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Could On Demand Medical Services Be Good for Doctors?

Could On Demand Medical Services Be Good for Doctors? | Healthcare and Technology news | Scoop.it

I’ve been seeing a lot of discussion lately about the peer sharing economy and how it applies to healthcare. Some people like to call it the Uber of healthcare, but that phrase has been applied so many ways that it’s hard to know what people mean by it anymore. For example, is it Uber bringing your doctor to your home/work or is it an Uber like system of requesting healthcare? There are many more iterations.


I’ll to consider doing a whole series of posts on the Peer Sharing Economy and how it applies to healthcare. There’s a lot to chew on. However, most recently I’ve been chewing on the idea of on demand medical services. In most cases this is basically the Skype or Facetime telemedicine visit on a mobile device. These models are starting to develop and it won’t be long until all of us can easily hop on our mobile device and be in touch with a doctor directly through our phone. In some cases it will be a telemedicine visit. In other cases it might be the doctor coming to visit you. I’m sure we’ll have a wide variety of modalities that are available to patients.


Every patient loves this idea. Every insurance company is trying to figure out the right financial model to make this work. Most doctors are scared at what this means for their business. Certainly there are reasons for them to be concerned, but I believe that this new on demand medical service could be very good for doctors.


In our current system practices do amazing scheduling acrobatics to ensure that the doctor is seeing a full schedule of patients every day. They do this mostly because of all the patient no shows that occur. This makes life stressful for everyone involved. Imagine if instead of double booking appointments which leads to all sorts of issues, a doctor replaced no show appointments with an on demand visit with a patient waiting to be seen on a telemedicine platform. Basically the doctor could fill their “free time” with on demand appointments instead of double booking appointments which then causes them to get behind when both appointments do show up.


I can already hear doctors complaining about them being “mercenaries” and shouldn’t they be allowed free time to grab a coffee. I’d argue that in the current system they are mercenaries that are trying to fill their schedule as full as possible. The current double booking scheduling approach that so many take means that some days the doctor has a full schedule of appointments and some days they have more than a full schedule of appointments. If doctors chose to back fill no-shows with on demand appointments, then their schedule would be more free than it is today. Plus, if they didn’t want to back fill a no show, they could always make that choice too. That’s not an option in the double book approach they use today.


In fact, if there was an on demand platform where doctors could go and see patients anytime they wanted to see patients, it would open up a lot more flexibility for doctors much like Uber has done for drivers. Some doctors may want to work early in the morning while others want to work late at night. Some doctors might want to take off part of the day to see their kid’s school performance, but they can work later to make up for the time they took off (if they want of course).


Think about retired doctors. I’m reminded of my pharmacist friend who was still working at the age of 83. I asked him why he was still working at such an advanced age. He told me, “John, if I stop, I die.” I imagine that many retired doctors would love to still see some patients if they could do it in a less demanding environment that worked with their new retirement schedule. If there was an on demand platform where retired doctors could sign in and see patients at their whim, this would be possible. No doubt this is just one of many examples.


Currently there isn’t an on demand platform that doctors could sign into and see a patient who’s waiting to be seen. No doubt there are many legal, financial and logistical challenges associated with creating a platform of this nature. Not the least of which is that doctors are only licensed to practice in specific states. This is a problem which needs to be solved for a lot of reasons, but I think it will. In fact, I think that legal issues, reimbursement changes, and other logistical challenges will all be solved and one day we’ll have this type of on demand platform for healthcare. Patients will benefit from such a platform, but I believe it will open up a lot more options for doctors as well.

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What new doctors don't realize. And it's holding them back.

What new doctors don't realize. And it's holding them back. | Healthcare and Technology news | Scoop.it

She wants to be busy, with lots of patients, operating every day. In fact, it is better not be busy, and instead to think long and hard about each patient, listening, pausing, recommending non-operative treatments and being patient. Doctors learn the most from the patients they take the time to truly listen to and care for with extreme attention and lovingness. They learn nothing from those they have little time for.

A new doctor wants to market himself. He wants to tell the world how well trained he is, how up to date he is with the literature, how knowledgeable he is about the latest techniques and tools. What he should really do is read more than he speaks, listen more than he argues, and apply the accepted techniques, while ever so slowly introducing novel approaches. He should stay under the radar, find and cultivate the wisest mentors, stand behind the pillars of the community, and gain their trust for several years before challenging and eventually leading them.

The new doctor wants to computerize, modernize, electronic medical ‘recordize’, and robotize every aspect of medical care. What she doesn’t realize is that most of the current digital data is not compatible with any other system, can’t be moved to a new hospital, and is subject to viruses, malware, and corrupted programs. Mostly likely, 20 years from now, all her computerized records will be unreadable, inaccessible, and useless. She must take note of the growing trend of a computer humming between every doctor and their patient, further distancing the doctor from learning the subtleties of the patient and of medicine, and she must find a way to overcome this.

The new doctor wants security while making money, independence while having a job, freedom to practice while contracted with insurance companies. What he doesn’t realize is that the security of working for someone else can evaporate in the first downsizing; the independence once visualized in medical practice is lost when taking a paycheck, the freedom to practice crushed when contracting with the lowest cost bidders, i.e., the health plans. The socialization of medicine is a choice a doctor makes when they choose not to work independently.

The new doctor wants to lead her field. She understands that performing research, presenting papers, writing books, and lecturing are the paths to stardom. She doesn’t understand how to do this while also practicing full time and meeting the financial and personal demands of a new practice and maybe a family. What she really needs to do is accept that to be both a fabulous doctor and a researcher one must commit full-time to both, integrating the research directly into the practice and setting the practice up to permit the research. It is all possible, and definitely worth it, though the sacrifices are usually financial and personal for many years.

New doctors want to be all that they can be on day one. The reality is that each decision on how to become the superstar affects the likelihood of getting there, and that patience, exquisite care of each patient, quiet tactical maneuvering, phenomenally hard work and a low profile early on under the guidance of wise mentoring is by far the best way.

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Medicine and Health Care Will be Personalized Thanks to Technology

Medicine and Health Care Will be Personalized Thanks to Technology | Healthcare and Technology news | Scoop.it

From wearable fitness trackers to virtual doctor visits to smartphone apps and attachments that can collect sophisticated medical information, new technology is giving users unprecedented direct access to their own health data. In his new book, “The Patient Will See You Now: The Future of Medicine Is in Your Hands,” Eric Topol, a cardiologist, professor of genomics and director of the Scripps Translational Science Institute, explores how this “great inversion of medicine” will transform the future of health care. He recently spoke with U.S. News about how new capabilities might impact the quality and cost of care, as well as what some of the barriers will be. Excerpts:

What have been some of the drivers of technology changing the world of health care?

I equated the impact of the smartphone in medicine to parallel the Gutenberg printing press in terms of how it affected civilization. That sounds like a reach, but in fact, when you think about it, you will have sensors measuring almost any medical metric known to man; you would be able to check the cost of any procedure, scan, visit, hospitalization; and you could contact a doctor at any moment, 24-7, through your phone. It’s almost kind of limitless how this little device, which changed the rest of our lives so dramatically, is now going to have a similar analogous effect on our health.


How will this impact the cost and quality of care?


That’s a really important unproven concept. Work needs to be done to certainly shore that up. There’s a lot of promise. There’s a big change from having physical office visits to see doctors to these virtual visits, and that has already been shown to reduce in a striking way the costs per visit. Hospital rooms will not be necessary in the future. You could have all monitoring done for very inexpensively in the comfort and safety of one’s home. There’s so much waste in our system. The patient is driving things much more and is alerted to the unnecessary aspects and trivial costs.


Who will resist this change the most?


The medical community, especially in the U.S. This challenges all aspects of reimbursement. There’s also the other issue of the loss of control. This is a very paternalistic profession. This is the greatest challenge it will ever face. Also there are knowledge gaps. This will be the case with sequencing data – for example, matching up drugs and a person’s DNA interactions – and even a lot of the ways that wireless devices can be used to do things like the physical exam. These things are not in the comfort zone of many physicians and health care professionals.

What role will the Affordable Care Act play?


It’s kind of in a different orbit. The only thing where there’s some overlap is it is trying to promote the concept that the patient has access to their medical information. But it needs to go much further. Patients have a hard time getting their data, and it isn’t right. The Affordable Care Act doesn’t get to the core issues here of the democratization of medicine. I’m hoping, of course, that in the future we’ll get governmental support. That’s essential. No one’s suggesting that we don’t need doctors and the infrastructure that exists today, but in a very different way, in a more equitable partnership model going forward.


What should policymakers do?


The hope is that we recognize the fact that this is an inevitable progression of medicine, and while it represents quite a radical change, it’s time to grant [patients] rights ownership and acknowledge that the flow of information is going to be completely different than in the past. These data are going directly to one’s own devices, that they own, about their own body, for services that they pay for; it’s about time that we adopt this new philosophy. This is something that is not in our culture, not in the medical culture. But I do think that it can be fostered, it can be embraced, and eventually consumers will demand it.

What risks should patients be worried about with new technology?

I think privacy and security is one of the greatest factors that will potentially prevent this from moving forward in a catalytic way. We’ve seen all these various hacks and breaches. People’s health data is quite precious. It isn’t even just the privacy. This whole concept that one’s medical data is being sold – for example, one’s prescription use is being sold to pharma companies. This can’t go on. We’ve got a lot of work to do.


What can consumers expect ahead?


You can have your child’s ears examined through your own smartphone attachment and get a diagnosis of whether they have an ear infection, or get a skin lesion diagnosed immediately through a picture and an algorithm. Can you imagine getting data while you’re sleeping or while you’re in traffic? We have the exciting potential to get involved with pre-empting disease for the first time. By having all that data on populations of people, then that affords new ways to foster better treatments and preventions. That takes the information era to new heights.


