Friday, August 29, 2014

What can we learn from Robin Williams in life and in Healthcare

Like many people the death of Robin Williams

was sad on so many levels and while my connection with him was limited to the exposure I had through his canvas of work, I like others felt I knew him.

He was not only prolific in his work with a list of films, interviews and shows (and if you have NetFlix - here's all the movies available there), but could often be found adding color and charisma in the most unusual places - in this story related by Christopher Reeve talking about his friendship as they walked past a lobster tank in a restaurant
One evening we went out to a local seafood restaurant, and as we passed by the lobster tank I casually wondered what they were all thinking in there. Whereupon Robin launched into a fifteen-minute routine: one lobster had escaped and was seen on the highway with his claw out holding a sign that said, ‘Maine.’ Another lobster from Brooklyn was saying, ‘C’mon, just take da rubber bands off,’ gearing up for a fight. A gay lobster wanted to redecorate the tank. People at nearby tables soon gave up any pretense of trying not to listen, and I had to massage my cheeks because my face hurt so much from laughing.”

Bet you wish you had been there to listen in!

The outpouring of grief, sadness and accolades was no surprise and while he may not be everyone’s favorite actor or character it is hard to imagine people feeling dislike for him.

He was a serious actor who’s work included playing characters with flaws
Good Will Hunting
Insomnia


And a personal Favorite (for the teacher we all wanted to have - Captain, My Captain)
The Dead Poet’s Society

But is best known for his comedic genius and unstoppable energy that could light up any room or interaction and turn even the most somber of moods into smiles and laughter

And his comedic view of what Lobsters were thinking in a tank as he demonstrated when he visited his longtime friend Christopher Reeve and making him smile for the first time after his accident
“As the day of the operation drew closer, it became more and more painful and frightening to contemplate,” wrote Reeve. “In spite of efforts to protect me from the truth, I already knew that I had only a fifty-fifty chance of surviving the surgery. I lay on my back, frozen, unable to avoid thinking the darkest thoughts. Then, at an especially bleak moment, the door flew open and in hurried a squat fellow with a blue scrub hat and a yellow surgical gown and glasses, speaking in a Russian accent. He announced that he was my proctologist, and that he had to examine me immediately. My first reaction was that either I was on way too many drugs or I was in fact brain damaged. But it was Robin Williams. He and his wife, Marsha, had materialized from who knows where. And for the first time since the accident, I laughed. My old friend had helped me know that somehow I was going to be okay.”
The friend we all want to have...?

With that in mind it can be hard to reconcile that character with someone who would take his own life:
  • How is it possible that someone with what appeared to be so much joy and happiness who was surrounded by friends and family find themselves in such a state of despair to take an irreversible path and commit suicide?
  • How is it possible that someone who outwardly seemed to have such a sharp insight into people and laughter who could make us all laugh at the most unlikely of issues or discussions could take his own life?
  • How is it possible that someone with such a storied and successful career could drop into a state of depression with so much to live for and so many people who loved him and end his own life?
  • How is it possible that a smart, intelligent and gifted individual with so many positive aspects to his life could see no alternative to ending his life and commit suicide?

We can be surrounded by people but be all alone


In what seems eerily insightful he talked about this in his “report to Orson” in the show Mork and Mindy in 1981 where Mork meets a famous celebrity (in this case it the famous celebrity is Robin Williams): “Mork Meets Robin Williams”. You can watch part of it here
Mork learns about the nature of fame on Earth and the toll it takes on those who get swept up in it, or try this link

There has been some mention of Parkinson’s Disease and this may have had a contributing role. But the underlying challenge was his battle with depression. On many occasions he had shared his struggle with depression and substance abuse and the ongoing challenge he personally faced dealing with his disease.

The word depression is used frequently by people to describe their feelings and emotions but it has a very specific meaning in medicine and is used to describe a mood disorder:

Clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for a longer period of time.

