Navigating Healthcare – Patient Safety and Personal Healthcare Management

Moon Landing Anniversary: Pictures From Historic Apollo 11 Misson (PHOTOS)

Posted in Health, Healthcare, HealthIT by drnic on July 27, 2012
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Anniversary of the Apollo 11 Landing on the moon set in motion with these words

First, I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the earth. No single space project in this period will be more impressive to mankind, or more important for the long-range exploration of space; and none will be so difficult or expensive to accomplish.

Sadly I do not think we have the same vision necessary to take the next giant leap

https://navigatinghealthcare.files.wordpress.com/2012/07/media_httpihuffpostco_jixjy-scaled500.jpg?w=260

http://drvoice.blogspot.com/2012/07/moon-landing-anniversary-pictures-from.html

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Moon Landing Anniversary: Pictures From Historic Apollo 11 Misson (PHOTOS)

Posted in Moon Landing, Space by drnic on July 27, 2012
Media_httpihuffpostco_jixjy

Anniversary of the Apollo 11 Landing on the moon set in motion with these words

First, I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the earth. No single space project in this period will be more impressive to mankind, or more important for the long-range exploration of space; and none will be so difficult or expensive to accomplish.

Sadly I do not think we have the same vision necessary to take the next giant leap

Apollo 11 Video Montage

Posted in Health, Healthcare, HealthIT by drnic on July 21, 2012
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Apollo 11 Video Montage

Posted in Apollo11, Space by drnic on July 21, 2012

News Round Up – July 20

Posted in Health, Healthcare, HealthIT by drnic on July 18, 2012

Some interesting news pieces to review this week including

The Value of the EHR

The Relationship Between Electronic Health Records and Malpractice Claims,” from the Archives of Internal Medicine on Jun 25 and featured in the AMED News: “EHR use linked to fewer medical liability claims” on July 16

A research letter published online June 25 in Archives of Internal Medicine found that the rate of liability claims when EHRs were used was one-sixth the rate when EHRs were not used. Researchers say their findings suggest there was a reduction in errors associated with EHR use.

That showed the following results before and after an EHR implementation:

A word about correlation and the fact this does not imply causality: …correlation between two variables does not automatically imply that one causes the other

But as the authors put it:

It’s entirely possible that there’s something still distinct and unusual about practices that adopted electronic health records earlier, and they just happen to practice in a way that reduces their risk of malpractice claims….But I think it’s equally plausible that there’s something about electronic health records that does reduce their risk.

Uncertain but an interesting positive development

High Price Variability in US Hospital Surgical Procedures

Calprig published a report “Your Price May Vary” that offered a view into the wide differences in pricing for the same procedure in California. For example for a knee replacement from $59,800 (Alameda County Medical Center) to $164,400 (Washington Hospital). But the variation doe snot necessarily track quality adn they pointed to an earlier study in the Archives of Internal Medicine that showed county hospitals usually charge the least and for-profit hospitals charge the most and did an an interesting analysis of the hierarchical model for percentage increase in median charge for various patient and hospital factors:

And the charges for Appendicitis:

The median hospital charge among all patients was $33,611, with a lowest observed charge of $1529 and highest of $182,955

Personal Health Records

This review of Kaiser’s myHealthManager: Lab tests and knowing our numbers can inspire patient engagement:

Engaging patents and sharing laboratory data helping them understand their results can inspire patent engagement. As they put it it is not enough to share the data you have to engage with the patient:

That means patients need to knowing their numbers: what they mean, and how changing them can impact their future quality and length of life… where personal behavior change has the potential to do this

This is the start of patient engagement and one that I think we will see increase in the coming months and years

This and more on #VoiceoftheDr

Join me on Friday at 2:30 ET on VoiceoftheDoctor
There are three ways to tune in:

• Stream the show live – click the Listen Live Now to launch our Internet radio player.

