organization, but we need to begin finding things that work – from re-skinning EHRs with easy to use tools like single sign-on or mobility to systems that respond to voice, touch or swipe to improve the experience for clinicians and patients. We need to start thinking of health IT more like headphones, coming in different styles to suit preferences, but providing the same function of reducing distraction and enabling the clinician to focus on the inflections in their patients’ voices, and truly hearing what is being said.
As Mick Jagger poignantly remarked, “The past is a great place and I don’t want to erase it … but I don’t want to be its prisoner, either.” We have accomplished a lot, but it is time to learn from the past and break free from what isn’t working. I think we can get health IT satisfaction (despite what the song says), but to do so we must all be engaged in the design, delivery, and re-imagination of healthcare and its intersection with technology. This truly is the art of medicine and we are all virtuosos contributing to the next masterpiece of healthcare.