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Pacific Cove's curator insight, March 11, 2015 7:42 PM

What can consumers expect ahead?

You can have your child’s ears examined through your own smartphone attachment and get a diagnosis of whether they have an ear infection, or get a skin lesion diagnosed immediately through a picture and an algorithm.  #SeniorCare  #HealthCare #HomeCare #Caregivers #Caregiving


Cameron's curator insight, March 26, 2015 10:25 PM

The author carefully explains how healthcare apps can change our lives. Even with a paragraph dedicated to the risks of healthcare apps, the 'beneficial paragraph' is directly after it, giving the readers a choice to weigh out the bad with the good. 

Ben Simpson's curator insight, March 27, 2015 5:19 AM

This source provides great in depth detail and explanation on how technology will impact the future of medicine.

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Should doctors offer a money-back guarantee?

Should doctors offer a money-back guarantee? | Healthcare and Technology news | Scoop.it

How many times each week do we hear the phrase, “If you’re not completely satisfied, we’ll refund the purchase price — no questions asked.”

This is more often a marketing ploy than a true money-back guarantee.  I have a sense that trying to obtain a promised refund on an item that dissatisfied us is about as easy and carefree as changing an airline ticket reservation or reaching a live human when our home internet service is down.   So, when the weight loss pills don’t really melt the pounds off, don’t be shocked if the check isn’t in the mail when you mail back the placebo pills to a post office box several states away.  And, of course, you won’t recover the shipping and handling costs.


(This is my opportunity to ask for help from my erudite readership.  What exactly is shipping and handling?  Doesn’t postage already cover the shipping?  $8.95 seems pricey for a handling charge for anti-wrinkle cream or a set of steak knives endorsed by make-believe chefs.  I don’t really want strangers handling my stuff anyway.  Are they wearing gloves, I hope?)

I often hear a commercial for a zinc product that promises a full refund if the product does not shorten the course of the common cold.  I do have some medical training, as readers know.  Readers who are smart enough to understand’shipping and handling’ are asked now to explain how an individual can assert that the zinc product was not effective.

The complaint

“Please give me a full refund.  My cold lasted six days. Usually, I feel better by the 5th day.  Your zinc stinks.”

The response

“Thank you so much for your input.  All of us at Zinc Jinx, Inc.welcome customer feedback.  Please send urine samples for days 4, 5 and 6 packed in dry ice at your own expense so we can verify that you were taking the product as directed.  Include all packaging including the shrink wrap around the bottle that you should have retained had you consulted our customer service web site prior to opening.  Expect a response in 6 weeks.  Even if your urine drug content is deemed to be sufficient, our on site cold and flu experts may conclude after impartial study that your cold would have lasted nine days without our product.”

I’m not offering an opinion on zinc’s effectiveness in fighting the common cold.  I’m suggesting that it is not possible for a zinc swallower to really know if zinc expedited his recovery.  Belief is not evidence.  If we recover on day 6, perhaps, zinc was an innocent bystander receiving credit for a favorable outcome that it did not contribute to.

Sometimes, we physicians are lucky in the same way.  Our patients get better, as they usually do, and we get the credit. As we know, the converse is sometimes true.  We get blamed when we don’t deserve it.

Should doctors offer a money-back guarantee if our patients are not fully satisfied?  The zinc scenario illustrates how difficult it can be in medicine to assign credit or the blame for the outcome.  The only secure guarantee in medicine is that there are no guarantees.

If any reader is not fully satisfied with this post, the full purchase price will be promptly refunded:  no questions asked.


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Most Patients Willing To Have Online Video Doctor Visits, Survey Finds

Most Patients Willing To Have Online Video Doctor Visits, Survey Finds | Healthcare and Technology news | Scoop.it

A majority of U.S. residents are willing to use an online video for a physician visit, according to a Harris Poll survey, MobiHealthNews reports.

The survey, which was commissioned by telehealth company American Well, collected responses from 2,019 U.S. adults ages 18 and older in December 2014.

Survey Findings

Overall, the survey found about 64% respondents were willing see a doctor via an online video consult.

Of those, 61% listed convenience as a factor.

The survey found respondents' willingness to switch to an online physician visit varied by age and the number of years they had seen their doctors (Pai, MobiHealthNews, 1/21). The survey showed:

  • 6% of respondents who had seen their physician for at least 10 years said they would switch;
  • 8% of respondents who had seen their physician for five to nine years said they would switch;
  • 10% of respondents who had seen their physician for two to four years said they would switch;
  • 7% of respondents who had seen their physician for less than one year said they would switch (Harris Poll survey, December 2014);
  • 11% of patients ages 18 to 34 said they would switch;
  • 8% of patients ages 35 to 44 said would switch (MobiHealthNews, 1/21);
  • 5% of patient ages 45 to 54 and 55 to 64 said they would switch; and
  • 4% of patients age 65 and older said they would switch (Harris Poll survey, December 2014).

However, about 88% of respondents said they would like to select the physician for a video visit rather than be randomly assigned one (Gold, "Morning eHealth," Politico, 1/22).

When asked how they would prefer to respond if a loved one needed medical attention in the middle of the night:

  • 44% of respondents said they would go to the emergency department;
  • 21% said they would use a video visit;
  • 17% said they would call a 24-hour nurse line; and
  • 5% said they would consult an online symptom checker.

The survey also asked consumers about their willingness to receive a prescription through a video visit. The survey showed:

  • 70% of respondents said receiving a prescription via an online video visit was preferable to receiving a prescription via an in-person visit;
  • 60% said they would be comfortable using an online video visit to get a prescription for a refill;
  • 42% of women ages 18 to 32 would be comfortable getting a prescription for birth control through an online video visit; and
  • 41% reported interest in getting antibiotics through an online video visit.

When asked about the costs of an online physician visit:

  • 62% said online video visits should cost less than an in-person visit;
  • 22% said both types of visits should cost the same amount; and
  • 5% said video visits should cost more (MobiHealthNews, 1/21).
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How Community Hospital Used Health IT to Conquer MERS

How Community Hospital Used Health IT to Conquer MERS | Healthcare and Technology news | Scoop.it

A little more than a month ago, Community Hospital was not in the most enviable of positions for a hospital.

The 450-bed, regional tertiary care facility in Munster, Ind. became home to the first patient in the U.S. with a confirmed case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in late April. The potentially deadly viral respiratory illness, which has no known recommended vaccine or treatment, can spread like wildfire to anyone in close contact with the patient. In Saudi Arabia, where it likely originated, the Centers for Disease Control (CDC) say there have been 450 lab-confirmed cases and 112 deaths (as of May 2014).


It’s fair to surmise that things could have gone very badly for Community Hospital. Look no farther than Abu Dhabi, where experts from the World Health Organization (WHO) say that failure to control the virus by hospitals and healthcare settings in the city have exacerbated the problem. If MERS had spread in the U.S., Community Hospital, which is located very close to one of the busiest interstate highways in the nation, very well could have been targeted for blame.

Instead, MERS cases in the U.S. have been few and far between, and not one person has contracted the virus from the patient who stepped into the Community Hospital’s ER the night of April 28th. Much of this has to do with Community Hospital’s fast acting approach in treating the patient from the minute he arrived.

“We have protocols and procedures in place that we like to use. When someone has respiratory symptoms, we like to isolate them every time because there are some diseases that we’re not aware of that could be contagious,” says Alan Kumar, M.D., Chief Medical Information Officer at Community Hospital. “You don’t want to take chances. We had a room that was negative airflow [when the air from the room doesn’t mix the rest of the hospital]. We put him in that room in the possibility that it was something bad.”

It ended up being something bad.

Thanks to the infectious disease specialist finding out the patient had recently visited Saudi Arabia, she and other members of Community’s medical staff were able to deduce that he likely had MERS. The isolation was amped up with Community using gloves, masks, gowns, and all kinds of protection. Two days later, a test confirmed that the patient was positive for MERS. The hospital began working with the CDC and Indiana Department of Health to ensure the disease didn’t spread and that the Community Hospital workers and public were being educated.

One important task was to determine who had come into contact with the patient and was possibly at risk for MERS. To do this, Community relied on video footage, patient interaction notes in the electronic medical record (EMR), and radio-frequency identification (RFID)-based technology.

The RFID system (from the Traverse City, Mich.-based Versus Technology) was installed by Community in 2009 to decrease overhead noise in hospital units. It automatically logs when healthcare providers have entered the room, how long they’ve been in a room, and how long it takes from them to go from one room to the next. Thus, when nurses and doctors are needed, the hospital knows where they are located. In this case, it allowed them to track who was in the room with the MERS patient and for how long.

“The CDC found this data absolutely amazing because it’s something they never had access to in any prior investigation, to know down to the minute and down to the second, how long a healthcare worker was in contact with the patient,” says Kumar. He adds that for those healthcare workers who don’t wear the RFID tags, such as ambulatory workers, imaging specialists, and social workers, the EMR was a useful tool in tracking interactions.


A few weeks after he first stepped into the hospital, the patient was cleared of the virus and deemed not a risk to the public. Every single person who came in contact with him was tested. Even though none of them came back positive, they were taken offline until the longest window of incubation (14 days) had passed. They were repeat tested after that window and again, none tested positive.

From beginning to end, Community Hospital was able to escape this incident unscathed. Everything went smoothly when it absolutely had to go smoothly. When it comes to the role RFID and other health IT played in this success, Kumar says there is a lesson to be learned for other hospital executives.

