utopium of the people.
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
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
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
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.
I am not alone in
my skepticism about the limitations of health reform.
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.”
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.
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
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.
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).
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.”