• You can also call in. A few minutes before our show starts, call in the following number:  Call: 1-559-546-1880; Enter participant code: 840521#

•  HealthcareNOWradio.com is now on iTunes Radio!  Stream the show live – you’ll find this station listed under News/Talk

http://archinte.jamanetwork.com/data/journals/intemed/0/m_ild120034t1.png

http://drvoice.blogspot.com/2012/07/news-round-up-july-20.html

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News Round Up – July 20

Posted in #hcsm, #voiceofthedoctor, #voiceofthedr, EHR, Health Reform, HealthIT, Quality of Care by drnic on July 18, 2012

Some interesting news pieces to review this week including

The Value of the EHR

The Relationship Between Electronic Health Records and Malpractice Claims,” from the Archives of Internal Medicine on Jun 25 and featured in the AMED News: “EHR use linked to fewer medical liability claims” on July 16

A research letter published online June 25 in Archives of Internal Medicine found that the rate of liability claims when EHRs were used was one-sixth the rate when EHRs were not used. Researchers say their findings suggest there was a reduction in errors associated with EHR use.

That showed the following results before and after an EHR implementation:

A word about correlation and the fact this does not imply causality: …correlation between two variables does not automatically imply that one causes the other

But as the authors put it:

It’s entirely possible that there’s something still distinct and unusual about practices that adopted electronic health records earlier, and they just happen to practice in a way that reduces their risk of malpractice claims….But I think it’s equally plausible that there’s something about electronic health records that does reduce their risk.

Uncertain but an interesting positive development

High Price Variability in US Hospital Surgical Procedures

Calprig published a report “Your Price May Vary” that offered a view into the wide differences in pricing for the same procedure in California. For example for a knee replacement from $59,800 (Alameda County Medical Center) to $164,400 (Washington Hospital). But the variation doe snot necessarily track quality adn they pointed to an earlier study in the Archives of Internal Medicine that showed county hospitals usually charge the least and for-profit hospitals charge the most and did an an interesting analysis of the hierarchical model for percentage increase in median charge for various patient and hospital factors:

And the charges for Appendicitis:

The median hospital charge among all patients was $33,611, with a lowest observed charge of $1529 and highest of $182,955

Personal Health Records

This review of Kaiser’s myHealthManager: Lab tests and knowing our numbers can inspire patient engagement:

Engaging patents and sharing laboratory data helping them understand their results can inspire patent engagement. As they put it it is not enough to share the data you have to engage with the patient:

That means patients need to knowing their numbers: what they mean, and how changing them can impact their future quality and length of life… where personal behavior change has the potential to do this

This is the start of patient engagement and one that I think we will see increase in the coming months and years

This and more on #VoiceoftheDr

Join me on Friday at 2:30 ET on VoiceoftheDoctor
There are three ways to tune in:

• Stream the show live – click the Listen Live Now to launch our Internet radio player.

• You can also call in. A few minutes before our show starts, call in the following number:  Call: 1-559-546-1880; Enter participant code: 840521#

•  HealthcareNOWradio.com is now on iTunes Radio!  Stream the show live – you’ll find this station listed under News/Talk

Higgs Boson Particle and Field Explained

Posted in Uncategorized by drnic on July 12, 2012

Not exactly medical but an area of great interest for me and one that is so fundamental to our world I thought worth talking about. If you want to get a sense of science and how little we still don’t know or understand I recommend you read 

 

A Short History of Nearly Everything – Bill Bryson – available here and in digital form eBook and audio. This form the opening paragraph

Welcome. And congratulations. I am delighted that you could make it. Getting here wasn’t easy, I know. In fact, I suspect it was a little tougher than you realize. To begin with, for you to be here now trillions of drifting atoms had somehow to assemble in an intricate and intriguingly obliging manner to create you. It’s an arrangement so specialized and particular that it has never been tried before and will only exist this once. For the next many years (we hope) these tiny particles will uncomplainingly engage in all the billions of deft, cooperative efforts necessary to keep you intact and let you experience the supremely agreeable but generally underappreciated state known as existence. 