“It’s not meant to watch employees. It’s meant for something more admirable. If you approach IT spending with the goal of ‘Does this improve quality of care to patients?’ and the answer is yes, that’s why you invest. Everything else is secondary to that goal,” Kumar concludes. 


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Who needs doctors at all if care is reduced to point and click?

Who needs doctors at all if care is reduced to point and click? | Healthcare and Technology news | Scoop.it

As I watch the business world’s fascination with the electronic medical record (EMR) and all of the big data that it accumulates, I see more and more processes codified and treatment pathways carefully honed. Only one small thing remains until the computer can tell doctors how to behave based on the developed algorithms: To turn free text in the patient chart into easily-definable binary push button selections. So now, this is being done.


The theory, of course, is for computers to understand doctor’s free text and medical decision making.  By making a myriad of discrete data entry choices, we are told, recommendations for care can be made based (of course) on the best evidence-based guidelines the world has to offer.  Data can then be quantified.  Physician selections, easily followed and tracked.  Quality measures (as defined by guidelines) simply quantified. This is our latest new vision for health care.  And as our nation hurries to implement electronic health care delivery through government mandates and regulations to assure meaningful use of computers, the gushing assurances of improved care spews forth from many who stand to profit from the system.

Imagine: Doctors won’t have to think.  They’ll just click the buttons and be in compliance.  Stay between the lines and you’re quality scores will be perfect,.  Your care will be impeccable in the eyes of the developer;  efficient, timely, thorough.

What could go wrong?  After all, the guesswork is gone. The knowledge base clearly defined. The treatment of the disease efficiently rendered. And now, everything can be perfectly quantified.

I should acknowledge that there are clearly efficiencies gained by such a tact.  But there is also a downside that really hasn’t been seriously considered by most: We risk developing physician skill-fade.  This, in turn, introduces a new unforeseen risks to our patients since practice freedom is restricted as each algorithm demands conformity rather than innovation, improvisation, and any semblance of risk taking on the patient’s behalf. After all, the computer code is optimized for its creator, the health care iron triangle, not the patient.

I was struck by a recent article by Nicholas Carr in the Wall Street Journal entitled, “Automation Makes Us Dumb.”  In it, Mr. Carr describes the benefits and challenges that automation has produced and mentions the EMR:

In a study conducted in 2007-08 in upstate New York, SUNY Albany professor Timothy Hoff interviewed more than 75 primary-care physicians who had adopted computerized systems. The doctors felt that the software was impoverishing their understanding of patients, diminishing their “ability to make informed decisions around diagnosis and treatment.”

Harvard Medical School professor Beth Lown, in a 2012 journal article written with her student Dayron Rodriquez, warned that when doctors become “screen-driven,” following a computer’s prompts rather than “the patient’s narrative thread,” their thinking can become constricted. In the worst cases, they may miss important diagnostic signals.

The risk isn’t just theoretical. In a recent paper published in the journal Diagnosis, three medical researchers — including Hardeep Singh, director of the health policy, quality and informatics program at the Veterans Administration Medical Center in Houston — examined the misdiagnosis of Thomas Eric Duncan, the first person to die of Ebola in the U.S., at Texas Health Presbyterian Hospital Dallas. They argue that the digital templates used by the hospital’s clinicians to record patient information probably helped to induce a kind of tunnel vision. “These highly constrained tools,” the researchers write, “are optimized for data capture but at the expense of sacrificing their utility for appropriate triage and diagnosis, leading users to miss the forest for the trees.” Medical software, they write, is no “replacement for basic history-taking, examination skills, and critical thinking.”

But what is the real issue?  While the development of  treatment rubrics can improve health care efficiency and productivity for their creators, I fear rote implementation of these algorithms will also also atrophy a physician’s clinical and reasoning skills. Binary decisions buttons might facilitate note creation and data gathering, but they discourage the use of physical examination (remember that?) and the  evaluation of nuance or clinical exceptions. With creation of our current iteration of care pathways and guidelines, there is now little need for exceptional thinkers, only adequate thinkers. What would skill-fade look like in medicine? And at what point do the exceptional experienced physicians start becoming vulnerable to skill-fade?

In fact, who needs doctors at all if care is reduced to point and click?  While our new breed of physicians have never known medicine without a computer, will all of their study and preparation to become clinicians at the bedside be rendered moot as these young doctors find themselves little more than data entry clerks? How will we keep them clinically skilled? Homogenized mannequins programmed to respond to regimented scenarios?

Creating disease-directed algorithms might be efficient at treating a medical problem but this does not really treat the patient. With the infinitely variable human condition, might we be fooling ourselves with a false promise of unwavering algorithmic simplicity?  Since patients rarely have one health problem but many, do these simplified treatment pathways consider the effects of other confounding ailments? Do our programmers and engineers care?

This myopic vision for medicine is where we are currently heading.  Scores of centrally-created computer mandates continue to restrict the freedom of developers to move where computer-aided treatment advances need to go.  As we create our linear and static algorithms that are unyielding to nuance or change (and created during a tiny snapshot of history), we should remember these limitations since physicians’ freedom to act in the best interest of their patients is lost if doctors become complacent and also financially incentivized to do so. Such restriction might lower costs, but at a risk to patient care.

Realizing computers in medicine are here to stay, I can only hope that in the years ahead as computerized health records develop, a new era of computerized algorithms will evolve that adapt to any number of physician-directed exceptions and exclusions appropriately. Computers and EMRs must inform the physician rather than mandate, instruct rather than impugn, encourage adaptation rather than thwart it, and always facilitate rather than inhibit patient care.  This way physician skill-fade will be minimized and a more efficient care delivery that is patient-centered rather than industry-centered can thrive.


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Should doctors consider costs when making medical decisions?

Should doctors consider costs when making medical decisions? | Healthcare and Technology news | Scoop.it

Most of us reject the rational argument that better medical quality costs more money.   Conversely, I have argued that spending less money could improve medical outcomes.  Developing incentives to reduce unnecessary medical tests and treatments should be our fundamental strategy.  Not a day passes that I don’t confront excessive and unnecessary medical care — some of it mine — being foisted on patients.


At one point in my career, I would have argued that physicians and hospitals were motivated only to protect and preserve the health of their patients, but I now know differently.  Payment reform changes behavior.

As an example, it is impossible for a patient with a stomach ache who is seen in an emergency room to escape a CT scan, even if one was done for the same reason months ago.  I saw a patient this past week with chronic and unexplained abdominal pain.  She has had 5 CT scans for the same pain in recent years.  This is a common scenario.  Once reimbursement policy changes to punish physicians and hospitals for overtesting, we will witness the mother of all medical retreats!

Physicians and the public have an interest in preserving medical resources to serve society.   There is an emerging debate if physicians who are counseling patients should be mindful of society’s needs while in the exam room.  In other words, if I am prescribing a medicine for a patient with Crohn’s disease that costs $25.000 annually, should I also be considering if this is a wise use of society’s resources?   Would this money be better spent giving influenza vaccines (“flu shots”) to uninsured or medically underserved individuals?  If you were my patient, do you expect that I am focused exclusively on your medical interests regardless of the cost?  Do I have a responsibility to consider how my advice to you impacts on others’ health since health care dollars are finite?  Should patients be willing to sacrifice their own medical care in order to serve the greater good?

Cost-effectiveness is presumed if someone else is paying the bill.  If patients had some skin in the game, then they would exert some restraint on the current frenzy of diagnostic testing and treatment.  If my patient cited above had to pay a portion of the 5 CT scans that she had undergone, there may have been only one scan.  And, if the hospital and the radiologists were paid only for necessary testing, there would have been a similar outcome.

More medical care often means lower medical quality.  How much longer do we want to pay more to receive less?



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What I learned from the next generation of doctors

What I learned from the next generation of doctors | Healthcare and Technology news | Scoop.it

“So this is Christmas, and what have you done?” John Lennon sang from my nightstand, waking me out of a deep slumber.

Bleary-eyed, I pondered his question: What have I been doing all year?

A decade ago, my conversations with my younger brother, went something like this: “Do anything but medicine for God’s sake, save your soul, man!”


He’s now an emergency room doc. Not only that, he’s also a wilderness medicine fellow, Himalayan rescue medic and disaster relief expert, working with first rescue trauma teams on earthquakes.

My second cousin, family friend and nephew-in-law, all of whom had the privilege of my twenty-year speech from the medical pulpit, are now finishing their residency positions as we speak.

So much for making a difference.

In an act of sheer desperation, I tried to save as many misguided souls as I could in my earlier blog, “My advice to a new generation of doctors.”

But it seems that a new generation of doctors has a lot more to say to me, than I to them.

I find myself on a crisp day in late September sitting at the medical school admissions committee of a large state university. Suddenly, I’m part of the interview team who gets to determine if the nervous guy or gal sitting in front of me is going to be the kind of doctor we need in ten, twenty or thirty years.

I get a whole 30 minutes to do it.

Jenny (note: all names have been changed) is my first candidate. She can’t be an inch over five-foot-two; her big blue eyes a mixture of trepidation and excitement. She tells me with a sweet smile that she’s a black belt in karate. She’s also the only female in her Dojo.

“It took years earning their respect,” she says. “But I did it. I got my black belt. And now, they’re like brothers to me. I’m truly their equal.”

Staring at her innocent face, I get the distinct impression that the words “gender” and “inequality” don’t compute in her online dictionary.

Bryce is a decathlete. He’s very accomplished, but you wouldn’t guess from his demeanor. He’s a solid presence in the room, the kind of feeling you get from a person who knows exactly who he is.

