Rethinking as a Game

Quality is the new watchword in health care, it is what we are looking for - and more what we are trying to measure. Drugs, equipment, hospital services, care delivery - all are now questioned, as we seek to measure it to their advantage, and justify their costs.
The idea of ​​using metrics to evaluate the quality of make sense, but only if we can trust the metrics themselves. Otherwise, we risk an updated version of the party always craniometry, systematized false precision that focuses on easily measurable parameters (such as head circumference), which can not represent meaningful indicators for the assessment that we really after (ie, intelligence).
The good news is that the science of testing, the development of evaluation tools has improved over time. We are now better able to recognize the qualities and characteristics of good tests - and to see where they are likely to miss.
We are also getting more comfortable with demanding robust evaluation tools. For example, the FDA approach puts patients reported exceptional results (and appropriate) focus on the assessment tool selected, and demands that they show the features before. On their results
Unfortunately, a critically important area within our health care system, such as the escape depth review is seems to have the way out the expertise of the service providers generally and certified.
Whether you're an X-ray technician, a physical therapist, a nurse or a surgeon, you are required to pass through a maze of costly certification exam. These tests, already considerable assume even greater importance as the health system still sees them as proxies for quality. Certification may be required for employment and admission privileges, and often impact on the reimbursement rate for healthcare providers.
All this makes perfect sense - provided that the certification tests themselves are solid.
Unfortunately, the world of the workforce in the health certification remains a bit like the Wild West, as medical organizations and professional societies certification testing approach with greatly varying degrees of severity - and usually little to no transparency.

Paradox

Everyone, including this blog writer who has been touting the virtues of the great discoveries of data already or will soon be in the electronic health record (EHR), are available, which heralds the learning health [1, 2]. It is sometimes unbridled enthusiasm that the data collected in the clinical systems, perhaps combined with the research data, such as gene sequencing, will supply us easily knowledge about what works in health care and as new treatments [3, 4] are developed. The data is unstructured? No problem, just use natural language processing [5].
I honestly must share in this enthusiasm, but I also know that it can be alleviated, or at least at a dose of reality. In particular, we must remember that our great and data analysis algorithms only get us so far. If we have poor underlying data, the analysis may end up misleading us. We must be careful to problems of data incompleteness and inaccuracy.
There are all sorts of reasons for a lack of data in EHR systems. Probably the most important is that those data, ie, physicians and other clinicians, you usually give it for reasons other than the data analysis. I've often said that the clinical documentation may be what stands between a busy clinician and home for dinner, so he or she charting terminate before the end of the work day.
I also know many doctors, whose enthusiasm for the entry of correct and complete data is tempered by their view of the input data as a black hole. That is, they give the data in but never derive its benefits. I like to think that most doctors would be an opportunity to look at the aggregate view of their patients in their practice and / or patient, the outliers in a measure or another to enjoy identify. But a common complaint I hear from doctors is that the data collection priorities are more attempt by the hospital or clinic to maximize their refund than to support clinicians in better patient care driven ..

Disruption

Disruptive conduct. This is a thing now? I was told that this is just a kind of guide-I, it was a market is dynamic.

Hmmm ...

What it takes to be a "disruptive" to be leader?

Does it talk like a pirate in explaining how the company will be cutting benefits?

Does it try to dress like Ali G and, to imitate him, but only to raise a WASP accent?

I guess it does ... But that's the easy part.

Job No. 1 disruptive in leading a true market economy: FIND HIDDEN and fertilize the rage at the STATUS QUO that within ALL OF U.S. IS. Find it in yourself and feed and then find it in the other and pull it with you to work.

I am constantly looking for change in my personal life. For example, I just bought a Tesla. My other car is a 1983 Land Rover. Why? As in 1983, you do not need to sell vehicles with a seat belt dinger and airbags in the front seats Andd because Tesla is the first attacker disruptive automotive manufacturers. Past the fetal stage in my life I have to feed them. I hate the established automotive industry! I'm trapped in a small number of culturally (and sometimes financially) bankrupt brands that have an interest in the fight against overregulated morass that restrictions have lost.

