Tag Archives: healthcare

Digital health exchange #healthxchange innovation session

This morning I am at the digital health exchange panel session in Arlington, VA.

Panel Moderator: Mark Naggar, Project Manager, HHS Buyers Club (HHS IDEA Lab) – Office of the Chief Technology Officer, Department of Health and Human Services (confirmed)

  1. Dr. Neil Evans is a board-certified, Co-Director of Connected Health, aligned under the Office of Informatics and Analytics, in the Veterans Health Administration within the U.S. Department of Veterans Affairs and practicing primary care internist at the Washington, D.C. Veterans Affairs Medical Center. Dr. Evans co-leads the effort to improve services to Veterans, their families and Caregivers by increasing access, fostering continuity and promoting patient empowerment through electronic health technologies wth a focus on mobile and digital health.  (confirmed)
  2. Kathryn Wetherby serves as a Public Health Advisor at the Substance Abuse and Mental Health Services Administration (SAMHSA)where she leads large health information technology projects and contracts. Ms. Wetherby has over 16 years of experience in both the public and private sectors; including implementation of large scale, enterprise-wide health information technology systems, mobile technologies, standards, strategic planning and organization and operational change. (confirmed)
  3. Justin Woodson is an Associate Professor, Uniformed Services University Health Services (USUHS), the institution charged with training, educating and preparing officers and leaders to directly support the Military Health System, the National Security and National Defense Strategies of the United States and the readiness of our Armed Forces. (confirmed)
  4. Joe Klosky, Senior Technical Advisor, Food and Drug Administration.   Having previously served as the Chief Technology Officer for the FDA in 2007, Mr. Klosky has supported a number of initiatives across HHS, including a detail to the to the NIH CIO and Chief Enterprise Architect. Mr. Klosky recently rejoined the FDA as a senior technical advisor in support of HHS wide work groups and projects. (confirmed)

 

The panelist roles and perspective:

Dr.Neil Evans – connected health covers all technology outside the face to face engagement for veterans.

Connected health runs the VA innovation competitions.

Kate Wetherby – leads health it projects including mobile apps and portals and solutions for outreach in rural areas.

Justin Woodson – innovating by “getting out of the box”. Justin is based in the military medical school. Role in innovation is to create unique experiences at the intersection of military and academia. Building interactive experiences.

Joe Klosky – FDA: troubleshooter – “into the breach”. Using Amazon cloud at FDA. Handling very sensitive data.

Mark Naggar – HHS is trying to develop a more collaborative and innovative ecosystem. HHS has its own internal accelerator.

Q: what organizations do the panelists admire for innovation?

Justin W: private organizations have more flexibility to acquire talent and apply it. Organizations like Google are willing to take risks.

Neil E: Procter & Gamble mixes employees across divisions. They expected people to take time out of their normal duties to mingle with colleagues from other divisions and to share ideas.

Justin W/Neil E: medicine tends to work in silos. More effort is needed to make inter-disciplinary interactions happen. This has to tap the people in the field that are doing the work.

Joe K:  use commercial tools to help collaboration happen. Also mingle commercial tools to create new solutions.

Kate W: combatting the “we have always done it this way”. You need to have people to drive the change.

Mark N: HHS has implemented the entrepreneur-in-Residence program. Unfortunately they are restricted from bringing people from for-profit companies. But people are trying to figure out how to do this.

Q: where have you gone from concept to execution successfully – or what have you learned from a failure to get to execution.

Neil E: VA has entrepreneur in residence. Last year they were able to partner with Walgreens to help veterans get their flu vaccine and have the data fly in to the Vista EHR.  After a pilot in 2013 this was rolled out across the country this year.

Choose a project with a hard deadline. Eg. There is a deadline for flu vaccines.

Even simple projects can require innovative approaches.

The va mail pharmacy implemented a system to allow veterans to track their medications through the mail system.

Justin W: innovation does not have to be new. It can be a mashup of existing solutions to solve a problem. Taking existing ideas in to a new realm.

Kate W: Consent to Share – working on interoperability. Dealing with privacy and security regulations. Working on data segmentation privacy and consent to share. Parse the medical record and segment it to allow the patient to share sub-sections of their health record. There are issues with sharing certain health data. Variations at the state level.

