The KHIT Blog: #HealthIT and the American Sickness

Monday, May 8, 2017

#HealthIT and the American Sickness

Elisabeth Rosenthal:

CHAPTER 18
BETTER HEALTHCARE IN A DIGITAL AGE

In the last twenty-five years, nearly every aspect of our day-to-day lives has been made easier by digital technology: banking, watching films, traveling, communicating with loved ones near and far away, purchasing a new home. But healthcare is an exception to the rule.

That’s not because of a lack of investment. Silicon Valley is hot on healthcare. Even though tech funding in general has fallen off lately, digital health funding went up 13 percent in the first quarter of 2016, with investment for the quarter reaching nearly $ 1 billion. Every week I get more than a half-dozen pitches from start-ups touting new machines or claiming that their algorithms and apps will empower consumers and solve the healthcare cost crisis.

The problem is that these huge investments and the products they spawn are of highly variable benefit to patients. Health technology can be deployed for enormous patient good, but often all it offers up are useless, but profitable, services. If a company exists to untangle or parse the data in our convoluted system, the real answer is not to add another layer designed by entrepreneurs looking for profit, but to make the system simpler.

Consider the five largest healthcare start-up deals in that first boom quarter of 2016: $ 175 million for a start-up that describes itself as a “clinical intelligence platform for cancer care providers” (funded largely by drug companies that want to mine the data for faster approvals); $ 165 million for a company that develops and sells wearable wrist monitors that provide “personalized insights into how [users] sleep, move and eat; $ 95 million for an (or “another”) online platform that offers “intelligent health information” to patients; $ 70 million for a company that promises to “warehouse” healthcare data; $ 40 million for an outfit that developed a kiosk to deploy in drugstores and malls that can screen for blood pressure, weight, pulse, and body mass index. (Automated measurements are notoriously inaccurate; there are simpler ways to measure these parameters and no medical reason to regularly monitor some of them anyway.)

With our purchases and our votes, we should make sure that new technology serves patients before investors’ profits...

Rosenthal, Elisabeth (2017-04-11). An American Sickness: How Healthcare Became Big Business and How You Can Take It Back (pp. 321-322). Penguin Publishing Group. Kindle Edition.

Hashtag #anamericansickness.

She goes on to discuss in more detail the relative (and sometimes dubious) merits of digital stuff such as "wearables," "telehealth," and "interoperability/patient data access." She also brings up the still-contentious federal "Meaningful Use" initiative, which gave birth to this blog in 2010.

apropos of all of this, excellent interview with the author:

Why are American health care costs by far the highest in the world? Journalist and former practicing physician Elisabeth Rosenthal chronicles how we got here in her new book, "An American Sickness." Economics correspondent Paul Solman talks with Rosenthal about the forces driving high prices and what could be done to bring costs down.

Again -- and particularly given the recent narrow House passage (by a 1-vote margin) of the controversial "AHCA" bill -- I find this book a must-read (though I have to admit to my concerns going to the viability of her "How You Can Take It Back" assertions, in light of the powerful forces aligned against patients).

UPDATE

I tweaked the crude little "Health Care UTIL" graphic I'd rendered.

Click to enlarge. Again, what am I missing?

Every health care stakeholder on the provider side -- physicians, clinics, hospitals, pharma, biomed, insurors, etc -- claims to be losing money and needs higher prices, or it will exit its respective market space. Yet, to our "Repeal and Replace" "conservatives," the ostensible beneficent magic of (inexorably margin-minimizing) "free market competition" will somehow leave them better off and happier (The Monopolism Wisdom of Peter Thiel notwithstanding) -- accepting lower returns in order to "bend the cost curve" significantly and durably down for the benefit of patients (and our chronically ballooning NHE). I'm not sure we're ever gonna get coherent, productive consensus dialogue on this maddening perplex.

On the subject of UTIL and costs, see my prior post "Rationing by 'Price'."

On health care "pricing,"

Ahhh... the lovely buzzword "transparency." My phrase above, "inexorably margin-minimizing" could not be more apt. Margin is inescapably to a significant degree a function of opacity (plus, of course, barriers to entry of competitors). "Conservative" politicians love to bloviate euphorically regarding the ostensible unalloyed virtues of "free markets" and "competition" until transparency erodes (their donors') margins, at which point they invariably whine and stomp about "predatory competition."

Again, read An American Sickness.
____________

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
___

"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.

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Monday, May 8, 2017

#HealthIT and the American Sickness

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