Friday, March 11, 2011

Updated Link to Updated Blog

The blog I write for has moved here.

Others have joined the effort and it's a great resource.

Wednesday, June 2, 2010

What will ARRA and HITECH Mean for Health Care?

The government health care reforms are intended, among other things, to increase the use of information technology to improve patient care. HITECH stands for Health Information Technology for Economic and Clinical Health. A recent report (the full report is available here.) expresses concerns and provides suggestions.

Among other things the report worries about the so-called "meaningful use" standard for receiving government funds for creating EHRs and the like. Also, interoperability of systems is key.

For some time now I've thought that health care IT needed something like the IEEE, which sets standards--mostly for interoperability of systems.

One of my partners recently had a piece in on the problems of preparing for and implementing health care IT.

Thursday, May 27, 2010

Will Comparative Effectiveness Studies Help Us?

A recent paper in the New England Journal of Medicine casts substantial doubt on this.
Our findings nonetheless have implications for health care reform. Comparative-effectiveness studies could be biased by the well-documented differences in diagnostic intensity across hospitals. Under public reporting programs, patients may be subject to harm to the extent that their own choices or their physicians' referrals are based on biased risk-adjusted quality measures.
What's a smart clinician to do?

Paper here.

Wednesday, May 26, 2010

Doping in Cycling

Okay, so this isn't exactly healthcare or management related. But I'm a former bike racer and found this article extremely disheartening.

Floyd Landis, who was stripped of his Tour de France title for testing positive for testosterone, and who has vehemently denied ever using performance-enhancing drugs has finally confessed to having done so. He's also accusing many others--not surprising Lance Armstrong as well. I'm not so concerned about Landis or Armstrong in particular, just the sport. And the health of racers.


Here's an article from the NY Times.

Monday, May 3, 2010

The Economist Praises Kaiser

I grew up in Southern California, and was a happy customer of Kaiser Permanente for a long time. I remember when it was common to complain about (and even fear-monger over) "managed care"; I honestly couldn't understand the fuss. Like many people, I was a happy customer.

Well, no less distinguished source than "The Economist" is praising Kaiser for numerous good reasons.

Article here.

Tuesday, April 27, 2010

Lesson of the Day: Don't get really sick

Although health care reform will--in principle--insure many uninsured people, those people may not have access to the care they need.

This article from yesterday's NYTimes points out that the sickest patients still may find it difficult to get health care, even after they are covered by the Medicaid program.
Only 40 percent of those [physicians] questioned in 2008 by the Center for Studying Health System Change, a research organization based in Washington, said they accepted all new Medicaid patients.
Coverage without care is, I think, the term of art.

Friday, March 12, 2010

Myths of Health Reform

With some health reform still a possibility, Paul Krugman writes what seems to be an extended plug in favor of the current plan under consideration. He cites three "myths" about health reform. Interesting read.

Article here.

Thursday, March 4, 2010

Multitasking and Nurses

A recent article from The Chronicle of Higher Education online, cites studies that have repeatedly shown that we are not built to multitask.

Contrast this with a recent article (sorry, don't have an ungated version) from a journal published by Joint Commission on Accreditation of Healthcare Organizations (JCAHO) on interruptions and multitasking among nurses. (Hat tip to Sal Bognanni of the Iowa Health System for sending me this paper.) The most surprising finding in the paper was that none of the many errors the researchers found were due to interruptions or multitasking. The authors point out that the many interruptions and frequent multitasking of nurses hold a potential for increased errors, but their data don't support for this claim at all.

Are nurses just superhuman? Did the study miss something?

Tuesday, March 2, 2010

Health Insurance Options

Options in the trading sense: the right to buy or sell something in the future. A cute idea in this article from Managed Care. The authors suggest creating an options market for individual services in health care. So, since I have kids and a trampoline, I should buy an option on pediatric orthopedics. But since there's no history of diabetes in my family, I might roll the dice and not buy an option on diabetic care.

I say this is a "cute" idea because it's clever, but totally ignores how people actually behave. Forget the complexity of options trading, how many of us are involved enough in managing our investments that we have even thought about buying/selling options? Remember, people have long thought that putting money into their 401k was important, but taking the time to figure out how to configure their investments proved prohibitive.

Who knows, maybe I'm ready for it. We're done having kids, who wants to buy our OB option?

Thursday, February 25, 2010

Does Health Insurance Improve our Health?