Healt İnsurance

A staple of the conservative critique of universal coverage is that having health insurance does not equal access. The corollary is that the. Already assured access to care from doctors and hospitals willing to take care of them to a non-profit basis and of "safety net" institutions

This argument is not new, after he made years before the Affordable Care Act became law. In 2007, said the Council for Affordable Health Insurance, that "universal coverage is not timely access":

"One of the false assumptions behind the push for universal coverage is that everyone has access to medical care. During the first appear, start within a short time to grow, the waiting time and start the access and quality, as the government limits decrease health care financing. Moreover, do the uninsured access to care ... some of which are free or at reduced cost in public hospitals. would be better with insurance coverage, but the uninsured can get care and want. "

Writing for the libertarian Cato Institute, Michael Tanner argues similarly that "health insurance does not mean universal access to health care., In practice many countries promise universal coverage but ration care or have long waiting lists for treatment."

Dr. Marc Siegel, a physician, takes the argument even further, blogging in the National Review that he instruct not only to the government health insurance for all objects, but rather the idea of ​​health insurance:

"The individual mandate is the glue that holds together from Obamacare shoehorning in young, healthy people who do not know .. the health insurance for the sick and elderly, who do not pay, but an even bigger problem than the mandate lies in the cumbersome insurance itself Obamacare will be much worse by the number of people who are insured extended, the procedures and other objects (such as contraception) covered, and is the expansion of government involvement in making it all. "

(I find it ironic that many conservatives, the Obamacare because they advocate contradict result in more people getting health insurance for converting Medicare to defined contribution program, where the government is you-you it-to buy a voucher for private health insurance ! guess)

But let's get back to the main argument: that health insurance does not equal access to care, and that the insured care anyway.

It's true that health insurance companies must ensure not only access-you enough doctors to take care of patients, for one thing, but the evidence also clear that without health insurance is consistently associated with less access and poorer outcomes.

Here's what the Institute of Medicine noted in his landmark 2009 report, "America's Uninsured Crisis: Consequences for Health and Health Care":

"A robust body of well-designed, high-quality research provides conclusive results about the harms of being uninsured and to gain the benefits of health insurance for children and adults. Despite the availability of some safety net services, there is a gap between the health needs people without health insurance and access to effective health care. This gap results in unnecessary illness, suffering and even death. "

What's with those long waiting times for care in countries that have universal coverage? Well, there's more waiting for elective surgery in some of them, but the United States does not compare very favorably even when measured on elements such as access to family doctors and eliminating it because of the cost.

In 2011, the Commonwealth Fund report and chart pack compares U.S. health care system with eight other countries (all in some form of universal coverage have), and found that that was U.S. second worst waiting time to get an appointment when them sick, third last in always care after hours without an emergency room, and had the highest proportion of people who reported that because of the cost, she did not get medical care, not fill a prescription or skipped medical test, treatment or follow-up.

Leadership-Candidates

The National Journal reports that the jobs and the deficit is likely to dominate today night presidential debate, but the most important deficit in the absence of leadership candidates to unsustainable health care spending, not the federal budget. But before you blame Governor Romney and President Obama, first look in the mirror: Politicians do not just need the voters about the victim to lower health care costs, because we would vote them out of office if they did.

Today's 90-minute debate on domestic issues only. The first 45 minutes on the economy to be followed by 15-minute segments on health care, the role of the state and over. But even though his health is only 15 minutes to get fame, you can not really talk about the other issues without health spending. Because when you solve the health care spending problem, you solve the deficit and improve the economy. And controlling health expenditure see basic questions, such as the candidates and the general public, the government's role and approaches to regulation. Problem is that we will not allow the voter to either President Obama or Governor Romney to us. The truth about health issues because we do not know what they have to say, although we lament the lack of plain language of politicians

Because that's what an honest answer to the question: "What should the United States do to health care costs and access?" would sound like:

"The simple fact is that we can not afford our health care system. It is too expensive, even though there are millions of us leaving without health insurance. My opponent and I disagree on how best to reduce spending, but it is not a contradiction that health spending come down soon, by a large crowd, and in a way that none of us like.

