Wednesday, June 29, 2016
The utopium of the people.
Professor Arthur Case (1894-1946), commenting on promises of welfare state
Health 2.0 is the premiere showcase and catalyst for the advancement of new health technologies. Through a global series of conferences, developer competitions, and leading market intelligence, Health 2.0 drives the innovation and collaboration necessary to transform health and health care.
Self-Definition, by Health 2.0
How have promises of the health reform law and potentials of Internet applications impacted patients and physicians at the site of care?    How have private sector efforts, as exemplified by the Health 2.0, advanced health reform?   Has the craze for more algorithms, guidelines,  protocols,  lists of tests doctors can and cannot do,  pay for performance based on data gone awry or just contributed to more clinician hassles at the point of care?  And has IT, as far we know, lowered health costs, expanded access, and improved quality and outcomes?
Health 2.0 and the Health Care Blog         
Health 2.0 is a powerful and impressive movement that considers itself “a leading showcase of cutting-edge innovation since 2007.” 
Indeed it is.  This fall Health 2.0, an Internet-related company, will stage its 10 annual conference.  It expects over 2000 participants.   It was co-founded in 2007 by Matthew Holt. 
Holt also co-founded The Health Care Blog in 2003. It has 50,000 to 150,000 readers each month.  
Among these readers are patients, caregivers, physicians, health information companies, and venture capitalists. Its goals include deployment of data to judge the value of health care, defined as outcome/price.
The Health Care Blog and Health 2.0 have been successful enterprises.   Its founders recognized the Information Age had arrived full force and would be vigorously applied to health care.    Given the reality that the government-medical-industrial complex is a $300 billion industry, the prospects for IT applications to transform health care are limitless. 
The world is moving fast on Internet time, and an innovative private sector, in conjunction with government,   had a powerful role to play.      The Obama administration acknowledged this reality as well,  and  led to its belief that an interoperable, all-purpose, all-reaching, all-the-time available, online system connecting all major health care players holds  the key to improving access and quality of the American health  system. 
Health 2.0 personified concepts like collaboration, openness, participation, and social networking.   It is concerned with software licensing and delivery and cloud-based technologies and their applications on multiple devices. Health 2.0 describes the integration of these into much of general clinical and administrative workflow in health care. About 3,000 companies offer with venture capital funding of over $ 2.5 billion.
A Technologically-Incorrect Mindset
But how has IT technologies and their broad applications affected patients and physicians, who are the key to any successful health reform?
As the author of 4350 Medinnovation and Health Reform blogs since 2006 and  three book Innovation-Driven Health Care (Jones and Bartlett, 2007), Obama, Doctors, and Health Reform (2009),  and The Health Reform Maze (2011).   I have reservations about the limits of the health care information revolution.   
HealthReform 2.0  is another mindset.    It is a loose term describing the limitations of Internet applications and how humans react to the cyber-revolution.
I accept the power of the Net and its applications to shape and power of  health reform, I  am  techno-skeptic.   Data isn’t everything,  it isn’t  the only thing,  it is one of many things, including skepticism about total reliance on data as the main indicator of what constitutes a health or a health-conscious society.  
Internet-driven care may be oversold as a tool to improve health care, implement reform, cut costs, and empower patients. Useful, yes, but over-hyped as the Holy Grail, as the OSHA (Our Savior Has Arrived) of heath reform.
Taking a Step Back
The time has come to step back, taking a deep breath, and to stop being breathless about the unlimited prospects of cyber-apps as the principle agent and Holy Grail for transforming health care.    It is time for perspective on the merits and shortfalls of web-driven information technologies.
Not Alone
I am not alone in my skepticism about the limitations of health reform.
·         In 2007 Jerome Groopman, MD, a Harvard oncologist,  wrote in his book  How Doctors Think, “A doctor can’t think with one eye on the clock and another on the computer screen… a movement is afoot to based all treatment decisions stt5icktly on statistically proven data.  This so-called evidence based medicine is rapidly become the canon... But today’s rigid reliance on evidence-based risks, having the doctor chooses care passively, solely on the number isn't realistic. Statistics can’t substitute for the human been before you; statistics embody averages, not individuals.”