SAMSHA has built this in to a PHR. Cerner and nexgen have done similar work. HHS has shown the direction and is encouraging others to build on what they have done for data segmentation.

Joe K: FDA is at every custom station. It is a massive undertaking. Working on a risk based model. Applying technology eg. Forensic technology lab in Cleveland. Technology is being used to handle globalization despite budget constraints.

Q: what barrier would you remove to improve the path to innovation?:

Justin W: change the manning model.

Joe K: the procurement process around innovation while complying with FAR

Neil E: in IT rules applied for production but need simpler!more agile approaches for pilots.

Kate W: workforce development to prep people for technology use.

Justin W:  focus on leadership development that includes innovation as a leadership responsibility.

Neil E: VA annual innovation competition. It creates community. Ideas get voted on and commented on. The comment process creates communities of interest.

Q: How do small businesses with innovative ideas partner with the agencies.

HHS has s&i framework committed and other work groups. There are a lot of open forums and information on HHS web sites.

Big challenge is to educate and communicate to the workforce about new innovations.

Kate W: project Echo – using Telehealth for workforce training.

 

Mark Scrimshire
HHS Entrepreneur-in-Residence at CMS building BlueButton Plus for Medicare.
Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Stay up-to-date: Twitter @ekivemark
Disclosure: I began as a Patient Engagement Advisor and am now CTO to Personiform, Inc. and their Medyear.com platform. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want.  Manage your own health records today. Medyear: Less hassle. Better care.

Heading to #MongoDB World next week and planning to hang out @BPHealth with @Medyears outside of the conference

Next week I am attending MongoDB World on June 23-25th. I plan to blog from the event, so watch out for a stream of posts over the course of next week.

Recently I gave a presentation to various MongoDB executives on the opportunities for MongoDB in Healthcare. Since I am heading to MongoDB World I thought I should share my thoughts on the opportunities for NoSQL in the $2.75 Trillion Healthcare industry.

Here is my presentation, which I have uploaded to my ekivemark account on Slideshare:

If you are attending the conference in New York City tweet a message to @ekivemark and we can connect.

You may also find me sporting one of my Walking Gallery of Healthcare jackets.

Outside of the conference you will probably find me hanging out at Blueprint Health in Soho with the Medyear Team. Let’s connect!

Mark Scrimshire
Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Blog: http://blog.ekivemark.com
email: mark@ekivemark.com
Stay up-to-date: Twitter @ekivemark
Disclosure: I am a Patient Engagement Advisor and CTO to Personiform, Inc and their Medyear.com platform. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.

Seniors and health IT: A match made to avoid heaven! – All Things HIT

Dec 30 2011   6:46PM GMT

Seniors and health IT: A match made to avoid heaven!

Posted by:

Patrick Howard

Senior care,

telemedicine,

eRx,

Senior Citizens League,

Cost of care

Last week I wrote a ceremonious, empathetic, ???Christmassy??? blog about being reminded how effective ???no tech??? methods can be in achieving better medical outcomes, increasing medication compliance, and so on and so forth. Well after reviewing the results of a most recent study by the Senior Citizens League, one of the largest nonpartisan seniors advocacy groups in the USA, based in Alexandria, Virginia, I???m back on the health IT soapbox. 

The study reviewed how the financial concerns of senior citizens affect their behavior when it comes to visiting the physician???s office, taking their medications and approaching their end of life care.  The study surveyed 1200 seniors and revealed the following:

  • 50% of respondents postponed filling prescriptions
  • 61% postponed visits to dentists, opticians, or hearing specialists
  • 44% postponed filling prescriptions or chose to take a lower dosage than prescribed
  • 44% are spending at least $300 per month on medical expenses
  • 10% are spending at least $750 per month

I admit, the results weren???t that surprising.  Anytime a person has less money and/or no health insurance, they will put off visiting the doctor, dentist, and even not-comply with their medication.  What was astounding to me, however, was the metrics???s large percentages and the high out-of-pocket monthly cost (points four and five above).  After reviewing the results, I couldn???t help but think about solutions that, not surprisingly, were in the health IT realm!  How can e-prescribing systems with a generic pricing default reduce the cost of the prescription? How can a clinical decision support systems be used for prevention, possibly eliminating that office visit and/or prescription?  I thought about how we can use telehealth appointments, in lieu of physical office visits, and hence increasing visit compliance, as this would reduce their costs and is more convenient, especially for those in rural communities.  Seniors wouldn???t have to get dressed, get driven, and spend valuable gas dollars visiting the doctor office.  