He tells me what it was like to change. After joining the decathlon team, he was forced to learn not just one new sport, but nine. “These guys were at their peak of their event,” he says. “And I was at the bottom of each one!”

“How did you do it?” I ask.

“Discipline. Hard work. Showing up every day with humility. But in the end, I found myself being a sort of leader.” He smiles softly.

We transition on this point to leadership skills. He believes that a good leader should be humble, supportive and “relentlessly encouraging” (his words, not mine).  I see clearly that his place is one where the accolades of the exceptional individuals among us aren’t worn on sleeves like Eagle Scout badges, but emanate from deep within like a warm, glowing light, embracing others.

I bow my head after his interview. My pen sticks to the paper. How can I express, on a scale of 1 to 4, how truly outstanding this individual is?

Anil is a second-generation East Indian from a family of engineers. He’s not a day over 18, if that. He’s in the BA/BS MD program, a fast-track from high school to med school. Grinning from ear to ear, he tells me that he was shy a few years ago. Without prompting, he gushes on.

“So I decided to do something about it,” he says enthused. “I was also struggling to decide if I should be an engineer, or a doctor. But our school didn’t have any shadowing opportunities, you know, like where we can go to hang out with someone in that career. So I got together a team. We launched this website. Can I show it you?”

I sit there in stunned silence. Am I supposed to be encouraging these young people to surf the web when they’re supposed to be serious about their commitments to entering medical school?

“Sure!” I reply within seconds. “Let’s take a look!”

Soon, we’re both pouring over the details of his website, staring at the screen on my Samsung Galaxy. He wasn’t allowed to bring his mobile to the interview. The site shows a cool video of his teammates doing a rap to the music from the Fresh Prince of Bel Air.

I shake my head in amazement.

Here’s a kid — the cream of the cream — who’s willing to gift his talents to what … to medicine? To our failed health care system?

All of them exuded humility, genuineness, heart-felt leadership, team building, management and organizational skills, effective communication, listening skills, collaboration, work–life balance, sharing and respectful attitudes, gratitude, determination, innovation and encouragement. Is this where health care was going?

According to the Jackson Healthcare (2013) and Physicians Foundation Surveys (2012), 77.4 percent of doctors were pessimistic about the future, over 60 percent would retire if they could, over 66 percent would not choose medicine again and 57.9 percent would not recommend going into medicine as a career to their children or other young people.

I thought about my own medical training. These expansive young minds would be eaten, chewed up and spat out, indoctrinated into the past paradigms of our medical educational system. They weren’t going to stand a snowball’s chance in hell keeping up with the future. What on earth were they thinking?

And then, it dawned on me what we were doing, what I was doing.

Our past lives, experiences taken from 10, 20 or 30+ year reference points, translated into this present moment now, and projected into a future that’s still unknown, has absolutely no relevance. None of us knows what’s going to happen.

Why wouldn’t we want these kids to champion the future of health care instead of chasing them away?

Inside the tiny rooms of these medical school interviews, I saw a place where paternalistic, apprentice-style ego-gratification was toppled. In its place glowed a bright, golden orb of sheer potentiality reflected in the willpower of these incredible young candidates. Who were we to tell them to do anything but medicine?

And so Happy Christmas. Another year is over. I’ve finally decided to change. How about you?



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Three Ways Doctors Can Use Patient Data to Get Better Results | The Health Care Blog

Three Ways Doctors Can Use Patient Data to Get Better Results | The Health Care Blog | Healthcare and Technology news | Scoop.it

Physicians have always been in the information business. We have kept records of patient data regarding the vital signs, allergies, illnesses, injuries, medications, and treatments for the patients we serve. We seek knowledge from other physicians, whether that knowledge comes from the conclusions of experts from research published in a medical journal or the specialist down the hall. However, a physician will always benefit from additional good information such as the analysis of pooled data from our peers treating similar patients or from the patients themselves.

Over the next few years, vast new pools of data regarding the physiologic status, behaviors, environment, and genomes of patients will create amazing new possibilities for both patients and care providers. Data will change our understanding of health and disease and provide a rich new resource to improve clinical care and maximize patient health and well-being.

Patient Data Used by the Patient

Instead of a periodic handful of test results and a smattering of annual measurements in a paper chart, healthdata will increasingly be something that is generated passively, day by day, as a byproduct of living our lives and providing care. Much of the data will be generated, shared, and used outside of the health system. It will belong to patients who will use it to manage their lives and help them select physicians and other healthcare professionals to guide them in their quest for a long and healthy life.

Based on a patient’s preferences and needs, the data will flow to those who can best assist them in maintaining their health. It will reveal important and illuminating patterns that were not previously apparent, and with the right system in place, it will trigger awareness and alerts for patients and other providers that will guide behaviors and decisions.


The future will mandate that healthcare systems have sophisticated analytical infrastructures in place to collect, analyze, and display these vast streams of data in ways that assist physicians and other care providers in delivering optimal care. Healthcare has always been dependent on managing information and knowledge to achieve the best possible outcomes, but this will become increasingly truer over the next decade.

Three Aspects of the Data-Driven Healthcare Transformation

This data-driven transformation will likely play out in at least three important ways.

1. Efficient and Effective Operations: Reduce Wasteful Spending

First, health systems will have to use data to run their operations more efficiently and effectively. Data can help healthcare providers better understand their operations. It can spotlight where they are wasting time, energy, and money. If an organization effectively uses information, it can optimize the use of resources, run more efficiently, and maximize reimbursement—all prerequisites for survival in the years ahead. While it sounds simple, this process alone promises to yield major efficiency gains and cost savings for organizations and for the nation. Experts have estimated that between 30 and 50 percent of healthcare expenditures in the United States are waste. Thus, this step alone represents a potential trillion-dollar opportunity to free precious resources for more productive use.

2. Manage Population Health
Second, data can help healthcare providers optimally manage population health. Data can be used to design more effective clinical processes that improve the diagnosis and treatment of the ill and injured. It can help physicians and other care providers understand how to standardize on evidence-based care processes. Standardization on a best practice represents significant additional opportunities to save costs and improve the quality and safety of care. Coupled with a physician’s knowledge and experience, data can augment a clinician’s ability to provide the best possible care.

3. New Technology-enabled Care and Personalized Medicine

Finally, new technology-enabled care delivery models will help healthcare providers deliver care that is more continuous, proactive, and geographically dispersed. Facilitated by the revolution in sensors, these care models will provide vast streams of data and turn society into an enormous learning laboratory. These sensors will provide information about what we do, how we eat, and when we exercise. They will provide information concerning our behaviors and our environments. In short, these new technologies will provide information regarding how we live in the real world and how our activities and environment impact health, disease, and treatments.

With the support of modern digital sensors, former trickles of information will turn into torrents creating vast pools of information that can provide new knowledge. In combination with genomic medicine, this new information will allow care providers to determine the right diet, medications, and therapies for each individual based on their specific situation, thereby delivering care that is far more personalized. And this type of personalized care will be empowering for patients and families, enabling them to participate in their healthmanagement in far more meaningful ways. The opportunities to improve population health are massive. Yes, there are significant issues regarding data security and privacy that must be addressed, but in time, they will be solved.

The Impact of New Data on Healthcare Costs

The impact of these trends on healthcare will be immense, to the point that it becomes hard to predict the ultimate impact on national healthcare expenditures. For years, healthcare policymakers and economists have been projecting massive increases in healthcare spending with each passing year. They correctly point out that this inexorable rise in healthcare costs poses an unacceptable risk to our economy.

While this is certainly of concern, the ultimate impact of aggressive waste elimination, process standardization, and new, more efficient, outpatient-centric care models is hard to quantify, yet it will likely be substantial. These powerful forces promise to drive healthcare expenditures down. As healthcare experiences the exponential impact of technological change, it is likely we will face a far different healthcare world a few years from now. Recall that not long ago we all relied on the thick Yellow Pages left on our doorsteps. Little did we know what impact a small company called Google would have on our lives.

Sooner or later, the same forces that have transformed other industries will fundamentally change healthcare. This will result in entirely new care environments and dynamics. This new world will most definitely revolve around data.Physicians have always been in the information business. We have kept records of patient data regarding the vital signs, allergies, illnesses, injuries, medications, and treatments for the patients we serve. We seek knowledge from other physicians, whether that knowledge comes from the conclusions of experts from research published in a medical journal or the specialist down the hall. However, a physician will always benefit from additional good information such as the analysis of pooled data from our peers treating similar patients or from the patients themselves.

Over the next few years, vast new pools of data regarding the physiologic status, behaviors, environment, and genomes of patients will create amazing new possibilities for both patients and care providers. Data will change our understanding of health and disease and provide a rich new resource to improve clinical care and maximize patient health and well-being.

Patient Data Used by the Patient

Instead of a periodic handful of test results and a smattering of annual measurements in a paper chart, healthdata will increasingly be something that is generated passively, day by day, as a byproduct of living our lives and providing care. Much of the data will be generated, shared, and used outside of the health system. It will belong to patients who will use it to manage their lives and help them select physicians and other healthcare professionals to guide them in their quest for a long and healthy life.

Based on a patient’s preferences and needs, the data will flow to those who can best assist them in maintaining their health. It will reveal important and illuminating patterns that were not previously apparent, and with the right system in place, it will trigger awareness and alerts for patients and other providers that will guide behaviors and decisions.


The future will mandate that healthcare systems have sophisticated analytical infrastructures in place to collect, analyze, and display these vast streams of data in ways that assist physicians and other care providers in delivering optimal care. Healthcare has always been dependent on managing information and knowledge to achieve the best possible outcomes, but this will become increasingly truer over the next decade.

