At All Cost?

How does an industry survive—and how can our society expect healthcare costs to be reasonable—when hospitals do not know their costs of production or reasonableness of the bills they send to patients and insurance companies?

Our Tower of Babel

Although this explains well why communication is so difficult among people from different countries, it fails to address the inability of our various healthcare information technology (HIT) systems to exchange patient data seamlessly.

Evolving to Health 3.0

Organizations that will survive under the new realities of ACA recognize the power of healthcare information technology (HIT) to assist them in reworking their business processes and clinical workflows to achieve the goal of high quality, affordable care.

The Health Supply Chain

The Health Supply Chain model provides a broad, all-encompassing view of care delivery that links both administrative and clinical processes and workflows in the “manufacture” of patient care.

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The Roberts Legacy: ACA Upheld

The Roberts Legacy: ACA Upheld

Thirty-seven years after the Federal government first departed on a journey to guarantee healthcare coverage to its citizens through an amendment to the Hill-Burton Act of 1975, our great country now ensures that all its citizens can obtain affordable healthcare services for their entire lives. No American will ever again be denied coverage due to pre-existing conditions or inability to pay. The United States now joins the rest of the world’s rich nations with a healthcare social compact first forged among its citizens with the passage of Medicare and Medicaid almost five decades ago.

Good for Employers and Employees

Irrespective of the rhetoric coming out of Washington, this ruling by the Supreme Court of the United States is good for both employers and employees. Cherry picking of enrollees becomes more difficult for insurers as payors now must accept all persons irrespective of pre-existing conditions. This motivates insurers, as well as providers who carry risk contracts, to focus on keeping people well rather than looking to make access to care difficult in their effort to boost profits. No longer can costly enrollees with pre-existing conditions be dropped from coverage. Payors must now take a population health point of view maximizing health while efficiently providing resources to achieve the associated clinical outcomes.

Businesses can now adequately budget for healthcare costs for their employees. A larger number of relatively healthy individuals enrolled in plans will expand the risk pool available to fund care, the underpinnings of all insurance models. This should decrease healthcare costs for businesses and employees alike. No more free rides for those who refuse to pay for insurance yet seek free care when they get sick with a catastrophic illness that they cannot afford pay for.

Businesses will benefit from the enhanced job mobility now afforded to employees. No longer will employees be trapped in jobs to ensure healthcare insurance for a family member with a pre-existing condition. Employees can now seek positions offering the best opportunity while businesses can hire the best candidates. These shackles are gone forever.

The Roberts Court

Finally, Chief Justice Roberts made a bold statement today. Although there are nine justices on the Court all with just one vote, the Chief Justice’s vote and role transcend the other eight justices. Every Chief Justice deeply understands the role of the Court in the lives of its citizens. Every Chief Justice understands his role in protecting the Court and ensuring its high standing in the eyes of its citizens.

In recent years the Court’s decisions have appeared politically motivated rather than legally forged. Whether true or not, public perception weighs heavily and a recent 44% approval rating in a recent national poll, the lowest in decades, surely unsettles Chief Justice Roberts.

This decision, decided by a conservative Chief Justice appointed by a Republican president, clearly makes a statement that Chief Justice Roberts intends to demonstrate to the American people that His Court – the Roberts Court – exists to serve the people, and decisions made by the Roberts Court are not politically motivated. The Roberts Court intends to study the law and rule accordingly to the best of its ability. The ruling wisely sends back to the Congress and the President the responsibility of governing – deciding what rules our healthcare system should function under and how to pay for it.

Five decades hence, scholars will look back on this decision the way we look back on Brown v. Board of Education. It is momentous in scope and will forever change how Americans live.

Patient-Centered Workflow

June 20, 2012 Health IT, PSQH No Comments
Patient-Centered Workflow

In the design of successful healthcare information technology implementations, patients matter. Although the importance of addressing the workflow needs of clinicians cannot be overstated, focusing on patient needs helps ensure newly designed workflows leverage the full capabilities of information technology tools. In addition, this delivers the clinical and financial outcomes desired by organizations. Entities that ignore the needs of clinicians in designing HIT driven workflows can expect to experience either low levels of HIT adoption among clinicians, suboptimal patient care results, or both.

