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healthcare industry

Jan 27 2015

Does the doctor-patient relationship need marriage counseling?

By healthcare industry

The healthcare system is all about building patient engagement lately. Which makes me ask: if we get to engagement, will we ever get married? And if we do … will we wind up needing marriage counseling? Short answer: we already need marriage counseling, and we’re not even officially engaged yet. Herewith is the evidence that the doctor (and health system)-patient relationship needs marriage counseling, stolen adapted from a post on YourTango.com. You aren’t talking – Given the state of digital, or even analog, communication in healthcare, how can doctors and patients talk? Even when we’re in the same room, it’s conversation-us interruptus, given the whole 10 minutes we have for face to face interaction. And remember the last time you emailed your doctor with a question, and got an answer that day? Oh, right. That was the 14th of Never. Thank you, health IT infrastructure of doom, which is so dedicated to the security of our medical data that NO. ONE. CAN. SEE. IT. You see your partner as an antagonist – The healthcare system seems dedicated to keeping doctors and patients in an adversarial relationship. Doctors rat us out for our poor compliance in medication regimens without asking if we can afford said meds. Patients worry that their insurance premiums will go up if they tell the truth about stuff like smoking, or eating habits. Neither side seems capable of climbing off the “forces set in opposition” ledge. And the band plays on … getting less and less healthy in the process. You’re keeping secrets – See #2, and know that antagonists don’t share information well with each other. Doctors keep secrets from patients, i.e. how much treatment options will cost, with payers being fully indicted co-conspirators on that secret-stashing. Patients keep secrets, too, on stuff like cutting pills in half so that fiercely expensive medication will last twice as…

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Jan 15 2015

Patient Engagement. You’re doing it wrong.

By healthcare industry

Now that I have, for my sins, been tagged as a patient engagement expert, I figure that entitles me to the occasional rant on the topic of the healthcare system – particularly the US iteration thereof – and its utter inability to understand how to connect and communicate effectively with its customer base: patients. If you’ve been a patient, for anything beyond a short trip to your primary care doc for something simple (and easily diagnosed) like a laceration or a minor infection, you know that arriving at the doors of The Medical-Industrial Complex is like being the new kid in school. There’s an old joke about bacon and eggs – the chicken is involved, but the pig is committed. In the ongoing sketch comedy/Shakespearean tragedy that is medical care. the clinical teams who deliver care, and the facilities in which they deliver it, are most certainly involved. Patients? We’re fully committed. We are engaged, we are fully present. What we’re not getting from the delivery side is an authentic invitation to engage. en•gage•ment: noun, a formal agreement, i.e. to get married; an arrangement to do something at a specific time; the act of being engaged, i.e. “continued engagement in trade agreements” Seems simple, right? Patient appears, asking for care. Clinical professionals deliver that care. Patient happy, clinicians happy, everybody wins. Oh, wait – did the doctor wash her hands before she started the physical exam? If the patient is aware of the importance of handwashing in preventing infection, and asks if the doctor lathered up and rinsed according to protocol, does that patient risk being labeled “difficult” or “aggressive”? If so, so much for patient engagement. Given that the statistics on handwashing in healthcare settings aren’t at 100% (~ 90% for RNs, < 75% for attending MDs in a 2008 study at an Ohio hospital), clinical folks…

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Jan 15 2015

Patient Engagement. You’re doing it wrong.

