The KHIT Blog: Home again

Wednesday, May 1, 2013

Home again

Above, NYC at night as we were heading into DC from Boston last Friday night on JetBlue. I was born 67 years ago in the area at the far upper left corner of that photo (Rockville Centre, Long Island). Shot this out the window, hand-held at ISO 12,800.

Came back via JetBlue, DC Reagan to BOS to LAS, got in about 11 pm. Thanks to my son Nick for the free standby tix (he works for JetBlue at Reagan). No hitches, made it onto both flights. My wife made it back to Walnut Creek fine as well.


The Birthday Boy and my future daughter-in-law, on his 30th.

LIGHT TRAVEL READING

This book was a disappointment, I have to say. $39.49 for the Kindle edition? Overpriced by at least $30. Nine co-authors? I read it in its entirety during our SFO to BOS leg last Friday on our way to DC to surprise our son on his 30th birthday.

Not that it is useleless. Just a fairly significant disappointment. But, it's motivated me to finish "Healthcare Kaizen," which has shown me more substance by far within the 27% of it that I have finished thus far.

It's not cheap either, at $49.74 for the Kindle edition. A far better buy, though. I would not recommend "Perfecting Patient Journeys" until they drop the Kindle to the $9.99 that it should cost. Specifics shortly.

Also got waylaid by another book. $10.87 Kindle edition.

Bob Burton and I have corresponded. His previous book, "On Being Certain: Believing You Are Right Even When You're Not" ($8.89 Kindle) is one of my favs.

Good review of and rumination on this book over at ScienceBasedMedicine.org.
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Just in.

TOPICS IN HEALTH: LESSONS FROM THE FIELD

How Nonprofit Hospitals Can Profit – Handsomely
Four 2013 Pultizer Finalists share tips from their investigative series
The Charlotte Observer, News & Observer, Karen Garloch, Jim Walser, Steve Riley, Joseph Neff, David Raynor, Carolinas HealthCare System, Wilkes Regional Medical Center, nonprofit hospitals, Pulitzer Prize finalists

In 2009, as the debate about health care reform picked up steam in Washington, D.C., an editor at The News & Observer in Raleigh, N.C., posed a question: Should the newspaper take a deep look at the cost of health care?

A series of interviews and some database work led to two key decisions: Concentrate on hospitals. And ask colleagues at The Charlotte Observer to join the research. North Carolina's largest hospital system, Carolinas HealthCare, was based in Charlotte. And it was suing thousands of its patients each year for payment. If the two papers worked together, they could run a statewide series, with more reach and impact.

The early stages

Early in our reporting, we read many academic studies, talked with many hospital experts around the country and developed a few fundamental questions:

– How profitable were North Carolina’s nonprofit hospitals?

– Were they giving back to the community as much as they were getting in the form of tax breaks?

– And how were hospitals treating those who couldn’t afford to pay their bills?

Read on.

OFF-TOPIC PROPS

Once I move fully back to the Bay Area, I will be donning boots and gloves over there to do some things more substantive than just tossing in a C-note here and there. I love all animals.

More to come...
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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
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"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
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"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
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"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
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"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
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"'Solutions' exist only in mathematics."

- Karen Martin
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"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
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"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Wednesday, May 1, 2013

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