Three Aspects of the Data-Driven Healthcare Transformation

This data-driven transformation will likely play out in at least three important ways.

1. Efficient and Effective Operations: Reduce Wasteful Spending

First, health systems will have to use data to run their operations more efficiently and effectively. Data can help healthcare providers better understand their operations. It can spotlight where they are wasting time, energy, and money. If an organization effectively uses information, it can optimize the use of resources, run more efficiently, and maximize reimbursement—all prerequisites for survival in the years ahead. While it sounds simple, this process alone promises to yield major efficiency gains and cost savings for organizations and for the nation. Experts have estimated that between 30 and 50 percent of healthcare expenditures in the United States are waste. Thus, this step alone represents a potential trillion-dollar opportunity to free precious resources for more productive use.

2. Manage Population Health
Second, data can help healthcare providers optimally manage population health. Data can be used to design more effective clinical processes that improve the diagnosis and treatment of the ill and injured. It can help physicians and other care providers understand how to standardize on evidence-based care processes. Standardization on a best practice represents significant additional opportunities to save costs and improve the quality and safety of care. Coupled with a physician’s knowledge and experience, data can augment a clinician’s ability to provide the best possible care.

3. New Technology-enabled Care and Personalized Medicine

Finally, new technology-enabled care delivery models will help healthcare providers deliver care that is more continuous, proactive, and geographically dispersed. Facilitated by the revolution in sensors, these care models will provide vast streams of data and turn society into an enormous learning laboratory. These sensors will provide information about what we do, how we eat, and when we exercise. They will provide information concerning our behaviors and our environments. In short, these new technologies will provide information regarding how we live in the real world and how our activities and environment impact health, disease, and treatments.

With the support of modern digital sensors, former trickles of information will turn into torrents creating vast pools of information that can provide new knowledge. In combination with genomic medicine, this new information will allow care providers to determine the right diet, medications, and therapies for each individual based on their specific situation, thereby delivering care that is far more personalized. And this type of personalized care will be empowering for patients and families, enabling them to participate in their healthmanagement in far more meaningful ways. The opportunities to improve population health are massive. Yes, there are significant issues regarding data security and privacy that must be addressed, but in time, they will be solved.

The Impact of New Data on Healthcare Costs

The impact of these trends on healthcare will be immense, to the point that it becomes hard to predict the ultimate impact on national healthcare expenditures. For years, healthcare policymakers and economists have been projecting massive increases in healthcare spending with each passing year. They correctly point out that this inexorable rise in healthcare costs poses an unacceptable risk to our economy.

While this is certainly of concern, the ultimate impact of aggressive waste elimination, process standardization, and new, more efficient, outpatient-centric care models is hard to quantify, yet it will likely be substantial. These powerful forces promise to drive healthcare expenditures down. As healthcare experiences the exponential impact of technological change, it is likely we will face a far different healthcare world a few years from now. Recall that not long ago we all relied on the thick Yellow Pages left on our doorsteps. Little did we know what impact a small company called Google would have on our lives.

Sooner or later, the same forces that have transformed other industries will fundamentally change healthcare. This will result in entirely new care environments and dynamics. This new world will most definitely revolve around data.



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Our health care system makes no sense. But what if it did?

Our health care system makes no sense. But what if it did? | Healthcare and Technology news | Scoop.it

The conversation was almost comical, until I thought more deeply about it later.  Apparently I was on “the list.”  Insurers make such lists for customers who are  searching for a doctor who accepts their coverage.  Every so often my name comes up on these lists, and I get a smattering of phone calls from perspective patients. Maybe a few times a year.


This particular call came around three-thirty in the afternoon.  My personal assistant had already signed over the phone to me, so my office number came right to the mobile.  I answered quickly expecting one of the nursing homes.  The voice on the other end was hesitant.  He was looking for Dr. Grumet’s office, but quickly realized he had the doctor himself on the phone.  This felt odd for a guy switching physicians because the next appointment at his current practice was two weeks away.  But his toe was hurting something fierce and he was desperate.

So he searched his insurance web site for a list of available providers.  He quickly crossed off any physician that belonged to his current practice or the hospital based medical group because he knew from experience that those doctors rarely had openings.  They almost never returned phone calls.  Although I do not accept his insurance, I somehow had landed upon the sacred list he was scrawling through anxiously.

He told me that I was the tenth phone call he made.  He came up empty with the first nine doctors.  Many claimed that they were closed to his insurance because they were too busy to take on new patients.  One was retiring in a few months.  Another was leaving medicine to work for a pharmaceutical company.  A third was transitioning into a hospitalist position.

I regrettably informed him that I would be happy to bill his insurance but also charged a yearly fee for non-covered services.  He paused for a moment.  I could feel the wheels spinning in is head.  He hated to pay extra, but was dumbfounded to find that he was actually talking to the doctor himself without jumping over any roadblocks or scaling any walls.  His foot ached.  And I knew that it would probably take little mental effort to assess and treat his problem.  Whether stress fracture or gout, infection or inflammation, I felt certain that I could help.

We talked a little longer.  Not about his medical problem in detail but more what was happening to our health care system.  It was a pleasant unhurried conversation.  He eventually decided that he would try his luck with the rest of the names listed in front of him  He thanked me profusely for my time and hung up with a sigh of resignation.

I hope he found the care he needed.  I doubt I will ever hear from him again.  These types of calls rarely end in the signing up of a new patient.

I wonder if he marveled, for just a moment, about how easy it could be.

What if you could talk to your physician whenever you needed to?

What if doctors and patients had time to form strong mutually respectful bonds?

What if our health care system made sense?



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Doctors, Not Patients, May Be Holding Back mHealth Adoption

Doctors, Not Patients, May Be Holding Back mHealth Adoption | Healthcare and Technology news | Scoop.it

Clearly, mHealth technology has achieved impressive momentum among a certain breed of health-conscious, self-monitoring consumer. Still, aside from wearable health bands, few mHealth technologies or apps have achieved a critical level of adoption.


The reason for this, according to a new survey, may lie in doctors’ attitudes toward these tools. According to the study, by market research firm MedPanel, only 15% of physicians are suggesting wearables or health apps as approaches for growing healthier.


It’s not that the tools themselves aren’t useful. According to a separate study by Research Now summarized by HealthData

Management, 86% of 500 medical professionals said mHealth apps gave them a better understanding of a patient’s medical condition, and 76% said that they felt that apps were helping patients manage chronic illnesses. Also, HDM reported that 46% believed that apps could make patient transitions from hospital to home care simpler.


While doctors could do more to promote the use of mHealth technology — and patients might benefit if they did — the onus is not completely on doctors. MedPanel president Jason LaBonte told HDM that vendors are positioning wearables and apps as “a fad” by seeing them as solely consumer-driven markets. (Not only does this turn doctors off, it also makes it less likely that consumers would think of asking their doctor about mHealth tool usage, I’d submit.)


But doctors aren’t just concerned about mHealth’s image. They also aren’t satisfied with current products, though that would change rapidly if there were a way to integrate mobile health data into EMR platforms directly. Sure, platforms like HealthKit exist, but it seems like doctors want something more immediate and simple.


Doctors also told MedPanel that mHealth devices need to be easier to use and generate data that has greater use in clinical practice.  Moreover, physicians wanted to see these products generate data that could help them meet practice manager and payer requirements, something that few if any of the current roster of mHealth tools can do (to my knowledge).


When it comes to physician awareness of specific products, only a few seem to have stood out from the crowd. MedPanel found that while 82% of doctors surveyed were aware of the Apple Watch, even more were familiar with Fitbit.


Meanwhile, the Microsoft Band scored highest of all wearables for satisfaction with ease of use and generating useful data. Given the fluid state of physicians’ loyalties in this area, Microsoft may not be able to maintain its lead, but it is interesting that it won out this time over usability champ Apple.

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What value do primary care doctors offer to our health care crisis?

What value do primary care doctors offer to our health care crisis? | Healthcare and Technology news | Scoop.it

When I was a resident at the University of Virginia, my wisest mentors gave me one piece of advice that far exceeded all the scientific and statistical jargon that others expected me to swallow. Consider this: When patients walk into your room and sit down, shut up and look into their eyes. When they are done talking, have a conversation. The key word is conversation. The visit should not include a lecture or statistics that diminish the complex needs and wants of the person sitting in front of us. Primary care doctors who care for the elderly and chronically ill confront a plethora of medical problems in virtually every patient who walks through our doors. To solve them all is not possible and may not be what the patient wants. As my mentor told me, unless you address the patients’ concerns, they will hear nothing else that spews from your mouth.

Sometimes it’s difficult to allow a patient to walk out of the room without addressing her high blood pressure, need for a mammogram, decision to stop taking statins, and lack of exercise. It can be painful to watch them leave without fulfilling any of Medicare’s quality indicators, which will be sent to the Centers for Medicare & Medicaid Services (CMS) through our computers and may cause our payments to suffer. Sometimes talking about the patient’s incontinence and back pain seems insufficient in light of all of the other medical issues. But as the patient leaves the room, I tell her that during the next visit, which will be soon, we will talk about those issues. I may encourage her to look over some data in the meantime about statins and mammograms. Many patients choose not to pursue many interventions after they see real data about them. That is their choice, as long as they make it rationally. Much of what we try to “fix” in our patients can harm them as easily as it can benefit. Their choices can lead to fewer tests and drugs and improved outcomes, even though it may mean failing grades for our quality indicators or ramifications for our pocketbooks.