Not to be confused with sadness which is a temporary feeling that is normally associated with some negative aspect of our lives or surroundings and passes

Our understanding of depression is still limited – our treatment of this disease is still in its infancy and mostly limited to broad-brush therapies that impact neurotransmitters that are implicated but not exclusively associated with depression. We have (mostly) moved past separating and isolating people from the general population (although some would argue that our prison system is the new version of the sanatorium). But our ability to treat or cure depression remains stubbornly missing.

Our understanding of the brain is limited and despite laudable attempts to jumpstart the process
The NIH BRAIN Initiative progress however remains frustratingly slow and leaves our society with a subset of the population suffering from varying degrees of debilitating diseases of our brain including depression, mania and schizophrenia and many others.

So what did Robin Williams teach us in Life

Laughter is the best medicine

It is hard to pick a single moment from his incredible repertoire, so I picked 3:
Mrs Doubtfire
Explaining Golf
 Or this medley tour of cultures and accents all done in less than 2 minutes
Laugh and laugh loudly

Being different is not just OK its what makes life worth living




Endless compassion



and the real Patch Adams


What did Robin Williams Teach us in Death


We need empathy, compassion and tolerance in our society
Empathy: The Human Connection to Patient Care

Social Media can help link people but even with these digital connections humans may still feel disconnected and alone despite outward appearances to the contrary and connecting, engaging and reaching out is even more important today in our “connected” world



Suicide is painful – not only for the unnecessary loss of life but for the trail of despair it leaves behind for all the people wondering
what if....
should have....
could have done….

I’ve experienced it with friends and still think about them. In fact I was reminded when I read about two more suicides in New York: Suicides At NYU And New York Presbyterian–2 Physician Interns Jumped To Their Deaths of two promising lives brought to a final and sad end.

Don’t let that be your legacy and reach out to someone today and remind them and yourself why life is great for both of you


Thursday, August 14, 2014

Speech and the Digital healthcare Revolution at #SpeechTek

Come join me in the conversation with my colleagues at the SpeechTek 2014 conference in Marriott Hotel in Time Square, Manhattan New York.

The Panel: C103 – PANEL: The Digital Healthcare Revolution at 1:15 p.m - 2:00 p.m. The panel moderator Bruce Pollock, Vice-President, Strategic Growth and Planning at West Interactive and on Social Media @brucepollock

I will be joined by Daniel Padgett, Director, Voice User Experience at Walgreens and on Social Media at @d_padgett and David Claiborn, Director of Service Experience Innovation at United Health Group.

We will be discussing the opportunities and challenges associated with the current digital healthcare revolution and of course how speech plays an essential role in integrating this technology while maintaining the human component of medicine that we all want. Rather than Neglecting the patient in the era of health IT and EMR

We have progressed from the world of Sir Lancelot Spratt


And the Doctor need to look at the patient not the technology perhaps in a cooperative Digital Health world like this



Is this future of Virtual Assistant Interaction good, desirable

Demo Video 140422 from Geppetto Avatars on Vimeo.

We will be discussing

  • What are the biggest obstacles to digital healthcare becoming a reality?
  • Where do speech technologies bring the most value to healthcare?
  • How will health providers, insurers, and payers provide patient support in the world of digital healthcare?


Perhaps the emerging Glass concepts improve this interaction as they are exploring in Seattle

Join us for analysis of the state of digital healthcare today and predictions for its future.

In the end

People forget what you said and what you did but they remember how you made them feel

Come join the discussion as we explore the digital technology and how it should be used in healthcare and how speech can help

Friday, July 18, 2014

Wearable Technology - An Exploding Segment

I attended a Wearble Technology conference today in Pasadena California: Wearable Tech LA

There was a wide range of technologies and innovations - everything from the mind monitoring by IntraXon’sMuse headband. Here’s their online demo video


One of the more interesting concepts takes the challenge we have all faced mastering the mechanics of walking, exercise, running and in some cases rehabilitation by placing sensors in the sole of shoes - Plantiga who have taken force analysis for our feet to a whole new level

The technology takes the static Force Plate sensor and turns into a continuous assessment 3-D tool offering an opportunity to apply this in specific sports and to help rehabilitate people who have been injured or have mechanical challenges (the side effect of capturing all this data is actually creating more comfortable shoes as they now have built in suspension and springs).
Better than this concept!

