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The Future Of Primary Care: HSAs, Catastrophic Coverage, And Direct Payment For The Basics

October 12th, 2009 by Dr. Val Jones in Expert Interviews
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I’ve been following the career trajectory of Dr. Gordon Moore since I first became aware of his low-overhead, high-tech model of medical practice. He’s come a long way since the AAFP first interviewed him in 2002. I had the chance to catch up with him at the recent Health 2.0 conference in San Francisco, and we discussed the future of primary care and a practice model that I believe in (I just joined DocTalker Family Medicine myself!) Here’s our peek into our healthcare crystal ball…

Dr. Val: Tell me about what got you interested in creating a new practice model for primary care?

Moore: I came into healthcare with a somewhat Pollyannaish vision of reducing suffering and improving health. Without any docs in my family, I had no understanding of what it meant to actually practice. About 5 years after residency, I realized that there was an increasing disparity between my vision of practicing medicine and its reality. At that time I joined a quality improvement initiative at the University of Rochester, and we looked at increasing efficiency in primary care, including creating the idealized design of clinical office practices. Read more »

Automatic Translation Services: Miscommunications Still Likely

October 5th, 2009 by Dr. Val Jones in Humor, True Stories
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Health IT is valuable in many ways and I do believe it will revolutionize how we practice medicine. However, we’ve got a long way to go yet, especially in auto-translating English into other languages. This short exercise in English-Spanish translation (through a computer software program) reminds me of how far off “seamless” health technology really is…

(My mother is fully bilingual in Spanish and English and decided to test the auto-translator service with a sentence from a book. Here is the result:)

ENGLISH: He popped a deep-fried sardine into his mouth and washed it down with a few swallows of beer.

LITERAL TRANSLATION OF SPANISH RESULT: He punctured a sardine fried deep in his mouth, and he laundered it near the bottom along with some swallows (referring to the birds) made of beer.

Prescription Privacy Doesn’t Exist

August 18th, 2009 by DrWes in Better Health Network, Health Policy, Opinion
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I wish this was hard to believe:

Like many other people, Ms. Krinsk thought that her prescription information was private. But in fact, prescriptions, and all the information on them — including not only the name and dosage of the drug and the name and address of the doctor, but also the patient’s address and Social Security number — are a commodity bought and sold in a murky marketplace, often without the patients’ knowledge or permission.

But given the money involved, I’m afraid it isn’t.

But with the pharmaceutical industry soon to release $150M dollars of ads promoting health reform as they cozy up to Congressional leaders, the conflicts of interest for patient’s privacy are staggering. Further, the promotion of the electronic medical record, personal health records, and ultimately, cloud computing (where no one will know where health data resides), are firmly part of the health reform landscape.

Now before people think I’m totally against the EMR, let me be candid: I’m not. It does facilitate care and is an incredible means of communication between physicians and laboratories and pharmacies and the like. When used properly, they are miraculous.

But the risks of losing information remain huge. Certainly, the above referenced New York Times article notes that safeguards are supposed to be enacted to prevent this wholesale marketing of your health data.

But suddenly, we learn of a White House snitch line where they will collect e-mails of people who might be spreading “misinformation” about the health reform efforts underway. (Thanks to my previous blog post, I am happy to report I’ve been reported! ;)) But this occurs at a time when privacy issues in health care must be seen as paramount and electronic medical records protected as secure.

Ooops.

So now we have a White House eager to build a snitch line as they cozy up to pharaceutical interests that are already selling personal information from prescription data, all while trying to promote the security of electronic medical records to the masses.

Who are they kidding?

But then, shucks, just think of the marketing possibilities for the government:

And lest people think I’m too partisan (who me?), the Republicans with their travel junkets aren’t any better.

Sheesh!

-Wes

Reference: White House blog with snitch e-mail link at flag@whitehouse.gov .

Musings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*

Innovative Healthcare Cost Containment: The Economic Informed Consent

August 17th, 2009 by admin in Better Health Network, Health Policy, Opinion
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By George Lundberg, MD

Just as “all politics is local”, so is all medical care personal. One patient; one physician; one moment; one decision. And in this era of balanced physician and patient autonomy, that decision often is an informed joint decision. Many patients now make serious efforts to learn about their conditions both before and after visits to their physicians. Many physicians welcome such informed patients and willingly discuss comparative effectiveness of the available diagnostic and therapeutic options. However, a frank discussion about the comparative costs and charges for the options, whether they be to the insurance company, Medicare, Medicaid or out-of-pocket for the patient, is usually missing.