The Institute of Healthcare Improvement —led by founder and former administrator of the Centers for Medicare and Medicaid Services, Don Berwick, MD—displays this mantra throughout its facility:

“Every system is perfectly designed to achieve exactly the results it gets.”

Therefore, organizations that utilize new information technologies to mimic the existing workflow of clinicians deliver results no better than outcomes previously reached. In some cases, the inherent complexity of the information technology when deployed within a paper-based workflow can deliver results worse than originally obtained.

To effectively implement HIT, organizations must understand in-depth the capabilities of the available information technology, the requirements of the practicing clinicians, and the expected outcomes of all impacted stakeholders (i.e., patient, clinician, organization). Readily available healthcare information technologies offer invaluable tools such as single sign-on (SSO), roaming desktops, location awareness, and fast-user switching to support impactful patient-centered workflows.

Patient-centered workflow requires stringing together individual steps, the linking of processes, and the bridging of activities by multiple caregivers to create an effective and efficient orchestration of resources to enhance the health of the patient.

Excerpts from: Patient-Centered Workflow. PSQH, July/August, 2012

Photo Courtesy of  Don Guerwitz PhotographyMonastery Buddahs, Bangkok, Thailand

Sitting on A Cure for Cancer – 2012

May 23, 2012 Interests No Comments

 

Sitting on a Cure for Cancer 2012 from Barry Chaiken on Vimeo.

Short video reviewing the last three years of my Pan-Mass Challenge ride – a 2 day, 193 mile event that raises funds to defeat cancer by contributing funds to the research efforts of the Dana-Farber Cancer Institute in Boston. This year’s ride is August 4-5, 2012. To review my story and make a donation visit this link – pmc.chaiken.com.

See you on the road.

 

Barry P. Chaiken

Print Me a Pill

Print Me a Pill

During the first Star Trek series released in the mid 1960s, the creators introduced viewers to several magical devices – the Communicator, the Padd, the Replicator, and the Transporter. Although building the latter device requires the repeal of several of the laws of physics, the other three commonly exist today for the public to use. Smart phones are the Communicator of today allowing us to speak, text, or email to anyone around the world who might have a similar device. The Padd is my Nook – it even looks like it and makes the same sound when dropped on a desk – or your iPad or similar tablet device. Finally, the Replicator is nothing other than a three dimensional (3D) printer, a device just entering the world of consumer products.

All 3D printing works from a digital file or blueprint that directs the building of the object. Some printers use tiny nozzles that deposit layers as thin as 0.1 mm in thickness from material contained in their “printer cartridges.” Other 3D printers use laser beams or tiny droplets of glue to fuse thin layers of plastic or material dust into solid objects.

Bioprinting represents the next step in 3D printing. Instead of materials, living cells fill the cartridges of the 3D printer. Cell by cell and layer by layer, these bioprinters deposit specific living cells chosen to perform a particular function in a pattern that allows them to perform a designed task.

3D printing offers the opportunity to print pharmaceuticals specifically produced to meet the needs of individual patients. A 3D printer with cartridges loaded with the pharmaceuticals required by the patient could print a pill that contains exactly the right amount of each of a patient’s medications, thereby customizing the drug treatment for the patient.

Excerpts from: Print Me a Pill. PSQH, May/June, 2012

Photo Courtesy of  Don Guerwitz PhotographyConch Fisherman, Grenada

Sensory Overload?

March 20, 2012 PSQH No Comments
Sensory Overload?

For many technology geeks the long march through ever more sophisticated televisions, computers and other electronic toys has run its course. The new buzz at Consumer Electronics Show (CES) drew its energy from the integration of electronics, Internet, social networking, and data analysis. The key to achieving that harmony of technology is through sensors, devises that collect vast amounts of data from an almost infinite number of sources. Fortunately, the technology arrived recently to deliver these sensors inexpensively and with very powerful capabilities. This opened the floodgates to allow entrepreneurs to utilize these unique devices in previously unimaginable ways.