It might take a while to arrive in healthcare but in the meantime may well show up as another input device for the X-box or PS3 for a more realistic interface.

There was sensors to be placed all over the body for respiration, heart rate, muscle movement, acceleration/deceleration and even some to be ingested

A major challenge highlighted by several speakers facing all of the wearables genre was the issue of battery life
(and ironically it was the same problem I faced as I tried to capture and post social media)

The opening keynote was from Nadeem Kassam - CEO of BioBeats (Founder of Basis which is now an Intel company). His journey was one of classic rise from poor neighborhood in South Africa where he started his entrepreneur sporty selling oranges

He focused on three lessons - the first an essential learning point for everyone especially those facing healthcare challenges
Nothing is stronger than habit

He also suggested that those looking to succeed with innovation should:

  • Look for innovation outside of your industry, and
  • Don’t throw a big team or money at innovation

His story behind this was a classic one of engineers told to build a product who came back with his wearable watch that was a huge device that weighed down his arm and had a velcro battery pack under the arm!


He ended up finding his greatest engineers on Craigslist who’s references and Resume was a cardboard box full of devices that he had built.

The new concept of “Adaptive Media” which is bridging the divide between human emotion, data and the media we consume and should adapt to our mood based on our emotion. His new company has done some interesting research programs including an experiment with machines designed to allow people to hear their own heartbeat and have it set to music in Australia. When people heard their heartbeat for the first time it created a deeply emotional experience and many were moved to share very personal life stories.

They took this a step further and worked to gather heartbeats worldwide - a clever BIGData gathering exercise that amassed large quantities of rate, rhythm and details of millions of people around the world.


His overriding point was

We have to make health fun and engaging - merging it with entertainment to help people achieve what we all want - long tail of healthy life

There was a fascinating blend of the Entertainment industry and Hollywood and a slew of companies taking different approaches to these devices:

Epihany Eyewear tries to make wearables fashionable as well as functional (I’d say it not so much as fashion but blending into society)
















Optivent with  powerful wearable glass - but no mention of the interface
They probably had the most fun concept video

Les lunettes d’Optinvent voient plus grand que les Google glass from Rennes, Ville et M├ętropole on Vimeo.

Enlightened design had the most impressive on stage display with a jacket that had lapels that constantly changing color

Janet Hansen - Founder & Chief Fashion Engineer, Enlightened Designs
Sporting her jacket with lapels that constantly changed color


Sports and Wearable


Given the excitement over the last month wight he World Cup it was fascinating to hear from Stacey Burr from Adidas who revealed that most if not all the teams were using technology to help them train and track in extensive detail - she suggested that there is not a single team or sport that is not using wearable technology in some form or another.

You can see some of the gear below
GPS enabled ECG/EKG monitoring Units plug into the back around the neck area


Paired with watches to offer players feedback


Digital insides of a ball used to sense how well it is struck














These are the professional versions used by major teams but Adidas is releasing commercial versions that will be available to the general public but lack the GPS capability and the analysis tools they offer

Surprisingly the leaders from a sports and country standpoint are Rugby and Australia and New Zealand who are "light years ahead" of wearable tech in sports
They are ahead in Psyching out their opponents too!


Sensoria demonstrated an exciting interactive future for sports and wearables where we challenge ourselves, other people and are coached by virtual assistants


Sensoria Fitness Shirt with Heart Rate Sensors from Heapsylon on Vimeo.