Here's why: health care spending is the largest single cause of our exploding budget deficit and debt. We can not balance the budget without, how much we spend on Medicare and Medicaid. As our population ages, is Medicare, the. More and more people, even if we are less young people they support with their taxes Yes, all of us pay into Medicare during our lifetime, but much more from him in return, as we put into it.

An average-wage worker pays $ 60,000 in Medicare in their working years, but will receive $ 170,000 in benefits, if a man, $ 188,000, when a woman. The rest comes from our adult children, but there is not enough of them to pay for the many millions of baby boomers' I'm not talking about my generation without massive tax increases on them. Or we can borrow the money to throw us into more debt, debt that will be passed on to our children.

Our health care system provides excellent support for many of us, and we are the global leader in medical progress and innovation. But millions of us do not get a good access to care. Forty-six million have no health insurance. And we know that people without health insurance delay always requires care, and many of them suffer from more serious diseases or die from diseases that could have been prevented with better access. And the rest of us end up paying for their care. One thing that we have both together (pointing to the other candidates), is that we both signed cover laws for most Americans, remain formidable in Massachusetts and at the national level through Obamacare, but we and our country, whether national divides Law should be implemented, improved, or repealed, and if canceled, what would replace them.

Remember!

Freaked Facebook users around the world this week, when rumors spread that some of their private messages now appeared in public. (We do not blame them, it is angry-you certainly do not want your father saw late-night messages to your hookup buddy.) Be But after reviewing the reports, the social network said there were no signs of previously private content published, and many people back down to their demands.

What happened? Facebook networks were intimate at the time, so some people were wrong remember how loose they were even with the exchange of personal data. In other words, human memories were in a very different context than when they were recalled, first a new study in the Journal of Neuroscience may explain why saved. "'.

During the three days of experiments, researchers at Northwestern University, asked people to learn the locations of the objects on a computer screen, then you remember the next day, and a third day.

All the wrong people, the objects placed on the second day and the third day while 70 percent of the internships were closer on day two internships, not the starting point. The wild part? The people gave off neural signals that a new memory card is in the specified brain also suggested if it was wrong.

If you recall a memory card, there is a possibility that your brain creates a different memory of that call, says Donna J. Bridge, Ph.D., the study's lead author and a postdoctoral fellow at Northwestern's Feinberg School of Medicine. If the details are confusing (as in something reminiscent in a different environment, mood or time), a false memory could become part of this original memor

New Cares in New Congress

Three months ago a contribution argues that America's primary care associations, organizations and members of groups have splintered into tightly-focused specialties. Individually and collectively, they have proven unable to withstand decades to the attack on the basic services of other health interests. The article concluded that the primary care accumulate a new, more comprehensive organization and requires the use of energy to be focused policy influence in favor of the primary health care needs.
The intention was to strengthen rather than displace the 6 different societies - The American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), the Society for General Internal Medicine (SGIM), the American Academy of Pediatrics (AAP) the American Osteopathic Association (AOA), the American Geriatrics Society (AGS) - which currently divide the primary care physician membership and dilute its influence. Instead, would convene a new organization and galvanize practitioners in ways that increase their power. It would also reach and embrace other primary care groups - for example, mid-level clinicians and primary care practice organizations - by weight and resources, and reflects the fact that primary care is always a team-based undertaking.
We came to believe that a single organization would not be serviced. Feedback on the article suggested that a number of units required to have achieved a workable design

