Thursday, May 17, 2012

Atul Gawande addresses ACO formation

The following link is to a lengthy presentation by surgeon and author Atul Gawande which is well worth watching. You may want to skip over the first seven minutes or so which includes the introduction of Dr. Gwande to the audience at Cleveland Clinic.

One hour and one minute into the presentation he responds to a question from the audience regarding the future of healthcare delivery in the United States and says that, in his opinion, the prospect of who is going to lead the way forward is being battled now among three kinds of players. They are the insurers, the physician groups and the hospitals. He believes that it is the physician groups that are most likely to lead in making the changes necessary to address our nation's healthcare needs.

http://www.youtube.com/watch?v=VSWQtOjsiXo

Begin at the one hour mark. Atul Gawande addresses the question of who will lead the way forward and survive in the new policy and market realities.

This post was edited on August 29, 2012.

Transforming sickness care to health care

Rebecca Onie at TEDMED 2012 made the case that college and university students can become organized to make a very significant difference helping link patients with community resources. She concluded saying, "I believe that we all have a vision for health care in this country. I believe that at the end of the day when we measure our health care it will not be by the diseases cured but by the diseases prevented. It will not be by the excellence of our technologies or the sophistication of our specialists but by how rarely we needed them. And most of all, I believe that when we measure health care it will not be by what the system was but by what we chose it to be."

http://www.tedmed.com/videos-info?name=Rebecca_Onie_at_TEDMED_2012&q=updated&year=all

Saturday, May 12, 2012

Publication of avian flu virus research?

CNN reported today that a science journal is poised to publish a study that some experts believe could give a recipe to bioterrorists. This takes the responsibility of peer reviewers to a whole new level.

http://www.cnn.com/2012/05/12/us/journal-avian-flu/index.html?hpt=hp_t1

I don't think such research results should be published. An argument can be made that humanity faces a threat in an "arms race" between human ingenuity and viral adaptations that may cause pandemics. But our existing method of sharing most scientific knowledge through publication does not limit the scope of knowledge distribution. The usual defense of publishing such information is that no bioterrorist is irrational enough to unleash a deadly virus that could destroy the very people whose interests motivate the terrorist. To trust the fate of mankind upon a belief in the sanity and rationality of every potential bioterrorist in the world who may have the skills and resources to design a deadly virus is to trust a very thin thread. Who, if anyone, will be legally responsible if the information published is used by bioterrorists to unleash a pandemic, assuming enough people survive to consider possible litigation?

Saturday, April 28, 2012

Scaling Care through Digital Health Coaching

Dr. Vic Strecher of the University of Michigan addresses the important topic of digital health coaching in the video below. When addressing TEDMED recently he spoke of the potential to create personalized online messages for patients to help then change their health-related behaviors. While this may not qualify as "rocket science" it is huge as our nation's healthcare delivery system becomes increasignly financed by capitation and as we try to scale up delivery of services to larger numbers of people. The bottom line in the presentation is that people are more likely to pay attention to (and act upon) highly personalized messages even if those messages were in fact computer-generated.



Additional information about Dr. Strecher is available here. http://www.ur.umich.edu/update/archives/100122/innovator

Sunday, April 15, 2012

Forgiveness, Trust and a Culture of Quality

In this video presentation, Paul F. Levy, recent CEO for the Beth Israel Deaconess Medical Center in Boston, makes a case for forgiveness in the culture of a medical institution striving for quality care. I suppose that to somehow punish a physician or other care provider for a serious mistake may be safe behavior for an administrator. People tend to admire active administrators who can make decisive decisions. But the quality of the services provided by a caregiver is more evident in the pattern of his or her work than in the exception. Physicians tend not to identify the mistakes and near-misses of others, realizing that they each are imperfect and may someday make a mistake. A culture of punishment does not promote a culture of trust, which is necessary to create continual learning and improvement.

Thursday, April 5, 2012

From social networks to social robots

At her recent TED Talk Sherry Turkle describes how she believes our electronic social and communication devices are becoming problems as we try to substitute connections for real relationships. About half way through her presentation she refers to the use of social robots in a nursing home.