By e-patients, healthcare industry

Now that I have, for my sins, been tagged as a patient engagement expert, I figure that entitles me to the occasional rant on the topic of the healthcare system – particularly the US iteration thereof – and its utter inability to understand how to connect and communicate effectively with its customer base: patients. If you’ve been a patient, for anything beyond a short trip to your primary care doc for something simple (and easily diagnosed) like a laceration or a minor infection, you know that arriving at the doors of The Medical-Industrial Complex is like being the new kid in school. There’s an old joke about bacon and eggs – the chicken is involved, but the pig is committed. In the ongoing sketch comedy/Shakespearean tragedy that is medical care. the clinical teams who deliver care, and the facilities in which they deliver it, are most certainly involved. Patients? We’re fully committed. We are engaged, we are fully present. What we’re not getting from the delivery side is an authentic invitation to engage. en•gage•ment: noun, a formal agreement, i.e. to get married; an arrangement to do something at a specific time; the act of being engaged, i.e. “continued engagement in trade agreements” Seems simple, right? Patient appears, asking for care. Clinical professionals deliver that care. Patient happy, clinicians happy, everybody wins. Oh, wait – did the doctor wash her hands before she started the physical exam? If the patient is aware of the importance of handwashing in preventing infection, and asks if the doctor lathered up and rinsed according to protocol, does that patient risk being labeled “difficult” or “aggressive”? If so, so much for patient engagement. Given that the statistics on handwashing in healthcare settings aren’t at 100% (~ 90% for RNs, < 75% for attending MDs in a 2008…

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Dec 07 2014

Keeping Patients in the Dark

By e-patients, healthcare industry

Back when I slaved in the depths of Hunter Thompson’s “shallow money trench,” we had a phrase we deployed whenever we thought the grownups were keeping us in the dark. We would say we’d been sent to Mushroom Land, where one is kept in the dark and fed sh*t, the better to keep us from making, or spotting, trouble. These were the very same grownups who, every four years like clockwork, would look at the calendar and say, “Holy crap, there’s a Presidential ELECTION this year?” But I digress. The medical-industrial complex has, for eons, kept its customers (commonly called “patients”) in Mushroom Land pretty consistently. For a very long time, that was facilitated by a lack of access to scientific knowledge for the common human, but that started to shift in the 19th and 20th centuries, as public education rose across most parts of the globe. Of course, “math phobia” and “science denial” are still pernicious little devils, but the average person with an 8th grade literacy level and an internet connection can find out about just about anything. I had the privilege of being awarded a seat at Dartmouth’s 2014 Summer Institute for Informed Patient Choice, or SIIPC14 for short, in late June 2014 (last week, as I write this). The purpose of the conference was to chew on topics and issues related to not keeping patients in the dark when it comes to making informed decisions about their health, their healthcare, and their relationships to the medical care teams they work with to gain or retain “best health.” This event had some serious meat on its bones, both in reputational throw-weight of the presenters and breadth of stakeholder groups represented in the audience. Dartmouth itself is no stranger to uber-smart-ness, particularly in healthcare, given the work and thinking that emerges from Geisel School of Medicine and the Dartmouth-Hitchcock Medical Center (one of…

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Nov 17 2014

#epatient – Are Millennials Born That Way?

By e-patients, EHR, health records, healthcare industry, participatory medicine

Most of the people I meet in my voyages ’round healthcare system transformation, grassroots edition, arrived at the portal of #epatient via a trip through the medical-industrial complex. Either they, or someone they cared for, wound up getting “a thing” – cancer, Parkinson’s, multiple sclerosis, player to be named later – and they found themselves inside the medical care delivery system, bewildered, and looking for answers. In short, most – not all, by any means, but most – are over 40. Imagine my surprise, and delight, when I was sent a report on a survey conducted with 385 randomly selected patients across the US*, with most of the responses coming from 18 to 35 year old millennials (people born 1982 and after). The survey asked them their opinions on shared decision making, open notes, and shared medical visits, three new medical practice models that are rising in adoption. Here’s the context of the survey questions: Shared decision-making involves the doctor and patient evaluating multiple treatment options and deciding together on the best course of action. Open notes is a policy allowing patients to view the medical notes doctors take about them during visits, which includes accessing those notes from home. Shared medical appointments, or “group visits,” involve attending an extended (60- to 90-minute) medical appointment with 10 to 15 other patients and one or more physicians. The survey results make me think we might finally be reaching a tipping point toward positive change, given that a big majority (76%) of respondents said they were extremely or very likely to use shared decision making. Over 60% were extremely or very likely to welcome open notes:   The demographics of the survey respondents was a pretty representative sample as far as chronic conditions go: One surprise in the demographic detail was that more men responded than women….