Worth sharing since there is a lot of interest right now following the announcement on July 4, 2012 at CERN that “CERN experiments observe particle consistent with long-sought Higgs boson

The core of the announcement is a discovery of the heaviest boson to date at 125GeV with a 5 Sigma signal (translation – pretty sure it is an accurate reading…1 sigma means the results could be random fluctuations in the data, 3 sigma counts as an observation and a 5-sigma result is a discovery)

The results are preliminary but the 5 sigma signal at around 125 GeV we’re seeing is dramatic. This is indeed a new particle. We know it must be a boson and it’s the heaviest boson ever found,” said CMS experiment spokesperson Joe Incandela. “The implications are very significant and it is precisely for this reason that we must be extremely diligent in all of our studies and cross-checks

So what does it all mean (or how do I understand this without becoming an expert in particle & quantum physics and quantum

The history of the the Higgs Boson dates back to Peter Higgs prediction of a mass-generating Boson that was eventually given his name. Fast forward and we have been on the hunt for this elusive particle in large part because the detectors were either unable to see them at the energy levels or create sufficient energy in the collisions to generate the particle or evidence for the particle. But the Large Hadron Collider (LHC) stepped up the game and in 2011 we saw data suggestive of evidence of the particle and on Jul 4 CERN confirmed the data was even more convincing.

So what is the Higgs Boson – this page offers the top 5 winners to the competition in 1993 to produce an answer that would fit on one page to the question

‘What is the Higgs boson, and why do we want to find it?’

This explanation (<4 minuets) provides a good basic understanding of the underlying particle and physics

This animation shows the time lapse of the data as it evolved over time

And as the data was captured they applied this process to determine what they were looking at:

Voice of the Doctor – July Part 2

July Voice of the Doctor Guests

Jul 13
Talking to Don Rosenthal (You can follow him on twitter @DonRosenthal) part of the original team that developed the scheduling system for the Hubble Space Telescope and ran the artificial intelligence group at NASA. HE is also the founder and CTO of Allocade and publishes a blog THITSE A Mashup of Tech, Healthcare IT, and Space Exploration
He published a two part blog on HiTech answer on Medical Records Interoperability: My medical data should move with me as easily as my music or photo library and Part 2 where he threw down the “latex” gauntlet to the #HealthIT industry in creating interoperability that was as easy as sharing my music and photos libraries <–I could not agree more with his points and these articles are worth digesting to get a good understating of the barriers we all face to sharing medical data effectively and creating truly interoperable healthcare.

We will be talking about Artificial Intelligence in Healthcare and how we can bring this technology to the complex world of medicine.

Will AI really make a difference to healthcare or is it still a mirage on the horizon of innovation
Can AI replace the clinicians consultation and review and should it
What can we learn from AI implantation from NASA and space exploration where time and distance have significant impact on the need for autonomous intelligence.

Jul 20
Monthly news round up – more opportunity to dive into the latest news and activities. THere has been lots of follow up commentary and discussion on the ruling and we will cover this as well as the most recent #HealthIT #HITsm #hcsm #HIT #EMR #CMIO #doctors #mHealth news

Jul 27
I am looking forward to talking with Gregg Masters (You can follow him on twitter @2healthguru). He is the CEO of Xantamedia and a well recognized voice and Top Players in the Social Media world. I had the privilege of meeting Gregg a while back in person and have enjoyed reading his posts and thoughts.

He and I exchanged tweets shortly after the #SCOTUS #ACA ruling was announced after I posted a link to this: Health-care leaders: Ruling no cure for spiraling costs which for me was an interesting take on the challenges that talked about the fragmented nature of the healthcare system and a general agreement that it’s broken:

“We all agree, I think, that the current fee-for-service model has all the wrong incentives in it,” said Swedish Medical Center CEO Kevin Brown. “The health-care system has been really fragmented, with independent entities all working for their own best interests.”

I liked the concept they talked about where:

Insurers and providers have worked together, rejiggering the typical payment model to shift incentives toward keeping people healthy instead of just running up bills when they’re sick.