While I know this is utopian, our seniors definitely deserve these impactful technologies, especially towards the end of life.  The costs associated with care and the mere inconvenience of an office visit during the time when a person is the least mobile seems inhumane when these barrier-breaking technologies exist. Although there are some ???no tech??? solutions that could address theses concerns, such as lowering prices, this seem less likely than implementing the technologies. Yes, health care IT and seniors can truly be a match made to avoid heaven.  

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Seniors are not as averse to technology as we often believe. They are connecting with their grandkids on Facebook and using technology to stay in touch with family. This is something that kids and grandkids can encourage. Using technology with them can help them become comfortable with using that same technology to help maintain their health.

Obamacare to the Rescue | The Health Care Blog

By Spike Dolomite Ward

I want to apologize to President Obama. But first, some background.

I found out three weeks ago I have cancer. I???m 49 years old, have been married for almost 20 years and have two kids. My husband has his own small computer business, and I run a small nonprofit in the San Fernando Valley. I am also an artist. Money is tight, and we don???t spend it frivolously. We???re just ordinary, middle-class people, making an honest living, raising great kids and participating in our community, the kids??? schools and church.

We???re good people, and we work hard. But we haven???t been able to afford health insurance for more than two years. And now I have third-stage breast cancer and am facing months of expensive treatment.

To understand how such a thing could happen to a family like ours, I need to take you back nine years to when my husband got laid off from the entertainment company where he???d worked for 10 years. Until then, we had been insured through his work, with a first-rate plan. After he got laid off, we got to keep that health insurance for 18 months through COBRA, by paying $1,300 a month, which was a huge burden on an unemployed father and his family.

By the time the COBRA ran out, my husband had decided to go into business for himself, so we had to purchase our own insurance. That was fine for a while. Every year his business grew. But insurance premiums were steadily rising too. More than once, we switched carriers for a lower rate, only to have them raise rates significantly after a few months.

With the recession, both of our businesses took a huge hit ??? my husband???s income was cut in half, and the foundations that had supported my small nonprofit were going through their own tough times. We had to start using a home equity line of credit to pay for our health insurance premiums (which by that point cost as much as our monthly mortgage). When the bank capped our home equity line, we were forced to cash in my husband???s IRA. The time finally came when we had to make a choice between paying our mortgage or paying for health insurance. We chose to keep our house. We made a nerve-racking gamble, and we lost.

Continue reading

@cyberslate: INFOSEC Preso on Security and Privacy in SharePoint 2010: Healthcare – Life in Caps Lock: cyberslate’s posterous

Some great information here about using SharePoint in HealthCare.

Compartmentalization with a robust security grouping strategy can pay dividends. in many cases SharePoint can be used to manage workflow because the process of managing the workflow does not require visibility to PHI/PII information. In these cases separate and compartmentalize the PHI/PII data and control access through security groups.

I built this capability in SharePoint 2007 using associated lists. This allowed teams to review case workload and progress without having to see member information. Yet the member information was accessible via a simple hyperlink, providing the viewer had adequate security rights.

As is correctly pointed out, this needs Administrator involvement from the outset and ideally the creation of utilities and web parts that support this approach so that we make it easy for site administrators/developers to create departmental and team workflows that remain HIPAA client and don’t divulge PHI or PII to unauthorized personnel.

Build Your Social Media presence one by one. Ten Rules for Health Care Organizations Interested in Using Social Media | The Health Care Blog

By

JAAN SIDOROV, MD

Include social media like ???Facebook??? or ???Twitter??? in health care business plan, and you???ll probably prompt glazed looks from the average health care administrator. Those who recognize the terms will want to know what they have to do with filling up that new heart catheterization suite or increasing referrals to their infusion center.  They???re too busy with marketing flotsam like ???Top 100??? billboard campaigns or convincing the local news media to mention that newly renovated lobby. These functionaries look, but they do not see.