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Aug 26 2014

The State of Health Information Exchange: Benefits and Challenges

By EHR, health records, healthcare industry, technology

This is a guest post by TechnologyAdvice.com writer Jesse Jacobsen. TechnologyAdvice.com is based in Nashville, TN, and their stated mission is to provide valuable insight to business technology buyers, while creating connections with the products and vendors that best meet those buyers’ needs. Their site is a goldmine of industry-specific intel on current software and IT products and trends … and they have a dedicated healthcare tech content channel! According to the 2013 HIMSS Analytics Report, 73 percent of respondents indicated they were participating in health information exchange (HIE), with 57 percent only participating in a single HIE. Of the practices in an HIE, 52 percent reported experiencing benefits with better access to patient information, 20 percent experience promoted patient safety, and 12 percent said HIE led to time savings among clinicians. Only 16 percent reported no benefits. As evidenced above, HIEs can be effective tools for improved practice operations, but that doesn’t mean the system is foolproof. In the same report from HIMSS, the top challenges faced by hospitals included other organizations not sharing enough data (49 percent), lack of necessary staff (44 percent) and resources (40 percent), and privacy concerns (39 percent). As government mandates continue to push provider use of electronic medical records (EMRs) and HIEs, more practices are beginning to consider if it’s time to participate in a health information exchange. The following will look at some of the current benefits from HIE participation and address some current challenges. Benefits Better Patient Information HIEs provide physicians with easier access to patient information, especially on a state level, such as the recently implemented HIE in Florida. Currently, accessing patient information can be a costly and inefficient process, with too much reliance on faxing and email. Utilizing an information exchange makes gaining patient data a quick process with far fewer expenses….

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Aug 08 2014

GM recalls are bad. Medical device recalls are worse.

By healthcare industry, technology

It’s bad enough when your GM SUV turns into a rolling fire hazard. Imagine needing, and getting, a hysterectomy, only to discover that the surgical procedure itself turned you into an advanced stage cancer patient? That’s exactly what’s been going on since power morcellators became common in laparoscopic uterine surgery to remove fibroids. In morcellation, the fibroid tissue, and/or the entire uterus, is ground up prior to being sucked out of the abdominal cavity. I’m sure that you, and I, can do the biological math on this question, “What if that fibroid is cancerous?” Yep, that would mean that previously encapsulated cancer cells would be set free to run rampant through the aircraft – the patient’s body – spreading its metastatic self far and wide. Why didn’t anyone at the FDA do that bio-math? Turns out that when these devices were approved in the late ’90s, since other similar devices were already on the market, no clinical trials were ever done. Here’s a graf from the NY Times back in April, talking about this very thing: “Morcellators were allowed onto the market in the 1990s without the usual clinical trials in patients because they were similar to other devices that had already been approved — a process that critics of the agency say can lead to safety problems like the one that has now been recognized.” tweet I’ve known about morcellators for only about 10 months – which is surprising, considering my interest in medical quality and patient safety – but my eyes were opened by my buddy Gilles Frydman, the man who started the Association of Cancer Online Resources (ACOR), which gets credit for helping some friends of mine, including ePatient Dave himself, save their own lives by giving them the information they needed to fully participate in their own care. Gilles is also behind SmartPatients.com, but I…

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May 09 2014

Employer-backed health insurance plans on life support?

