Data, Use and Misuse - Limits of Data-Driven Health Care

Prelude: A school of thought exists that says information technologies, authoritative information available at the click of a mouse, will rationalize and cut costs, and improve outcomes and quality. I am not a fan of this school. There’s something Orwellian about it to me, and I think that the permutations and combinations of the human condition are so complex they defy categorization. Still, the availability and the instantaneity of clickable information are worth a try. Just don’t expect miraculous results.

My Assumptions
Have a moment to spare? Good. Because I am assuming you, the reader, are a busy clinician with no time to waste.

I am assuming you have reached the end of a long practice day, and you have a few unanswered questions that linger from the 20 or so patients you have seen today.

I am assuming you would like quick, easy, relevant, and recent answers to your questions – and you would like those answers to be authoritative and targeted to your specialty or to problems you confronted today.

I am assuming you are Internet-savvy and have previously gone to the all encompassing Google.com or PubMed.com, the massive U.S. government website, for your answers.

I am assuming you have found these sites too often yield long lists of articles or bits of information that take too long to scroll through and are often clinically irrelevant or outdated.

Searchmedica.com

According to Lois Wingerson, content editor of Searchmedica.com, these were the same assumptions the developers of Searchmedica.com, made 2 ½ years ago when the parent company, United Business Medica, based in London, and its subdivision, CMPMedica, Ltd launched Searchmedica.com. They assumed busy doctors, most of whom now use the Internet, want clinically focused, timely answers for pressing questions. Searchmedica.com was such a success that 2 years ago it expanded to the U.S.

Ms. Wingerson operates out of New York City, the U.S. headquarters is in Darien, Connecticut, the project manager is in Framingham, Massachusetts, and the software company, Convera, is situated in California. To make its information authoritative and clinically relevant, searchmedica.com vets all of information through clinical experts, located in the U.S. and abroad. Searchmedica.com has United Kingdom, France, and Spain editions. Each day it has hundreds of thousands “page views,” the criteria by which it judges its acceptance by clinicians worldwide.

Clinician Feedback
According to Lois Wingerson, clinician feedback is essential to keep Searchmedica.com clinically vital, relevant, and timely. She spends her time entering and deciding upon content, telling the search engine where to go, reading and weighing feedback, and writing the Search Tips Newsletter (to which you can subscribe on the homepage). The newsletter is based on searches being conducted and clinical responses and criticisms. To date, searchmedica.com has been almost completely clinical, but Wingerson foresees extending the website reach and contents to socioeconomic issues, particularly in the search tip newsletter.

Visit the Website

But I digress. If you want to know how Searchmedica.com works, I invite you to visit their website, so you can judge for yourself if this search engine is for you.

First, note the categories listed on the home page: all of medicine, cancer/hematology, cardiovascular, diabetes/endocrine, infections, mental/nervous system, musculoskeletal, pediatrics, practice management, radiology, and respiratory. Note also the search box, which you may want to use to get a specific answer.

The practice management category may interest readers of Physician Practice Options most. It is only several months old, as the interest in practice efficiency has grown and practice profit margins have shrunk.

As Ms. Wingerson observes, practice management is a “different beast.” Much of the practice management information is extracted from practicemanagement.com.m another website in the United Media family of websites and publications, which include Searchmedica UK, Searchmedica France, Searchmedica Spain, Cancer network, Consultant Live, Diagnostic Imaging, Physician Practice Management, and Psychiatric Times.

Narrowing the Search

Searchmedica assumes you may not only be interested in some broad topic but in a narrower aspect of that topic, such as.

• Research/reviews of the subject extracted from major journals, such as the New England Journal, JAMA, the Annals of Internal Medicine, Lancet, the British Medical Journal, among others.
• Practical articles/news - This information may come from Trade journals, specialty newsletters, Internet websites or a host of other sources.
• CME – This speaks for itself
• Evidence-based articles – As you well know, evidence-based medicine is the rage these days, and often serves as a basis for reimbursement for pay-for-performance. This material comes mostly from major journals.
• Patient-education – Increasingly, clinical medicine is perceived as a patient-physician partnership, and involves active patient engagement and education.
• Complementary Medicine - There’s no getting around it. Complementary, or alternative medicine, is here to stay, as patients seek answers outside of traditional Western Medicine.
• Evidence-based guidelines - As health expenditures have exploded, so have “best practice guidelines.” i.e, what works and what doesn’t and what should be paid for.
• Clinical trials - The conduction of clinical trials has become an international industry as pharmaceutical companies and device manufacturers seek evidence that their products work in selected populations. Here you will find clinical trials known to the U.S. Government.

In short, searchmedica’s founders believe they have developed a website that allows clinicians to find exactly what they want to know quickly without endless scrolling through long lists generated by such generic websites such as Google or Pubmed.com, The founders consider the site “agnostic” in that it does not favor one source over another and neutrally covers the clinical landscape.

A Practice Management Example – Coding

Let’s suppose you are interested in coding – either to maximize acceptable revenues to avoid an audit. If you type in coding in the search engine, you will get these top ten entries. Each contains a brief abstract of what the article is about.

1. Physicians Practice Articles : Coding: Your Top Coding Concerns Solved, November 1, 2008
2 Physicians Practice Articles : Coding: Your Top Coding Concerns Solved, October 1, 2008
3 Physicians Practice Articles : Billing: Finding Lost Revenue, November 1, 2008
4 Physicians Practice Articles : Billing: Billing Problems? Consider Your Charge Ticket. November 1, 2008
5. Physicians Practice Articles : Billing: Finding Lost Revenue, November 1, 2008
6 Physicians Practice Articles : Billing: Finding Lost Revenue, November 1, 2008
7 Physicians Practice Articles : The Law: Third-party Audits on the Rise, November 1, 2008
8 Physicians Practice Articles : Coding: Your Top Coding Concerns Solved, November 1, 2008
9 Color coding aids 3D interpretation in virtual colonoscopy. September 10, 2008
10 Physicians Practice Articles : The Law: Third-party Audits on the Rise, November 1, 2008


So if you have a moment to spare, visit searchmedica.com. I have. If it has one shortfall, it might be its failure to specifically cover some of the burning broader issues of today - Medicare mandates, shrinking reimbursements, physician shortages, decreasing access to care, and policy issues in general – into one category.

Organizing these issues into one category may be asking too much, for these issues are not solely clinical and cross philosophical, ideological, and political boundaries. They are hard to categorize. Still, searchmedica.com does contain abundant source material on the financial, legal, and administrative issues facing individual practices, and these are addressed in its new practice management section.