One of the highlights:Seeing Dick Fosbury of the "Fosbury Flop” Olympic Gold Medal Winner from Mexico 1968 and it turns out he is a Cancer Survivor, has an aneurysm and fully engaged in the intersection between healthcare and wearable technology

Neil Harbisson - Co-Founder, Cyborg Foundation


who was born totally color blind was definitely at the edge of wearable technology. He has an implanted device that turns color into sound and this is directly fed into his brain. He described that it took 5 weeks for the headaches to stop with this sudden input of data and then 5 months before it just became part of him and he now sees in color.
Here's his TED Talk: I listen in Color

He also has a permanent internet connection in his brain so people cane send him colors and images directly (he joked the address is private - but I did wonder given the ease with which spammers seem to find new addresses how he protects this destination from spam!)
I don't wear technology I am technology, I can't tell the difference between the software & my brain

The healthcare focused panel: Emerging Wearable 2.0 Health Platforms:

The furthest along and well know was probably Misfit wearables (Sonny Vu, CEO) who try and make sensors “disappear” but still simple sensors

OMSignal (Jesse Slade Shantz - Chief Medical Officer) was the most interesting as they are trying to change the monitoring from attached sensors to using fabric that can be loose fitting but can capture physiological information.

Breathometer (Charles Michael Yim - CEO) focus on analyzing your breath and have a range of products directed at health (over and above their simplistic alcohol breathalyzer available today) that assessed fat burning (using acetone) and asthma

NeuroSky (Stanley Yang - CEO) offer a system that other manufacturers can integrate into their wearables. Typically found in mobile phones or headsets

LUMO (Monisha Perkash - CEO & Co-founder) offering a discreet sensor that is designed to help improve your body posture and works as a tracker.

It's an exciting future with some fascinating technology to come - one thing for sure - with ubiquitous technology comes ubiquitous complexity and your voice will become an essential tool for successfully managing and navigating. Dragon Assisatnt is one of several tools built to assist in using and navigating technology that is reinventing the relationship between people and technology


Friday, June 27, 2014

Health Insurance Reform - It's Not a Bumper to Bumper Warranty

We have some Healthcare reform in the US but we are still challenged with a system that is failing to deliver results. This piece recently: America Ranks No. 1 for Over-Priced, Inefficient Health Care featured the chart from the Commonwealth fund

That ranks the US last in a group of 11 industrialized countries.

As he puts it:
There is one way America is clearly exceptional:  we have a healthcare system that is dramatically more expensive than the rest of the industrialized world, but it doesn’t manage to make us any healthier.While  the Affordable Care Act attempts to address access it does little to address the cost of the system and the inefficiencies. This does not require a reduction in premiums it needs to address the costs built in to the system that we are all paying for in on form or another

Dr Hans Duvefelt wrote this piece on the healthcare blog: A Swedish Country Doctor’s Proposal for Health Insurance Reform that draws on his personal experience in "socialized medicine, student health, cash-only practices and government-sponsored rural health clinic working for an underserved, underinsured rural population."

His focus is as a primary care physician but most would agree this is one of the most challenging areas for reform with the shortage in clinicians and low reimbursement rates that is driving doctors out and certainly no encouraging our new generating of clinicians to dive into this essential area.

His main proposals center on basic services that are covered by a flat rate for populations

  • Have the insurance company provide a flat rate in the $500/year range to patients’ freely chosen Primary Care Provider, similar to membership fees in Direct Care Medical Practices.
  • Provide a prepaid card for basic healthcare, free from billing expenses and administration.

but importantly changing the responsibility and feedback on the cost from a central purchasing authority (the government for example) to the user themselves.

  • Unused balances can be rolled over to the following years, letting patients “save” money to cover copays for future elective procedures.

And offers a pathway to specialty care with some appropriate oversight and appriroate levels of reimbursement.

  • Keep prior authorizations for big-ticket items, both testing and procedures, if necessary for the health of the system.
  • Keep specialty care fee-for-service.

