News Blog

A patient’s expertise is often undervalued
Monday, March 12, 2018

Thanks to a surprising and devastating diagnosis, I know more than most physicians about what it’s like to live with the brain cancer known as glioblastoma, everything from self-titrating my anti-epileptic medications to making sure the right ICD-10 code appears on my MRI referrals. As much as I’d rather not have this expertise, I’ve learned that it is extremely valuable for medical students, physicians, people with brain cancer, pharmaceutical companies, and others. I’ve also learned that it is undervalued.
Since I was diagnosed 20 months ago with glioblastoma — a disease I share with Sen. John McCain and about 18,000 other Americans — I’ve tried to learn all I can about the disease, its treatment, and how best to live with it. In doing that, I’ve become an expert patient, what some call an e-patient, following in the footsteps of pioneering e-Patient Dave.

I and other e-patients have a lot to offer in at least three separate areas:

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Unnecessary testing wastes money and can lead to further testing
Monday, March 12, 2018

Unnecessary testing wastes money and can lead to further testing. Why does it occur?
Almost 60% of medical personnel surveyed at a large academic medical center believed that hospitalized patients should have daily laboratory testing.
Of 1,580 attending physicians, fellows, residents, physician assistants, nurse practitioners, and nurses sent surveys, 837 (53%) responded; 393 (47%) were RNs, and 80% of those nurses felt that daily laboratory testing should be done on all patients.
Nurses strongly felt that patient safety and protection against malpractice litigation were enhanced by daily laboratory testing.


Of note is that more than half of those who returned completed surveys said they thought attendings would be uncomfortable with less testing, and 37% said they ordered unnecessary tests to satisfy attendings. However, the category of respondents who least felt daily tests were needed was attending physicians at 28%, and 84% of attending physicians said they would be comfortable if their patients had fewer laboratory tests.
Unnecessary lab testing on their units was observed by 60% of respondents, but only 37% said they had requested unnecessary testing themselves. Perhaps the unnecessary tests had been ordered by people who did not respond to the survey, or the tests were ordering themselves.
The authors of the JAMA Internal Medicine study, done at Memorial Sloan Kettering Cancer Center in New York, concluded that although nurses did not order laboratory testing themselves, they might have some effect on the frequency of lab tests being done.

https://www.kevinmd.com/blog/2018/03/unnecessary-testing-wastes-money-can-lead-testing.html




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Unnecessary testing wastes money and can lead to further testing
Monday, March 12, 2018

Unnecessary testing wastes money and can lead to further testing. Why does it occur?
Almost 60% of medical personnel surveyed at a large academic medical center believed that hospitalized patients should have daily laboratory testing.

Of 1,580 attending physicians, fellows, residents, physician assistants, nurse practitioners, and nurses sent surveys, 837 (53%) responded; 393 (47%) were RNs, and 80% of those nurses felt that daily laboratory testing should be done on all patients.
Nurses strongly felt that patient safety and protection against malpractice litigation were enhanced by daily laboratory testing.


Of note is that more than half of those who returned completed surveys said they thought attendings would be uncomfortable with less testing, and 37% said they ordered unnecessary tests to satisfy attendings. However, the category of respondents who least felt daily tests were needed was attending physicians at 28%, and 84% of attending physicians said they would be comfortable if their patients had fewer laboratory tests.
Unnecessary lab testing on their units was observed by 60% of respondents, but only 37% said they had requested unnecessary testing themselves. Perhaps the unnecessary tests had been ordered by people who did not respond to the survey, or the tests were ordering themselves.
The authors of the JAMA Internal Medicine study, done at Memorial Sloan Kettering Cancer Center in New York, concluded that although nurses did not order laboratory testing themselves, they might have some effect on the frequency of lab tests being done.
Another recent survey published in Hospital Medicine asked internal medicine and general surgery residents at the Hospital of the University of Pennsylvania why they ordered unnecessary tests as defined by the authors.

https://www.kevinmd.com/blog/2018/03/unnecessary-testing-wastes-money-can-lead-testing.html
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Are patients using social media to attack physicians?
Monday, March 12, 2018

I have a colleague who is a pediatrician in private practice in the suburbs. He has a great practice and loves his patients. One day, he walked in 15 minutes late to a 7:00 a.m. meeting we both attend. “Moms are calling early today.” Parents in his practice have learned to bypass their elaborate phone triage system. They have learned that if you press “1” for emergency, an actual doctor will call you back within 15 minutes, regardless of whether an actual emergency exists. When I asked what can be done to curb such behavior, he shrugged and replied, “We’ve tried a few things, but then we just get slammed on Facebook … and that’s bad for the practice.”
Another physician friend provided factual and evidence-based testimony as an expert witness during a legal proceeding. When the proceedings did not go in favor of the plaintiff, they took it upon themselves to post slanderous comments about this physician (not their own personal physician, mind you) on various online forums, including comment sections on advocacy group websites.

