Navigating Healthcare – Patient Safety and Personal Healthcare Management

Applying AI in Healthcare for Iterative Efficiencies

The Incrementalist Graphic Falgun Chokshi

Applying AI in Healthcare for Iterative Efficiencies

This week I am talking to Dr. Falgun Chokshi, MD (@FalgunChokshiMD), a Neuroradiologist and host of the podcast “Looking Around the Corner”. Falgun’s vision is to connect a healthcare innovation ecosystem that creates collaboration and focuses on a novel but importantly practical solutions.  He has experience in bioinformatics (machine learning/AI) and advanced technology assessment (AI/Blockchain).

Hear what this neuroradiologist thinks about the impact of Artificial Intelligence will be on radiology, imaging, and medicine in general – its more about supporting radiologists getting to the “gestalt” of information and insights vs replacing them with technology.

His incremental step in improving healthcare

“Iterative Efficiencies”

Listen in to find out about his experience with Intermittent Fasting and the positive impact it had for him on will power and consistency of purpose.

Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


Listen along on HealthcareNowRadio or on SoundCloud

Applying AI in Healthcare for Iterative Efficiencies was originally published on Dr Nick – The Incrementalist


Stemming the Tide

The Opioid Epidemic

Drug Overdoses and Prescription Misuse
The Opioid Epidemic by the Numbers

130 people die from an overdose of an opioid every day in the United States. Death from overdoses reached a staggering 47,600 people in the United States in 2017 – to put that into perspective that’s a 130 people per day, or 1 person every 11 mins, and now in the top 10 causes of death in the United States. The problem has been getting worse with an increase in preventable opioid deaths of 26% in 2016 which is only overshadowed by the 544% increase we have seen since 1999.

The background and causes to the problem are varied but in many cases, the start of addiction begins with medically prescribed medication and far too frequently end tragically with death from overdose. With the rising incidence, the epidemic is having a wide impact with barely anyone left untouched.

Opioid Epidemic
Jim Kopetsky and his Parents

For some struck by tragedy, such as Ed Kopetsky, the CIO for Stanford Children’s Health, Lucile Salter Packard’s Children’s Hospital, they have turned devastation into a drive to action. Ed sadly lost his son, Jim, to an overdose following a history of exposure to opioids that dated back to high school. Take a look at the video of two of the stories from CHIME members here.

“If we can save just one more person from that addict path by speaking up and using our voices and using the power of CHIME and the power of the people all united to try to change, I think we will make a difference”

Together with his colleagues and friends from CHIME they formed the CHIME Opioid Task Force. Their mission is to harness the unique insights and assets of their healthcare leaders and institutions to make a real difference to address the crisis. They are united in their goal of combatting the increasing addiction and growing mortality of the Opioid Crisis by raising awareness, publicizing leading healthcare practices, providing data for medical research, policy advocacy and leveraging our leadership talent in unique and powerful ways.

NTT DATA Give Back

NTT DATA has a long history of giving back to worthy causes and this year at HIMSS19 as joined forces with The CHIME Opioid Task Force, DisposeRx (who offers a unique and safe method for disposal of unused or expired medications) and Luster Mosaics to create a mosaics picture from individual user-contributed pictures posted on Twitter and Instagram.

For every post using the hashtag #NTTDWhyICare NTT DATA is donating $5 (up to 15,000) to the CHIME Opioid Task Force and will use the pictures to create a unique mosaic image live on the show floor. To get involved, simply snap a shot, post it to Instagram or Twitter using #NTTDWhyICare with a statement about why you care.

You can click here to create a tweet with the correct hashtag

Or this link:

Join in at HIMSS 2019

Stop by booth #3301 at HIMSS19 in Orlando to see the mosaic as it gets put together and see if you can find your picture. While you are there, pick up a DisposeRx packet and see how easy and effective it is to safely dispose of any medication in your home.

Come join us for a reception on Wednesday, February 13 at 5:00 pm EST at the NTT DATA HIMSS19 booth #3301 as NTT DATA and DisposeRx present a check and reveal the completed hashtag-driven social media mosaic art to the CHIME Opioid Task Force.

If you’d like to donate directly to the CHIME Opioid Task Force, you can do so here


Stemming the Tide was originally published on Dr Nick – The Incrementalist

Saving Healthcare Quality

Saving Healthcare Quality

The Incrementalist Graphic Fred Trotter

This week I am talking to Fred Trotter (@fredtrotter), CTO CareSet Systems – the first commercial Medicare Data company. Fred has a long and fascinating background that unlike many healthcare Cybersecurity experts started in the security field and transitioned to healthcare and healthcare data. You can read his musings on Hacking Healthcare here.