Which reminded me of the ancient practice of paying the doctor in your village while you were healthy, only stopping paying him when you fell ill (I know simplistic but quite compelling). They did say that

The Affordable Care Act, which relies on private insurance, for the most part doesn’t directly address costs.

And while it represents a start (every journey begins with a step) there are still holes (tort and medical liability to mention a couple). Gregg responded and suggested that:

innovation will come via margins aka CMMI. Private market ACOs & direct practice models galloping ahead

We had a series of exchanges and I suggested that instead of the 140 character exchange he come on my radio show to discuss and he graciously agreed. Much as I did pre the release of the ruling, when I had the pleasure of talking with Sam Bierstock on March 30, we started with tentatively opposing views but in reality our opinions were not widely different. You can hear download that show here

I’m looking forward to a lively and informative discussion and by then will have had an extra 2 weeks to diets more of the details of the ruling and its potential effects.

Hope you can join me on #Voice of the Doctor

Join me on Friday at 2:30 ET on VoiceoftheDoctor There are three ways to tune in:
• Stream the show live – click the Listen Live Now to launch our Internet radio player.

• You can also call in. A few minutes before our show starts, call in the following number: Call: 1-559-546-1880; Enter participant code: 840521#
• HealthcareNOWradio.com is now on iTunes Radio! Stream the show live – you’ll find this station listed under News/Talk

Voice of the Doctor – July Schedule

Voice of the Doctor – July

This month we will be

July 6
I will be joined by my friend and colleague Reid Coleman who joined Nunace as the CMIO for Evidence Based Medicine. Reid was previously the CMIO for Lifespan. He and I both attended the recent Association of Medical Directors of Information Systems 21st annual conference in Ojai Jun 26 – 29 – (Agenda)

We will be discussion the conference which took place right at the time the SCOTUS ruling was issued which made form some interesting discussions and even some unexpected opinions. Other areas that came up adn we will review include:

  • Government regulation of EHR’s
  • HIE’s and the disappointing lack of progress
  • Documentation standards including a draft white paper that several AMDIS members had worked on and presented
  • Mobility adn the challenge of the explosion of devices being brought into facilities with limited security
  • Usability and an interesting divergence on how much the government should be involved in setting standards

Jul 13
Hoping to talk to Don Rosenthal (You can follow him on twitter @DonRosenthal) part of the original team that developed the scheduling system for the Hubble Space Telescope and ran the artificial intelligence group at NASA. HE is also the founder and CTO of Allocade and publishes a blog THITSE A Mashup of Tech, Healthcare IT, and Space Exploration
He published a two part blog on HiTech answer on Medical Records Interoperability: My medical data should move with me as easily as my music or photo library and Part 2 where he threw down the “latex” gauntlet to the #HealthIT industry in creating interoperability that was as easy as sharing my music and photos libraries <–I could not agree more with his points and these articles are worth digesting to get a good understating of the barriers we all face to sharing medical data effectively and creating truly interoperable healthcare.

We will be talking about Artificial Intelligence in Healthcare and how we can bring this technology to the complex world of medicine.

  • Will AI really make a difference to healthcare or is it still a mirage on the horizon of innovation
  • Can AI replace the clinicians consultation and review and should it
  • What can we learn from AI implantation from NASA and space exploration where time and distance have significant impact on the need for autonomous intelligence.

Join me on Friday at 2:30 ET on VoiceoftheDoctor There are three ways to tune in:
• Stream the show live – click the Listen Live Now to launch our Internet radio player.

• You can also call in. A few minutes before our show starts, call in the following number: Call: 1-559-546-1880; Enter participant code: 840521#
• HealthcareNOWradio.com is now on iTunes Radio! Stream the show live – you’ll find this station listed under News/Talk

HealthIT Innovation Summit

Posted in #hcsm, Health Reform, HealthIT, HIMSS, Meaningful Use by drnic on July 2, 2012

Last week I had the privilege of attending and participating held at the Nixon Library in Yorba Linda California that took place the same day the Supreme Court announced their decision upholding the Patient Care adn Affordability Act

The agenda was filled with a great list of speakers, innovators and visionary thinkers. The early part of the day was inevitably slanted towards the results of the ruling but interestingly many of the speakers commented that even though they had an opportunity to change their presentation and adjust based not he ruling most did little to change their overall message commenting that no matter the decision the innovation and march forward of HealthIT continued apace.