https://www.kevinmd.com/blog/2018/03/are-patients-using-social-media-to-attack-physicians.html
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Online ratings have me scared for the future of medicine
Monday, March 12, 2018

When did patient satisfaction become more important than appropriate medical care? Medicine has been turned into a service with bonuses related to the patient’s satisfaction score. There is a complete disregard for the appropriate medical care if the patient is dissatisfied with what they’re told. Doctors are so afraid of losing satisfaction scores and getting sued that inappropriate medical care has become the norm. The opioid epidemic is just one example of this. Other examples include unnecessary testing when a good physical exam and history suffice.
While I agree that there should be a rapport between patient and provider, telling a patient what they don’t want to hear is bound to cause dissatisfaction. You will never please everybody no matter what kind of provider you are not what you do for your patients. So what is best?

https://www.kevinmd.com/blog/2018/03/online-ratings-scared-future-medicine.html
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New Dental Care Model Helping to Solve Healthcare InequalityNew Dental Care Model Helping to Solve Healthcare Inequality
Monday, March 12, 2018

While Congress continues the seemingly endless debate over healthcare reform, we need to remember that community-based solutions are addressing our health equity crisis right now. The Community Dental Health Coordinator(CDHC), along with improved Medicaid dental benefits, are proven, complementary solutions to a complex problem.

First, consider the challenge. 2.2 million people visit hospital emergency departments (ED) each year for dental pain, according to the ADA's Health Policy Institute. 91% of adults aged 20-64 have caries, the disease that causes tooth decay and cavities, and nearly a third (27%) go untreated, according to the CDC. Almost half (47%) of people over age 30 have some form of gum disease.

These statistics aren't just numbers. If unchecked, infection from severe tooth decay may develop bacteria-filled abscesses with potential to spread to other parts of the body. Severe gum disease has been associated with increased risk of several other chronic diseases like diabetes and heart disease.

But many Americans face barriers to care such as low income, lack of awareness of available public health resources, low health literacy, and transportation and childcare challenges. Compounding these challenges is that while Medicaid includes dental coverage for children, “dental benefits for Medicaid-eligible adults are optional. States have considerable flexibility in determining the scope of dental services covered. As a result, Medicaid adult dental coverage varies tremendously across states, and is [sometimes] limited to emergency services such as tooth extractions, or to specific populations such as pregnant women,” according to the Center for Health Strategies. In Maryland for example, adult Medicaid enrollees are more likely to visit the hospital to treat chronic dental conditions than any other adult group, according to DentaQuest. Many people across the country without a dental benefit often turn to the ED for non-emergency dental pain instead of a dentist, which can cost the health system $400 - $1,500 per ED visit compared to $90 - $200 for a dentist appointment.
http://www.modernhealthcare.com/article/20180227/SPONSORED/180229930
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7 big announcements from HIMSS18
Monday, March 12, 2018

More than 43,000 people descended on Las Vegas last week for the Health Information and Management Systems Society annual meeting. The buzz at HIMSS has shifted from meaningful use and health IT adoption, to tapping into artificial intelligence, generating actionable data, and, importantly, embracing consumerism.

And in case you missed it, here's a roundup of some of the big announcements that happened at HIMSS18.

1)Alphabet announced the Google Cloud Healthcare application programming interface, which can pull data from electronic health records and other sources. It relies on DICOM, FHIR and other standards to extract and gather data for machine learning. The company also announced that the Google App Engine and Cloud Machine Learning Engine support HIPAA compliance.

2)CMS Administrator Seema Verma announced the Trump administration's MyHealthEData initiative, through which the government intends to give patients more control over their data. Verma also announced an overhaul of the government's EHR incentive programs. White House adviser Jared Kushner spoke before Verma, calling for greater interoperability. The Trump administration is pushing for greater patient control of health data. "Medical data belongs to the patient," Kushner said.

3)Cerner Corp. will add Salesforce's Health Cloud and Marketing Cloud to its HealtheIntent big data platform. The combination will better engage consumers and providers, according to the company.

4)Validic launchedValidic Impact, a remote-monitoring platform that connects to at-home medical devices and wearables for tracking patients with chronic conditions and in post-acute care. The platform integrates directly into EHR and care-management systems.