We talked about Fred’s coordination of the Save the Agency for Healthcare Research and Quality (AHRQ) data project that took off online using twitter and other social channels as an unofficial mechanism. The AHRQ and the National Guideline Clearinghouse (NGC) was expected to be taken offline earlier this year as part of budget cuts and there was a significant concern that the 1,500+ clinical guideline summaries currently available would disappear forever. Some of us might think its a simple thing to copy content thus preserving the material but as Fred explains it was not that simple


In fact he contributes to the Internet Archive project (aka the Way back Machine) on a regular basis as one fo the important community projects that is workmen to preserve the digital history fo the web. Listen in to find out why the internet archive copy that was stored on this site was not enough and how Fred and the others used the insights and data from the Archive site to improve their data capture and storage. You can access the data on Guidelines here and the Quality Measures here – all sourced from this GitHub Project

We also talk about his history and involvement in the Health Care Industry Cybersecurity Task Force that was convened under President Obama’s administration by the DHS in March 2016. They issued their report to congress June 2017:  Report on Improving Cybersecurity in the Health Care Industry. Listen in to hear about the experience of bringing this diverse group together as they attempted to predict future attacks (Hint – many of the things they predicted came true that same year!)

Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.

Listen along on HealthcareNowRadio or on SoundCloud

Saving Healthcare Quality was originally published on Dr Nick – The Incrementalist


Keys to Successful Conferences

How do you describe the CNS Summit and what it offers – the word impossible springs to mind. Even the name can be a little misleading especially for medical folks who might look at that and think “Central Nervous System” but actually its stands for Collaborating for Novel Solutions

CNS Summit Collaborating for Novel Solutions

This coming year will be the 10th year of the event and it continues to get better – testing new ideas and concepts for conferences to make the event valuable on multiple levels. The history and experience reminds me a lot of friendships and how they develop – the first interaction can be awkward and uncertain but intuitively you get a sense that the person you are talking to is someone who will be a friend pretty quickly (science suggests it is not minutes or seconds but a 1/10th of a second). Over time the relationship deepens and you learn more, and understand more, and how much you enjoy working with, learning from, sharing and sometimes just hanging out. So it is with the CNS Summit or more frequently know as “Summit”.

Photography Techniques from Experts

Where else can you come to a conference and get clever new ideas and techniques on how to use your mobile phone camera in interesting and creative ways from the incredibly talented and inspiration photographer Asa Mathat (recommend instagram @AsaMathat to get a sense of his incredible lens on the world and people). He is a renowned Photographer to the stars, creator of the big pink ribbon and at Summit – photographer for attendees as well!).

(Hint – Don’t think in traditional planes of movement and use your volume buttons as triggers and when you reach the end of your panorama, just reverse direction to switch it off).

CNSSummit Asa Mathat Photo Booth
Asa Mathat Photo Booth at Summit

Areas Covered

It hard to categorize the conference into a bucket – it benefits from being not too big so as not to overwhelm but large enough to attract an impressive diversity of participants and speakers. The mix includes leaders from the Pharmaceutical Industry, digital health, medical and device companies and technology companies.

Insights continued from cancer survivors who parlayed their personal experiences to focus on taming the data mountain in healthcare and science, the pharmaceutical executive who nearly died from a side effect of a drug that had a life changing effect on the personal trajectory that allowed for a rethinking the model of industrial production of pharmaceuticals.

CNSSummit WoodyWhisky
Woody’s Whisky Tasting Selection

Of course for this Whisky Librarian, there is even a special highlight put on by Woody Woodaman – the whisky tasting that raises money for a fund set up in his wife’s name Betty Jean Memorial Scholarship Fund to support nurse training. The conference floor is always offers new concepts and technologies – everything from taste experiences to the highly popular hugging booth set up by friend and colleague Andrew Chacko.

Each year is an eye opening experience full of surprises that Amir Kalali the conference Chief Curator keeps close to his chest like a proud parent who know’s he’s picked the best birthday gift for their child and can’t wait to reveal it.

This year there were many mind blowing presentations – for me “Breaking the Logjam in Medical Imaging” by Mary Lou Jepsen from Openwater that pushed the boundaries of wearables by offering a path to an MRI wearable. Sounds far fetched – not if you approach the problem with a different lens and understand that our photo sensor chips have reached a sensitivity of a micron – the wavelength of infrared. Combine this with the fact that our bodies are translucent to red and near infrared light – but red light scatters but this is not random, it is deterministic and reversible if you can record a hologram of it. So with some clever use of relatively old technology that allowed us to move from overhead foils

CNSSummit OverheadFoils
Remember these Devices?

to LCD projectors we are all accustomed to. This now allows the generation of ultrasound waves from small devices and using the change in phase of the light as it passes through the red light (you all know the doppler shift experiment you learnt in physics at school) they are now able to find vasculature at higher resolution than MRI and fMRI and even have additional capabilities to differentiate between oxygenated and non-oxygenated blood as achieved with the fMRI

Absorption of Hemoglobin for fMRI
Mapping Oxygenation of Blood in Real-time

But the resolution is now down to a few microns which is at the size of neurons, meaning they have the ability to see into our bodies at the detail of our nervous system… real time!

Image Resolution of Neurons
Neuron level granularity of Imaging

Combined with the early science that shows we can reconstruct what we are thinking and seeing based on analysis of our brain activity (Reconstructing visual experiences from brain activity evoked by natural movies, Nature – pdf). Most exciting the project is driven by a challenge to deliver a low cost, better imaging solution, to everyone, given that 2/3 of humanity lacks access to imaging.

Final Conference Day


The highlight for me was the last day – which according to my research and discussions with others, is just like every other conference poorly attended with many people missing the best elements.

It included two amazing presentations by the compassionate and gentle Daniel Friedland (Leading Well from Within), the wonderful, funny and insightful Chris Hadnagy (Social Hacker and previous guest on my radio show) and Stephanie Paul’s fun and eye opening Improv experience and included Asa Mathat participating and recording the activities with his unique eye. This picture captures the fun and learning we had as we learnt and connected

CNSSummit LastDayFun

So my Incremental step for you is set aside Oct 31 – Nov 3, 2019 for Summit 2109 (It is the 10th anniversary so I’m imagining Amir and the guiding council is thinking hard about making this event super special) and you to will have the learning opportunity and fun as you find a new friend in CNS Summit

CNSSummit AsaMathatandNick

And one more Incremental step – if you are taking the time to go to a conference, don’t head out before it finishes but rather plan to enjoy the last sessions where organizers often try to save the best till last.

Summit was originally published on Dr Nick – The Incrementalist

Consumer Rights Driven Data Access

The Bluebutton Innovator


The Incrementalist - Mark Scrimshire

This week I am talking to Mark Scrimshire (@eKiveMark) a fellow Walking Gallery member and Entrepreneur in Residence at NewWave and on assignment as Medicare Blue Button 2.0 Innovator at CMS where he is designing and implementing the new API to enable 53 million Medicare Beneficiaries to share their claims information with the applications, services and research programs they choose to trust.

His work extends back to 2010 when the initial concept of the Blue Button was conceptualized but it took several years before this started to really take off with the concept of View, Download and Transmit. One of the key Incremental Steps to get this interoperability rolled out centered on changing the positioning of HIPAA from a barrier to sharing and portability to an enabler. Ironic when you consider that it stands for “Health Insurance Portability and Accountability Act”! Listen in to find out the details behind the change and a key incremental step to progress – changing the messaging

Part of this changed messaging centers on the Office of Civil Rights (OCR) and the clear guidance to direct consumers to have the right to access their data in electronic format. As promised in the broadcast here is the Rights to Access Memo they issued in September 2015 and something I carry with me to all my medical appointments.

He shares his view on how to move toward interoperability and his incremental step connected with the Fast Healthcare Interoperability Resources (FHIR, pronounced “Fire”) set of Resources and removing complexity and simplifying the approach the is a recurring theme for Incremental Improvements.

Don’t let perfection stand in the way of progress

You can read more about the project in the FHIR Wiki he mentioned here. Listen in to hear Mark talk about the new project and how he is turning the oxymoron of Explanation of Benefits (EOB) which fails to provide insights to the people it is directed at and how the DaVinci project. The move from the old model of Fee for Service (FFS) to paying for outcomes is also driving a whole shift in data accessibility and utility and willingness to share which is exciting for our the consumer rights driven access movement.

Their Incremental steps to improvement include the huddle but listen in to hear what other incremental steps you may be missing that has added significantly to their team-based approach, coordination and success

Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.

Listen along on HealthcareNowRadio or on SoundCloud

Consumer Rights Driven Data Access was originally published on Dr Nick – The Incrementalist

Digging in to Your Social Media Feed

Social Security
Digging into your Social Media Data

It was with interest I read a recent Viewpoint article in the Journal of American Medical Associations (JAMA) titled: Social Determinants of Health (SDoH) in the Digital Age, Determining the Source Code for Nurture authored by Dr. Freddy Abnousi, the head of healthcare research at Facebook, along with a couple of other authors, Dr. John Rumsfeld, Chief Innovation Officer at the American College of Cardiology (@DrJRums) and Dr. Harlan Krumholz, Professor of Medicine at Yale (@hmkyale)

They rightly point out the major contribution of social determinants of health – a fact highlighted as far back as to 1946 and the World Health Organization (WHO), but the research has been hampered by the inability to capture accurate granular data which is mostly self-reported (with the associated unreliability). We do need better approaches and the social networks offer a tantalizing look into data of this nature with a peek into online behavior, data that is posted by the millions of users who engage daily online.

They offer an intriguing potential to pre-identify suicidal ideation, “with enough advance warning and accuracy to stage a peer-driven intervention“. The opportunity to identify high risk for opioid addiction or finding those at highest risk of cardiovascular mortality and engaging with the users corresponding social network who would be “tasked with responsibilities”.

There is much to applaud in the concept but it raises some serious and challenging issues in my mind

1) Informed Consent is a major challenge and history and recent revelations do not engender any confidence that this data or insights would not be used against the patients or their families

2) De-Identification of data is already problematic – when you consider Intensity Analytics ability to identify individuals and behavior simply from their interaction with a keyboard

3) Trust is broken across so many areas and the current system is working as designed – a business. It is highly unlikely that users would ever *knowingly* give their consent

4) Healthcare consumers in the United States are struggling while the business of healthcare continues its march towards profit. Intuitively any insights from an SDoH program would have to focus on the best economic solutions which are mostly non-healthcare solutions (food, housing, income, education)

We need insights and data to provide the data to support and effect change and this idea has merit – but without some real changes to the business of healthcare, it will struggle to take off or deliver value to our population. I’d suggest a better incremental step would be to look at this data to show the underlying struggles of the users and creating a catalyst for change


Digging in to Your Social Media Feed was originally published on Dr Nick – The Incrementalist

The NHS at 70

Healthcare, NHS

The crown jewels of British society

The NHS was the crown jewels of British society providing healthcare to every member of society no matter who they were, where they came from and what personal resources they had. It was the great leveler of society creating a single standard of care and service that was accessible to rich, poor and disenfranchised and it was well loved.
To me personally, it was my guide and educator – I was lucky to attend one of the great London medical schools – The Royal Free Hospital School of Medicine. The “Free” hospital created to treat all comers and the original medical school (The London School of Medicine for Women) for women created in an era when women were not admitted to British Medical schools

That hospital and the NHS provided me with a first-class medical school education, access to groundbreaking research that included the early work and discoveries around HIV/AIDS, Hemophilia, Liver disorders and beyond.
The staff in every department were friends, colleagues and members of a community that were family and all pulled in the same direction – that of the patient. I spent time working in different areas during my time, staffing the manual telephone switchboard, helping the porters and security staff, nurses, technologists, and maintenance and quickly realized the well-oiled NHS machine demanded a family of committed people to make it work and deliver outstanding care each and every day.

What Could We Do Better

As we know today, and probably knew 70 years ago and before, healthcare is as much about our environment and resources as it is about medical treatments, technology, and innovation. We know that 60-80% of health is attributable to lifestyle but fail to take account of this in the NHS and in the majority of health systems from around the world.


We need a WellCare system not Healthcare


The system spends large sums of money providing medications to the population but fails to take account of the most basic needs of the population and acknowledge that food is also a drug. What we put into our bodies contributes to our health and well-being. Failing to acknowledge and manage these elements of health with sleep as the foundation and exercise and nutrition built on top has created a system that treats the failing of these issues at great financial and personal patient cost. Investing in the prevention would create a WellCare system and not the Healthcare System that the NHS is.

Manage and Allocate the Limited Resources with Transparency

It’s an unpleasant fact that few want to address or even acknowledge but the reality of treating people is that in this day and age of innovation, scientific progress and developments we could spend every last penny on treating patients. There is an unlimited supply of possible treatments and a never-ending procession of people needing those treatments. But not all treatments are created equally – some don’t work, some are harmful and in the cases of those that do work there is the wide disparity in the effectiveness and cost. Any healthcare system needs a means of assessing the effectiveness of treatments that includes the financial and resource cost linked to the improvements. The problem with a “free” (the NHS is not free – it is simply free at the point of care, paid for through taxation of the individuals) is the inducement of un-economic behavior by individuals looking for every last treatment option no matter the cost or effectiveness. That path is unsustainable and breaks the system and ultimately harms patients.

Enable Informed Decision Making for Everyone

Doctors Die Differently and do so because they understand the economic and personal tradeoffs between treatments and quality of life. In the data presented by the Johns Hopkins Study of a Lifetime we see a big discrepancy in treatment choices between doctors and everyone else. We make our choices in the context of the knowledge of effectiveness weighed against the personal cost of treatments and quality of life impact. An open an honest assessment of treatment that is clinically effective would level the disparity in treatment choices selected by patients. As a society, we struggle to discuss end of life but it is a reality that everyone faces and we must find ways to educate and support people through all aspects of life and death.

Technology and innovation is essential to the future of the NHS

The future of a scalable meritocratic system accessible to all that does not bankrupt society will be dependent on technology and innovation. Humans remain the core constituents of any compassionate caring system and technology is a supporting player. But as Michael Dell put it:

Technology has always been about enabling human potential

Michael Dell, Dell
Technology has always been about Enabling Human Potential

Technology does not replace the human beings or interaction but rather augments it in ways that extend our capabilities and improves the accessibility and economics.

It is an impossible task for humans to process the amount of data currently being generated about our patients, the knowledge derived from research and advances in science and put it into the context of treatments at the point of care when it is needed most.

We have expanded beyond the human brains capacity to absorb, process and apply the knowledge and must rely on technology to augment the brains abilities and place information into the context of the individual patient and the care choices available.

Selecting the innovations that deliver the most value

Innovation impacts each and every area of the NHS and will continue to do so but the challenge will be to select the innovations that deliver the most value to the largest number of people based on scientific peer reviews.

Innovation is not confined to the clinical treatment but extends to every element of the NHS system and the delivery of wellness care. It is changing the design of facilities to include features that improve care and outcomes – for example by adding natural light and open spaces.

Innovation is allowing patients the option to access their care team at any time and from any location – for example bringing the care team to the patient as we used to do with home visits but now using technology to extend the reach and scalability.

Innovation is building rooms and beds that can be efficiently and effectively cleaned between visits while maintaining comfort and welcoming surroundings. It is using available data to predict potential health issues before they occur and reaching out to patients helping to guide them to better healthier choices and wellness. Innovation is allowing parents to stay with their child in the hospital when they are sick and in need of care in comfortable and caring surroundings.

Innovation is offering dignity and compassion to those facing death and offering realistic options for no treatment and hospice care.

What can Britain and the NHS learn from the rest of the world?

Over 700 years ago, China had village doctors who were paid by the villagers when they were well but received no money when the patients were sick. This is the principle of wellness over sickness care. In Norway, they have a wide and uniform implementation of a digital health record that is accessible to everyone that needs it including the patient – tied together with a unique patient identifier designed for that purpose. One Citizen, one record.

The European Union allows citizens to cross borders and different health systems but to receive urgent care while traveling and administers the cross-country charges, managing fees and removing the patient from worrying about payments while they are sick and abroad.

Look also to Africa and the innovation that takes place on a continent with access to far fewer resources and technology to see what’s possible with the existing technology. Small incremental steps in using technology to boost healthcare services such as text messaging have been wildly successful and yet remain simple, easy to implement and understand and accessible through all social groups in society.

In Rwanda, they have integrated drone delivery for hard-to-reach locations, offering lifesaving support that was previously almost impossible. Expect to see more of this and bi-directional capabilities for resources, tests, and samples as well as lifesaving treatments.

Finally, in Korea, they have a culture of celebrating aging and the elderly that includes dignity in end of life and the inclusion of everyone in the family and their health. Korean culture sees the 60th and 70th birthday as a big family affair and the inclusion and the universal expectation that roles reverse once parents age, and that it is an adult child’s honorable duty to care for his or her parents’ health.”

A version of this appeared previously here

The NHS at 70 was originally published on Dr Nick – The Incrementalist

Should You be Taking a Statin

Statin, Cholesterol, Heart
Are statins the wonder drug for your Heart Health


The answer to that question is complex and individual and before thinking about that you should have a basic understanding of cholesterol in your body. You can learn about this from my video and blog post


In the previous episode, I talked about Cholesterol in your body. This week as a follow up I’m talking about Statins, a group of drugs that lower the level of cholesterol in the body. They work by acting on the liver’s mechanism for producing cholesterol inhibiting the enzyme Hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase).

The Human Circulatory System

We know that cholesterol is closely linked to atherosclerosis – the formation of plaques that build up on the walls of our arteries and contain cholesterol and that these plaques can rupture or break off and cause blockages that cause cardiovascular disease that ranges from the mild decrease in blood flow to our limbs to the severe effects that throw blood clots into our brains and heart causing strokes or heart attacks. But as we learned last time – cholesterol is not all bad – it is an essential part of our body systems making up parts of cell membranes and integral to several signaling molecules.

Statins are also known to have additional effects beyond the simple reduction in cholesterol levels and production in our body and several studies have shown that these drugs also reduce inflammation in the cell walls which is not connected to the cholesterol-lowing effect. In fact, this effect occurs rapidly and is seen as soon as 2 weeks after starting statin therapy

Statins Drugs

Medication choices

There are multiple Statins around the oldest and best known is Atorvastatin (widely known by its brand name Lipitor) with its breakout general usage in 1996. The good news is this drug is off patent and there are plenty of low-cost generic options available and there is lots of safety data gathered given it has been in widespread use for over 20 years.

But Statins are not side-effect free and some find themselves suffering from constipation, diarrhea, and fatigue and in some 5-10% of people muscle cramps that can make the drug intolerable. This can be mitigated with some of the newer variant drugs that can help mitigate or even completely reduce the muscle cramps and other side effects. There is a rare and significant effect of causing diabetes in a small percentage of patient’s which is an important factor to consider when considering if Statins are right for you.

New Research on Statin Therapy

There has been lots of research and trials and the most recent I mentioned in the video the HOPE-3 trial which had a multifactorial design – meaning multiple variations on treatment therapies were tested in different populations.

They had a diverse group of patients divided up into multiple groups in a 2×2 factorial design that had groups being treated with a statin, an Angiotensin-converting enzyme (ACE) inhibitor for blood pressure and a diuretic hydrochlorothiazide also for blood pressure (BP). They had 12,000 people with a follow up to 5 years and they maintained good adherence for drugs of around 75%.
Overall, the anti-hypertensives did not reduce the risk of cardiovascular events at all – but there were differences depending on whether or not you had hypertension when you entered the trial. Interestingly the combined statin with an antihypertensive treatment was no better than a statin alone. And the data offered a clear benefit for Statins for those at intermediate risk of cardiovascular disease.

The details of this are nicely summarized here and the article includes links to the 3 published studies that were published from the data. One of the specific questions answered by this study is on that one cardiologist friend of mine and I have discussed before – should Statins be placed in the drinking water like fluoride. Given the cost and the side effects associated with statins, the answer is no for economic reasons as well as increased risk of side effects.

In the intervening time since I recorded this video another paper was published:
Finding the Balance Between Benefits and Harms When Using Statins for Primary Prevention of Cardiovascular Disease: A Modeling Study, and a new set of guidelines from the American College of Cardiology (ACA)/American Heart Association (AHA) on the management of cholesterol in the blood: 2018 ACC/AHA Multi society Guideline on the Management of Blood Cholesterol

Which emphasizes a heart-healthy lifestyle but then details some very specific “high-intensity” statins to focus on specific cholesterol levels in people who are at high risk or with proven clinical cardiovascular disease (they reference ASCVD or atherosclerotic cardiovascular disease) alongside detailed clinical guidelines for stating therapy based on specific risk and disease assessments in individuals. There are too many variations to make any generalization beyond what I stated in the video – start with the incremental step of knowing your numbers and the details of your family history and medical history as contributing factors to your risk assessment to take with you and discuss with your doctor to decide what’s right for you

Once you have your numbers you should calculate your 10-year risk of heart disease or stroke using the Atherosclerotic Cardiovascular Disease (ASCVD) algorithm published in 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. This is available from several sources including this from MDCalc or this one which includes a spreadsheet you can download to plug in your values as well.
To include the new updated guidelines from 2017 and the ASCVD Risk Estimator Plus tool (background available here) you can download the app with updated guidelines from 2017 for Apple iOS but Android is a little more challenging with a generalized cardiology app which does not get as good reviews.

Ultimately the decision is a very personal one and is driven by data and supported by clinical evidence. There are no quick global answers, but it is an important decision for everyone to consider, especially if you have any contributing factors in your family history, past medical history or are suffering from any aspects of cardiovascular disease.

Listen in to hear the details Statin Therapy and if its right for you

Incremental steps – Deciding on a Statin

  • Measure your Blood Cholesterol
    Gather the details of your medical history
    Use the ASCVD calculator to give you a guide based on the clinical research
    Bring everything to your doctor and discuss the evidence data and make a personalized decision together


The evidence is clear for those in the groups that have treatment with a statin recommended that the benefits outweigh the risks and side effects.

Should You be Taking a Statin was originally published on Dr Nick – The Incrementalist

Using Advanced Trauma Life Support Methodology in Population Health

 Preventative Health for Everyone



This week I am talking Joshua Scalar, MD, MPH, Chief Medical Officer for BioIQ where they are working to seamlessly connect people to preventative health testing by removing the friction from the system and allowing as many people as possible to access essential, cost-effective life saving preventative testing services.

Josh had an interesting path to his current role – find out how a Saxophone playing band member became a passionate advocate for patient engagement and widespread and easy access to preventative services

Hear how Advanced Trauma Life Support (ATLS) insights offer a model and guide for the triage and delivery of preventative care that should address a problem that by some estimates has only 8% of people accessing fully validated life-saving preventative care opportunities in the United States

Like many of my other guests, Josh made the point that one of the clear incremental steps to getting patients and consumers to access preventative services is

Making the right choice the easiest choice

Hear how he and his team have addressed a basic problem of colonoscopy screening that is an effective and well-tested method of picking up and preventing untimely death from colon cancer but is still poorly adopted. As he points out – colon cancer killed 50,000 people in 2017 – that’s more than the opioid epidemic did but it continues to lack the focus and attention warranted.

Listen in below to find out how this can be applied to Diabetic Retinopathy – preventing blindness that is a high risk for Diabetic patients

Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


Listen along on HealthcareNowRadio or on SoundCloud

Using Advanced Trauma Life Support Methodology in Population Health was originally published on Dr Nick – The Incrementalist

Why Healthcare Needs More Women Leaders

Posted in DigitalHealth, Healthcare Technology, Incremental, Innovation, Inspiration, Technology by drnic on November 19, 2018

Women as the Key Healthcare Decision Makers

Venture Capital

This week I am talking Lisa Suennen, (@VentureValkyrie) Managing Partner of Venture Valkyrie, LLC, an advisory firm that works with healthcare and other companies on investment and innovation strategies and host of the Tech Tonics Podcast. Lisa is a twenty year veteran of healthcare investment, healthcare technology and venture funding and a history with behavioral health company that was treating 35 Million people.

This interview arose from on twitter discussion

featuring #ThisWomanRocks that I nominated Lisa and several others for and I asked them to join me on my show to share their experiences and thoughts on how we change the poor representation of women. In the Venture capital world when Lisa joined the statistics were dismal – only 8% of Venture Capitalists were women – 20 years later, its still about the same!

This despite the fact that gender diverse companies show better financial performance – so its not just good to do its the best for the bottom line too. As Lisa highlighted, Kevin O’Leary (aka as M.r Wonderful on Shark Tank) has highlighted the fact that in all the companies he is involved in – the ones with gender equity and women backed are far more successful on multiple measures.

So why are we still seeing dismal representation for women and what incremental steps can we take to improve this – listen in to hear what Lisa has to say and why in healthcare especially this should be a prime directive (hint – think about who makes the majority of healthcare decisions for any family)

As we discussed, the way to get more women onto the stage and engaged is to be part of the solution and there is no better way than signing up with CSweetner, a not-for profit organization dedicated to helping women benefit from mentorship to become the best leaders they can be and offering a speaker bureau for conferences to find women speakers

Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.

Listen along on HealthcareNowRadio or on SoundCloud

Why Healthcare Needs More Women Leaders was originally published on Dr Nick – The Incrementalist