The KHIT Blog: "Transforming" Health Care?

Wednesday, May 8, 2013

"Transforming" Health Care?

I saw mention of this book this morning amid the Health IT news I scour every day. Into my Kindle Cognitive Crack Pipe it goes, at a pricey $43.53. Let's hope it turns out to be worth it.

"Transforming health care" has become one of those noble cliches regarding which we all tend to nod in unreflective agreement. But, what constitutes "transformed"? Is that semantically and materially different from "reformed"? "improved"? "re-engineered"?

I immediately went searching for Mr. Fasano's definition of "transformed." Haven't found much yet (though, in fairness, I've only begun to read the book in depth).

Definitions matter. To a scientist, operational definitions matter centrally (i.e., outset metrics via which to determine attainment of significant improvement or, more broadly -- "transformation").

...George Halvorson, who I have always said is really the CIO of Kaiser Permanente. His vision, mentorship, and partnership are inextricably linked to my own passion for transforming health care through technology...

As you read what I hope will be some inspiring predictions and heartening examples of how health information technology is already transforming health care, ask yourself how in your position— whether you are a technologist, a healthcare provider, or another player in the healthcare and technology industries— you can accelerate the change that we know must come to health care.

...smartphones will play a big role in transforming health care. Mobile devices mean that any place can be the right place to deliver healthcare information. Mobile technology has already changed how we connect with families and work, with our finances and friends. It is about to change our relationships with our physicians and personal health information as well.

Useful detail only emerges at the conclusion.

Conclusion

If you take away only one thing from this book, I hope it is the conviction that transforming health care through the use of health IT is essential to building the healthcare system we need; a system that is:

Connected, beginning with EMRs that are part of an HIE that follows a patient throughout her life.

Consistent, so it can be shared through HIEs and added to care registries and databases where it can advance our understanding of disease, treatment, and prevention, leading to better health for all.

Mobile, allowing patients, physicians, and other caregivers to meet, converse, and exchange information of all sorts from anywhere.

Personal, achieved by giving individuals more transparent and secure access to their own data (including their own genetic makeup) and by tapping into the masses of data that will be generated by the technologies described in this book, and others that have yet to be dreamed of.

No one can deny that the stakes are high. The amount spent on health care in the United States is unsustainable. The United States spends the highest percentage of its GDP on health care in the world (18 percent in 2010; 19 percent projected in 2020). 37 Yet, we do not see the kind of health outcomes that one would expect that level of expenditure to buy. Indeed, most doctors and healthcare providers in this country are paid to treat illness, order tests, and deliver treatment, not to ensure health. Too many hospitals put an empty bed on the debit side of the ledger. Instead, we should see empty hospital beds as a credit to the quality of preventive care being delivered.

But the rewards we stand to gain are even higher. Some rewards are financial; reducing our overall healthcare expenditures would strengthen our economy overall and ease the financial burden on individuals and families. Private sector companies, large and small, that participate in the healthcare IT transformation will deserve to prosper from their contributions. Even healthcare plans and payers stand to reap financial benefits for the effort they put into change. Better health outcomes also have financial implications: People will be more productive on the job and have more discretionary income without big pharmacy bills to pay each month.

And of course, the biggest rewards are intangible: a better start in life for babies born to women who get good prenatal care; active, happy children who never know the clutching terror of an asthma attack; the peace of mind of women who don’t have to fear breast cancer and men relieved of the specter of prostate cancer; more years to spend with the grandkids. Not to mention the satisfaction of a doctor or nurse over a job well done, another patient well cared for. We hold the key to all of this in our hands: information leveraged through technology. I hope you will be motivated to join me in using that key to open the door and step into the transformed future of health care...