Case in point: during a recent work-out at the local fitness center, the Disease Management Care Blog  witnessed two elder women chatting while speed-walking on side-by-side treadmills.  Down the row were two younger women on side-by-side exercise bicycles, also chatting.  The difference was that the two younger women had ear plugs in place, their cell phones out and were simultaneously texting.  All four women were continuously talking at the same time, but that???s not the point.  The point is that two-way web-based cellular communication is fast becoming a 24-7 standard for tens of millions of people.  Those two elders may currently command greater purchasing power, but those texting youngsters is where the future lies.

As mentioned in yesterday???s post, health care organizations that realize that they need to get the attention of the two women on those exercise bikes will find it extremely challenging.  That???s because those ladies will have to ???opt-in??? and agree to ???friend??? or ???follow??? you.

While social media is just as new to population health providers, the DMCB thinks they???ll have a leg up because they have been in the ???opt-in??? business for over a decade.  After doing some reading and talking to some colleagues in the disease management industry, here are ten insights that can help other health care organizations such as accountable care organizations, integrated delivery systems, medical homes or other provider organizations build followers, tweeps, and friends the opt-in world of social media:

1) Offer brief, personalized, meaningful and relevant content: mass messaging and links to milquetoast advice offer little value.  Efficiently written humor, unique insights and actionable information need to make the effort it takes for your customers to pay attention worthwhile. Being snarky , rude and pushy isn???t necessarily bad. Extra points for catering to ???micro??? communities.

2) Expect slow uptake, one person at a time: adoption is non-linear, starting slowly and building as awareness grows to, if you do this right, a tipping point.  While big Twitter communities weren???t built in a day, the good news is that once a base of readers/friends/followers is established, it won???t easily go away.

3) It???s a part of a larger coherent marketing and branding strategy: traditional communication ???channels??? still have a role to play.  Print, email and phone calls should continue in addition to tweets and postings.

4) Aim it relevant generational health issues ??? current younger users of social media are more likely to be interested in personally important issues like health promotion, obesity or child care.  Chronic conditions like diabetes or hypertension are less relevant???. for now.

5) Incentives are OK: assuming you can get past the kick-back, privacy and insurance rules, think gift certificates or raffles for sign-ups as well as referrals. It works in employer settings, why not out on the net?

6) Worries? Yes, including HIPAA, creepy data mining, hacking, surveillance, cyber-bullying and predatory behavior.  You???ll need to be up-front with friends and tweeples about this and promptly notify them of any problems.

7) It???s messy: the likelihood that this can be predictably planned is very low.  Flexible adaptation and trying to get buy-in from a skeptical audience means this will be more of a journey than a destination.

8) Social media networking is important: in addition to building your community of individuals, you???ll need to interact with other Twitterers, Facebook pages and blogs.  Play nice with them and they???ll notify others about you.

9) Prize relationships: this is a two-way street, which means you have to have a reputation for listening. That means being aware of any community ???buzz??? and promptly answering all individual questions, comments and concerns.

10) It isn???t cheap: This takes time. This has to be supported with policy and procedure. This requires training and staffing. This needs money.

Jaan Sidorov, MD, is a primary care internist and former Medical Director at Geisinger Health Plan with over 20 years experience in primary care, disease management and population-based care coordination. He shares his knowledge and insights at Disease Management Care Blog, where this post first appeared.

Filed Under: THCB

Tagged: , , , ,

May 5, 2011

Jaan offers some common sense guidelines for stepping in to Social Media. The bottom line, don’t treat it as another mass media channel. You build an engaged channel one person at a time.

Health is Private. Wellness is Social.

On Friday I am attending a round table event in Washington DC. There is an amazing list of attendees and I am honored to be involved with such distinguished thought leaders from across the health care spectrum. The theme of the event is patient engagement. A topic near and dear to me and a subject of many discussions at HealthCamps around the country and around the world. Thinking about this topic led me to a recent post by Stowe Boyd – one of our leading thinkers on the impact of social tools on society.  

I have long admired and respected the work that Stowe Boyd (@stoweboyd) is doing in the Stream. He is someone who really understands the Social Flow that is far more than the individual platforms that represent what we refer to as Social Media or Social Networking.