I have not yet digested the relevance of her thoughts to health and administration. But I wonder if the connection (no pun intended) may be to the notion of, "patient centered care." Medical care is now team-based and individual patients sail through an entire trajectory of teams in an episode of acute care. Sooner or later someone will probably invent some charming robot that patients can carry with them through the experience and perhaps even carry home with them. It will be programmed to help the patient understand what is happening to them now and why. It may even become the repository of some data useful to medical caregivers along the way and may monitor the patient's vital signs. Those of us who remember the joys of early social technology in the era when Turkle wrote her book Life on the Screen remember fascination with live online communications. The very idea that a computer could reproduce the sound of a baby's cry or the gesture of person on the other side of the earth was exciting.

Now I observe my students who almost always have their mobile telephones in hand. I share a concern that we may be losing more than we are gaining. If someday I slowly walk or roll the corridors of a nursing home I want good meals and broadband internet access! But I hope for myself and others for more than a cute robot to talk to as I reflect upon life and circumstances. The healthcare delivery system is not friendship service. But I do believe that "patient centered" is about being person centered and that we may have used the phrase, "patient centered" to gloss a dimension that cannot scale through technology or process design.

Friday, March 9, 2012

Digital records and costs

An article in The New York Times by Steve Lohr published March 5, 2012 reports on a study using existing data that concluded that availability of digital records may not cut health costs. Someone expressed doubt in the findings because they were based on correlations in existing data rather than a controlled test intended to test the hypothesis regarding electronic records and costs.

http://www.nytimes.com/2012/03/06/business/digital-records-may-not-cut-health-costs-study-cautions.html?_r=1

In my opinion, not every study requires a method like that of a clinical trial and it is both valid and cost-effective to make use of existing data in responsible ways. Correlation certainly does not prove causality, of course. But I believe the discovery of interesting correlations resulting from hypothesis-based research can be worthy of the attention of professionals. I am not advocating for just mindlessly searching available data for any possible relationship among variables and then pretending to have completed disciplined research.

It is reasonable to anticipate that computerized medical offices have the potential to both save money (by reducing the need for repetition of tests already taken) and to spend additional money as the availability of data stored in electronic records drives the propensity of physicians and patients to want still more data. The new iPad 3 with its high resolution screen is likely to push the, "let's get more images" propensity further. Medical providers want to do what is possible and the availability of higher-quality data easily accessible extends what is possible.

Wednesday, February 8, 2012

Using multimedia in personalized health education

In the following TEDMED video Alexander Tsiaras, Founder of The Visual MD, discusses and demonstrates how multimedia can be used to make a patient's lab report come alive to the patient in ways that plain text cannot.

The leadership challenges of transformation

Dr. Ricardo Azziz, President of Georgia Health Sciences University (GHSU) and CEO of Georgia Health Sciences Health System, has made a blog post dated February 4, 2012 regarding the consolidation of GHSU and Augusta State University.

http://azziz.georgiahealth.edu/archives/406

The decision by the Board of Regents of the University System of Georgia will surely test the leadership of both those at Augusta State University and Georgia Health Sciences University. Twenty-five years from now I doubt anyone will credit or fault the Regents' decision based on levels of spending for higher education in Georgia. The consolidations will be judged by whether or not campus administrators and others found synergies in new realities.

From what I can observe as a student the leaders of both insitutions are accepting the new reality as opportunity. I think Dr. Azziz' blog post sets the right tone. He and others worked very hard to implement the institutional name change of GHSU to emphasize the mission of the historic institution. Now he is accepting the leadership challenge of adapting his vision to the new opportunity. The entire field of higher education in the United States is in transition and the need for adaptive leadership is everywhere. I appreciate Dr. Azziz for his leadership and his willingness to share his concerns and hopes through his blog and by other means. This is not just about the metropolitan Augusta area. The implications of this particular decision by the Regents regard the entire state of Georgia and beyond because of the scope of medical education and patient services provided by Georgia Health Sciences University and Georgia Health Sciences Health System.

Friday, January 20, 2012

Nanotechnology to the rescue?

Ray Kurzweil offers an exciting vision of the future and we learn to engineer alternative biological structures at the molecular level. Think how "positively disruptive" such abilities may be to our existing medical care systems.

The promise and challenges or more personalized medical interventions

In this video Ger Brophy highlights exciting opportunities to improve medical care for individuals and possibly reduce aggregate costs. Success will require a combination of advancements in medical knowledge and advancements in information technologies.