 These are clever suggestions and would do much to encourage the patient engagement that will be, as Leonard Kish stated

Patient Engagement is the  Blockbuster drug of the century


He rightly points out that the current health “insurance” products are often poorly named - given that insurance that pays and copiers to identify diseases with screening but then stops short of paying to treat conditions and diseases when they are found through that screening. But most of all Insurance should be user driven and priorities and decision left in the hands of the individual and their clinician and not relegated to others who sit in offices emoted from clinical practice and focused on fiscal drivers not on care and quality fo life

Health insurance is not like anything else we call insurance; all other insurance products cover the unexpected and not the expected. Most people never collect on their homeowners’ insurance, and most people never total their car. Health insurance, on the other hand, is expected by many to be like a bumper-to-bumper warranty that insulates us from every misfortune or inconvenience by covering everything from the smallest and most mundane to the most catastrophic or esoteric.

His point about setting of priorities is important - no matter how you cut it there is no unlimited pot of money o resources to treat everything and everybody. These are difficult conversation and ripe for abuse by those with their own agenda’s through fear mongering and use of emotive terms like “Death Panels”.

None of this aspect of reform is simple but it needs to be addressed and included.

The United Kingdom’s National Health Service (NHS) may not be perfect but they have started this process of addressing the challenge of allocating resources in an open manner. They developed the the quality-adjusted life years measurement (QALY) out of the National Institute for Health and Care Excellence (NICE). There has been criticism and push back as there will always be but the concept and methodology use is not limited to the UK. While imperfect as Laozi (c 604 bc - c 531 bc) stated:
A journey of a thousand miles begins with a single step



There is lots of detail in this piece and I would encourage you to go over and read it

Tuesday, June 17, 2014

We Must All be Engaged in the Design, Delivery, and Re-imagination of Healthcare

Previously posted on HITConsultant

On a recent flight, I had my headphones on and the Rolling Stones’ “Satisfaction”

began to play.

It’s a song I have heard hundreds of times over the years, but I was struck by the difference listening to it with headphones made. With no distractions, I noticed the bass line, in time with the percussion, provides the perfect offset to Mick Jagger’s distinctively strained voice. It was a completely different experience than hearing the track play in the background of a movie or while at a restaurant. Being fully-immersed and listening only to that song allowed me to pick out and appreciate subtle details I had never noticed previously. It’s no surprise that things sound differently when you’re able to concentrate your full attention on what is being said, but as I was sitting there, I became acutely aware of the function headphones serve—they enable the wearer to listen, blocking out distractions.

That is exactly what we are seeking in healthcare and it has proven to be difficult to achieve – in part because of pace, complexity of care, and technology. For centuries, physicians have listened to their patients and relied on their senses— their powers of observation— and matched these insights with clinical experience to heal. Clinicians need to be able to listen and concentrate on what their patient is telling them and noticing those distinctive symptoms he or she may be exhibiting. As Sir William Osler



famously advised:

“Listen to your patient, he is telling you the diagnosis.”

Being able to dedicate your undivided attention to anything these days is a rarity, but in healthcare, it is a crucial but frequently missing element. The last thing you want to feel when you are at your most vulnerable is that your physician is multi-tasking. Patient satisfaction scores will suffer, but more concerning are the clinical risks and missed opportunities of distracted physicians.

Distracted clinicians are the result of what Dr. Steven Stack of the American Medical Association refers to as an “over-designed” health IT system.” In a recent discussion with industry leaders, he explained that we seem to have become victims of our own ambition. We have devised structures that don’t work for everyone and policies that create very real, very expensive consequences for those who don’t abide. And this has left physicians stretched too thin, trying to do more in less time without any direct impact on improving their ability to care for their patients.

So, maybe it’s time we scale back. Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center and co-chair of the nation HIT Standards Committee, noted that while we are in this period of transition and growth, we need to focus on parsimony, or determining the smallest number of moving parts that need to be adjusted in order to create seamlessness in HIT. Quite simply put, while the cart has been upset, there is no reason to trample all over the apples.