Stowe’s latest line of research is around “Social Cognition.” Two observations from his Defrag presentation caught my attention:

“Reynol Junco conducted a study at Lock Haven University that required a group of students to use Twitter as part of their class work: tweets on others’ presentations, or as a social note taking tool when researching. This led to higher social engagement and a GPA increase of one half grade on average. Imagine if they used it in all classes? Or if the whole school used it?”

“Damon Centola has undertaken research that shows that behavioral changes are transmitted more quickly in denser networks. A company or a community where the members in general have more connections to others will be more likely to adopt new behaviors than in more  loosely connected networks.” 

Social Cognition and Health Care

This got me thinking… Does this make a case for Participatory Medicine? Where medical professionals, their patients and fellow sufferers of chronic conditions pool their experiences and knowledge to achieve better outcomes. 

The health care Tsunami, where rising costs threaten to bankrupt our nation while fewer and fewer people can afford basic care will force us to rethink how we care for ourselves and each other.

The transformation of health care demands that we become more open. Chronic disease sufferers are already forming networks to share information to help them live with their condition. Each of us needs to establish not just a Personal Health Record but a Life Record. We need to break down the glass walls between the patient and medical professionals. Patients and their personally collected data needs to be put on an equal footing with clinical data. This is where Technology can really play a transformational role.

Transformation Through Life Technology – Not Health Information Technology    

Technology and connected platforms offer us an opportunity to gather information at a level of granularity and accuracy that has been impossible, or at least unaffordable, up until now.

Health Information Technology is needed to be able to filter and correlate these enormous volumes of data to look for anomalies and trends that can assist in early diagnosis of conditions.

Presenting this information back to consumers in a form that can be easily understood and acted upon is crucial. Enabling us to share and compare with others will help to reinforce behavior change that leads to continued vitality. 

The real challenge for the health care industry is to develop affordable, easy to use, consumer oriented solutions that are connected and fit in to the “rhythm of life.” 

In conclusion, once again I will make this request to Google Health, Microsoft HealthVault and any other Health IT vendor that cares to listen:

Connect your Health Record to Twitter, Facebook and Text Messaging. Make it easy for people to have data pulled in to their records. Why shouldn’t my Health Record follow me on Twitter and determine my mood or my level of exercise from the messages I am sharing with my friends.

On the other end you need to build the tools to make it easy to compare, filter, chart and export different data sets that are being collected. Medical professionals will never have the time to manually pore through the vast flow of data from each patient. They will need tools to summarize, highlight trends and help them act on anomalies.   

Cognition is social. We need to build tools that leverage the social fabric of our lives. This is indeed the next big challenge for Health Care Technology – to create tools and platforms that integrate easily in to the social fabric of our lives. 

Health is private. Wellness is social

We hold the keys to better health

Jim Marks posted a great article on The Health Care Blog: Health Insurance Doesn’t Necessarily Mean Better Health.

The choices we each make have a profound effect on our health. As Jim points out:

Although genes and medical care are vitally important, we’re increasingly understanding that where we live, learn, work and play affect our health even more. That is clearly what we saw last year when we released the first look at what factors affect health in every county of the nation.

What we eat, the quality of the education we provide for our kids, the housing and community all have an impact. When we couple those factors with a Life Record that helps us track health, habits and well being we have the building blocks for a life of vitality.

More healthcare doesn’t automatically equate to better health. We need to pay closer attention to our vital signs and overall well being so that we can seek medical attention when it is appropriate.

Why don’t you come along to one of the upcoming HealthCamps to discuss this and other aspects of engaged health. 

HealthCamps are taking place in San Diego, CA, New Haven, CT and Tampa, FL:

#healthCamp – Pause for Thought:Game-Changing Statistic: 1 in 250 CT Scans can cause Cancer

By BOB WACHTER

Bob Wachter

Although the medical profession has been harming unlucky patients for centuries, the patient safety movement didn???t take flight until 1999, when the Institute of Medicine published its seminal report, To Err is Human. And that report would have ended up as just another doorstop if not for its estimate that 44,000-98,000 Americans each year die from medical mistakes, the equivalent of a jumbo jet crashing each day.

Come to think of it, the quality movement also gelled after the publication of Beth McGlynn???s 2003 NEJM study, which produced its own statistical blockbuster: American medical care comports with evidence-based practice 54% of the time, a number close enough to a coin flip to be unforgettably disturbing.