What value do primary care doctors offer to our health care crisis? Conversation. It is our ability to look people in the eyes, allow them to set the agenda, converse with them about medical issues and interventions using reliable data and base decisions on their interpretation of personal risks and benefits. However, when we are forced to stare at computers and enter data, when CMS and the Affordable Care Act (ACA) have set much of the agenda by compelling us to adhere to their often perverse quality indicators, when visit times continue to shrink to pay for the escalating overhead, then none of the value we offer can exist. Being a primary care doctor is one of the most satisfying professions on this planet. We come to know our patients well over many years and live through their peaks and valleys. They rely on us to help them with some of the most difficult decisions they will ever be forced to make. We do our best to keep them healthy, active and happy. I get as much value as my patients do from a conversation that works well. Our health care system gets value, too. The bond between doctor and patient, when it allows for meaningful conversation, leads to fewer tests, fewer medicines, fewer referrals, less hospitalization, lower cost and greater satisfaction.

The ACA and CMS are trying to measure value and quality in all the wrong ways. They are talking about shared savings, incentives and disincentives that rarely work and typically decrease both patient and physician satisfaction. They throw metrics at us that have no correlation with our patients’ wants and needs and only squander our time in the exam room. The value we must insist on as primary care doctors is the ability to have a conversation, which is more difficult to measure but ultimately what will work. It brings greater satisfaction to our patients and to us. And it saves the health care system money while enhancing our patients’ health and well-being. It’s what we do best.


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3 ways to change the way we pay for care

Incentive structures in health care have to change. Right now, we pay for services, or have a so-called, fee-for-service system. The idea is that the more patients doctors see, the more expensive tests doctors order and the more patients doctors hospitalize, the more money clinics and hospitals make. This incentive structure has transformed our health care into sick care.


The reality is, in America, we are adept at caring for complicated medical problems that require multiple tests, specialists, long hospitalizations, and frequent clinic visits. We focus a lot of resources and attention on this part of medicine because it is what we are paid to do. And to further our efficiency in providing this model of care, many medical systems have adopted business practices, like Toyota’s Lean Strategy, to run our hospitals and clinics more like factories. We essentially increase the number of cogs, or patients in this case, on our conveyor belt, to increase profit margins.

Now, it is only fair to acknowledge that “Lean” and other strategies to improve health care efficiency also have real hopes of lowering healthcare costs. In fact, there may be evidence of that. And streamlining health services so that every patient gets a standard quality of care, will likely create equity in the system and reduce costly medical errors, preventing patients from receiving disparate care based on race, gender, or cultural affiliation.

But as we extol the benefits of these patterns of practice, we must also be critical of their overall impact. Is the way we are paying for medicine coming at the expense of delving deeper into the heart of our field? As care becomes more standardized and protocolized, with each patient treated with machine-like accuracy and precision, we do improve “quality” and efficiency in the system. But where is the healing? Where is the prevention? Where is the practice of medicine caring for the human condition and working to keep us well?

Being well isn’t simply having your diabetes under control, it is preventing you from getting diabetes in the first place. If we continue to commoditize patients, valuing their ailments over their wellness, we miss the opportunity to provide the very care we claim to offer, health.

So how do we re-organize the way we pay for care to build a health care system instead of perpetuating a sick care system?

First, if we recognize that social needs have profound and costly health impacts, then as we transform our payment structures under the Affordable Care Act (ACA), we have to support innovative models that address social inequity. That means, using health care dollars that are typically spent on clinic visits and hospitalizations to also pay for education, food, housing, and job creation in low-income communities of color. That also means that in the spaces where we provide medical care, we should also be equipped to address patients associated needs. There are models for this.

Second, we have to change the narrative about what it means to provide care. We need to think about the overlap between natural life processes, like birth and death and medicine, and learn the limitations or boundaries of the medicines we wield. When there are no quick fixes or magic pills, how will we care for the human condition? In the spaces where listening is better than treating and healing doesn’t come at the end of a needle, we need to foster the relationships in our communities that provide healing and build resilience.

Third, it is time to transform the physician-patient relationship, a dynamic historically limited to a clinics and hospitals, to team-based care. In team-based models, physicians use their trusted relationship with patients to lead a team of community health advocates to address patients’ health needs in the places where they arise. Sometimes those places are hospitals and clinics but more often they are in homes and neighborhoods. The future of care, if we are smart, will deploy complex networks of healers that extend the reach of the system into people’s lives, supporting their wellness as we address their disease. This will require thinking across sectors, partnering with unconventional liaisons in the social service and for-profit sector, to have a coordinated approach for health.

Right now, the Department of Health and Human Services (HHS) is doing historic work to re-design how we will pay for health care. With the guidance of the ACA, HHS is laying out a plan for a population-based payment structure that incentives providers to be efficient with precious medical resources. Doing less for more means we will have to learn how to keep people well. These new changes have the opportunity to shift the focus of our system, towards health. Looking down the pike, let’s be actively engaged in ensuring quality, efficiency, and equity guide how care and healing are provided.


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Apple's New Plan For Healthcare: The Doctor Will Track You Now

Apple's New Plan For Healthcare: The Doctor Will Track You Now | Healthcare and Technology news | Scoop.it

An Apple relay will keep your doctor’s fears allayed.

That’s the plan, at least, behind the company’s growing health care strategy: To use the Apple HealthKit platform to collect real-time data from iPhones, the soon-to-be-released Apple Watch, and other devices — and connect it to hospitals, doctors, and your electronic medical records.

More than a dozen top hospitals already are piloting Apple’s HealthKit software, Christina Farr reported Thursday in an exclusive for Reuters.

This isn’t a surprise. Five months ago, details leaked that Mayo Clinic had teamed up to test several health care applications for the iPhone, such as a service to alert patients when their Apple apps detected abnormal health results, and help schedule them for follow-up visits.


And at the September debut for the iPhone 6, Apple officials said that they’d struck partnerships with a number of other top hospitals, like Stanford University Hospital and Duke University.

The two medical centers last year began helping Apple test whether chronically ill patients could use HealthKit to remotely track and manage their symptoms.

A similar trial is now underway at Ochsner Medical Center in New Orleans, where providers are seeing if HealthKit can help several hundred patients control their blood pressure. The patients use sensors and other devices to remotely measure their blood pressure and other clinical indicators, and send the data to Apple phones and tablets through HealthKit.


Apple plans to use its new Watch as part of its strategy to move into the U.S. health care market.

Ochsner also has launched what it’s calling the “O Bar” — the hospital’s version of Apple’s Genius Bar — to help patients pick between different health and fitness apps for their iPhones, and teach them how to use them.

Are Apple’s Rivals Playing Catch-Up?

What is surprising is how far ahead Apple is compared to purported rivals, Google and Samsung.

According to Farr, Google has developers working on applications for its Google Fit service, but hasn’t appeared to make major inroads among the top hospitals yet. Samsung’s own health care platform also has lagged Apple HealthKit on both hype and deal-making.

The market potential for these companies is significant, to say the least: The U.S. spends about $3 trillion each year on health care, and all the incentives are pushing hospitals and doctors to get better at remotely managing patients’ symptoms.

Being able to see real-time data for chronically ill Americans could offer significant financial and clinical benefits. For instance, tracking their health and fitness could encourage positive behaviors that reduce the cost of doctor visits and other treatments. And doctors could use the data to be proactive when a person’s health appears to be taking a turn for the worse.

There are several major hurdles before realizing that vision, however.

For example, Apple appears to have pinned some of its health care-hopes on the Apple Watch, which launches in April. But early indications suggest that the device’s initial applications for health care may be limited; based on current reports, there’s very little chance that the Watch will come with a breakthrough technology, like a built-in glucose monitor.

(However, the Watch may display updates from a separate glucose monitor, per this demonstration last month.)

If Apple Watch can’t add much unique health care value, it may face a practical problem: Regardless of how cool the technology is, most Americans end up abandoning their wristbands and other smart-tech wearables.


And simply introducing new data streams isn’t so simple in health care. Hospitals already are juggling the pressure of protecting patients’ medical information, with hackers constantly trying to penetrate their systems, while trying to identify and organize the data that they do need.

“This is a whole new data source that we don’t understand the integrity of yet,” according to William Hanson, chief medical information officer at the University of Pennsylvania Health System.

So unlike the launch of the iPad — where Apple essentially redefined the tablet computer market overnight — the company will almost certainly need months or years to fully realize its health care strategy.

“There are unrealistic expectations for when and how mobile health is going to come together,” Patty Mechael, former executive director of the mHealth Alliance, told the MIT Technology Review last summer. “We are somewhere between the peak of the hype cycle and the trough of disillusionment,” she added.

Of course, Apple may defy the odds. For one, it’s Apple — the company can create buzz by simply posting a job opening. More than 600 developers are already integrating HealthKit into their health and fitness apps, helping ensure that Apple’s new software is already becoming an industry standard.

That kind of scale and momentum is the key reason why Apple stands apart.

John Halamka, the chief information officer of Beth Israel Deaconess Medical Center and an informal adviser to Apple, told Reuters that many patients at his hospital already use Jawbone trackers and other devices to collect personal health and fitness data.

“Can I interface to every possible device that every patient uses?” Halamka asked ruefully. “No.”

“But Apple can.”

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1 In 4 New Doctors Would Change Careers If They Could Start Over

1 In 4 New Doctors Would Change Careers If They Could Start Over | Healthcare and Technology news | Scoop.it

Even as doctors enter a medical field with more paying patients under the Affordable Care Act and unprecedented numbers of job opportunities, 25 percent of “newly trained physicians” would still choose another field if they could, according to a new analysis.

More than 60 percent of doctors-in-training who were in the final year of their medical residency last year received at least 50 job solicitations during their training, according to a survey by physician staffing firm MerrittHawkins. Another 46 percent received at least 100 job solicitations.

