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Patient safety update

I’m passionate about patient safety. I’m happy to report a couple of things that aren’t exactly breaking news, but still worth bringing to your attention.

First off, there is a fairly new peer-reviewed journal called Diagnosis, and it’s about exactly what the title suggests. The first, quarterly issue, from German academic publisher De Gruyter (North American headquarters are in Boston), came out in January, so the second issue should be published soon. The online version is open access. That means it’s free. (A print subscription is $645 a year.)

A highlight of the premiere issue is a submission from the legendary Dr. Larry Weed and his son, Lincoln Weed, discussing diagnostic failure and how to prevent it. “Diagnostic failure is not a mystery. Its root cause is misplaced dependence on the clinical judgments of expert physicians,” they begin. The answer? Clearly defined standards of care and wider use of clinical decision support tools. It’s not anything new. Larry Weed has been advocating this for a good 50 years and saying that the unaided human mind is fallible for probably 60 years. Yet, medicine still largely relies on physicians’ memory, experience and recall ability at the point of care.

This doesn’t mean evidence-based medicine ,which is based on probabilities. Probabilities are fine when the patient has a common condition. They’re useless for outliers. No, Weed has long said that IT systems should help with diagnosis by “coupling” knowledge to the patient’s particular problem, and this starts with taking a complete history.

Weed, of course, created the SOAP (subjective, objective, assessment, plan). I recently talked to a CMIO who is advocating flipping that around a bit  into an “APSO” (assessment, plan, subjective, objective), which he said works better with electronic records. I’ll have more on that in an upcoming article for a paying client, and I’ll probably want to dive into that again in the near future.

For those who still believe American healthcare is safe, effective and efficient, ProPublica worked with PBS Frontline and marketing firm Ocupop last year to produce a video “slideshow” called “Hazardous Hospitals.” It’s worth a view for healthcare industry insiders, and definitely merits sharing with laypeople. I recommend that you share it. Please. Do it. Now. I’m serious. Patient safety is a problem that doesn’t get enough attention. :)

 

March 25, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Happy New Year! Lots of hard work ahead

Here’s a light way to end the year, with a Dilbert cartoon that’s actually more than 7 months old, but one that seems apt.

Dilbert, May 26, 2013
©2013 Scott Adams

No, healthcare technology is never easy. Neither is healthcare improvement, not that a diagnostic robot would necessarily be an improvement. There’s a lot of work to do in 2014. For now, enjoy the evening, and have a happy new year! Don’t drink and drive. Here’s a map of regions where AAA is providing free tows home for drunken revelers. Lots of local taxi companies are offering free rides tonight. Here in Chicago, the CTA is letting riders board buses and trains for a penny. There’s no excuse. Stay safe, and I’ll see you soon.

December 31, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Say it with me: clinical decision support

I just read one of the worst articles I’ve ever seen about the quality of American healthcare, and it illustrates just how badly some reporters who don’t regularly cover healthcare can misunderstand this sector that accounts for more than one-sixth of the U.S. economy.

I give you this Motley Fool story entitled, “The 5 Most Misdiagnosed Diseases,” written by Sean Williams. (His profile says he has experience investing in healthcare. Investing in companies is one thing. Figuring out how to fix a broken industry is another. And really, from a financial standpoint, plenty of people are getting rich off of others’ suffering.)

The story curiously discusses a 2009 study in the Internet Journal of Family Practice that found the five most misdiagnosed diseases, based on autopsy and malpractice data. I suppose Motley Fool might decide to run something that’s four years old in order to discuss current investment opportunities. This is where the story veers off the rails.

According to the article: “The benefit of this data is twofold: it exposes problem areas in diagnosing certain diseases, which should help improve attention to detail from both physicians and patients exhibiting those symptoms, and it highlights the potential for more accurate diagnostic equipment. As investors, it also gives us definable opportunities to take advantage of instances where certain medicines or diagnostics may greatly increase in usage to improve patients’ quality of life.”

Wrong.

The problem isn’t the accuracy of diagnostic equipment and the solution isn’t more expensive testing and treatment. The problem is accessing and processing data that physicians should already have but perhaps do not. The answer to this problem is an accurate, current and complete record with an accurate, current and complete patient history, run not through the physician’s brain on the spot but through a clinical decision support engine that matches patient-specific facts with known medical evidence.

Say it with me: clinical decision support.

 

July 21, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: Intel’s Eric Dishman on connected care management

Did you miss Eric Dishman’s keynote address Tuesday at the Medical Group Management Association‘s annual conference in Las Vegas? That’s OK, because I secured a few minutes with Dishman, director of health innovation and policy at Intel, immediately after his talk, and the results are right here.

This podcast, recorded in the somewhat noisy press room at the Las Vegas Convention Center, is a companion piece of sorts to my coverage in MobiHealthNews on Thursday, so I hope you have a chance to check out both.

Podcast details: Intel’s Eric Dishman on connected care management, recorded Oct. 26, 2011, at MGMA annual conference in Las Vegas. MP3, mono, 64 kbps, 5.2 MB. Running time 11:08.

0:30 Virtual care coordination in nontraditional settings
1:05 Overlap/collaboration with Care Innovations joint venture
2:10 Prototype device for monitoring symptoms of Parkinson’s patients
4:00 Home monitoring of “classic” chronic diseases
4:55 Tracking behavioral changes for prevention and early detection
6:05 Realizing the potential of mobile health
6:55 Care coordination and health reform
8:30 ACOs and payment for quality
9:35 Intel’s future providing “strategic blueprints” for healthcare
10:20 How to share ideas with him

October 26, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Imagine Cup participants show smartphone malaria diagnosis app

About three months ago, I wrote about the Imagine Cup, an annual student technology competition sponsored by Microsoft, in a commentary for MobiHealthNews. I mentioned a winning project in the U.S. competition, a smartphone-based imaging system that can help diagnose malaria in far-flung corners of the globe.