Many health economists insist that the medical marketplace does not behave like other markets and believe it is fruitless to expect market principles to usefully inform the medical arena. That bias is true in emergencies,
operating rooms or intensive care units, and with patients who are mentally disabled.

Such behavior does not have to persist in an outpatient setting. In my book Severed Trust: Why American Medicine Hasn’t Been Fixed (Basic Books, 2000, paperback 2002), I presented the concept of “the economic informed consent.”

I believe that every patient who is mentally competent and in a non-emergency situation should be informed of the cost of a proposed diagnostic or therapeutic procedure or product, before it is “ordered.” This includes referral to another (often more specialized and costly) physician, no matter who pays the bill. The costs should all be discussed IN ADVANCE decision. This discussion should include whether it is worth it and
whether there a less expensive good alternative.

A recent NPR/KFF/HSPH survey reported that 55% of Americans believe that their insurance company should have to pay for an expensive treatment, even if has not been proven to be more effective than a less expensive
treatment. This attitude underlies the ruling convention, “if insurance will cover it, do it,” that lies at the root of our problem of health care cost inflation. No one is held accountable.

If we as a country could widely apply the “economic informed consent,” physicians and patients would become educated together. They could both become wiser shoppers for the most cost-effective diagnostic tests,
prescribed drugs, and specialists.

With an “economic informed consent,” physicians and patients can reset attitudes toward a healthy concern for the total costs or charges, stifling the usual knee-jerk response, “if the insurance covers it, do it.” No one
knows whether this approach, diligently applied, would actually cut down on wasteful spending, such as choices that drive huge geographic variations, but we do know that pricing an automobile, an airplane ticket, a dinner or a bottle of wine does affect consumer decisions. Why not try it for medical charges as well? Current sweeping proposals for health system reform all state that there must be “cost control” but offer little likelihood of delivering real cost savings.

Now is the time for the US Health Information Technology Initiative to create inter-operative systems that would provide the data to support widespread use of the “economic informed consent” in a timely fashion and
let the medical marketplace speak. Knowing the cost of a medical decision in advance should become a part of a new “Patient’s Bill of Rights”. In a medical care decision, it is the right of a patient to know “who pays whom
how much for what.” All of us in health care laud “transparency”–let that include economic transparency.

George D. Lundberg MD
President and Board Chair, www.lundberginstitute.org

Information Overload: The New Electronic Administrative Burden

June 26th, 2009 by DrWes in Better Health Network
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I filter through progress notes looking for the few sentences different from the day before, only to find them sandwiching pages and pages of electronically-produced babble dutifully and automatically mass-reproduced in every note. I wonder, has anyone ever looked retrospectively at the mess created by this process developed to assure doctors were doing what they said they were doing? Ironically, I find we’re rarely reading most of what we re-create each day.

But we’re sure good at following the rules.

Next.

I now see prescription refills for each and every bottle of prescriptions ever filled by a patient, the date a patient filled it, and how many pills they received with each prescription. I’m not sure why. I sat awestruck in clinic yesterday when the list extended 94 pages, double-spaced, since January, 2009. No one, and I mean no one, filled that many prescriptions, did they? Or did they? Am I supposed to correct that list? Oh, by the way dear referring doctor, my note’s at the bottom of that listing.

Next.

I get pre-surgical notifications, even though I was the one to notify everyone else about the need for admission, just so I can click on the patient’s name again, lest it not appear I’m not doing enough, I guess.

Next.

I get EKG results forwarded for me to sign electronically, even though I’ve already read them, and signed them, by hand, on the EKG. I get notified again that the order I entered for that EKG now has a result, and I have to click on that to tell the computer, “I know.” But that, you see, is not enough. I must also log in, review, and sign off on my EKG’s on the EKG server, too. After all, I’m responsible, and it’s all about quality.

Quality three times over.

Now, multiply that same process for each and every other test I have ordered.

Next.

I see orders for things I’m not sure I ordered, just to be sure I’m responsible, and watching, literally hundreds of times per day.

Next.

I get e-mails and electronic notifications, and electronic communications, as if I know the difference.

Next.

I bypass nursing notes that are mere QA checklists and say nothing about the patient, except that a nurse was there last night.

Next.

I feel guilty entering data as I talk to my patient while serving my electronic master. Yet I find the stakes are high to assure accuracy and timeliness in clinical electronic reporting. After all, you never hear the bullet that hits you.

Next.

I go home on call, am paged, and reprimanded by a patient who wonders why I can’t look up their medication list on-line, even though I’m standing in the grocery store.

Next.

Worst of all, I find myself sending myself messages, just to make sure I do something tomorrow that I could not get done today.

Killing me softly …

… with information overload.

*This blog post was originally published at Dr. Wes*