“There are simply not enough physicians coming out of training to fill all the available openings,” MerrittHawkins president Mark Smith said.

This comes amid a physician shortage, changing payment structures and new regulations and paying customers under the health law that are creating more opportunities yet anxiety among doctors as they enter this new order.

“The paramount thing on new doctors’ minds is: will I have a life,” said Phil Miller, vice president at MerrittHawkins, a division of AMN Healthcare (AHS). “They are running into a maelstrom and there are all sorts of changes taking place.”

Merritt executives say it shouldn’t be surprising that 25 percent would select another field of study if they had to start over with their education given the turbulent environment they face.

The 2015 survey of residents in their final year of medical residency, which tallied more than 1,200 responses last year from a sampling of 24,000, indicates young doctors are ready to enter a world of “9 to 5” employment rather than launching their own private practice. More than 90 percent said they preferred employment with a salary rather than an “independent practice income guarantee.”

The more predictable hours young doctors want comes after four years of medical school and three to five years of residency, often with long hours and an exhaustive schedule.

Here are some other survey highlights from residents in their final year:

  • 78 percent expect to make at least $176,000 in their first year of practice
  • 39 percent are unprepared to handle the business side of medicine
  • 2 percent preferred a solo setting as their first practice
  • 93 percent preferred to practice in communities of 50,000 or more people


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5 ways to improve patient engagement in hospitals

5 ways to improve patient engagement in hospitals | Healthcare and Technology news | Scoop.it

Improving patient engagement is a subject that’s being talked about in hospital boardrooms across the country. It’s become the in-fashion political buzz phrase. Certainly sounds very well and good, but what exactly does it mean?

Likely different things to different people depending on what angle they approach it — all the way from a care assistant up to the hospital CEO. In a nutshell, it’s all about allowing the patient to take center stage in their health care, and being fully informed and understanding each step of the way. It’s about education, encouraging healthy behaviors, improving health outcomes, and lowering health care costs. The ideal state is to allow the patient to feel that they are in the driving seat and full participants in their own care.


As things currently stand, most health care systems across the world are way off from this place. It’s not just the health care that’s to blame either — because the biggest part of patient engagement involves the patient stepping up to the plate themselves. And there are some very real barriers to this including education, demographics and motivation. There’s also the reality that most 90-year-old chronically unwell patients in hospital will have difficulty taking care of themselves. The issue is thus a complex one.

No one has a better understanding of where the opportunities for improvement lie than the doctors and nurses working at the coalface. We get to see all the problems up close and personal on a daily basis. I’m going to talk about how this pertains to my own specialty of hospital medicine, and where we have enormous room to engage patients better while they are in hospital. Here are 5 areas to focus on:

1. Encouraging patients to ask questions when they see their doctor every day. As simple as it sounds, this is not done nearly enough, and is a big missed opportunity to make a difference to patients’ understanding of their illness. There are a number of reasons why this doesn’t happen, ranging from a “rushed” hospital environment, to patients sometimes feeling embarrassed to ask certain questions. I’m actually surprised by some of the questions I hear when I ask my patients if they have anything they want to ask me, and there’s no way I would have guessed what they were unsure about unless I encouraged them to speak up.

2. Giving patients all the knowledge they need about their medical condition. Writing details such as blood count numbers on the whiteboard at the end of their bed is one way to do this. In the future, patients will likely be able to pull up some of their own data on computers. The more that patients know, the more empowered they will be to make important health care decisions.

3. Involvement of families. Just as important as the patient, is the family. This is true for any patient who is too unwell to speak for themselves, and particularly applies to the elderly. Doctors and nurses have to ensure that family is completely on board with the plan of care and what their role is in the recovery process. I’ve always said that if you want to make sure that something is done after discharge, tell the patient’s daughter. It’s been my observation everywhere.

4. Involving the patient fully in the discharge process. The discharge process by its’ very nature is a risky endeavor. Typically there are medications that have been changed, tests pending, or even an uncertain diagnosis. All this at a time when the patient is still very frail. It is a crucial transition point, more important than almost any other to get right.

5. Follow-up care. All hospitalized patients must follow-up in a timely manner after being discharged. Nipping a potential problem in the bud can help reduce readmissions and potentially serious complications. Reminders should be sent to the primary care physician and a post-discharge follow-up call from a nurse or administrator would not go amiss — and also shows that we care.

There is no one magic formula for solving the issue of patient engagement in hospital medicine. It will require a multifaceted and multidisciplinary approach. Whichever arena we are in, it is vital for a number of reasons. Whether we are talking about raising the quality of health care, improving outcomes, or lowering health care costs — there’s a great deal to play for. The more knowledge and opportunities to participate in their own health care, the better it is for both patients and doctors.


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The rise of the employed physician: What it means to new doctors

The rise of the employed physician: What it means to new doctors | Healthcare and Technology news | Scoop.it

As the youngest member of a family of doctors, it was not uncommon during my childhood to spend summers at my father’s private practice. I fondly remember greeting the familiar office staff as I recklessly ran amok among an endless array of rickety cabinets containing an untold amount of aging, yellowed paper charts. My dad’s patients would tousle my hair like family and his partners would always leave an insurmountable supply of candy for my taking.


Years later, I found myself accompanying my father and his practice partners for lunch as they discussed the ebb and flow of running a medical practice. Beyond sharing complicated medical cases, conversation often revolved around the complex relationships with local medical practices and the independently-owned hospital that my father and his partners had been affiliated with for the past several decades.

By the time I entered medical school, I developed the fixed assumption that, like my father (and grandfather and great-grandfather), I would ultimately be co-running a small office practice, develop a large but manageable patient panel and become highly involved with a local hospital.

Now, I am not so sure.

Around the same time health care reform became a central theme to major media outlets, enormous changes quickly presented themselves to my father’s workplace. The community hospital to which he was politically and financially bound was rebranded into a multi-institution hospital network. That same corporate system soon bought out his practice and ultimately became his employer. This all occurred in the matter of a few years.

I asked my dad why he didn’t resist these marked changes to his career. His response didn’t surprise me.

The daunting tasks of billing for multiple insurance networks and keeping up with proper medical coding for hundreds of diseases were becoming unbearably time-consuming and costly. Transitioning to electronic medical records and staying current on meaningful use and quality measures without managerial support was an increasing daily burden. Dictation companies were eating up his bottom line and documentation was eating up his time spent with his patients. He was tired of having to keep up with the business and politics of medicine, but he wasn’t ready to let go of his practice of medicine.

And so, at 62, my father started his first employed job since finishing his medical training.

Selling one’s practice to work as an employee, as my father has done, or being hired directly out of medical training, as I am likely to do, is not unique to this era of health care.

Physician-owned practices in 2012 accounted for about 50 percent of all working doctors in comparison to about 75 percent in the late 1980s. The number of physician-owned practices continues to precipitously decline, as the percentage of physicians who were practice owners in 2012 dropped almost 10 percent from the previous five years, according to the AMA 2012 Physician Practice Benchmark Survey. This movement away from physician ownership is expected to continue.

Larger political and economic incentives are certainly influencing these trends. The public national agenda for rapid care integration and coordination and the private agenda for reducing competition and increasing leverage through consolidation are likely to accelerate the move away from self-employment, particularly for emerging physicians.

How does the shift away from self-employment affect the new wave of practicing physicians?

I can only speculate that newly-trained doctors must learn to be more comfortable with managerial oversight from both physician and non-physician executives. Skill-sets such as effective team building, employment contract negotiation and the ability to “manage up” are likely more relevant now than in prior generations, where self-employed physicians predominated.

Importantly, in an era where patients see an ever-increasing number of non-physician providers, it is likely that young doctors will require a much more conscious effort to maintain a sense of personal responsibility for the health and well-being of the patients they care for.

I truly believe that this era of health care is providing better care for our patients than ever before, and I couldn’t be more satisfied in having the opportunity to take part in it.

Yet it remains to be seen how the trend from the “physician-employer” to “employed physician” will impact my generation of newly licensed physicians.



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A Shortage of Juggling Doctors

A Shortage of Juggling Doctors | Healthcare and Technology news | Scoop.it

A controversial statistic suggests that in the near future our country will be in desperate need of more doctors. The Association of American Medical Colleges has estimated that by 2025 we will be about 130,000 short, thanks primarily to an exploding older population. Ten thousand Americans now turn 65 every day, entering their golden years of disproportionate consumption of medical care.

Not all the experts agree with these calculations. A panel at the Institute of Medicine, for example, has countered that geographic variability always undermines these dire predictions, with a reliable glut of physicians persisting in some places and reliable shortages in others. The real problem, they say, is a profession top-heavy with specialists, leaving too few to provide primary care.

I have no particular professional expertise to inform an opinion on these matters. I do, however, have a pertinent personal perspective, having lived in a miniature version of our soon-to-be-geriatric nation for most of my adult life. Thanks to extremely long-lived parents who married late in life with a sizable age difference between them, it is now closing in on three decades that our nuclear family has contained an extremely old person to worry about.

So here’s the bottom line: We have had no doctor shortage. In fact, even with just the one permanently on-call house doctor (me), I would say we have actually had enough doctors. Maybe even a surplus.

My mother, ever the comic, used to drag out an annoying little routine at dinner parties to the effect that she and my father sent me to medical school specifically to supervise their old ages. After many years chewing that one over, I am forced to conclude that the joke is on her. Not the best choice, Mom.