Same Question in Different Flags

If all of us were easy to make for better use of our feet, our forks, and our fingers - if we are to be physically active every day, were eating a near-optimal nutrition and avoidance of tobacco - just 80 percent of the chronic disease burden that plagues of modern society could be eliminated. Really.
Better use of feet, forks and fingers - and that's what - could reduce our personal lifetime risk for heart disease, cancer, stroke, severe respiratory disease or diabetes by about 80 percent. The same behavior could slash both the human and financial costs of chronic disease in the implementation of our children's future and the fate of our nation danger. Feet, forks and fingers not only represent behaviors that we have the means to control, they represent control, we have the resources to the behavior of our genes powers itself.
Feet, forks and fingers could redesign our own medical destinies and modern public health, dramatically for the better. We have known this for decades. So why does not this happen?
Because a lot more in the way. For starters, there are 6 million years of evolutionary biology. Throughout all of human history, calories were previously relatively rare and hard to get, and physical activity - in the form of survival - was inevitable. Only in modern times we have developed a world that is in physical activity to get tight and difficult, and calories are unavoidable. We are adapted to the former and have no native defense against the latter.
Then there are about 12,000 years of human civilization. Since the dawn of agriculture, the less we use our big homo sapiens brain and imagination to the challenges of the rich production of our food growing, stable and tasty, and the demands on our muscles always. With the advent of modern agricultural methods and labor saving technologies in any concept, we have succeeded beyond our wildest expectations.
So now that we are victims of our own success. Obesity and related chronic diseases could be also called "sexs" - "the syndrome of excessive success.

Medicines in socializing

Obamacare can be described as many things, but it certainly is not socialized medicine. No decent socialist would favor to purchase with government checks for 16 million people, the supply of private (and often for-profit) private health insurance. Plus, the Affordable Care Act maintains the employer-based coverage system, from which the vast majority of Americans continue to receive coverage. Heck, it's not even the public option favored by liberals!

I write this blog today from a country that is the real thing: Canada! ACP Board of Governors met this week in beautiful Vancouver, British Columbia. Coincidentally, one of the political decisions being discussed this morning by the governors of a call for a single client, the ACP system to assist as Canada. (Decisions by each ACP chapter may be imported, so the fact that this resolution is discussed, does not mean that there is, or will be, ACP policy. Plus, decisions of the Board of Governors have adopted the advisory College Board of Regents, what is the final authority to set company policy.)

So what can we learn from Canada? I would not say that my brief visit here makes me an expert on Canada's socialized health care system. But so far I have not seen masses of very ill patients desperately queue in long lines to get health care from besieged doctors and hospitals, although it evoked the image of critics of the Canadian health care system, such as this description conservative from a Canadian doctor "So , at a time when Canada's population aging and needs more care, not less, cost-crunching had bureaucrats reduces the size of medical school classes, shuttered hospitals, and capped physician fees, which suffered hundreds of thousands of patients waiting for needed treatment-experienced patients and in some cases, died from the delays. "

Actually seems the Canadians I've seen in this Pacific Northwest city damn fit and healthy! But casual observations are of course not really a fair way to assess Canada's socialized health care system. It is entirely possible that behind a seemingly healthy and contented Canadians lurking is a system that deny needed care and unnecessary suffering and death.

So instead of random observation and guess what does the evidence tell us about Canada experience and how it works in the United States compare?

The highly respected, nonpartisan Annenberg Public Policy Center is a site www.factcheck.org, objectively evaluates the evidence behind competing public policy claims. It's a short answer to the question "Is health care for better in Canada?" Is that "waiting times are longer in Canada, but health and medical quality do not seem to suffer."

Specifically, reports the Annenberg Center, that "A study by the Commonwealth Fund, a nonpartisan research foundation, which promotes improved access to health care and quality, showed that 57 percent of adults in Canada, an expert said necessary, they waited more than four weeks for an appointment, compared to only 23 percent who said so in the U.S. for emergency medical visits, said 23 percent of Canadians and 30 percent of Americans get that she was able to see the doctor the same day, but 23 . waited percent of Americans and 36 per cent of Canadians more than six days waiting times for elective and non-emergency surgery were disparate yet: Thirty-three percent of Canadians reported a wait of more than four months, but only 8 percent of Americans have had to wait so long in. another study, 27 percent of Canadians said that waiting times were their biggest complaint about their health care, compared with only 3 percent of Americans. "