Today, the creators of that system and a few other Imagine Cup participants are in New York for the international finals. A few of the students appeared with Microsoft CEO Steve Ballmer on CNN’s American Morning early Friday. CNN said the malaria app is 94 percent accurate, better than the traditional field test for malaria.

Another project, Harmonicare, incorporates a tablet computer to add a musical aspect to the “blowing” test used to help patients regain respiratory function while recovering from pneumonia.

Watch the video and see for yourself:

 

July 8, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Not so elementary, my dear Watson

In just the last few hours, I’ve seen a huge wave of pushback and doubt about Watson, the IBM supercomputer, being used for clinical decision support.

Yesterday, I covered a “healthcare leadership exchange” at IBM’s new Healthcare Innovation Lab in downtown Chicago. I posted some of my observations on the EMR and HIPAA blog, and made the case for diagnostic decision support.

I also wrote a story for InformationWeek, but that hasn’t run. Instead of posting my story, InformationWeek healthcare editor Paul Cerrato wrote a column about Watson already being “beaten in the medical diagnostics race” by Isabel Healthcare, a diagnostic decision support tool that’s been available for years. I have to admit, he’s right. I first interviewed Isabel founder Jason Maude probably in 2002 or so, and I first blogged about the company in 2005. I mentioned Isabel in a 2007 post that, interestingly, also alluded to the work of Don Berwick and Larry Weed.

Cerrato mentioned Jerome Groopman’s 2007 book, “How Doctors Think,” which discussed, in part, how IT could help doctors avoid many types of cognitive errors. “[D]octors tend to lean toward diagnoses that are most available to them in their day-to-day routine,” Cerrato wrote (emphasis in original). That’s exactly what Weed has said for decades, and exactly what Atul Gawande talked about in his groundbreaking book, “Complications.” Computers should not make decisions for physicians, but rather should help them reach the right conclusions, particularly when they see rare cases.

Wouldn’t you know, “e-Patient” Dave deBronkart commented on my EMR and HIPAA post to say he just finished reading Groopman’s book. He tweeted a link to my post, which a few of his 6,500 other Twitter followers noticed. They also noticed EMR and HIPAA grand poobah John Lynn’s comment that the example in yesterday’s Watson demo, a 29-year-old pregnant woman being prescribed doxycyline was “pretty weak.” (He’s right, by the way.) Aurelia Cotta, who blogs about issues such as infertility and adoption, started this thread that also got South Carolina nurse Sunny Perkins Stokes interested:

@ @ @ I can see great uses for this, but I find it funny the example they give of doxy in pg is wrong.
@AureliaCotta
Aurelia Cotta
@ @ @ because it's still using the FDA's pg categories, which are 30 years out of date. GIGO anyone. Heh
@AureliaCotta
Aurelia Cotta
RT @: @ @ @ find it funny the example they give of doxy in pg is wrong.| How so?
@sunnystill
Sunny Perkins Stokes
@ @ @ sorry to reply late--but FDA is binary, and Motherisk is risk vs reward ratio. Critical difference
@AureliaCotta
Aurelia Cotta
@ @ @ doxy is an excellent drug, and cheap. Lyme disease can cause m/c + stillbirth. What if pt needs it?
@AureliaCotta
Aurelia Cotta
@ @ @ baby teeth that have a line on them as a remote chance, might be worth the risk to a pt with no $
@AureliaCotta
Aurelia Cotta
RT @: @ @ @ baby teeth might be worth the risk to a pt with no $ ?Amoxicillin not just as good?
@sunnystill
Sunny Perkins Stokes
@ @ @ maybe to you, but what if the pt is allergic? Or they've already tried amoxicillin, and it didn't work?
@AureliaCotta
Aurelia Cotta
@ @ @ context matters is all, and I just think any sources used should be good, not "lawyer endorsed"
@AureliaCotta
Aurelia Cotta

 

Well, there’s a reason why I call myself a “healthcare” reporter and not a “medical” reporter. I don’t know the science, and I do occasionally get myself in trouble when I start talking about things like whether doxycycline is contraindicated during pregnancy. (To my credit, I did attribute the statement to IBM’s chief medical scientist, Dr. Marty Kohn.)

As I was reading the above tweets and contemplating this blog post, I came across a link to some tongue-in-cheek pushback against Watson in healthcare. An anonymous radiologist who blogs about PACS as “Dr. Dalai” compared Watson to HAL, the diabolical mainframe in “2001: A Space Odyssey.” Dr. Dalai wrote: “Watch out, boys and girls, Watson is headed to a hospital near you, and he (it?) may challenge you as much as he did Ken Jennings.” Jennings, of course, is the Jeopardy! champion whom Watson beat earlier this year.

At first glance, I thought Dr. Dalai was yet another whiny physician clinging to the status quo. But he hit on the real issue: application of knowledge. Quoting from an interview with one of Watson’s programmers, Dr. Dalai noted that the supercomputer is being loaded with all kinds of medical reference material in preparation for “learning” human physiology and ultimately gathering experience in medicine. “This isn’t fair!  If I could just take a text book, stick it up my, ummmm, brain, and have it instantly memorized, I would be whiz, too!” he wrote.

Yeah, isn’t that the whole point of clinical decision support?

June 3, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.