The real reason I joined Kaiser Permanente was to contribute to an industry where the results of my efforts might have a small part in creating better health for all Americans. I knew that the healthcare system was in desperate need of transformation, and I thought I might be able to transfer my experiences in industry-transforming technology to what I saw as a more worthy cause.
The coming transformation of healthcare IT presents significant opportunities for entrepreneurs and established technology firms, venture and angel capitalists to invest and reap the benefits of their investments. The options for the kinds of technology investments that will be needed are almost limitless. They range from mobile platforms, software, and apps to the software and hardware needed to enable virtual consultations through telehealth technologies.
How can we be sure this transformation will work? There are no guarantees, but we have examples in other countries. This book presents three case studies from countries with high levels of EHR adoption and well-connected systems. They paint pictures of how we might proceed and what health care will look like when we arrive.
Done thoughtfully and methodically, the transformation of health care can help my colleague achieve his goal of helping as many people as he can. I want to help him do just that in the way I know best: with technology. So do the other players in the transformation of healthcare IT: the health plans and insurers who help pay for health care, the government that regulates and mandates care, and most importantly, the private sector, whose proven ability to fill unmet needs with innovation will deliver.

We shall see. Stay tuned. I hope this e-book turns out to have been worth 44 bucks (unlike the $40 Kindle edition "Perfecting Patient Journeys" I could have done without).

The word "transform" is itself value-neutral, ja? My own value system calls for the necessary goring of a number of egregiously bloated oxen in pursuit of systemic "transformation" resulting in significantly improved, significantly less expensive health care for all people. I've been thinking about this stuff for a long time.

BGladd.blogspot.com

apropos, see

How Kaiser bet $4 billion on electronic health records -- and won
Kaiser Permanente CIO Philip Fasano explains how electronic records have paid off and the health care giant's embrace of mobile technology

In July 1907, the first great breakthrough in medical IT took place at the Mayo Clinic in Rochester, Minn.: the paper medical record, dropped into a paper folder and stored in a file cabinet. Until then, information on patients was kept in a ledger that recorded all of a day's patient visits, one after the other. Different departments kept separate ledgers, making it extremely difficult to track down patient information in a timely manner.

But 106 years later, the paper record remains the state of the practice in medicine. In 2009, only 9 percent of America's hospitals were using even a basic form of electronic health records...

This is the article that put me onto Mr. Fasano.
__

Attention stressed-out docs: Can the consumer be the "cavalry" that rescues you? "Transformative"?

__

COMMENT

From "Why EHRs fail" at PhysiciansPractice.com

I'd love to be challenged on this assertion. Let me illustrate (anyone can go into Open EMR, log in, and look at these structures -- unlike those of the for-profit proprietary EMR vendors):

Username "admin" password "pass"
Left vertical panel "administration" / "other" / "database.

Pick a table. Say, "patient_data"

See also my July 8th, 2012 post:

Analytics - SAS, R, SQL, EHR database schema. An old school data miner's ramble involving the intersections of workflow, audit logging, and CER, etc.

Wherein I discuss things such as "schema" (the manner in which an application links and governs its RDBMS tables consistent with "relational integrity enforcement at the data dictionary level" -- the very definition of true RDBMS).

Look,

We know the number of licensed medical specialties and subspecialties;
We know the number and types of data structures essential to their practices (many of which overlap and some of which are unique to each specialty);
We absolutely can construct, deploy, and enforce one certification standard master data dictionary encompassing the foregoing.

You would think that the 363 kg. Payor Gorilla -- HHS -- would mandate this as a priority. It would be the only HIT architectural mandate they would need issue. Their beloved "innovative private sector" could build whatever they wished out of it.

Absent this, Meaningful Use EHR "Certification" continues to be crippled out of the gate with respect to the seamless "interoperability" end -- and all of the ends flowing from that goal, e.g., data mining for CER, financial metrics for resource utilization analytics, event audit logging for fraud and HIPAA violation detection, etc...

What am I missing? (Beyond profit margin Vendor Lock Data Silo opacity.)
___

More to come...

No comments:

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
___

"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
___

"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
___

"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
___

"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
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"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
___

"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.

The KHIT Blog

Search the KHIT Blog

Wednesday, May 8, 2013

"Transforming" Health Care?

No comments:

Post a Comment