HEALTH CARE TECHNOLOGY

At the J.P. Morgan Healthcare Conference in San Francisco, Mr. Andrew Slavitt , acting administrator at the Centers for Medicare & Medicaid Services (CMS), announced on January 11th that �The meaningful use program as it has existed will now effectively be over, and replaced with something better�, and later clarified on Twitter that �In 2016, MU as it has existed-- with MACRA-- will now be effectively over and replaced with something better�. Meaningful Use is dead. Just like that. No apologies. No nothing. As someone who�s been lamenting the havoc wreaked by the program on both doctors and patients, I should be elated nevertheless. Well, I am not. Let�s start with appearances. The J.P. Morgan Healthcare Conference is the �largest and most informative healthcare investment symposium in the industry which brings together global industry leaders, emerging fast-growth companies, innovative technology creators, globally minded service providers, and members of the investment commun...

Click here to view: Reading of the Donald J. Trump children's book by Jimmy Kimmel We don�t win anymore in health care. After repeatedly drilling in our heads that America�s sick care system is a disaster, that those who care for the sick are incompetent and stupid, and that the sick themselves are losers, Meaningful Use was advertised as the means by which technology will make health care great again. The program has been in place for 5 years and the great promise of Meaningful Use is just around the same corner it was back in 2011. The only measurable changes from the pre Meaningful Use era are the billions of dollars subtracted from our treasury and the minutes subtracted from our time with our doctors, balanced only by the expenses added to our medical bills and the misery added to physicians� professional lives. Meaningful Use, a metastasizing web of mandates, regulations, exclusions, incentives and penalties, is conveniently defined in the abstract as a set of indisputably wh...

It was a dark and stormy night. My computer didn�t catch fire while typing the previous sentence. No alarms were triggered warning me about the quality of such opening. I wasn�t prompted to select subjects and predicates from dropdown lists. I typed the entire sentence, letter by letter, not at all dissimilar to its first rendering back in 1830. Computer software in general, and Microsoft Word in particular, magically removed the hassles of quills, ink, paper, blotters, sharpeners, ribbons, whiteout, carbon paper, dictionaries, and all the cumbersome ancillary paraphernalia needed to support authoring, but made no attempt to minimize the cognitive effort associated with writing well.  Authoring great literature today requires as much talent and mastery as it did in the days of Edward Bulwer-Lytton.                               ...

Whenever you read a health care article, paper, book, blog post or even tweet, that substitutes the term consumers for patients, and the term providers for doctors, or physicians, you should inherently assume that the authors are advocating for something that will not benefit you or the people you care for, something that will most likely harm you financially and if you happen to be less than independently wealthy it will harm you physically in real and immediate ways. These advocacy pieces usually come dressed in the sheep clothing of empowerment, liberation, convenience, savings and democratization, but underneath it all, and often unbeknownst to the authors themselves, there is always an ominous incarnation of the wolf of Wall Street. Whenever you read something emanating from selfless, do-gooder (usually public or supposedly not-for-profit, but certainly for-revenue) institutions, alliances, consortia, coalitions, and such, note how you are always addressed in the third-person plur...

In a previous post we explored the doctor-patient relationship, which according to many is an important factor influencing the health care trifecta of quality, outcomes and cost. So far the doctor-patient relationship escaped rigorous quantification, because �relationship� is largely a nostalgic quantity, and because �communications� was deemed to be a reasonable substitute. There are various tools and instruments for subjective measurement of communications with one�s doctor, with the most common being the ubiquitous patient experience survey. However, if we accept a broader definition of the doctor-patient relationship, such as the 6C�s proposed by Dr. Emanuel , a more objective measurement of the relationship seems not only possible, but desirable even for those who may be questioning the value and purpose of quantification in general, and obsessive measurement in particular, present company included. Let�s take the 6C�s from the top, leaving out communications and compassion, whi...

There are three visions of peace in the seemingly never ending, but really rather brief, Israeli-Palestinian perpetual crisis. One peace features two independent countries living in collaborative harmony on a piece of land approximately the size of New Jersey. Another peace yearns for a messianic Jewish state stretching from the blue Mediterranean shores to the Jordan River, and possibly beyond. The third and final peace is expected to materialize after the Zionist entity has been permanently erased from the face of this earth, or at least from the face of that New Jersey size holy piece of land.  Each definition is amenable to slight compromises in form, but not at all in substance. There are three visions for the future of medicine in the seemingly insurmountable, but really rather minor, perpetual health care crisis in America. One future of medicine sees physicians unencumbered by useless administrative tasks, wielding sleek and useful technology tools, offering the best medica...

Much has been written about the Patient Centered Medical Home (PCMH) model of primary care, both complimentary and critical. Most evaluations and opinion pieces refer to the particular PCMH flavor defined by the National Committee for Quality Assurance (NCQA), since this is by far the most widely adopted model, and all other models are just minor variations of the same. Practically all reviews, studies, opinions and assessments pertain to the ability of PCMH practices to improve �quality� measures and generate savings for the system, and in all fairness both evidence and opinions are mixed. One aspect of the PCMH that is rarely discussed, is the cost incurred by the practice for sustaining PCMH operations over time. A new article published in the Annals of Family Medicine estimates ongoing PCMH costs to be approximately $105,000 per physician FTE per year, in personnel costs only. Data was collected through interviews and staff surveys at 20 primary care practices, 8 owned by an acad...