The MIT Technology Review recently interviewed Sarah Lewis, a doctoral candidate at Yale, about her recent book that explores how different unlikely circumstances or paths, like failure, have often spurred innovation. Citing creative geniuses such as Cezanne and Beethoven to Nobel laureates, she defines failure as the gap between where one is and where one would like to be. Confronting this gap, she asserts, is important because it “lets people go deep with their failure while letting it be an entrepreneurial endeavor if they like, or an innovative discovery.” We, in health IT, are currently at that gap where there is a disparity between where we are and where we would like to be.

The recent ICD-10 delay has provided the perfect opportunity for us to find Halamka’s parsimony, leveraging solutions that work for physicians and creating consistency and impact wherever possible. Like medicine itself, there will be no one perfect solution for every physician or organization, but we need to begin finding things that work – from re-skinning EHRs with easy to use tools like single sign-on or mobility to systems that respond to voice, touch or swipe to improve the experience for clinicians and patients. We need to start thinking of health IT more like headphones, coming in different styles to suit preferences, but providing the same function of reducing distraction and enabling the clinician to focus on the inflections in their patients’ voices, and truly hearing what is being said.

As Mick Jagger poignantly remarked, “The past is a great place and I don’t want to erase it … but I don’t want to be its prisoner, either.” We have accomplished a lot, but it is time to learn from the past and break free from what isn’t working. I think we can get health IT satisfaction (despite what the song says), but to do so we must all be engaged in the design, delivery, and re-imagination of healthcare and its intersection with technology. This truly is the art of medicine and we are all virtuosos contributing to the next masterpiece of healthcare.

Tuesday, May 27, 2014

Getting Value from the EHR - Yes it is Possible

I have the privilege of spending a lot of time on the road interacting with clinicians around the country (and world). I hear with too much frequency many doctors complaining about the Electronic Medical Record and how it fails to help them and in many cases makes their work harder. Some of this is a hangover from the past and the inadequate technology and in some cases hardware at the time
In fact I’ve told this story a number of times that I can date to around 1995/6 and in this piece: Clinical documentation in the EHR
Many years ago, an excited friend who worked for one of the electronic health record (EHR) vendors at that time — it was really more of a billing and patient tracking and management system than an EHR — was desperate to show me some of their latest applications. In particular, a new module they had developed to capture clinical data.
My friend pulled out his laptop, fired up the application, selected a patient and proceeded to enter blood pressure (BP). Some 20-plus clicks later, he had entered a BP of 120/80. While he was excited, I was dumbfounded. When it comes to patient care, doctors didn’t have time for 20 clicks to record BP years ago and they definitely don’t have that luxury in today’s demanding medical environment.
There is still some of that going on and not enough focus on the User Interface design and turning the technology into a barrier - this is the focus of the Art of Medicine campaign we launched some weeks ago



This article on Government HealthIT Are electronic health records already too cluttered? highlights a rising problem and one I hear about frequently. This is not just a healthcare problem and it is the focus of the work by Edward Tufte an American statistician and professor emeritus of political science, statistics, and computer science at Yale University who is well known for his books on information design which are bets acquired by attending one of his frequent courses on data visualization
Here is a recent overview of visualization on the iPhone



He has a section on healthcare but many of his principles apply

For Brian Jacobs the problem was even more acute working in a Pediatric ICU:
The ICU is a very toxic and tech-laden environment….because of that, it offers the opportunity to make a lot of mistakes
As he points out much of the cutter derives form the multiple notes entered into the EHR every day. "It’s not uncommon in teaching hospitals to have six to seven notes per day on one patient, by the time the attending physician, residents, consultants, other doctors and fellows check on the patient."
So they instituted a policy of One Note per day

Actually its
It’s actually one note per team per patient per day; one giant multi-contributor note. They still may be all writing their components, but it’s one note
With a template to hold the content generated each morning by the resident and then everyone contributing to that one note, adding and amending as necessary