But wait a minute, is Canada's long waiting times for some specialty care results in poorer clinical outcomes and poorer health? No, says the Center, because "most measures of patient-reported physician quality, Canada comes out slightly ahead of the U.S. .. Less reported medical errors, laboratory errors, medication errors and duplicate tests north of the border, and Canadians report more . satisfaction with their doctors, general health is also better in the north, according to the World Health Organization: Life expectancy and healthy life expectancy is higher in Canada, the infant mortality rate is lower, and the maternal mortality rate is much lower there are fewer deaths from non-communicable diseases. cardiovascular diseases and injuries in Canada, although slightly more cancer deaths. It is not clear how much of the divergence is on health care, but as other standard-of-living differences between the two countries ... But this statistics simply do not support the notion that universal, single-payer health care system cripples the health of Canadian citizens compared with U.S. citizens. "

And the Center reported that both the Canadian and U.S. health care reform "score on health low measures compared with other industrialized countries." In the overall ranking of the Commonwealth Fund of health system performance, came Canada fifth, and the U.S. was sixth, from six countries. On the other hand, the WHO World Health Report 2000 Review Canada slightly better, making it the 30th for the overall performance of the health system - three other Commonwealth countries study (Australia, New Zealand and the USA), but lower than the other two (UK and Germany). All these countries, except the United States, publicly funded health care have, as any large country in the WHO's top ten. "

My take-away is that Canada has the system, like the U.S., strengths and weaknesses. Canada is not the health care nirvana that some liberals believe it to be, but it's also the health of the hell that describe the Conservatives. It is a system that includes all, are operating at lower costs and at a much lower total cost than the United States, accustomed to long waits for some attention as a U.S. citizen, but (better in some cases) with comparable results. The U.S. provides cover only 85% of the population, so that 46 million without health insurance. We did not care to wait that long as our northern neighbors, but our results are no better (and sometimes worse) and it will cost us much, much more. Obamacare would take us one step closer to Canada, for the purposes of extending coverage to 92% of U.S. citizens, but by a decidedly non-socialist model of subsidized private and public health insurance, at a much higher cost.

Today's question: What do you think is the single payer health care and the Canadian health care system? You see it ever adopted by the United States?

Obamacare

Medical Malpractice in America remains a sensitive and controversial issue that made ​​it no less by its virtual exclusion from the Affordable Care Act (ACA or Obama Care) on the reform of health care in the United States.
Which is why I was glad to see the former head of President Obama's Office of Management and Budget, Peter Orszag, now with the liberal Center for American Progress, call it as his second top priority for the control of our out-sized medical expenses was - an implicit criticism of his omission from Obamacare.
Although associated with the criticism Rep. Paul Ryan (R-WI) speaks plan vouchers offer Sun Medicare enrollees private health insurance, his comments about the need to acquire to address malpractice reform there could be a shift away from the liberal talking points on Obamacare. Here's what he had to say ...

Obama's Care to Surveys of Medicine

Previously, I wrote about some wonderful developments taking place in medical science. Implantable or attachable devices already exist - or soon will be - that can monitor the conditions for diabetics, asthmatics, heart patients and patients with many other chronic diseases. These devices allow patients and physicians to change therapy regimes and therapies tailored to the individual needs and responses. Genetic testing of the point is reached where the patients need to take certain medications or to avoid other drugs that can only be on one's own genes.
Cut almost all HIV treatment in these days to the therapy cocktails for each individual patient. The FDA has approved a breast cancer drug for women with a certain genetic makeup. Patients are advised to steer clear one ADHD drug and certain blood thinners, if they have certain genetic variations.
We are entering the era of personalized medicine, where the treatment that is best for you is based on your physiology and genetic material - and may not be right for other patients.
But standing in the way this is a limitless potential Obama administration, the entire approach. Healthcare reform revolves around the idea that patients are not unique and that bureaucrats develop standardized treatments that apply almost all with a certain state When former White House health advisor Ezekiel Emanuel recently told CNN that "personalized medicine is a myth," he was fully reflecting the worldview of the authors of health reform

Can We Trust Retail Clinik?