These two examples demonstrate the unique power of a memorable statistic to catalyze a movement.

Last month, my colleague Rebecca Smith-Bindman, professor of radiology, epidemiology, and ob/gyn at UCSF and one of the nation???s experts in the risks of radiographs, gave Medical Grand Rounds at UCSF. Her talk was brimming with amazing statistics, but this is the one that took my breath away:

A 20-year old woman who gets an abdominal-pelvic CT scan (i.e., just about any young woman coming to the ED with belly pain) has a 1 in 250 chance of getting cancer from that single scan.

Did that fully register? One CAT scan, which until recently most of us ordered with no more restraint than we exhibit when asking the Starbucks barista for a tall latte, will cause cancer in one out of every 250 patients. Two-hundred fifty: that???s the number of students in my college Bio 101 class. Wow.

This is particularly scary given the remarkable increase in the use of this technology. Get this:

  • Three million CT scans were performed in the U.S. in 1980. In 2011, there will be 72 million, an average of 19,500 every day.
  • One in five Americans will receive a CT scan in any given year; some experts suggest that at least one-third of those scans are unnecessary.
  • Between 2000 and 2005, Medicare spending for imaging studies more than doubled, from $6.6 billion to $13.7 billion, twice the rate of growth of physician fees.

And, although none of these examples has quite the impact of the 1-in-250 statistic, there are lots of other scary risk data, such as:

  • The best estimates are that radiation from CT scans causes 29,000 excess cancers each year in the U.S., mostly in women.
  • Researchers estimate that 15,000 people will die from the direct effects of the 72 million CT scans performed in 2007 alone.
  • A 2004 study found that less than 50 percent of radiologists, and 9 percent of ER docs, were aware that CT scans could increase the subsequent risk of cancer.
  • A multiphase abdominal/pelvic CT scan has the same radiation wallop as 500 transcontinental flights, 450 chest radiographs, and 74 mammograms.
  • And those airport body scanners you???ve been so worried about? You???d need to be scanned 200,000 times in order to accumulate the radiation that you get from a single CT scan. I???m a 1K United flyer, but I won???t close in on 200,000 scans for the next couple of centuries.

In her grand rounds, Rebecca walked us through the multiple lines of evidence on the risks of radiation from CT scans, particularly those drawn from studies of Japanese A-bomb survivors and individuals who received radiation for both malignant (i.e., lymphoma) and non-malignant (i.e., acne) disease. All pointed to the conclusion that doses in the range of those delivered by CT scans are fully capable of causing cancer.

Remarkably, with all the attention given to regulating food and drugs, the radiation delivered by CT scanners has gone largely unregulated. (If you ask me, I???d rather receive a precise and predictable dose of radiation than of Vitamin D or Azithromycin.) Rebecca found that CT scanners at four Bay area hospitals delivered radiation doses 66% higher than the usually-quoted doses, and that there were staggering variations (up to 13-fold) among different scanners performing precisely the same test. In her talk, she blamed the lax regulations on radiation physicists, fastidious types who have been reluctant to take a stand on maximum radiation doses since they can???t define those doses precisely.

While I???m sure that???s true, I have to believe that some of the reluctance to blow the whistle can be traced to the usual Medical-Industrial Complex: scanning equipment manufacturers, radiologists, and hospitals who have no particular interest in killing this particular egg-laying goose. If you doubt that these forces are at play, witness the billboards for $1000 total body scans that line Florida???s highways (scans that, when performed in healthy people searching for asymptomatic tumors, undoubtedly cause more cancers than they cure). Even now, despite powerful evidence of the risks, there are some in the radiology community who don???t find the science compelling enough to alter their practice. The parallels to the Global Warming debate are eerie, and troubling.

Even if the risks turn out to be less than we fear, most skeptics now agree that we???re causing a lot of cancers, and that many could be prevented if we took a few sensible steps. Manufacturers, hospitals, and radiology facilities should test the radiation exposure of their scanners, with the goal of decreasing the variation and delivering the minimum dose that creates an acceptable image. Ultrasounds should be substituted for CTs when possible, such as in follow-up of patients with documented kidney stones. There is evidence from Mass General that the use of computerized appropriateness protocols can markedly cut down on the number of CT scans, and thus the cancer risk. And, if we need to obtain the patient???s informed consent before transfusing a unit of blood, we should also do so before ordering a CT scan, since the latter is a far riskier procedure.