So in addressing the issue clutter they also addressed usability and design turning the note into a living breathing document that is updated and maintained by the team that now takes care of patients
But he addressed some other important issues - especially when it comes to quality of care and the quality of the medical note

Copy Forward is subject to some warranted scrutiny from a billing and audit standpoint. Much of the repetitive and “clutter” in the note comes form the copying forward of past information. But:
These notes should never be the same
And as part of that message they moved to an "End-of-day note” that was a fresh summary of the patient.
Add to that an updated and well maintained Problem List and integration with the billing system to allow doctors to select their code for the work carried out that day and they moved to a valuable addition to the healthcare team in delivering quality healthcare with their EHR
EHRs are: more complete, legible, accessible and can be auto-populated and searched. They can provide diagnosis codes and they’re good for billing. On the other hand, they can sometimes lack quality information and are by far, too cluttered.
I said this back in 2003 (yikes!) - The Future of Technology is already here - Who’s on Board the train and who’s left at the station. I still believe it and understand that the technology does need to get better and be more integrated into the existing workflow

The next generation of health care technology is here, with visionaries and futurists pushing the envelope to enhance, create and generate the newest cutting edge in health care delivery. Advances in technology, like advances in medicine, are a shared entity that enhances life expectancy and the quality of life.

Wednesday, May 7, 2014

Patients Prefer Electronic Documentation

Software Advice recently published this survey: Do Patients Really Care if You Use Your EHR in the Exam Room? It was very revealing! It turns out contrary to the perception that the intrusion of EMR’s in the office patients prefer electronic documentation to alternatives
Most Patients Don’t Mind Electronic Note-Taking During Exams
In each case, more than 80 percent of respondents indicated they would not be bothered. On a sliding scale, patients indicated the least concern for doctors using tablets during the exam.



What was more surprising was the push back by patients on having scribes



But worst of all - recording devices



Ultimately, over one-third of patients said they’d be bothered by doctors using tape recorders to assist in charting medical notes. Specifically, patients at the furthest end of the spectrum—those who chose “would bother me a lot”—were more prevalent when it came to tape recordings than with any other method of charting during an exam.



There was a big preference to Electronic documentation at the point of care




They asked about reasons for dissatisfaction

Its not the technology that causes the dissatisfaction but in order of importance (for patients)

  • long wait times at the doctor’s office,
  • unfriendly staff
  • short duration of visits with the doctor
  • Trouble Scheduling Appointment

And coming in with a sliver of dissatisfaction at 5% “Doctor using a Computer in the exam room"






Monday, April 21, 2014

How Americans Die

How Americans Die
This is a fantastic visual presentation of data that you can look at in more detail on the Bloomberg Site
Error: Embedded data could not be displayed.
If the embedded page does not work head over there directly here


The main points highlighted
  • The mortality rate fell by about 17 percent from 1968 through 2010, years for which we have detailed data...Almost all of this improvement can be attributed to improved survival prospects for males
  • The surge in for 25- to 44-year-olds was caused by AIDS, which at its peak, killed more than 40,000 Americans a year (more than 30,000 of whom were 25 to 44 years old)
  • AIDS was the single biggest killer of Americans who should otherwise have been in the prime of their lives (Sobering Statistic)
  • 45- to 54-year-olds are less likely to die from disease, they have become much more likely to commit suicide or die from drugs
  • How does suicide and drugs compare to other violent deaths across the population? Far greater than firearm related deaths, and on the rise. (Suicide and has recently become the number one violent cause of death) - (Sad Statistic)
  • The downside of living longer is that it dramatically increases the odds of getting dementia or Alzheimer's
  • The rise of Alzheimer's and other forms of dementia has had a big impact on health-care costs because these diseases kill their victims slowly. About 40 percent of the total increase in Medicare spending since 2011 can be attributed to greater spending on Alzheimer's treatment

They do a great job of slicing the data by cohorts of age groups showing how much we have improved mortality and how our 25 and under age group is benefiting from the health improvements with the lower mortality and higher life expectancy than any other cohrot

Friday, April 18, 2014

Giving Personal Health Advice to Family and Friends

In an interesting post on the medscape site (subscription/registration probably required): The Pitfalls of Giving Free Advice to Family and Friends Shelly Reese described some of the challenges of giving medical advice

to friends and family (even if you are a wannabe Dr Phil).