There were some notable ideas on how to achieve innovation through disruption that has repeated itself through history in many industries. The computer industry started with a centralized model with mainframes and slowly decentralized providing increasing access at lower and lower costs to mini-computers, personal computers and now mobile devices. Agile companies had to innovate accepting the change and focusing on the next wave – those that did not were left behind often disappearing entirely from the playing field

decentralization through disruption leads to accessibility

Innovators Prescription - Decentralization through disruption leads to accessibility.jpg

Disruptors leap frog their competition and in a telling comment from Jason Hwang

If you are wildly successful and innovative, you are doomed

In healthcare the same principles are in play. We have centralized healthcare system with hospitals, surgical centers, data collection from laboratories and imaging facilities but these activist and resources are being decentralized as we move to local clinics, retail clinics, home care and the individual engagement of consumers in home healthcare that does not always necessarily nor need to be delivered by a physician.

This move away form centralized care should not be feared but rather embraced as an opportunity to survive and thrive in the new economy. The key to survival is to disrupt your own business model and engage in offerings that replace the current methods and systems. Clinicians often fear and object to their removal form all care processes but we have seen this applied in a number of areas already (Nurse Anesthetists, Nurse Practitioners) and as technology improves and patient become more engaged we see more routine activities being ceasing to be the eminent domain of physicians.

Our use of technology should not just be limited to making our current processes and care givers better at what they do but should allow for others to deliver the routing care reserving the highly trained and experienced professional for the complex and non-standard elements. Dr Hwang cited the example of the surgical robots in use today that are currently making surgeons better but suggested that instead we should be thinking about how this technology can make non-surgical staff able to do routing surgical procedures. For many clinicians this would be deemed the think end of the wedge but if history is any guide, as it often is, this will be part of or future and indeed I have seen the potential of this. I was in a virtual minimally invasive training center with a 16 year old high school student who had been given the opportunity to take on the virtual course work as part of work experience. I watched in amazement as the student blazed through the initial courses that taught a range fo skills necessary to perform a laprascopic cholecystectomy. So much so it made it look easy. This culminated in a simulated version of the procedure which I watched the student do. Fooled into thinking this was just easy I attempted a small portion of the course and failed to progress at anywhere the rate or with the adeptness that I had just watched.

No – this high school student could not do a Laprascopic Cholecystectomy but what this clearly showed in my mind was that with the application of technology & training we will find individuals that will be highly suited and finely tuned to perform routine procedures. We already see this with the military machine and surveillance drone pilots who are not pilots in the current sense of that term but can and do fly complex aircraft albeit remotely and from the ground

In fact Dr Hwang quoted Dr Warner Slack

“Any Doctor who can be replaced by a computer should be”

You can see one of his presentations How Disruptive Innovation Can Fix Health Care

Innovation is coming in many different forms and to survive and thrive we do need to embrace it, not at the expense of quality and safety but neither of these need be compromised with innovative application of disruptive technology. We see some of this going in the speech world as we move away from traditional transcription with back end speech recognition and the increasing penetration of front end technology that provides real time results. Layered over this is Natural Language Processing Technology (NLP) or Clinical Language Understanding (CLU) that provides medical intelligence to the words offering further enhancement to the interaction. We have seen this concept adeptly applied byApple with Siri which takes account of context, understand intent and offers a voice interface that has an inbuilt Artificial Intelligence. Siri has disrupted the mobile interactions and these techniques and tools offer disruptive innovation opportunities to healthcare that I expect will emerge in the coming months.

These are exiting times and I came away with a sense of great fortune to be here at this time to witness innovation and the excitement as we watch HealthIT explode in the healthcare sector

Here’s the Slideshare version of his presentation