By healthcare industry

I’ve been heard in these precincts and elsewhere on the topic of employer-backed group health insurance, and the reasons why I believe it’s an idea whose time has gone. Granted, I’ve felt like a little voice crying in the wilderness, but with a firm conviction that I was just an early adopter of this opinion. So imagine my glee when a headline popped up in my Google+ news feed that the Robert Wood Johnson Foundation had published a study showing a distinct downward trend in the number of companies paying for employee health insurance. The key findings: The percentage of non-elderly people with employer-sponsored insurance declined 10.2 percentage points from 69.7% to 59.5% over the study period while pubic coverage increased 3.1 percentage points. While most states saw “significant declines” in employer-sponsored insurance coverage, the range was wide—from New Hampshire (73.8% coverage) to New Mexico (48.0% coverage). Employer-sponsored insurance coverage varied by income. It fell less (2.8%) for high-income groups (400% federal poverty level [FLP] or above) than for those with lower incomes (200& FPL or below) where the fall was 10.1%. Nationally, the percentage of private-sector firms offering employer-sponsored insurance fell from 58.9% to 52.4% (although the percentage of workers eligible for coverage at firms that offered employer-sponsored insurance held steady). The take-up rate also fell from 81.8 percent to 76.3 percent. Small firms offering coverage declined (67.7% to 56.3%) while at large firms it remained essentially unchanged. Single-person premium costs doubled ($2,490 to $5,081); family premiums rose 125 percent ($6,415 to $14,447); employee contributions increased (17.5% to 20.8% of the total premium). In short, less than 60% of adults who are employed full-time now have employer-backed group health insurance coverage. My response in the G+ thread? HALLELUJAH. The prospect of losing group health insurance scares the pants off of those who still have that coverage. What I…

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Apr 23 2014

Human Health. It’s . . . Human.

By e-patients, healthcare industry, participatory medicine

Guess who got invited to WHO? No, really. The World Health Organization (WHO) invited yours truly to its First Global Experts’ Consultation in service of building a WHO framework for patient and family engagement. This is all due to my part in the ongoing anvil chorus that is the new Patient & Family Engagement Roadmap, developed by a group of dedicated folks from all parts of the healthcare compass over the last couple years, with funding from the Gordon & Betty Moore Foundation. I spent just over two days in Geneva, most of the time head-down in discussions about how the global health system – a patchwork of services delivered by an even patchwork-ier cadre of healthcare delivery systems – can better serve the needs of the people/patients who seek medical care and health information from them. This post will not attempt to report everything I saw/heard/thought/felt in that jam-packed 16 hours of ideas and outlooks. What I’ll share is my perspective on the challenges, the opportunities, the pitfalls, and the hopes that – in my view, at least – emerged during that lightning round of global spitballing. CHALLENGES There’s an old joke that asks, “What’s an elephant?” The answer: “A mouse designed by a government committee.” That’s the risk, and challenge, to any attempt to build a definable set of standards for a human effort. Education, transportation, trade, infrastructure, communication, medicine – all require some sort of standardization to make them useful to more than one or two people huddled over a campfire. A study of history will show that as much as we humans are great idea generators, trying to get the rest of the tribe to adopt our new idea isn’t easy. The father of quantum mechanics, Max Planck, said it best: “A new scientific truth does not triumph by convincing its…

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Jan 08 2014

Deja vu all over again

By cancer, healthcare industry

Long ago and far away … well, OK, from 1979 to 2008, I had health insurance. Started with employer group insurance, moved to rolling my own (individual) in ’89, then negotiated small business group insurance for the micro-enterprise I ran with my 2nd husband in the ’00s. Then came the Cancer for Christmas adventure, during which I had insurance (still deeply grateful for that), but at the conclusion of treatment when I got to become a Friend of NED (No Evidence of Disease) I got a jack-you notice from my insurer. All of these stories are already available for your delectation all over the interwebs: Here. Here. And here. For starters. In my five years sitting on the Group W bench known as “uninsured,” I became an advocate for price visibility in healthcare. Since I was paying my own way, I needed to know before making a medical purchase. Other more high-profile folks have joined me on the quest for answers to “how much is that?” See my thoughts on that here. So along comes the Affordable Care Act, also known as Obamacare, to help me get back in the game.

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