As she puts it the path can sometimes lead to challenging areas of ethics and professional boundaries.
How do you address or deflect such requests? Unfortunately, there are no easy answers. It depends a lot on you, your boundaries, and the situation.
And she links to the AMA Guidelines
The American Medical Association (AMA) Code of Medical Ethics is clear, however: "Physicians generally should not treat themselves or members of their immediate families."[1] The statement goes on to provide an extensive list of good reasons why, including personal feelings that may unduly influence medical judgment, difficulty discussing sensitive topics during a medical history, and concerns over patient autonomy (Ref: American Medical Association. Code of Medical Ethics Opinion 8.19: Self-treatment or treatment of immediate family members. Issued June 1993.)
Some of the challenges of simple advice include

  • Escalation to more complex or persistent advice 
  • Long distance diagnosis with missing data
  • Lack of Doctor/Patient relationship and documentation
  • Litigation
  • Impaired judgement 
  • Changing and coloring of relationships

In one section she describes the challenges of dealing with family members and says
"I try not to give too much medical advice, even to my parents. I see my role as an advocate: to help them synthesize information when they have questions. When my mother calls and says, 'I'm short of breath and I don't know what to do,' I walk her through all the things her doctor has talked to her about: Have you taken your blood pressure and pulse? Do you know how many times you're breathing per minute?"
Good advice on being the patient advocate and healthcare manager for your family members (which many already are)
In the end it boils down to personal judgement and your own boundaries.
Questions are appropriate and to be expected, Caplan says, but doctors have to wrestle with themselves in determining how to respond if they're to act responsibly and ethically. "When close friends and family ask for medical advice, that's always a matter for introspection, and at the end of the day, it's not resolved by codes of ethics but by considered individual judgments."
It used to be as the trusted source of knowledge where access to information was limited this was a significant responsibility but with the age of

and medical applications like
AskMD, iTriage and HealthTap to mention a few you might find there is fewer and fewer requests. So for those of you that like the opportunity to help others out...enjoy it while you can mHealth and Telemedicine may be changing the landscape and soon!

Monday, April 14, 2014

Social Media in Healthcare

Social Media is here to stay and its impact in Healthcare has been impressive and far reaching.



If you still need convincing - look no further than this piece 24 Outstanding Statistics & Figures on How Social Media has Impacted the Health Care Industry that features a host of examples. As they put it
In a generation that is more likely to go online to answer general health questions then ask a doctor
And that’s the point our population and customers are changing and they are using the internet and social media as a major source and guide to their care.
A few choice data points:
90% of respondents from 18 to 24 years of age said they would trust medical information shared by others on their social media networks
This may be the younger generation but in many instances they are becoming the healthcare support infrastructure for their parents and will use the same methodology to for their parents care as their own
31% of health care professionals use social media for professional networking
I am willing to be this is increasing and I only have to look at my own twitter feed and lists of doctors I am connected with, follow and use as major source and guides
41% of people said social media would affect their choice of a specific doctor, hospital, or medical facility
Ignore this at your peril - 2 in 5 of your patients are looking at social media to guide their healthcare selection.
And the opportunity and impact will increase as we see the penetration of mobile devices increasing
International Telecommunications Union estimates that global penetration of mobile devices has reached 87% as of 2011
So for those of you already online the impact and effect will increase. Those of you not….well that train has left the station. This graphic by Howard Luks (@hjluks) captures the extent of the opportunities