Peter Zweifel raises some important questions regarding “Big Data”:
”The question of how manageable big data might be when applied to coordinated care is primarily the concern of health insurers, who have a strong incentive to invest in big data. Once insurers and medical directors agree on measures of performance, big data can be condensed so it is more manageable for both of these parties.
”However, it is doubtful whether the cost savings are sufficient to overcome the resistance of service providers who seek to retain their professional autonomy. Big data is a double-edged sword for consumers; improved coordination of care comes at the risk of a loss of privacy, which governments may be eager to exploit.”
A blog in HealthAffairs looks at redesigning the American health system to better address the needs of patients with advanced illnesses. To do this, the authors recommend six steps, and they give examples of places with successful models.
The authors write: “To ensure that the voices of patients with advanced illness will guide treatment decisions, patients’ values and preferences must be documented. Knowing and honoring patients’ preferences requires redesign of the health system using clear and specific design principles.”
The aim is a system that is:
- “Person- and Family-Centered: Care is focused on treating the person with an illness rather than a disease.
- ”More Coordinated: When systems are established to document and communicate this person-centered conversation, the healthcare system becomes more organized.
- ”Individualized: Management of disease and palliative services are not an either/or choice; rather, under individualized plans, patients receive care in the “dose” that fits their medical condition and informed preferences.”
He says that startups seeking to commercialize new technologies should:
- Define ”clinical utility” before spending millions of dollars.
- Understand who core and tertiary customers are, and the sales and marketing process ”required for initial clinical sales and downstream commercialization.”
- Assess intellectual property and regulatory risk ”before designing and building”.
- ”Know what data will be required by future partnerships/collaboration/purchases before doing the science.”
- “Identify financing vehicles” before they’re needed.
”Among high-risk children with chronic illness, an enhanced medical home that provided comprehensive care to promote prompt effective care vs usual care reduced serious illnesses and costs.”
The aim of the study was to find out “whether an enhanced medical home providing comprehensive care prevents serious illness (death, intensive care unit [ICU] admission, or hospital stay >7 days) and/or reduces costs among children with chronic illness.”
The study’s authors had noted that regular “Patient-centered medical homes have not been shown to reduce adverse outcomes or costs in adults or children with chronic illness.”
Jonathan Merril, M.D., has joined Cambridge Management Group (cmg625.com) as a senior adviser.
Dr. Merril has devoted his career to improving provider and patient education through technology. He is currently developing a “chronic care university’’ at Partners HealthCare. The new “university’’ is an online service for patients and primary-care providers meant to improve the lives of people with chronic conditions, with the first program to be focused on multiple sclerosis.
Cambridge Management Group (cmg625.com) has increasingly worked with providers to improve care and control costs associated with patients with chronic conditions as their numbers increase with the aging of the population. Dr. Merril and his colleagues at Cambridge Management Group recognize the growing need to manage chronic diseases with innovation in diagnostics and therapeutics.
He uses mobile and simulation technology and healthcare-education expertise to work with businesses, government and non-profit organizations to create novel opportunities to enhance care.
He is also the chief executive of Astute Technology, which streams large medical conferences, including those of the American Heart Association, the American Society for Clinical Oncology and many other organizations. Dr. Merril holds many patents in the digital capture of such gatherings.
Dr. Merril has used the Internet and App technology to build some of the most widely used online (including mobile) learning resources for physicians and patients. These systems power the Partners Healthcare Office of Continuing Professional Development and some key activities (including board reviews) of various other large non-profit healthcare organizations.
He is an expert in building and integrating platforms for continuing education, maintenance of licensure and promoting best practices for hospitals and professional societies.
Dr. Merril received his M.D. degree from The George Washington University School of Medicine and Health Sciences. He did his internship in internal medicine and then completed a fellowship in medical informatics in a joint program of George Washington and Massachusetts General Hospital. Jonathan Merril is married and has three children.
The Supreme Court will soon hear case that threatens subsidies that form a core of the Affordable Care Act. That has Republicans putting pressure on themselves to rally around their own plan, drawing on such ideas as tax credits to buy insurance, high-risk pools and letting insurance be sold across state lines.
If the justices follow the GOP plan, subsidies ”could be abruptly cut off to millions of people in states relying on the federal health exchange. That financial assistance would be available in just the 13 states running their own exchanges.”
All this would “spill over into the rest of the U.S. health insurance system. Without subsidies in two-thirds of the states, the uninsured rate would probably rise, reversing its sharp decline. Premiums could soar if only the sickest people stick with their more expensive coverage.”
Healthcare Renewal’s Roy Poses, M.D., and the Minneapolis Star Tribune look at the controversial case of Carl Elliott, M.D., a psychiatrist and bioethicist at the University of Minnesota who challenged the University of Minnesota’s handling of the death of a patient in a clinical trial run by the university.
Dr. Joshi notes that the Joint Commission has found that ”communication failure (rather than a provider’s lack of technical skill) was at the root of over 70 percent of serious adverse health outcomes in hospitals.”
”{O}ne survey found, two out of every three patients are discharged from the hospital without even knowing their diagnosis. Another study discovered that in over 60 percent of cases, patients misunderstood directions after a visit to their doctor’s office. And on average, physicians wait just 18 seconds before interrupting patients’ narratives of their symptoms.”
Dr. J0shi describes started a program that he and his colleagues started to improve doctors’ communication with their patients at Pinnacle.
They developed a physician-training program, which, he writes in The Times, ”involved mock patient interviews and assessment from {an} actor role-playing the patient. Over 250 physicians were trained using this technique. We also arranged for a ‘physician coach’ to sit in on real patient interviews and provide feedback.”
And it helped a lot, as his op-ed explains.
The Washington Post reports that “federal officials are trying to create a new model for neuroscience research, one that emphasizes innovation and cooperation across specialties and institutions. To do that, they threw a two-day ‘kickoff’ for scientists fortunate enough to have received the first funding slices of what probably will be a multibillion-dollar federal pie.”
