The GV Hot 7, especially the finally-acknowledged physician burnout. Google Ventures’ (GV) Dr. Krishna Yeshwant, a GV general partner leading the Life Sciences team, is interested in seven areas, according to his interview in Business Insider (UK):
- Physician burnout, which has become epidemic as doctors (and nurses) spend more and more time with their EHRs versus patients. This is Job #1 in this Editor’s opinion.
Dr. Yeshwant’s run-on question to be solved is: “Where are the places where we can intervene to continue getting the advantages of the electronic medical record while respecting the fact that there’s a human relationship that most people have gotten into this for that’s been eroded by the fact that there’s now a computer that’s a core part of the conversation.” (Your job–parse this sentence!–Ed.)
Let’s turn to Dr. Robert Wachter for a better statement of the problem. This Editor was present for his talk at the NYeC Digital Health Conference [TTA 19 Jan] and these are quoted from his slides: “Burnout is associated with computerized order entry use and perceived ‘clerical burden’ [of EHRs and other systems]”. He also cites the digital squeeze on physicians and the Productivity Paradox, noted by economist Robert Solow as “You can see the computer age everywhere except in the productivity statistics.” In other words, EHRs are a major thief of time. What needs to happen? “Improvements in the technology and reimagining the work itself.” Citing Mr. Solow again, the Productivity Paradox in healthcare will take 15-20 years to resolve. Dr. Wachter’s talk is here. (more…)
A study published in the Journal of the American Medical Informatics Association (JAMIA) may be one swallow and not the spring, but points to something doctors have been reporting anecdotally for years. Researchers examined initial progress notes of patients admitted to Beaumont Hospital in Royal Oak, Michigan both before and after the Epic Systems EHR implementation (POLITICO Morning eHealth) in 2012. Their sample of 500 notes examined five specific diagnoses with invariable physical findings: permanent atrial fibrillation, aortic stenosis, intubation, lower limb amputation and cerebrovascular accident with hemiparesis. The error rate of EHRs compared to the paper charts was 24.4 percent versus 4.4 percent. Residents were better at EHR-ing than the more experienced attending physicians for inaccuracies (5.3 percent v. 17.3 percent) and omissions (16.8 percent v. 33.9 percent). As this is an older snapshot, it may have narrowed with familiarity and training, but this is in line with prior reporting in multiple countries (here) that customization by real clinicians needs to be part of the implementation (designed by IT people without clinical background), often design doesn’t meet clinical needs, many have glitches and that they take entirely too long to fill out, notoriously in mental health (see JAMIA study from April). And let’s not get into the plagues of hacking, ransomware and health data exchange. HealthcareITNews, JAMIA (abstract only)
Health tech as perceptual barrier. A study published Monday in JAMA Internal Medicine-Online First (limited content) found that patients were noticeably less satisfied their care when the physician used the computer (e.g. EHR) during the appointment. According to Reuters, only half of the 25 visits with high computer use were rated as “excellent care” by the patients, compared to more than 80 percent of the 19 encounters with low computer use. iHealthBeat cited that physicians who spent more time on the screen:
- Spent less time making eye contact with patients
- Tended to do more “negative rapport building,” such as correcting patients about their medical history or drugs taken in the past based on information in their EHR.
The researchers (primarily from the University of California–San Francisco) used data from two years of visits by 47 patients to 39 doctors at a public hospital. The patients had Type 2 diabetes, rheumatoid arthritis or congestive heart failure, with some having multiple chronic conditions. What is downplayed is that the patients were considered ‘safety net’ patients with communication barriers–limited health literacy and often limited English (primary Spanish speakers). But even this special population may be pointing to an overall problem (more…)
Many of our recent stories have touched on ‘big (health) data’ as Achieving the Holy Grail–how it can be shared, how it can work with the Internet of Things and how poorly implemented personal health record (PHI) databases can derail national health systems (and careers) [TTA 22 Sep]. They are, after all, 1) extremely difficult to design to preserve privacy and 2) must satisfy patients’ requirements for easy use as well as privacy including opting out. But when despite all good intentions, data goes awry, the consequences can be severe.
- A daughter applies for health insurance from Aetna, and her mother’s medications, about which she had no knowledge, are attributed to her. How? Data mining off Milliman’s IntelliScript data service which mixed up the records.
- EHR exchange can spread errors such as a dropped critical health or medication record. One led to the death of an 84 year old woman. VA also had a problem with its EHR (not cited but likely VistA) slotting medication histories into the wrong patients’ files. An Australian hospital mixed up discharge files in electronically sending them to doctors. The more records are exchanged, the more possibility there is for propagation of errors.
