“So why the rush to conclude that the guidelines were part of an industry plot? Have stories about industry greed so permeated our collective consciousness that we have forgotten that industry and physicians often share a mission — to fight disease?”
“Frugal innovation — doing more with less — redefines the traditional notion of innovation in healthcare. It is often discussed in the context of emerging countries and economies, such as rural China and India, and may provoke images of makeshift tools and technologies. A lack of resources calls for the industry to find new ways to do things.”
Molly Coye, M.D., chief innovation officer of UCLA Health, says ”’frugal innovation’ sounds like it’s something entirely new and different. {But} frugal innovation begins with the patient experience and the problem to be solved. It asks the question, ‘How can we do this at the lowest possible cost and the greatest convenience for the patient and their family and still have high-quality results?,'” she told Becker’s.
As some observers have said, healthcare innovation shouldn’t be technology looking for a use, but rather a smarter use of technology. Consider, for example, telemedicine to decrease clinic visits.
Dr. Wachter calls Epic, both its product and business practices, a fine operation and asserts that it delivers what hospitals and health systems want, inter-operability and all.
Another defender, says Becker’s Hospital Review, is David Bates, chief quality officer at Brigham and Women’s Hospital, in Boston. He told Dr. Wachter that Epic’s platform is the only EHR system that offers most of the capabilities that an organization wants in an EHR. “If you make a big matrix of all the various things that you want as an organization, Epic covers many more of the boxes than others,” Mr. Bates said.
Still, as Becker’s notes, the hospital industry “by and large remains critical of Epic’s willingness to share data. Dr. Wachter argued in his book that the type of inter-operability the industry is gunning for isn’t the type of inter-operability many health leaders are focused on.”
“Out here in the outpatient world — in the ‘real world’ as we like to call it — the relationships may start out smaller {than in a hospital}, but they have great potential to grow. We may be fine-tuning or wholesale changing medicines, learning about barriers to medical literacy, overcoming patients’ fears of undergoing certain tests or procedures, or adapting our preset notions of what is right and best for our patients to a patient’s own set of personal and cultural beliefs. This builds connections, and it only matures with time.”
Herewith a JAMA interview on how Vivek Murthy, M.D., the new U.S. surgeon general, sees his job.
Among other things, he told JAMA:
“The issues that I want to focus on are the issues that are causing us the greatest loss of life, the greatest disability, and the greatest healthcare costs, and those are obesity and chronic disease; tobacco-related disease; mental health—where we still struggle with not only providing people with adequate care but getting them to come forward; and substance abuse. Statements that I’ve made in the past around gun violence stem from my experience with patients who have been the victims of gun violence over the years.Violence in general is a public health problem.
“Issues come up. For example, few people anticipated that Ebola would be a big problem a year ago. The measles outbreak that we had at the end of December—that was an issue not everybody would have predicted. My goal as surgeon general is to focus on the issues that are costing us the most in terms of lives and dollars, but to also be nimble and flexible so that we can respond to issues as they arise.”
“Where does the high cost of American healthcare really come from? Mostly it comes from our futile attempts to fend off death. Everyone knows that a disproportionately high percent of your life expenditure on healthcare comes in the last few years of life. ”
“One thing we do know is that people will make better choices when we communicate with them effectively. The C4 Project out of’ Johns Hopkins looked at structured communication with family members of ICU patients involving the entire treatment team. They found that patients and families made their own quality of life decisions when properly informed.”
“The project concluded that a little communication went a long way to reduce futile, unwanted, and costly care.”
“{T]here is the fact that Americans just get too much medicine. They see doctors when they don’t need to. They get tests and procedures that aren’t necessary. ”
“As always, the best answer to a complex problem draws from many sources. But there are some guiding principles that emerge. First, we need to line up the incentives. Right now, the hospitals, providers, and insurers make money when the patients are sick or perceive themselves to be so. Let’s turn that around. We make money when the patient is not sick. And I don’t mean that we refuse care. Let insurance, providers, and hospitals work together for a common fee. When the patient is healthy the system spends less and we make more.”
“{L]et providers run the system, including the insurance companies, and compete with other providers who are doing the same. Without any wish to canonize Kaiser, they have created an impressive model for this kind of unified care. ”
“So why would CIOs claim to ‘own’ patient engagement? Maybe they are simply clueless about what patient engagement really involves. CIOs rarely interact with patients. Most CIOs have no direct healthcare experience, and are not trained as doctors or nurses. For example, a recent list of “100 Hospital and Health System CIOs to Know” included only 10 with health professional degrees (seven M.D.’s, three R.N.’s).
”Why then, not simply admit that the issue is out of their area of expertise, rather than claiming ‘ownership.’ My best guess is this is the bravado, or arrogance of generic managers.”
It can be an informational nightmare.
In his MedPage Today blog, he writes:
”We need to create systems that allow any provider anywhere to see all of the relevant information on our patients, whether through a patient portal, a smartphone app, or some other technological connectivity that allows them to bridge the barriers that exist once our offices close for the day.”
Similarly, we need to get feedback back from them, what they saw, what they thought, and what they did. All too often patients come to us and say “I went to a walk-in clinic over the weekend, they told me I had something, and they gave me some medicine, and they told me to follow up with you right away on Monday, ” and we are left to recreate the wheel.
The Do No Harm Project at the University of Colorado-Denver was started because founders recognized that healthcare overuse is “an urgent ethical issue,” said co-founder Brandon Combs, M.D., in a webinar hosted by the Lown Institute.
At the core of the initiative is the idea that clinicians should do “as much as possible for the patient [and] as little as possible to the patient,” Combs said.
He distinguishes between more obvious patient harms — malpractice and errors–and what he termed “reasonable overuse,” such as ordering unnecessary tests or procedures, that’s harder to define but can be just has harmful and costly, which is why it’s the focus of the Do No Harm Project.
His best practices for the Do No Harm program include, FierceHealthcare reported:
“Think big, start small. The University of Colorado identified three initial goals in its campaign: recognize harms from overuse, start a conversation about it and change the local culture, Combs said, adding that it’s important for providers to remember that they don’t have to do it all overnight.”
“Find your niche.” The founders focused on clinical vignettes because, he said, “patient stories are very powerful” and can be rallying cries for change.
“Make it stick. One key to UC-Denver’s success was supportive faculty, particularly its chief medical resident, ”who served as both a facilitator and educator for participants….”
”Don’t underestimate your potential.” The Do No Harm Project extended its reach and credibility far beyond what its founders expected by partnering withJAMA Internal Medicine to publish the participants’ vignettes in its “Teachable Moment” series.”
“Measure and celebrate success. ‘If you’re going to take the time, measure the impact to see if it’s important,’ Combs said, adding that it’s also key to share these results as widely as possible so that others can replicate your success.”
