The KHIT Blog: Up next: "Improving Global Health: Focusing on Quality and Safety"

Monday, June 26, 2017

Up next: "Improving Global Health: Focusing on Quality and Safety"

I saw this at THCB and signed up for it. We'll see. It's a nominally free "MOOC" -- though they keep trying to get $99 out of you for a "Certificate upgrade." I already have a health care QI "Cert" from IHC (and had an ASQ CQE Cert for years prior to retiring it). At 71, I'm past the days of needing any "certs" for "career advancement." I'm just interested in the learning. Given the uncertainties of my daughter's illness (she just finished chemo round 4), I just hope I can devote the time to get through the entire course. If they let you buy the certificate later, I may do that. The $99 is no issue.

"We are at a critical inflection point in global health. We have seen improvements in access to care, but struggle to improve human health. A key component of this equation is quality of care.

Improving access to healthcare is only as useful as the quality of care provided. Many agree that quality is important – but what is it? How do we define it? How do we measure it? And most importantly, how might we make it better?

The course is designed for those who care about health and healthcare and wish to learn more about how to measure and improve that care – for themselves, for their institutions, or for their countries. Each session will be interactive and provide concrete tools that students can use. We will empower you to raise questions, propose concrete solutions, and promote change.

We have assembled leading thinkers from around the globe – not only people who are experts – but people with real, hands-on experience running organizations, hospitals, and ministries of health. So join us – whether you are a physician, nurse, or other healthcare provider, if you are a student of medicine, public health, or health policy, or a patient who simply cares about getting good care – this course is for you."

SPEAKING OF "WHAT IS QUALITY?"

From THCB

MACRA is a $15 billion boondoggle that the best research shows will neither improve quality nor control costs. Paying doctors for quality (e.g., doing a blood pressure exam) or efficiency may make sense theoretically, but it doesn’t work...

ELEMENTS OF HEALTH CARE "QUALITY?"

Some of the (interlinked and overlapping) factors I think about, and have blogged on at some recurrent length here:

dx accuracy and precision;
px/tx efficacy;
Workflow;
Process QI;
Organizational culture;
Leadership;
Clinical pedagogy;
Clincal science;
Analytics;
Technologies (e.g., HIT, AI, applied "Omics");
Economics -- business and public policy/legislative realities.

THE "LOOK AND FEEL" OF THE COURSE DELIVERY VIDEOS

They provide scrolling (and downloadable) text transcripts with the videos.

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SPEAKING OF LEARNING

My next-of-kin caregiver duties have seriously hampered my normal reading pace, but here are a few titles in various stages of completion, to be reported on soon.

Much of the motive here maps to my interest in "Natural Language Processing," and its prospective utility (if any) regarding applied AI in health care.

ERRATUM

EHR users have long complained about "vendor lock," the circumstance resulting from the large sunk cost of buying (uh, "licensing") a platform and the lack of data exchange / '"interoperability" between systems. A post over at Naked Capitalism is broadly intriguing in this regard.

US Copyright Office Wimps Out on Right to Repair
Posted on June 27, 2017 by Jerri-Lynn Scofield

By Jerri-Lynn Scofield, who has worked as a securities lawyer and a derivatives trader. She now spends much of her time in Asia and is currently researching a book about textile artisans. She also writes regularly about legal, political economy, and regulatory topics for various consulting clients and publications, as well as scribbles occasional travel pieces for The National.

As more and more devices require software to operate, copyright holders employ a number of measures that thwart an end user’s right to repair a product s/he ostensibly owns.

As the Electronic Frontier Foundation (EFF) recognizes, although in theory one may own a device outright, one’s only allowed to license the software necessary to make the device work properly. The terms of that license may preclude any efforts to tinker with the device, reverse engineer it, or have a third party undertake a repair…

Very interesting post. Including the comments.

BTW, Adrian Gropper, MD has long been an insistent voice for "open source" in Health IT.
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Registration Link

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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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Monday, June 26, 2017

Up next: "Improving Global Health: Focusing on Quality and Safety"

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