Target, Walgreens and CVS have recently started clinics in their stores. The opening of "retail clinics" seems both potentially profitable and at first sight, somehow pushes the lines of our tradition view, should be located where medical services. Giving the concept of retail clinics might reveal some thought store-based providers to easily and cost-effectively, or alternatively full of conflicts of interest and possible damage. Should we turn make retail clinics in the Walmart of medical concerns?
The retail clinic industry seems to grow in recent years. Most of these clinics are from three major chain Target, Walgreens and CVS carry but there are also a mix of smaller providers branch of the existing chains such as the Mayo Clinic. Their primary use seems to be the treatment of acute "urgent care" conditions be as symptomatic treatment of infections of the upper respiratory tract (many sore throat), or providing simple precaution such as vaccinations. Most patients who visit these retail clinics to see a nurse. According to a recent study that tracked the growth of these clinics from 2007 to 2009, there was a fourfold increase in the number of these clinics so that it now see more than 1,200 retail clinics that nearly 6 million visits per year.

Danger in Electromedical

There is a great debate in the health tech community on a controversial keynote by Vinod Khosla at the Health Innovation Summit (HIS), in which he stated that 80% will be replaced by machines of what doctors could do given.
If you have a doc like me, who have no idea who the hell is Vinod Khosla (he is a venture capitalist and co-founder of Sun Microsystems), why he has to be a keynote speaker at a medical meeting and what the hell HIS is, well yes, that's the point of this post. You see, there are a lot of people out there like Khosla - investors, entrepreneurs, tech-types - who are trying to redefine health care are by their own personal vision. Where we see a health system in crisis, they see an opportunity - just another problem with a technological solution. Computer-driven algorithms are the answer to mis-diagnosis and medical errors, IPhone apps can replace doctor visits, video connectivity can increase access.
Where we see disease and misery, they see a market.
And what business people call as to disrupt the market. Think about what happened in the downtown small town USA after the first shopping center opened. Or what cinema when Netflix offers online since DVD rental. Or where did all the independent bookstores, as the first open borders, and what happens when the boundaries Kindle hit the market.
Out with the old, in with the new.
If Khosla is right that we docs are in our offices and hospitals, the old downtown department stores, bookstores, and the brick and mortar businesses in an online revolution. We are interchangeable. At least most of us.

Cancer Country

Diagnosed with metastatic esophageal cancer on 8 June saw, 2011 Christopher Hitchens, he was transported to a strange place. Until his death 18 months later, the award-winning author picked up pen and wrote about his travels in a "new country" where everyone, "smiled encouragingly," "where the cuisine is the worst of any destination" and where one language is spoken, that "it is possible to both boring and difficult." The recently published book "mortality" is his journey in "sick country," a place we call Cancer country.
The idea of ​​moving away is "described cancer land." In Chet Skibinski's 2012 diary-like book "On 15 May 2008 I went to a foreign country" with freakish rules and annoying habits. Skibinski takes the reader on his journey though several years of complex care and metamorphosis, not only medical but also social, spiritual and personal.
Cancer Country is a place not only visited by a body, hospitals, clinics, undergone knives, drugs, x-rays and deconstruction of machines, but it is an object of the mind, where confusion know to transform isolation and fear grows, and comfort in a bizarre, painful, spinning world that tries to break the mental suffering result. As a patient, authors note that it is a transit of which it is difficult to return.
Cancer patients throw from safety, stability and control in a state of danger, chaos and subjugation. Understanding of the disease process as an independent site, with foreign language offers, morals and goals Notes on the survival of the body and mind. Cancer see land as unwelcome Kafkaesque journey can help us in the fight against the disease and adapt to the changes that occur.