Early adopters of sensors rally around the concept of “self-tracking, collecting information about one’s self to improve their lives. Whether to lose weight, sleep better, eat healthier foods, or manage chronic disease, these sensors provide an inexpensive, easy method to measure physical condition (e.g., heart rate, blood pressure) and behavior. This allows users to discover insights that can be applied to improve one’s being.

Some innovators see “gamification” as a way to encourage self-tracking. Gamification turns everyday activities into games by awarding points and merchandise, and encouraging people to compete with their friends.

Excerpts from: Sensory Overload? PSQH, March/April, 2012

Photo Courtesy of  Don Guerwitz PhotographyLead Dancer. Tiji Festival, Tibetan Kingdom of Mustang, Nepal

 

Big Data Drives Big Change

January 6, 2012 Health IT, PSQH No Comments
Big Data Drives Big Change

The digital age is the age of big data where every piece of technology captures data available for later use. The McKinsey Global Institute (MGI) describes data generated in this way as digital “exhaust data,” data that are created as a by-product of other activities.

The rapid expansion in the use of EMRs and digitally-driven technology—MRI scanners, body sensors, automated lab tests—brings the era of big data to healthcare. MGI estimates that big data presents a $300 billion potential annual value to the U.S. healthcare system. The five broad areas to deliver that value are: 1) clinical operations, 2) payment/pricing, 3) R&D, 4) new business models, and 5) public health. Sub-areas include comparative effectiveness research (CER), clinical decision support, remote patient monitoring, health economics, and personalized medicine.

The four large data sources for healthcare include clinical, pharmaceutical, administrative, and consumer.

New analytic tools such as Semantic Web 3.0linked data—offer ways for machines to analyze these data sets leveraging approaches impossible using standard relational databases and statistical methodologies. These new tools permit researchers to work around the barriers presented by data sets’ non-conformance to standards for data collection or storage.

Similar to the use of metadata, Semantic Web techniques allow the assignment of descriptors to each data point, providing a context and meaning to the data. This allows machines, applying powerful statistical techniques, to analyze the disparate data sets in ways not available to humans alone due to the data sets’ size and complexity.

Organizations that properly collect, analyze, and utilize big data will achieve a significant competitive advantage over those organizations that fail to recognize the opportunity big data presents.

Excerpts from: Big Data Drives Big Change. PSQH, January/February 2012

Photo Courtesy of  Don Guerwitz PhotographySahara Dunes. Niger River, Mali

It’s All About Jobs

November 2, 2011 Health IT, PSQH No Comments
It’s All About Jobs

What would Steve do? Steve Jobs, the 20th century’s greatest and most successful innovator, engrained that mantra into the heads of every Apple employee. Only those staff members who thought through problems the way Jobs did would offer solutions that were acceptable to their boss. Jobs relied upon his own research and intuition, not focus groups, to guide him. When asked about the research that went into the design of the iPad, Jobs replied “None, it’s not the consumer’s job to know what they want.”

Although physicians employ the iPad in many clinical settings, the tablet computer functions as a front end to existing EMR and other clinical applications. The iPad is not an innovation in and of itself but a tool to innovation, and few healthcare information technology (HIT) vendors actively leverage the “innovation” inherent in the iPad in their clinical applications.

What Would Steve Do?

Therefore, we must ask ourselves, what would Steve do in healthcare? First, Jobs would not be constrained by current practice. Like hockey, solutions come from skating to where the puck will be rather than where it is. In addition, he would consider all problems together in an effort to create an “ecosystem” that binds one product with another, the same way Apple now threads together the iPhone, iPad, and iMac with iTunes and iCloud. Jobs cherished style and ease of use, combining them with function and utility. Any Jobs-inspired healthcare application must be intuitive to use, support efficient workflow, and facilitate the delivery of safe, high-quality care to the patient.