5)UnitedHealthcare is bringing the Apple Watch into its United Healthcare Motion wellness program. UnitedHealthcare Motion participants pay tax and shipping for an Apple Watch and then apply earnings from the program to "pay off" the cost of the device. They will own it after they have racked up enough activity.

6)Data network Human API and the CMS will push the CMS' new Blue Button 2.0 API through Human API's network, making the tool available to 53 million Medicare patients. Third-party developers and providers can use the API to integrate claims information from Medicare beneficiaries. Those beneficiaries, in turn, can link their information to third-party applications.

7)Epic Systems Corp. has integrated Nuance's AI-powered virtual assistant into its EHR. Now, providers will be able to ask for lab results, medication lists, visit summaries and other information in the Epic Haiku mobile app. Also, scheduling staff will be able to use the virtual assistant to modify appointments via voice technology.

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Shulkin: VA poised to break interoperability logjam
Monday, March 12, 2018

LAS VEGAS—Veterans Affairs Secretary Dr. David Shulkin called on providers and health information technology vendors Friday to commit to working on a set of standards aimed at breaking the interoperability logjam.

Speaking at the Health Information and Management Systems Society's annual meeting, Shulkin said the VA is developing a set of common data standards for collecting patient information. The department is also testing an open-source API platform that would make it easier for electronic systems to speak with one another. Both are important for the VA as it works to create interoperability with the Defense Department and as more veterans seek care from community providers.

"We are asking industry to open up API access to all developers who want to work with veterans," Shulkin said. "And stop the practice of information blocking."

The VA last year offered a no-bid contract to Cerner, estimated to total $10 billion, to scrap the department's 130 existing systems and convert them to a single platform. Shulkin has delayed signing the contract, however, due to what he said were concerns over interoperability.

"We've been working to get this issue of interoperability correct," he said, adding that over the past three months the VA and its industry partners have made progress. Shulkin added that the no-bid contract was used to jump start work on interoperability rather than having to deal with a lengthy government procurement process.

Shulkin was effusive his support of developing common data standards and the open API structure. Through a new initiative the department unveiled earlier this week at HIMSS18, the VA has already come up APIs for a handful of categories, including allergies, scheduling and patient medications.

http://www.modernhealthcare.com/article/20180309/NEWS/180309895?utm_source=modernhealthcare&utm_campaign=am&utm_medium=email&utm_content=20180309-NEWS-180309895
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CMS Aims to Give Patients Access to Health Records
Monday, March 12, 2018

Patients should be able to 'share their data with whomever they want'

WASHINGTON -- The Trump administration launched a program Tuesday aimed at giving patients more control over their own healthcare records.
The initiative, called MyHealthEData, "will help to break down the barriers that prevent patients from having electronic access and true control of their own health records from the device or application of their choice," the Centers for Medicare & Medicaid Services (CMS) said in a press release. "Patients will be able to choose the provider that best meets their needs and then give that provider secure access to their data, leading to greater competition and reducing costs."

Patients deserve to receive an electronic copy of their health record and to "be able to share their data with whomever they want, making the patient the center of the healthcare system," the release continued. "Patients can use their information to actively seek out providers and services that meet their unique healthcare needs, have a better understanding of their overall health, prevent disease, and make more informed decisions about their care."
As part of the initiative, CMS Administrator Seema Verma also on Tuesday announced a Medicare patient records initiative known as Blue Button 2.0. In her prepared remarks, Verma said that although Medicare patients have for a long time had the ability to download their health information from the CMS Blue Button site, what they got was in the form of an excel spreadsheet or a PDF file, "without any context or help in understanding what the data is telling them."

https://www.medpagetoday.com/practicemanagement/informationtechnology/71582
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It’s time to ban productivity from medicine
Monday, March 12, 2018

According to Wikipedia, “Productivity describes various measures of the efficiency of production. A productivity measure is expressed as the ratio of output to inputs used in a production process, i.e., output per unit of input. Productivity is a crucial factor in production performance of firms and nations.”
Please tell me how this relates to being a physician or a patient. We do not produce anything. Rather we work with individuals to diagnosis, prevent, treat, and hopefully improve both longevity and quality of life.

Physicians work with individual patients. We should strive to tailor care with our patient.

Productivity implies that we can count patient units. That idea really disrupts the essential “why” question?
If you are unfamiliar with “why,” I highly recommend Simon Sinek’s book Start With Why. Why did we become physicians? I think the answer for most physicians includes helping individual patients. We strive to do our best for each patient.

https://www.kevinmd.com/blog/2017/09/time-ban-productivity-medicine.html

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