It would have been better by far to send me to nursing school. Talk about shortages — how our little world could have used an in-house individual formally trained in patience and small acts of kindness, one whose knowledge of health care reflected the more practical, symptom-focused schematic that distinguishes nursing from medical education. Certainly, doctors are now making tentative forays into this territory: We have, for instance, added the concept of “comfort care” to our knowledge base, and we use the term freely. But most of us are not too clear on the actual techniques.

It would have been better to send me to physical therapy school. No surprise there: A doctor’s familiarity with obscure diagnoses — and the ingrained habit of reviewing them compulsively when something goes wrong — is considerably less helpful for the old than an understanding of some normal activities, like sitting, standing and tottering around. Unless you are a rare physician indeed, you know nothing about the process of rising from a chair except to politely conceal your impatience while it is accomplished.

It would have been better to send me to design school, given the fact that every single item marketed to help old people stay in their homes is uglier than ugly, making their reliable decision to have nothing to do with it (cane, walker, bathing aids, you name it) particularly difficult to countermand. Furthermore, nowhere in the universe does there exist a portable, slim, elegantly designed, mechanically sound, reasonably priced chair that a person with no strength or balance can spend a lot of time in and then actually get out of.

It would have been better, much better, to send me to clown school, to pick up some validated tools for amusing and distracting people. It turns out that when a lifelong worker no longer works, a reader no longer reads, a person who never took a vacation is on a long one, miserably elastic time stretches long and wide and heavy in every direction. The days may be running out, but there are still too many of them and they are all much too long. An on-call juggler would be just the ticket.

Best of all, I think, would have been the decision to send me to graduate school in philosophy, to observe wiser minds making sense of it all, possibly to absorb some rudimentary techniques for soaring high above the small, sad details to a serene understanding of the bigger picture. Or perhaps a few years in aviation school would have provided the same perspective.

You could certainly say that our family has experienced serious decadeslong shortages of various professionals. But doctors — those valiant but limited warriors schooled to think only about their own tiny little battles in an irreversibly lost war — were not among them. We probably had one too many of those.



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Is there really a doctor shortage, and what can we do about it?

Is there really a doctor shortage, and what can we do about it? | Healthcare and Technology news | Scoop.it

There is controversy about whether or not there will be a doctor shortage in the near future. I wonder why there is so much speculation. The Association of American Medical Colleges estimates that we will be short 90,000 physicians by 2020 and 130,000 physicians by 2025. If things stay as they are now, of course there will be a shortage. The number of patients is increasing while the number of doctors is decreasing. It is a matter of mathematics.


Baby boomers

According to the Center for Disease Control (CDC), half of all adults have at least one chronic medical conditions, one-fourth of them have two or more chronic medical conditions. Chronic medical conditions require more services and care.

Medical complications increase as we get older. 10,000 baby boomers turn 65 years old every day and will do so through 2029. The geriatric population will double within two decades. The complexity of our patients and the amount of care needed is rapidly increasing.

The uninsured become insured

More than 40 million Americans did not have access to health insurance prior to the Affordable Care Act. With mandates requiring insurance coverage for 2014, more Americans will be added to the existing health-care roster. Doctors are being asked to see an increased number of patients in one fell swoop.

Increased number of insured patients + increased number of geriatric patients = Increased total patients + increased complexity of patients

Doctors in practice

There are 893,851 doctors practicing in the U.S. according to a September 2014 report by the Henry J. Kaiser Family Foundation.  As it stands today, 1 in 3 of those doctors are over 50 years old, and 1 in 4 is over 60 years old. That means that at least 25 percent of the physician work force could be retiring in the next 5 years. That would be a loss of more than 223,000 doctors in that time.

A survey of 20,000 physicians in 2013 shows that 62 percent of them expected to retire even sooner, within the next 1 to 3 years, irrespective of their age or medical specialty. 55 percent of them stated they would scale back their hours due to their frustrations with the increasing demands of medicine. Our doctors are burning out under the reams of red tape and regulations.

Medical training

The number of medical school positions has increased. In 2002, there were 125 U.S. medical schools and today there are 141, resulting in a 30 percent increase in medical school graduates. By the 2016 to 2017 school year, there will be 21,434 graduates per year. The problem? These graduates may have an MD after their name, but they are not qualified to practice medicine.

These graduates need to complete residency training programs, but the number of residency slots has remained relatively stagnant since 1997. The Balanced Budget Act of 1997 capped Medicare’s funding to U.S. graduate medical education (GME), the largest source of funding to these programs. States may contribute to GME positions as well but do so by a much narrower margin. Money is needed to provide salaries to these residents as well as contribute to any additional costs to their training, including the costs of liability insurance and payment to the teaching hospitals for supervision.

There are also osteopathic medical school graduates and foreign medical school graduates to account for. In 2014, more than 40,000 applicants competed for 26,678 entry level residency positions. You do the math. Adding 30 percent more medical students has been a stop-gap solution to train more physicians, but it is an ineffective measure if their training cannot be completed.

Increased number of doctors retiring + same number of resident training positions = Doctor shortage

Replacing doctors

Many people have argued that nurse practitioners (NP) and physician assistants (PA) can take the role from doctors to fill the gap. There remains a great deal of controversy over this issue. While many NPs and PAs are qualified to care for patients without physician supervision, their training is less extensive than that of a physician. This may make it more challenging for them to care for more complicated patients. With an increasing elderly population, there will be more of these complicated patients. Also, many states require that a physician supervise care offered by these providers.

Only 84 percent of NPs chose primary care as their specialty in 2012 and only one-third of PAs did the same. Even if we replaced physician roles with NPs and PAs, these providers are as susceptible to burnout as our physicians. Many are still not entering the primary care work force where they would be most needed. We could still face a shortage for America’s health-care needs.

Solutions?

What we need is for the red rape and regulations to be reassessed. Bureaucrats are burning out our doctors so they are less likely to stay in the health care system. Is meaningful use improving how electronic health records are utilized? No, it is turning physicians into data crunchers staring at screens rather than empathizers at the bedside. Is pay for performance criteria improving quality of care? No, it is penalizing doctors who give quality care but whose patients may have a more difficult time complying with treatment plans. Is the SGR formula saving our country from a worsening deficit? Of course not. Let’s boost dollars to GME residency programs to strengthen our work force.

Medicine needs to be about people, not numbers. It needs to be about patient care, not paperwork. Doctors are left fighting battles for their patients on the front lines while administrative demands mount on the back end. We need health-care reform that focuses on how the system cares for people more than about dollars and cents. We cannot let doctors work with their hands tied behind their backs or we will continue to lose them. American citizens are the ones who suffer when they cannot get the care they need.



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How Doctors Improve Health Via 'Disruptive Technology'

How Doctors Improve Health Via 'Disruptive Technology' | Healthcare and Technology news | Scoop.it

From electronic health records and telemedicine to “internet-driven physical therapy,” Dr. Richard Rothman, founder of the Rothman Institute, says providers of medical care are embracing the promise of the digital age.

In an interview at the 2014 Forbes Healthcare Summit, Rothman talks about how a health care system with more than a half million patient visits annually is moving into the digital health space with “disruptive technology,” reducing costs by moving therapy online, conducting telehealth consults with patients and using eletronic health records to improve patient experience.

“We are very pro disruptive technology,” Rothman said in his interview, which can be seen in its entirety below.  “We are into disruptive technology that will lower costs and improve convenience for our patients.”


As insurance companies like Aetna (AET), Cigna (CI), UnitedHealth Group (UNH), Humana (HUM), and others push away from fee-for-service medicine to accountable care and bundled payments, Rothman said digital health can achieve what the insurers want in lower costs and better quality. As one example, the Rothman system is practicing “internet-driven” physical therapy that will reduce costs by 80 percent.

As the Affordable Care Act and trends in insurance payment move away from paying for quantity to reimbursement based on quality, Rothman believes health plans and government health plans will, in turn, embrace provider ideas in digital health.



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Why Doctors, Managers Should Rethink Their To-Do Lists | Physicians Practice

Why Doctors, Managers Should Rethink Their To-Do Lists | Physicians Practice | Healthcare and Technology news | Scoop.it
Ambitious physicians often face the problem of taking on too much. They’ve been so effective at accomplishing things in the course of their medical career that they seek to accomplish even more. Their inherent productivity causes them to create longer and more involved to-do lists than others.

The problem is that these individuals are setting themselves up for failure. They unconsciously ensure that they won’t reach the end of their list, by continually adding more tasks after accomplishing just a few.

This approach to managing one’s to-do list is fraught with problems. It is both rewarding and appropriate when you cross off everything on your list and feel complete about your achievements. When you’re able to finish your lists, say two to four times a week, you often return to the office the next morning with more energy, focus, and direction than you might presume.

Conversely, when you perpetually leave the office with unfinished tasks for that day’s to-do list, you unconsciously engender a situation in which you never quite feel complete or satisfied, and you find yourself in a perpetual “striving” mode.

In the short run, it’s OK to leave unfinished tasks, especially when you’re on a specific campaign or project. In the long run, however, continually overextending your daily to-do list can have a harmful, de-motivating effect on your life.

It’s understandable that as a highly ambitious person you want to achieve as much as you can and build a strong practice. If you’re not careful, however, and you attempt to accomplish one major task after another instead of alternating large and small tasks, your productivity could suffer. Attempting to tackle one major task after another can become mind-numbing, stressful, and frustrating.

Hereafter, choose to tackle a handful of key tasks in a given day, alternating them with some minor tasks so that you can maintain a fairly high level of energy and allow yourself to leave the office with a sense of completion.

You’ll be more effective with patients and staff the next day, as well as throughout the course of your week, month, year, and career. You’ll engender a distinct sense of accomplishment while experiencing, at the least, recurring feelings of work-life balance.
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