·          Robert Wachter, MD a West-Coast medical school professor, explained in his book The Digital Doctor: Hope, Hype, and Harm at the Dawn of the Computer Age (2015) that electronic heath record use could bring harm... A 2013 study found that the electronic health record was a dominant culprit in bringing harm.   A 2013 study found that emergency room doctors clicked a mouse 4,000 times during a 10-hour shift. Computer systems, noted Wachter,  "have become the dark force behind quality measures.”….evidence has mounted that even superb and motivated professionals had come to believe that the boatloads of measures, and the incentives to ‘look good, had led them to turn away from the essence of their work.”  

·         Andrew Keen, a denizen of Silicon Valley, executive director of Silicon Valley's FutureCast, and a regular commentator on all things digital, asserted in this book The Internet Is Not The Answer (2015), that that data and it computer applications,   were oly part of the answer for improving society, but they were not the total answer and were often destructive in undermining our culture and our economy. He examined the dimensions of its worldwide networks, showed how had destroyed many major industries, created a culture of personal narcissism, destroyed personal privacy, and caused deepening economic and social inequalities.  “Creative destruction” is part and parcel of capitalism, but it has its downsides.

·         In 2016,  Andy Slavitt, acting CMS director,  after he and his team  interviewed  thousands of physicians about their perception of the utility of electronic health records said  he believes that the measurement craze has had its negatives. He said doctors feel all the data entry “took time away from patients and provided nothing or little back in return. Physicians are baffled by what feels like the ‘physician data paradox,’” he said. “They are overloaded on data entry and yet rampantly under-informed.”But the rest of Slavitt’s statement reveals he has no idea how to solve the “data paradox.” He asserted that “technology that works for doctors and patients” is the ideal solution but it offends many physicians.   He added, “We have to get the heart and minds of physicians back.  I think we’ve lost them.”   Because of widespread physician resistance,  Slavitt  announced the end “meaningful use” EHR mandates.

·         A  study on electronic medical records use by the California HealthCare Foundation, a philanthropic group, found that 15% of the 1,849 adults surveyed said they’d conceal information from a physician if “the doctor had an electronic medical record system” that could share that information  with other groups. Another 33% would “consider hiding information.”   This is an example of the garbage in, garbage out phenomenon when it comes to interpreting the reliability of algorithms to improve care.
The Internet Age is upon us, and it may well  in the end transform the health system for the betterment of all.    Information technologies have the potential of making health care more efficient and objective, improving the health and extending longevity,   identifying what is of value for each dollar spent,  decoding the genomic secrets of disease,  and  deciphering and streamlining the organizational and disease complexities.   
And yet, the Internet is no panacea, no cure-all for the problems, costs, and complexities of health care that beset and befuddle  humankind.  Medicine and health care are fiendishly complicated, and the Internet sometimes makes them more so. 
The Internet often intrudes into patient-doctor relationships, tends to decrease private and confidential relationships, and accumulating the data that feeds its algorithms and helps it reach its conclusions pose expensive, cumbersome, and distracting propositions for clinicians and patients alike on the front lines of care.   
One last comment. The extensive use of electronic health records has contributed to physician shortages, to physicians abandoning traditional practices to enter concierge practices to escape coding and other 3rd party electronic mandates,  to physicians accepting fewer Medicare, Medicaid, and ObamaCare exchange patients,  and to physician burnout. 
According to Mayo Clinic studies, EHRs are the leading cause of physician burnout, to wit, “Although electronic health records, electronic prescribing, and computerized physician order entry have been touted as ways to improve quality of car, these tools create clinical burden, cognitive burden, frequent interruptions and distraction – all of which contribute to physician burnout):”Electronic Tools Fan the Flames of Physician Burnout, “” Health Leaders Media, June 27, 2016).
In a recent Washington Post article “Why Doctors Quit,” Doctor Charles Krauthammer, psychiatrist, conservative commentator, and prominent health law critic, after attending his 40th Harvard Medical School reunion, quotes one of his classmates, “My colleagues who have already left practice all say they still love patient care, being a doctor. They just couldn’t stand everything else…. a never-ending attack on the profession from government, insurance companies, and lawyers... progressively intrusive and usually unproductive rules and regulations,” topped by an electronic health records (EHR) mandate that produces nothing more than “billing and legal documents” — and degraded medicine.” 

No comments: