Navigating Healthcare – Patient Safety and Personal Healthcare Management

Wise Up to Hidden Healthcare Fees

It’s perverse but the healthcare system in the United States is making you sick. Don’t believe me – then maybe you have a high-end plan with no deductible and full access and no ceiling. But there are not many of those and for the rest of us, I imagine your interaction with the system is as frustrating and stressful as mine – probably on a spectrum depending on your plan (High deductible plan or the more traditional Preferred Provider Organization (PPO) and co-payments.

 

Fee for Service Healthcare

The cynical view might be this is deliberate since our system remains firmly stuck in a fee for service model – healthcare providers are paid to do something…anything. From its original development, this made sense – our capacity to treat conditions was limited and the cost of these treatments in line with our ability to pay for them. But along this journey science and in particular the incredible progress of medical research got involved and we have been on a veritable tear of progress and innovation, or as the Exponential Medicine group would say Exponential progress.

Original from Foundation Teaching Economics

There is a continued push towards a more robust and accountable model – Accountable Care Organizations have been set up and these models of total care and coverage and responsibility tested for effectiveness and economic effect. There is lots of disagreement on the success or failure of ACO’s and it is fair to say that the jury is still out. But intuitively we know that taking care of the complete picture and being responsible for the total care of patients health is better for the patient and for outcomes. I have seen it time and again where individual mandates or focus induce unwanted/unexpected/unintended consequences elsewhere in the whole system.

Discharging Patients Early – Unintended Consequences

Discharging patients from the hospital early typically results in better outcomes. Early programs that incentivized this behavior and rewarded programs that got patients out of the hospital early were deemed successful but failed to take account of the downstream impact of readmissions resulting from too early a discharge and subsequent complications for that patient that could have been avoided.

Fixing a Broken System

The recent book “American Sickness” by Dr Elisabeth Rosenthal “An American Sickness” takes on the existing system and is filled with strategies for patients faced with mounting medical bills, an intractable and aggressive healthcare system that is unflinching in seeking payment and by many estimates the leading cause of personal financial crisis and insolvency. While the figures remain under debate my own personal reality living with a High Deductible Plan that has found me

  • Self-treating Fractures
  • Becoming my own compounding pharmacy and
  • Spending months and many hours fighting multiple bills

 

In the case of one screening procedure, that under the current regulations are fully covered but thanks to either mistaken coding or perhaps even deliberate coding, remains outstanding and in two of the three cases, the billing organizations despite my attempts at regular communications, response and protests were handed over to debt collection agencies.

So I am with Dr. Rosenthal and “breaking down the monolithic business”.

The situation is far worse than we think, and it has become like that much more recently than we realize. Hospitals, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Americans are dying from routine medical conditions when affordable and straightforward solutions exist.

Employer Sponsored Insurance

Central to the challenges is the arcane concept that you access to healthcare and health insurance should be linked to your employment. As one friend of mine commented, “There are some who believe this is a deliberate policy on the part of employers to lock in employees to jobs they may not want but have to take because they need the health insurance and can’t afford the challenge or cost of changing (health insurance”. I don’t quite go down that rabbit hole and think Dan Munro’s explanation in his great book “Casino Healthcare

that detailed the history linked to the war effort and the need to find other incentives after they introduced: “An Act to further the national defense and security by checking speculative and excessive price rises, price dislocations, and inflationary tendencies, and for other purposes.” (EPCA) in 1942 – wages were frozen to stop inflation but as is so often the case left the door open for unintended consequences that found employers looking for ways to compete for a shortage of labor. And as they say what follows is history – Employer Sponsored Insurance (ESI) was born.

History of the NHS

It is interesting to note that the NHS model was also a product of the war that found the wounded servicemen and women in need of healthcare. A need that was serviced by the “Emergency Hospital Service” (aka Emergency Medical Service) that provided a model and experience to the country that became the model for what is now the NHS established in 1946.

But whatever the history, reasons, and background – this remains a millstone around American’s. It can add to job reductions and General Motors have stated that their employee healthcare costs add $1,500 – 2,000 to the price of every car they produce. It makes us less competitive internationally and crippling many with overheads that add to the cost of goods sold. It also puts employers at the table on healthcare decision making for their employers that present potential conflicts of interest given their need to service their share holders and remain profitable.

Finding a pathway to resolving this big intractable healthcare mess is going to take some major re-thinking and compromise on all sides. In the meantime, I suggest focusing on individual incremental approaches locally.

 

Incremental Steps to Coping With Healthcare

The list of 6 Questions to ask your doctor before your appointment and 5 questions to ask before you stay in a hospital are excellent resources from Dr. Elisabeth Rosenthal, that are featured in the book and on the website. So in the spirit of the incremental approach, I offer up two credit card size templates containing the

  • 5 Questions to Ask During Your Hospital Stay
  • 6 Questions to Ask Before Every Doctor’s Appointment

 

Formatted in a handy Avery 5371 White Business Card Template that can be printed – double sided and put in your wallet: Questions When Using Healthcare Avery Template 5371

Do you have any tips or suggestions in dealing with the healthcare system? Disagree with any of this – feel free to leave your comments or reach out.

Wise Up to Hidden Healthcare Fees was originally published on Dr Nick – The Incrementalist

Advertisements

Healthcare in the Year 2030

The Year 2030

by Dr Nick van Terheyden (@DrNic1)

How will the world of medicine change in the next 15 years? Well 15 years ago AOL had just bought Time Warner, the human genome had just been deciphered and published and the first inhabitants of the International Space Station had arrived.

The Year 2030 – my bed has been tracking my vital signs throughout the night and notices I was restless and managed fewer REM cycles during sleep than usual. Prometheus (my personalized artificial automated agent) checks my calendar and traffic and elects to wake me an hour later. Appointments for the morning are rescheduled and my drone pick up is postponed. Prometheus sends an update to “Hestia” (my kitchen AI) with instructions to increase the energy component of my meals for the day to adapt for the lack of sleep and deliver a boost of energy with almond snacks through the day. Prometheus sends my updated sleep and vitals data to my personal health record. While I rest peacefully the rest of the household is awakened and sets about their day.

 

Time to Get Up

When it’s time to awaken, the bed starts warming to ease the process, the lights slowly turn on and the GPR (Galactic Public Radio) custom news cycle is playing gently in the background. My calendar has been reorganized, and there’s an additional appointment with Asclepius (My health AI) before I leave in the morning. My food is ready and waiting and contains a boost in energy, helping me wake up and acclimate after the poor night’s sleep. I hear the inbound calling for Asclepius and take the call. We review the reasons for my poor night’s sleep and agree I should track this more closely for the next few days to ward off any potential problems. In this instance Asclepius suggests no further investigation is warranted, but if I am worried a drone will be dispatched with some auto investigator tools to apply and track additional parameters if necessary.

Personal Drone
Personal Drone

As we finish my personal drone arrives and I step outside, catching my foot on a fallen replicator brick discarded by one of the children. As I fall my head strikes the corner of a table and carves into my cheek. Prometheus is immediately on top of the situation checking on my vitals, and while no major damage to my body, the cut will need review and probably some stitches. Checking with local urgent care facilities, the optimal treatment for me today is a quick trip to the urgent care clinic and my drone is reprogrammed to take me there immediately.

Urgent Care in the Future

As I arrive my MedicAlert Digital Bracelet transmits my allergy to lignocaine and identifies me based on the bracelet

and my retinal scan taken as I walk through the door, which authenticates my presence and consent initiates transfer of my medical data and records to the clinic.

Robot Nurse
Robot Nurse

 

 

I’m guided to a room where a robot nurse cleans my wound and positions me on the bed and brings in the Panacea (the medical repair robot). My medical record shows I have had a recent Tetanus shot, and a comparison of my previous vitals shows there are no serious changes that would warrant additional investigation. Repair completed, my records are updated with the new details and a drone appears to take me to work.

 

 

 

Medical Offices and Care in the Future

As I step into my office my team are all walking in (virtually) and the central console and screens around the room light up with data on our first patient. We process through the details provided by the various Artificial Intelligence agents and data gathering tools. “Jane” (name changed to preserve her privacy) has been having some frequent dizzy spells and falls – her mother had Meniere’s disease and a degenerative disease linked to the A2ML1-AS1 / ADAM20P1 / MTor Complex 2 / WDFY3-AS2 – we think there may be a link. Even though Jane does not have these gene expressions there may be a new epigenetic influencer she received that is affecting her stable sequence. We need to get to the bottom of this. Jane is here too (virtually) – with her mother and father – and they are looking at the same data, shown with basic annotations to help them understand the details.

South Korean Researchers unveil first CRISPR nanobot editor
South Korean Researchers unveil first CRISPR nanobot editor

We think we have an answer, but want to share the details and show Jane and her family the model of the CRISPR editor nanobot and its effects before we decide on the next course of action. Do we create a more realistic model of her body functions with the cell printer and test on that? Or is the confidence in our simulation high enough to warrant immediate therapy? Whatever we decide we will get real time approval from the GMAA (Galactic Medical Agent Agency that replaced the FDA in 2021). Jane and her family have seen a new therapy advertised and they want to understand how that might work for them. We pull up the details and all the data on patients and do an immediate comparison. The data’s questionable but, more importantly, it’s contraindicated in anyone with GRAMS domain, Heat Shock 70kDa protein expression and several others that disqualify Jane.

We elect a wait and see approach – so much easier these days with the real time monitoring and detailed data we have on patients that allows us the scope to wait and watch while reassuring patients. Directives are sent to their family “agents” and a drone dispatched to their location with some additional monitors for Jane to wear to give more detailed data on her for the next few days.

Amazon Prime Air Drone Delivery
Amazon Prime Air Drone Delivery

 

As we complete the consultation a drone arrives with my almond snacks and some water – perfect timing.

 

 

 

 

 

 

This post appeared in abbreviated form on SHIFT communication site – and is included in their downloadable ebook

 

Healthcare in the Year 2030 was originally published on DrNic1

Tagged with: , ,

Population Health is a Team Sport

Designing an Effective Population Health Program

Population health is the topic du jour for the health care industry, and I’m glad to see us all focusing on this important issue. But there is a lot of confusion as to what, exactly, constitutes population health. Or more correctly, an effective population health system.

A good population health program consists of four major components:

  1. Identification and stratification of risk within a discrete population
  2. Dissemination of information to physicians, care coordinators or others designated to contact patients and arrange follow up.
  3. Appropriate follow up to further understand the risks for individual patients, identify gaps in care and design a care plan to help the patient improve his/her health status.
  4. Ongoing care individualized to each patient’s need. That might be coaching, medication reminders, telehealth visits, remote monitoring or other strategies customized to each person’s condition and socio-economic environment.

The key to making a population health program effective is ensuring that all four components are in place and working well. If there is a break anywhere in the chain, you lose the opportunity to improve patients’ health. The best analytics in the world are useless if the results do not quickly and easily pass into the hands of the people who can take action. And very good follow up and care planning can be ineffective if the ongoing support is lacking.

Friction

One of the biggest barriers to effective population health improvement is friction in the flow of information between health plans, hospitals/health systems and physicians. This has been a constant source of difficulty for the entire healthcare ecosystem for years, but with the new focus on population health and improving outcomes, it has reached a new level of urgency.

African heart disease is much lower
African heart disease is much lower

In traditional African societies coronary artery disease is virtually nonexistent, but in the migrant population to Western societies the rates are similar to those of the local population indicating that the primary determinants of these diseases are lifestyle and diet and not genetic. These indicators are a key asset in changing our healthcare system and addressing the current 75% of our healthcare spending that is focused on patients with chronic conditions which have their roots in lifestyle choices and behaviors. To address these challenges we need a way to better target our limited healthcare resources more cost effectively for maximum effect and identification and targeting with a robust population health system is no longer a nice to have – it’s a must.

To help patients improve their health, not just react to a situation that has already developed, requires information and insights. But in a survey of primary care physicians by The Commonwealth Fund, only 31% of U.S. physicians said they are notified when a patient is discharged from the hospital or seen in an emergency department. This is important information for primary care physicians, and is not that difficult to fix. All you need is standard protocol in place and a mechanism for notification. It could be a standard action that happens at every discharge. It could even be automated. If the retail industry can automatically send an email to confirm an order, hospitals and health systems should be able to send an automatic email to a physician with discharge information. But hospitals and health system executives haven’t made it a priority, so it doesn’t get fixed.

Get to know your team mates

This is just one example of the inward-looking approach that still permeates much of healthcare. Hospitals, nursing homes, skilled nursing facilities and other care providers pay attention to what happens within their organizations, but they neglect to look beyond. Organizations act as though the care they give is the only care patients receive. They forget that there are a multitude of other professionals who are also responsible for care and need to know what’s going on. We don’t just have data silos in healthcare, we have attitudinal silos that make data transfer and exchange an afterthought at best.

It’s like each care provider is a golfer alone on the course and the patient is the ball. As long as that lone golfer moves the ball forward, it’s all good.

The reality is that healthcare is a team sport, more like football (or soccer as it is called in the US) than golf. If you can’t make an accurate, effective pass to your team mates, you lose the ball.

Population Health a Team Sport
Team Sport

But patients aren’t balls, they’re human beings. When one member of the healthcare team fails to inform the rest of the team, a human being gets lost in the confusion with poor outcomes and frustrated patients.

In population health improvement, you have to play on a team, because it takes a wide variety of skills to make this all happen. And you have to be aware of all the other players on the team. The successful population programs include everyone who is part of the community – not just the healthcare system and resources but all aspects of the community. Dell Medical School held an inaugural event to crowd-source their population health strategy, coming up with areas of focus and metrics for success that included input from a wide range of stake holders. This is the kind of team based approach to population health that will help the whole community win – getting people healthy and staying healthy.

 

It starts with leadership

Most healthcare organizations are at least partly aware of the problem and are making efforts to solve it. But it is a complex problem, involving, as I noted above, attitudes as well as technology. To make data flow freely to those who need it, you have to have effective technology to integrate, manage and analyze the multitude of data streams in healthcare, and you also need leadership who prioritize data sharing over the competitive interests of conflicting health delivery systems. With free flowing information routed to all the interested parties including the oft forgotten but all important patient, in understandable and actionable form that includes the insights and management options we can successfully identify those at risk and develop appropriate interventions. By including the patient and personal care team that typically includes multiple family members we capitalize on underutilized resources that are both essential and highly effective at improving the trajectory for the patient’s outcome.

 

Custom Communication and Targeting

Traditional systems and methods have targeted the existing clinical systems and communications which, while suited to some, fail to adapt to the changing world of technology and the fact that people no longer go online – they live online. This doesn’t just apply to patients and their families; it’s increasingly true for clinicians. It can be as simple as a text based reminder for medication, timed to coincide with the patients personal schedule and preferences or as complex as an automated avatar with augmented intelligence that engages with the patient to assess their status and determine the need for additional intervention or personal follow up by the care team.

 

Each year HealthIT week raises awareness of technology in healthcare, bringing together innovators and key healthcare leaders who are diligently working together to make the best use of information technology to improve the healthcare systems and ultimately our each and everyone’s individual health. This past year we lost one of the titans whose personal journey of uncoordinated care she shared in her attempt to correct the system – Jess Jacobs (#UnicornJess). It might be too late for Jess but let this be the year we move past the individual approach in healthcare driven by underlying economics and focus on the team sport of population health and democratize access to the best possible care and outcomes to the widest swathe of people…worldwide.

 

This post originally appeared here

Population Health is a Team Sport was originally published on DrNic1

What 2016 will Bring for Healthcare Technology

Posted in Africa, Disruptive, Innovation, Patient Engagement, Technology by drnic on March 25, 2016

2015 was an incredible year in technology and healthcare; from new consumer technology and personalized devices coming to market to the introduction of new supercomputers that reduce the time and cost of healthcare data analysis. It’s been great to see how innovation continues to penetrate the medical profession, improving patient services and care. As we look to 2016, there are some areas that we can expect technology to further impact.

Dance like no one watching Encrypt - Security

Growing patient concern over security

Security is a major concern for consumers and the healthcare industry, and the threat of it is only rising. While technology and data provides patients with the precise, personalized medicine that they want, individuals have not forgotten the security breaches that occurred this past year, which had heightened their concern, particularly with the type of personal information in medical records. Implementing stronger, more reliable and transparent security practices will be a critical objective for medical practitioners, but equally important will be reestablishing trust with their patients and consumers.

The consumerization of healthcare

Consumers have grown to expect personal and custom experiences from technology.  The consumerization of healthcare will gather greater momentum and the healthcare industry will see the first effects of this trend on individual behavior in 2016. By treating patients and individuals seeking healthier lifestyles as consumers, the healthcare and related technology developed becomes more and more applicable to serving their needs and meeting them where they are. This is a great thing. As an example, imagine telehealth kiosks now allow patients to engage in a face-to-face video consult with their doctor, or have their vitals taken and receive a diagnosis – without setting foot in their doctor office.  Pilot programs for these “pods” are being tested in Rite Aid and the Cleveland Clinic.

The latest innovations will further fuel the moment around treating patients as consumers and developing relevant technology that make it easier for them to monitor their health and seek treatment, driving more adoption and healthier populations.

IoT - We have to go out for Dinner - Fridge not Talking to Stove

Embracing the Internet of Things toward patient engagement

The Internet of Things (IoT) connects billions of objects around the world, and in 2016, the healthcare industry will take the first steps in tapping IoT’s full potential through passive monitoring. Leveraging wearables and connected devices, healthcare organizations, with the consent of patients will be able to passively monitor the wellness of patients and personalize their experience. For example, for those with chronic diseases, such as diabetes or heart disease, these devices can monitor all aspects of the patient’s  daily life to provide insight to the patient and the healthcare providers, into how different activities, such as eating, sleeping or watching TV, affects his or her body. Connected devices equipped with real-time feedback can provide subtle alerts that prompt, caution or encourage patients to stick with or avoid certain behaviors.  These devices can also help them to comply with a treatment or regimen. In 2016, we’ll see the industry understand that subtle patient engagement through passive monitoring can have positive, long-term effects on behavioral change.

 

The potential of ICD-10

While the rollout of ICD-10 was reluctantly undertaken by some in 2015, the healthcare industry will begin to realize its actual potential in 2016. As a result of ICD-10, healthcare organizations will receive a higher level of granularity in the clinical data that has been collected including patient information and clinical data.  Utilizing this data will enable new insights and deeper analysis.  This will be the first step in turning descriptive healthcare analytics to predictive and prescriptive insights enabling results like reducing readmission and improving population health management. However, as we see potential benefits being realized, discussions will center on the interoperability of systems that is limiting analysis and holding back potential insights.

Africa-Kids-iPad

More democratized, globalized healthcare

While diseases such as AIDS and malaria are now considered chronic or curable with the proper treatment, there are still geographical, technological and societal barriers that pose great challenges when trying to treat the demographics that are most commonly affected. In the third world and emerging countries, healthcare organizations are leveraging technology, including simple mobile devices, to provide patients with faster, more effective care. In 2016, we will see more companies create technology that democratizes healthcare with innovations that help to lower the cost of healthcare, enhance patient engagement and improve overall worldwide population health.

Not only is it exciting to imagine how we’ll see technology continue to evolve and change everyday life, but also fascinating to see the impact and opportunities for enabling healthcare providers. These trends will manifest in some exciting and innovative changes in 2016 that will have a tremendous impact and further improvements in patient care.

 

This post originally appeared in HealthIT Outcomes

 

Original

 

 

What 2016 will Bring for Healthcare Technology was originally published on Dr Nick van Terheyden, MD

Tagged with:

Achieving Effective Population Health

Posted in Analytics, bigdata, Disruptive, Healthcare Technology, Interoperability by drnic on March 10, 2016

value-based-payments - nvt

The move to value-based payments will be the most significant trend of 2016, because it will force both caregivers and health plans to radically change the way they think and act. Population health, which emphasizes identifying risk and gaps in care, and filling those gaps, will be an existential capability for hospitals, physicians and health plans. If they get it right, they will prosper. If not, they will struggle at best or worse, wither and fail.

Effective population healthcare requires both a change in thinking and adoption of new technology for success. Organizations that have focused on episodic care and procedures to pay the bills will be the most challenged, because a completely new mindset will be needed.

If you are a surgeon who has been highly valued by a hospital because you bring in lucrative procedures, your life will change radically over the next couple of years.

  • Hospitals will be looking to physicians who can reduce costs and avoid the need for expensive interventions to help them succeed.
  • The surgeons (and other procedure-based specialties) will still be needed, of course, but they won’t have the rarified status in the future that they enjoy today.

Those who can find innovative ways to help patients improve their health status without a hospital stay or other expensive interventions will be the most successful in this new world.

Hospitals and physicians will also need to add technological capabilities to succeed. They will need to integrate data, analyze that data and use telehealth and remote monitoring to provide more effective use of resources and delivery of care. For many organizations, data integration probably seems overwhelming with too many applications speaking disparate languages.

The good news is that technology exists now which can create a nearly seamless interface among all these silos and allow data from a wide variety of sources to be used for population health, better treatments and more efficient operations.

Physicians will find a light at the end of the tunnel for those who hate their EHRs, as new vendors provide applications that make using an EHR simpler and more efficient. These vendors are creating applications that use the EHR and other clinical applications like a database, presenting patient data in a simpler, more clinically relevant user interface. This will mean that organizations can make their caregivers much more satisfied and efficient without having to ditch the huge investments they’ve made in clinical technology.

The next year will be a wild ride for many organizations, as they adapt to all these changes, but the work and effort should pay off in all kinds of important ways, liberating data for effective use in traditional clinical and patient care and unleashing innovation for its use and in new and unimagined ways.

This article originally appeared on the HIMSS16 Conference Blog here

 

Achieving Effective Population Health was originally published on Dr Nick van Terheyden, MD

Digital Health for the Undeserved

A recent report published by Jane Sarsohn-Kahn for the California Health Foundation: Digitizing the Safety Net Health Tech Opportunities for the Undeserved offers some deep insights into reaching the population most in need of help but often left out in the discussions of the latest and greatest technology to break into the news cycle.

As pointed out low-income households have access to mobile technology with 8 out of 10 sending and receiving text messages – in fact mobile phone usage and ownership mirrors the experience in Africa where many of the communities have little choice given the paucity of existing infrastructure and have bypassed the traditional communications systems in favor of mobile networks
Adults who own a cell phone, Africa

and gave rise to a whole innovation of mobile banking that originated that pre-dated, is more flexible and is more widely used than anything developed in the west (The M-Pesa system) – servicing the unbanked people of Africa without requirements to have a smart phone nor to use an app. I’ve written about the opportunity we have of learning from our African friends in the past)
In the case of the undeserved here in the US many of these people mirror these experiences and providing easy access using simple tools is effective not just from a cost standpoint (as Healthcrowd showed $1 for mobile messaging vs $34 for paper mailing) – and that’s even before you consider the engagement/response rate we find with mobile applications and interactions…think about it, when you want to reach your children do you send them an email or text them

Textpectation

 

Take the time to read about the multiple projects that are reaping big benefits and doing so cost effectively. These are real working projects with a range of technology that has demonstrable impacts and could be applied to many more groups and environments. The extensive piece takes you on a journey from everything as simple as text messaging from Healthcrowd to the medication adherence and tracking concepts of Proteus Digital Health of digestible sensors that track your pill from manufacture to ingestion.

There are a few guiding principles to help steer you to success

  • Meet people where they are – widely varied and none are typical
  • Build Trust – under promise, over deliver; everything is fragile for this community and failure can be far more catastrophic for them than “average” users
  • Address social determinants of health – just providing a ride to get to the clinic could mean the difference between success and failure and an Uber Ride is a lot more cost effective than an ambulance required for the crisis that could have been averted
  • Consider the cost of data service – data is expensive on many plans treat it like memory used to be in the days of 640K
  • Recognize the many layers of health literacy – not just comprehension but basic literacy and even language
  • Speak in the Vernacular – and make it culturally sensitive too

As Aman Bhandari said

“The new sexy is scaling what can work”

Proven solutions that have been effective provide great opportunities for those looking to make that impact on their own area.

 

 

 

Digital Health for the Undeserved was originally published on Dr Nick van Terheyden, MD

Personal Healthcare Management

This piece by Aaron Carroll detailing his personal experiences with the healthcare system for what should be an easy and simple activity represents the frustration and challenges everyone faces on a daily basis including myself

I have the exactly the same challenges with renewal of what is a long standing formulation

I know this is not good for anyone and as pointed out it is not good for personal health – in my case as my wife and family will attest it definitely raises my blood pressure as I spend countless hours on the phone fighting with systems.