But changing culture will be more important, and harder, than changing protocols. We physicians have become so accustomed to saying ???Get the scan??? that we have turned our brains off. Several months ago, I care
d for a woman with a painful lumbar compression fracture of unknown duration. We asked the orthopedic surgery service to see her in consultation, and the resident???s recommendation ??? made without a hint of self-awareness or irony ??? was that we obtain both a CT and an MRI. I was dumbfounded. Yes, each test can provide slightly different information, but I don???t believe that both were absolutely necessary; nor did a couple of experts I later spoke with. (We ended up getting the MRI only, which produced all the information we needed.) Somehow, we must find a way to break our reflexive radiographic profligacy.

As we struggle as a nation to ???bend the cost curve??? and we grapple with the nexus of low yield and expensive medicine (the dreaded ???R word???), let us all agree that when we have an issue like this ??? an overused technology that harms or kills thousands of patients each year ??? we come together to do the right thing. CT scans can be immensely helpful, even miraculous, at times, but there is no question that the right thing is to Just Say No far more often than we ever have before.

Robert Wachter, MD, is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Lee Goldman, he coined the term ???hospitalist??? in an influential 1996 essay in The New England Journal of Medicine. His most recent book, Understanding Patient Safety, (McGraw-Hill, 2008) examines the factors that have contributed to what is often described as ???an epidemic??? facing American hospitals. His posts appear semi-regularly on THCB and on his own blog, Wachter???s World.

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Filed Under: Bob Wachter, Patient Safety

Feb 11, 2011

If you are concerned about your health you need to read this article on the Health Care Blog before you go for your next Hospital or Doctor visit.

I am not saying don’t have a CT Scan but instead actively question whether it is really necessary. Whether other alternatives would be as appropriate.

More is not always better and the current Pay for Service model encourages the use of more medications, scans and tests. As patients we need to question the value that we get from each test or prescription we receive. Sometimes the side effects are worse than the symptoms.

#hcsd10 Bump your Prescription – Creating the virtuous circle of PHR adoption

This week saw a vibrant HealthCamp San Diego (#HCSD10) go in to the history books as the Inaugural South West Health Un-Conference. HealthCamp San Diego took place the day before the mHealth conference. There are a lot of mHealth events scheduled. It is THE hot topic in healthcare at the moment.

I was just reading Chilmark’s review of: 

“Is the mHealth Hype Justified?”

One comment caught my eye: 

the story from Stanford Medical School where new med students this year have been issued an iPad in the hopes of replacing mounds of paper that are typically distributed to students for a course over a semester. The students seem to like it and even one of the doctors is quoted as saying towards the end of the article that the iPad is in an ideal form/function factor for a busy physician.” [my bolding]

This made me think. We have a brilliant opportunity to create a virtuous circle of ePHR adoption amongst consumers. When the iPad launched a survey showed that 60% of physicians were purchasing or showing an interest in the device. 

Imagine the situation where Doctors are using an iPad in their surgery to record the notes from a patient visit. When they issue a prescription the patient could pull out their iPad or smartphone and “bump” to collect the prescription and any notes from the visit. Gone would be the days where the patient forgets most of what they are told within five minutes of walking out of the Doctor’s office. The hyperlink truly becomes a prescription.

The technology for this is already available:

A Bump Application

QR Codes could handle prescription data – just like airline boarding passes. We used the United Airlines Mobile Boarding Pass on the return trip. No need for paper as we passed through the TSA checkpoints and the boarding gate.

Smartphones can read QR Codes. Therefore a major scanner infrastructure is not essential but can be implemented in high volume locations. This means that adoption at even the smallest pharmacy is possible. The prescription can be “held” at a web site and once used is no longer available. This is exactly how online boarding passes work.

A mobile PHR application can be used to collect the information and store the data securely on Google Health or Microsoft HealthVault where it can be integrated with other data to create a complete view of our health.

The same bump application could be used to securely pass data collected from the patient – from their PHR to the doctor’s iPad as part of the consult.