- More information is shared with third-party suppliers; survey companies are increasingly tapping into these databases to send annoying, potentially privacy-invading treatment questionnaires to individuals.
Bloomberg Business’ conclusion is that this could be a problem, but much beyond the tut-tutting doesn’t get into solutions. The Pitfalls of Health-Care Companies’ Addiction to Big Data
Canada’s health system
is nominally nationalized, but in a way that leaves large gaps in coverage–for long term, in home, specialty care and prescriptions–as well as variable by province. According to this article in HIT Consultant
, VC funding is also thin on the ground, which leads to a short-term outlook. Local governments are stepping into the gap with innovation funding (similar to the Partnership for NYC) and the national government has eased restrictions on foreign investment. EHRs haven’t been a priority (skipping the troubles experienced in the US) which leaves digital health–telehealth, telemedicine and diagnostic apps–to enjoy the available talent and funding. This Editor doubts that any of the 20 profiled here will be familiar names other than possibly InterAxon
which we noted at last year’s NYeC Digital Health Conference
, and many tread the familiar ground of genomics, social sharing of medical images, and gamification for behavior change, but there are three unique companies in the neurological area in nerve stimulation (MyndTec
), nerve disorder diagnostics imaging (NerveVision
) and pharma (Oxalys.
) We salute the Royal Canadian Air Force with their WW2 roundel on the anniversary of the Allied invasion of Sicily, July – August 1943
Take your time this weekend and read this article from the Washington Post on the ‘brave new world’ of data mining health records. While those with experience analyzing real-world health data snicker at Larry Page of Google’s inflated claims of ‘saving 10,000 lives in the first year’ if only he could get his hands on that identified data (of course, then there’s the opportunity to make $£€¥, which is what Larry and Sergey are really interested in–count your Editor as a cynic!), the Health Data Analytics Express rolls on. The promise lies in more precision in treatment areas such as brain tumor radiology where sizing is critical (BraTumIA) and individualized genomics for disease. Yet the author does not touch on healthcare decision support systems best exemplified by IBM Watson, (more…)
Preventable medical errors persist as the No. 3 killer in the US – third only to heart disease and cancer – claiming the lives of some 400,000 people each year.
(US Senate hearing, cited in HealthcareITNews 18 July 2014)
At the end of last month, this Editor questioned the efficacy of our current state of ‘consumer engagement’ in Patients should be less engaged, not more. The ‘less engaged’ was a call for simplification: regimens and devices which were easier to use, less complicated and far easier to fit in everyday life. (Aesthetics helps too.) Back in 2013, HeartSister/Ethical Nag (and Canadian) Carolyn Thomas called for health app (and by inference consumer engagement) designers to ‘skate to where the puck is going’–as in “For Pete’s sake, go find some Real Live Patients to talk (and listen) to first before you decide where you’re going!” Often it seems like these apps and platforms are designed in a vacuum of the entrepreneur’s making. The proof is the low uptake (Pew, Parks, IMS) and the apps’/programs’ lack of stickiness after all this time (Kvedar 8 Sep blog post).
Now Laurie Orlov tells us we were looking at the wrong puck, as analysts do. First, all that ‘nudging’ and all those apps haven’t moved the needle on diabetes and obesity. Second, why are app developers neglecting that third largest killer, preventable medical errors? Add to that 400,000 yearly–over 1,000 per day–the 10,000 estimated patients every day who suffer serious complications. (more…)
Deloitte and Towers Watson obviously disagree on the savings from eVisits (Deloitte) and telemedicine (Towers Watson). Deloitte’s study of eVisits projects a global savings of $5 billion in 2014. Towers Watson is estimating $6 billion in 2015 from US employers alone if there is full employee utilization of telemedicine. Deloitte is also more transparent in its estimating, for example on the $50-60 billion total addressable market for eVisits in ‘developed countries’. This Editor doesn’t see a major difference in definitions between the two; Deloitte defines eVisits as video consults plus the forms, questionnaires and photos that have become part of telehealth, but not the vital signs monitoring part.. Perhaps our readers, looking at both more closely, can discern, or confirm that Towers Watson has too rosy a picture? Deloitte‘s ’21st Century Housecall’ study (short paper) is also worth a read for presenting facts/figures on the global addressable market and for a surprising conclusion–that the ‘greater good (in developing countries) may come from saving tens of millions of lives’. Hat tip to reader Mike Clark. Clinical Innovation + Technology summary.
‘Virtual care is much more effective than brick-and-mortar care.” (Editor’s emphasis) A bold statement that Microsoft and the writer from Intel fail to back up with facts. The focus of this ‘In Health’ article is preventing readmissions. There are the usual Panglossian pointers (more…)