I'm sure I'm not the first on the scene, but I was reading The Atlantic this morning--I'm still stuck in the hard-copy world--and found an interesting article by Megan McArdle.

McArdle questions an assumption that, so far as I know, no one else does: is health insurance good for us? McArdle's article is polemical, to be sure. But she points out something very important: the data on the benefits of health insurance are, well, shaky.

And there's even some surprising evidence against the efficacy of one of the most powerful insurer in the US--Medicare. McArdle quotes researchers at University of Michigan.
Medicare increases consumption of medical care and may modestly improve self-reported health but has no effect on mortality, at least in the short run.
To be honest, I'm not willing to throw health insurance and health care under the bus, even given problematic evidence for/ against it. But I am glad that someone is questioning mostly unexamined assumptions about health care.

Monday, February 22, 2010

Standards for EHR, Part 2

In a previous post I noted a problem that arises from our not having an agreed-upon forum for setting standards for health information. To recap, computers have settled standard interfaces like USB ports, whereas health information has competing standards. In this post, I'd like to mention a couple of other issues.

The first issue is economic. Keyboards, for instance, would be a lot more expensive if there were no USB standard. Each keyboard and its computer would have to be custom made to fit each other. Among other things, this would mean that there would be no competition among keyboard makers, which would drive prices up. Keyboards aren't terribly expensive, so this might not seem like a big deal. But the EHRs that hospitals often buy cost millions--even tens of millions--of dollars. Both initial costs--in the broadest sense--and switching costs are low for a USB keyboard (or mouse or hard drive). But for EHRs, no standard means no competition. And no competition means astronomically high initial costs and generally prohibitive switching costs. Put another way, my doctor may not be able to afford to have his system talk to the hospital's.

The last issue I'll mention is that without an information standard we have a severely limited ability to compare the effectiveness of various treatments. For instance, it has taken more than 30 years to get a modicum of clarity about the relative efficacy of angioplasty vs. bypass surgery. Lacking apples-to-apples comparisons (or the willingness to do randomized controlled trials, which would mean some people would get no intervention after a heart attack) we’ll continue to have a devil of a time figuring out what works.

So, I'm hoping for an IEEE for health care information. But I'm not holding my breath--the IEEE took nearly 80 years to emerge as the standard for standards.

Standards for EHR, Part 1

We take for granted that any device with USB connection will work with our computers. We owe this clarity to the IEEE (Institute for Electric and Electronics Engineers). This professional organization has been setting standards for lots of things since 1963, including the USB ports on our computers.

Electronic health records (EHRs, which includes "EMRs," where M is for "Medical") don't have similar clarity. There are standards, but they're currently competing for supremacy. (See this paper for a summary of the standards.) That is, there are standards, but no standard for standards like the IEEE.

Consequently, the system that my primary care doctor uses may not (in fact, probably doesn't) "talk to" the system at a hospital or even to the one used by the orthopedist my doc referred me to for ankle pain.

To be clear, I don't need my doctor and the orthopedist to use the same EHR, I just need their systems to talk to each other. The USB analogy is useful to illustrate what I mean. I can buy any brand USB keyboard--Logitech, Microsoft, Targus, Apple, etc.--and it will work with any computer that has a USB port. EHRs, however, have no such standard.

For this post, I just want to mention one disadvantage of competing standards: the orthopedist has to cover lots of things my primary care doc already covered. The redundancy is not just a hassle, it's costly and dangerous. The orthopedist and I both waste time and brain power that could otherwise spent on a more accurate diagnosis of my problem or on treating another patient. What's worse, if I'm unlucky enough to wind up in an emergency room, I may get treatment that fails to take into account important facts about my health.

More to come.

Monday, December 21, 2009

Studer and "Accountability"

Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston, has a post today on the problems of accountability. Levy cites a book by Quint Studer and argues that "it is not only impossible to hold people accountable in an organization, but trying to do so is a misallocation of managerial attention."

Readers of this blog may remember that I wrote two posts (Post #1 and Post #2) disputing the usefulness of another of Quint Studer's central ideas: hire (and keep) the right people (while getting rid of the wrong people, of course).

To be fair, Quint Studer neither owns this idea, nor is he an outlier in endorsing it. In fact, when I was still doing research at HBS, we found that hiring the right people was topmost in the minds of nearly every manager.

Likewise, holding people accountable is another cherished piece of conventional wisdom about leadership. Levy's post not only does a good job of laying it to rest, but provides four good questions that can substitute for all the hand-wringing managers do over accountability.