Everyone’s story will be different and in my case I don’t love the drug company who have taken long standing medication mixed them in a standard way and patented this to make it extraordinarily expensive for a formulation that contains one over the counter medication (OTC) and one generic prescription medication. And because of the artificial limits placed on supplies (90 days supplies with a maximum 1 year) behavior is modified attempting to reduce unnecessary costs. Ultimately everyone is behaving in the way the system incents.

Imagine that experience in the store – CostCo refusing to allow you to buy your supplies in bulk limiting your purchase to 3 months supply of toilet paper

and having to keep going back to an external party to require approval for purchasing when CostCo offers a special deal to purchase 12 units that might cover you for a year. Costco want you to purchase more and if you have the space and storage and will use it you want to buy in volume because it saves you money and the manufacturer wants purchasing their product. Costco is focused on making the process and cost as efficient as possible.

Before the deluge of complaints that buying drugs is not the same as buying toilet paper – true but take many maintenance drugs with excellent efficacy and safety. Even if it does require regular blood tests forcing the workflow to link the two in an sequence that tortures everyone in the process makes no sense. Engaged patients want an efficient process, will follow sensible and safe treatment guidelines and don’t need to be squeezed into a sequential process that includes steps that are linked for clinical reasons but remain disconnected in real life and difficult and expensive to follow for everyone concerned

As the costs shift to the individual the frustrations rise with the process and the necessary costs and waste – expect a rising voice of complaints and frustrations that might hopefully start to effect change

Personal Healthcare Management was originally published on DrNic1

Want to See #Mobile #Health Success – Look to #Africa #mHealth

Posted in #mHealth, Africa, Disruptive, HealthIT, Kenya by drnic on October 25, 2013

I’ve said it before – Africa like many of the under developed countries is exploding with great use cases for mHealth. This piece: Kenya Has Mobile Health App Fever tracks the explosion of #mHealth.
Promoted and supported by the Kenyan Medical Association and Shimba Technologies the latest release MedAfrica offer ready access to medical information and verifying clinicians in the field and even a tool to verify the authenticity of drugs.

With over 50% of banking done by mobile phone in Kenya they are clearly adopting the platform in large numbers (Kenya is rich in mobile phones, with 25 million subscribers; Africa has more than 600 million of them). Applying #mHealth to the slew of health problems is exciting and rewarding. The size of and range of health challenges is daunting:

Many Kenyans have serious health problems; for example, according to the World Health Organization, more than 30 percent of children under age five show stunted growth. At present, only 7,000 doctors serve a nation of 40 million people. 

All this out of a company that was founded by Stephen Kyalo and Keziah Mumo, with $100,000 in seed money from a European VC

Seen here Steve Mutinda Kyalo

And its not just Kenya:

Mobile health platforms are making a strong showing in other parts of Africa, too. In South Africa, efforts include platforms that give HIV-infected patients automated ways to receive health information and reminders about upcoming doctor visits. In Johannesburg, 10,000 people infected with HIV have taken on these SMS-based alerts, resulting in big declines in missed appointments.
In Ghana and Liberia, a group called Africa Aid is experiencing strong success with MDNet, a system that allows users to call or text doctors for free. Since its founding in 2008, 1,900 physicians in Ghana have logged more than a million calls to patients, the group says.

Having real impact with that funding – awesome

Nkosi Sikelel’ iAfrika

You can take the boy out of Africa, but you can’t take Africa out of the boy

Nuance joins a who’s who in 50 Most Disruptive Companies for 2013

Posted in Disruptive, Innovation, Nuance, Technology by drnic on February 20, 2013
Media_httpwww2technol_ywbgd

This is really cool – Nuance made the list for top 50 disruptive companies in technology. We join other great and innovative leaders like
SpaceX
Google
IBM
Square
Toyota
Apple
Amazon
Corning
Facebook
….to name a few

But also some neat Healthcare focused companies like
Diagnostics for all
Foundation Medicine
Illumina
UniQure

Congratulations to all the others but should out to Nuance – proud to be a part of this team