Friday, January 13, 2012

Merger of GHSU and Augusta State University in Georgia

It was recently reported in The New York Times that several pairs of colleges and universities in the University System of Georgia are being merged, including Georgia Health Sciences University (GHSU) and Augusta State University (ASU).

http://thechoice.blogs.nytimes.com/2012/01/11/georgia-university-merge/

I earned the MBA at Augusta State University years ago and am presently a student in the Master of Health Informatics degree program at GHSU. I think two valid reasons to merge institutions are the benefits of synergy and the possible savings of money. Higher education is costly and the desire to reduce costs is understandable. My guess is that the motivation of the Regents for this merger is primarily based upon an anticipation of cost savings. Synergy can be achieved through shared services and cooperation among institutions.

It seems to me that mergers are more likely to be successful if the missions of two institutions are similar. Given that educational services are increasingly being delivered virtually (online), perhaps decisions about mergers should be based upon mission statements rather than geography. And, in any case, I wonder about the hope for cost savings. The resulting complexity of merged institutions may in fact lead to more costly operations. If institutions with different missions are merged, costs may actually increase while the focus of the institutions may be diffused.

In my experiences, both Augusta State University and Georgia Health Sciences University are good and valuable institutions. ASU is more a general-purpose state university, offering a wide variety of kinds of degrees. Augusta, Georgia is certainly large enough to need and merit such an institution. GHSU is, of course, focused on medicine and the administration of health care institutions. There are a number of valuable state universities in the Georgia system similar in mission to ASU. GHSU is a more specialized institution and is already complex in its administrative structures. There is going to be a period of adjustments and transitions resulting from the merger. I wonder if in the short term the quality of health care delivery in the state of Georgia and beyond may be affected while attention is diverted to some degree from mission to adjustment at both existing institutions.

In the long run, is the ASU campus going to become medically oriented throughout its existing degree programs and research? Is GHSU going to become less focused on medicine and healthcare administration? Or will the two institutions each remain pretty much as they are but operate under a single (highly stretched) administration? For starters, there is going to be a struggle to decide who who stays and who leaves among the administrative ranks. And what will the new entity be named? Will selected programs be merged at the college and departmental levels? GHSU just went through the process of changing its name from the former name, "Medical College of Georgia." The new name is intended to emphasize the mission and focus of the University. As a citizen of Georgia my major immediate concern regarding this merger is the continued quality of medical education and the continued quality of medical care. I wonder if in fact any cost savings will be realized by this merger and if the possible synergies might have be realized through the sharing of services rather than merger.

Tuesday, January 10, 2012

Financial challenges of private practice

I am posting this hoping that it will spark some interest and conversation in the foundations of healthcare administration course I am teaching this spring semester.

http://money.cnn.com/galleries/2012/smallbusiness/1201/gallery.doctors-broke/index.html

First responders risk lives solving health hazard mystery in Phoenix, Arizona

I am thankful to Chuck Mitchell, Chairman of the Dougherty Georgia County LEPC for distributing information about this video regarding the potential hazards of storage containers of liquid CO2 and the challenges faced by first responders.

Wednesday, January 4, 2012

Smarter than the average pixel?

What I understand of this TEDMED presentation by Dr. Eric Schadt is that it is not adequate to try to understand complex systems using simple linear thought (unless, of course, you are running for high political office). The part I am struggling to understand regards the idea that the causation of disease cannot be determined by studying populations of people and using statistical methods of analysis. Isn't epidemiology based on the notion that aggregate research designs can lead to insights into the causations of diseases in populations? And if an independent variable is important in the aggregate explanation for a disease or condition, isn't it likely to be important in the understanding of specific cases? It might be helpful to me to hear Dr. Schadt engage in a conversation with an epidemiologist about patterns of medical causations in individuals and populations.



It is the metaphor of the movie and the "average pixel" that I have not yet understood. Yes, there is no perfectly "average" patient. A specific instance of a disease or condition may be unique in causal origin. But I want to believe that understanding the health of populations sheds light on understanding the likely causes of instances of diseases/conditions. Patterns in complex systems are usually fractal in nature, meaning that the same patterns are evident at multiple scales. Perhaps I am trying to think too deeply about this or am simply missing some essential insight. Reader, I would welcome your comment that could shed some light.