Excerpts from: It’s All About Jobs. PSQH, November/December 2011

Photo Courtesy of  Don Guerwitz PhotographyFishing in the Moat, Hue, Vietnam

Web 3.0 Data-Mining for Comparative Effectiveness and CDS

Web 3.0 Data-Mining for Comparative Effectiveness and CDS

“Turbulent times” accurately describes the state of the American healthcare system. The list of critical challenges is well known—upward spiraling healthcare costs now approaching 17% of GDP, healthcare payment reform, shortage of clinical professionals, aging population, and the economic downturn. While current investments in health information technology (HIT) begin to deliver increased reimbursements to providers, these same at-risk organizations, along with payors, seek better ways to leverage HIT to enhance quality care and reduce costs.

Although much effort focuses on improvement of clinical workflows, an opportunity exists to transform healthcare delivery by implementing evidence-based clinical decision support at the point of care. Such clinical content delivered effectively within new, efficient clinical workflows directs patients toward evidence-based therapeutic plans that produce desired clinical and financial outcomes. While informaticists work on developing these clinical workflows, the lack of clinical knowledge limits the ability of organizations to leverage HIT in order to personalize therapeutic care plans.

Identifying Affordable Therapies

Comparative effectiveness research, supported by data mining, allows organizations to identify affordable therapies that enhance patient care. With the implementation of HIT, data warehouses contain petabytes of searchable clinical, outcomes, genomic, and financial data across multiple patient populations. Bringing together this data using sophisticated knowledge analytic tools and domain-specific interfaces allows researchers to discover relationships among multiple variables gleaned from previously unconnected databases.

In turn, this new clinical knowledge enables clinicians to personalize treatment for patients based upon their genetic background by linking it to descriptive patient data and outcomes. Personalized medicine transcends analysis of a population-based cohort by placing the patient within a sub-population that better reflects the expected outcome from a prescribed treatment. Embedding this personalized medicine knowledge within an EMR’s clinical decision support module facilitates the delivery of these evidence-based best practices at the point of care.

Semantic Web

Sophisticated software indexes the databases on metadata that “describe” each data point. Although the indexing allows for rapid retrieval of the data, it more importantly builds links among each data point based upon the descriptive information contained in the metadata. Discovery of these relationships is impossible without semantic web technology and the ability of computers to utilize it to read and understand metadata. Experts can utilize semantic web technology to query multiple large data sets to explore comparative effectiveness hypotheses.

Excerpts from: Web 3.0 Data-Mining for Comparative Effectiveness and CDS. PSQH, September/October 2011

Photo Courtesy of  Don Guerwitz Photography – School Outing. Hanoi, Vietnam

Say No to Paper

July 21, 2011 Health IT, PSQH No Comments
Say No to Paper

Paper came one pill away from killing my 91-year-old mom. Only through luck did we dodge a medical error that could have extinguished a life that survived the Great Depression, World War II, polio epidemics, the birth of two children, the Cold War, the loss of her husband, and more than 60 years of employment. Up until her admission on May 7th, she never experienced being an ill patient in a hospital.

Mom was admitted to a hospital affiliated with her cardiologist located in Westchester, New York, a location close to the home of my sister, a trained endocrinologist with more than 20 years of clinical experience. After treatment for an upper respiratory infection, urinary tract infection, and symptoms of viral pericarditis, Mom was discharged to my sister’s home.

After a week of rest, she returned to Westchester for continued recuperation with my sister. Unfortunately, her condition worsened after a few days, leading her physician to re-admit her to the hospital. At the conclusion of a few days of further tests and treatment, she was transferred to the hospital’s co-located rehabilitation facility for several days to continue her treatments in a less acute care setting. Due to the lack of availability of required therapy over the upcoming Memorial Day weekend, we collectively decided to have Mom discharged to my sister’s home where she could receive better care.

Holiday Weekend Dangers

As Mom suffered from new onset of intermittent atrial fibrillation, the physicians prescribed Pradaxa, an anticoagulation therapy drug that greatly reduces the probability of stroke in patients suffering from atrial fibrillation. The decision to discharge my mom on the Friday before a holiday weekend immediately proved problematic. Pradaxa at the 75 mg dose was unavailable in several pharmacies in the area around the hospital.

Over a 2-hour period, working with a very helpful social worker in the hospital, we convinced the outpatient hospital pharmacy to fill a prescription for the drug. While my sister prepared Mom for discharge, I rushed down to the pharmacy with the paper prescription for 75 mg of Pradaxa. With the prescription bag in hand, I rushed up to meet my mom and sister to help them prepare for discharge.

I handed the prescription to my sister who promptly opened the packaging and looked at the bottle of meds. “This is wrong”, she shouted. “Mom should be on 75 mg not 150 mg.”

Although the prescription was written correctly, the pharmacy dispensed the wrong dose. Knowing my mom had just dodged a potentially fatal medication error, I promptly returned to the pharmacy with the incorrect mediation in hand and explained to the pharmacist what happened. All color left his face as he began to apologize profusely. He just experienced a sentinel event that required immediate and complete reporting.

Anatomy of an Error

Reviewing the sequence of events surrounding the medical error, it becomes clear how it occurred. Although the handwritten prescription was legible and correctly written for 75 mg of Pradaxa, the pharmacist mistakenly selected an unopened, 60 capsule bottle of Pradaxa 150 mg to fill Mom’s prescription. He then placed the medication in a sealed paper bag, attaching the prescription receipt to it. Had the hospital been equipped with ePrescribing and an electronic medication administration system, the system would have immediately alerted the pharmacist of the dosing error. The scanned barcode of the bottle of 150 mg of Pradaxa would not have matched the expected barcode of a bottle of 75 mg capsules.

Going forward I will never allow anyone I know to be treated in a facility that bases its medical care on dangerous paper-based processes. Nor should any American ever be subjected to such inferior care. If we continue our efforts to promote and properly deploy healthcare information technology, this soon will be true.

Excerpts from: Say No to Paper. PSQH, July/ August, 2011

Photo Courtesy of  Don Guerwitz PhotographyGamelan Orchestra. Bali, Indonesia

PMC 2011 – Still On the Road

June 25, 2011 Interests No Comments
PMC 2011 – Still On the Road

Last year was filled with some happiness and some worry. While Beka’s mom is doing great, fighting and so far defeating her non-smoking lung cancer, my mom’s lifelong friend Miriam just began a difficult battle with pancreatic cancer. And a close friend, former rider, and longtime Pan-Massachusetts Challenge (PMC) volunteer escaped a cancer scare with a cure after they removed a small chunk of skin from his chest. For all of these people and many more we do not know, we need to continue our fight to defeat cancer.

It’s been 27 years since cancer took my dad from me. He was such a brave man, always thinking positively and never complaining. A year after his death, in 1985, I rode my first PMC. The August 6-7 PMC is my 27th ride and one I am looking forward to as much as any of them. The PMC is my opportunity to engage in the fight against cancer while honoring my dad. I sure wish he was here to watch.

Over these years, I rode for friends, colleagues, and people I did not know. I hoped to offer them hope and comfort through my connection to the wonderful PMC family. Perhaps the knowledge that over 6,000 riders and volunteers really cared provided them with a bit of help as they went through one more day fighting cancer. This fight will forever be personal. It has touched my family too hard to ever be forgotten.

Thank you for being part of my PMC family and supporting me now and in years past. Without you, this ride is just 193 miles long. With you, it is a crusade, that we are winning, against a disease that hurts too many of us. Please consider boldly investing in the miracles that are unfolding today. Every single dollar (100%) of your PMC donation fights cancer. We raised more than $33,000,000 last year, reaching $303 mil. overall. I think we can do better. Economic times may be tough for us, but times are tougher for those who are fighting cancer. I need you, and those looking for hope need you.

See you on the road.

Barry P. Chaiken

To donate to the PMC, click here

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