News 12/28/18

Top News

Cinematic butt-kicker Chuck Norris, who is a shocking 78 years old, talks about physician burnout in his monthly health column.

He says PCPs have only an ever-shortening 7-22 minutes to spend with each patient, meaning that health and lifestyle counseling get pushed aside.

Chuck also notes that insurance company and government requirements force doctors to spend half their time documenting in the EHR as “medical clerks.”

In an unrelated item suitable for a slow news day, Chuck’s real name is Carlos.

Reader Comments

From Carbon Dating App: “Re: BS in healthcare. Check out Wharton School’s list.” The Ivy League school’s tongue-in-cheek report bluntly labels as BS many recent healthcare examples of “deceptive, misleading, unsubstantiated, and foolish statements,” even including medical literature in which a self-appointed expert considers only a single theory in performing studies that cannot be replicated. The authors cite a major BS problem in trying to improve healthcare quality while reducing costs, in which programs are launched based entirely on political appeal and the optimistic idea that their skimpy details can be refined on the fly. The article includes a BS Checklist Manifesto to identify these major forms:

1. Top-down solutions in which C-level executives come up with visionary ideas and then move on to the next shiny object as their underlings are forced to try to implement complex change without their involvement.
2. Consulting firms that pitch one-size-fits-all solutions for healthcare that have saturated the market in other industries and thus require fresh sales.
3. Silver bullet solutions with little evidence to back them up, such as EHRs and care coordination, that make incrementalism seem meek in comparison.
4. Following self-appointed gurus such as Don Berwick, Michael Porter, or Michael Hammer, with programs such as the Triple Aim receiving widespread endorsement even though nobody can define the numerator, denominator, or desirable ratio and people continue to confuse ”health” with “healthcare.”
5. The faddish idea of disruption, which has never really taken off in healthcare, partly because consumers don’t like the idea of healthcare change and neither do the companies and people making fortunes from it.
6. Stage-based models (of which Meaningful Use is an example) that support models that are often simplistic or wrong.
7. Excel-driven assumptions that prove wildly incorrect over the long term, such as the prediction that Medicare would cost $12 billion by 1990 instead of the actual $110 billion or that ACOs would save big money.
8. Fashionable bandwagons, such as hospital mergers and vertical integration that don’t improve performance, as health systems “get the bug that has infected your competitor.”
9. The idea that best practices such as those of Cleveland Clinic and Mayo Clinic will work for everyone else as consultants claim.
10. Buzzwords such as “scale,” “synergy,” “population health,” and the worst offenders of three-letter acronyms such as ACO and EHR.

From Academic Health System CIO: “Re: HIStalk. I am a long-time reader and appreciate your very reasonable list of questions to Judy Faulkner and balanced comments about the New York Times article. Thanks for the site, the balance of topics, and approach to the field.“ Thanks. The most fascinating aspect of the Epic story involves the company’s culture and its ability to identify and train bright new college graduates to function effectively in healthcare technology. I can’t imagine any other industry in which a 24-year-old employee with no relevant non-Epic work experience can command the attention of highly experienced health system clinicians and executives and actually get them to complete a painful project as defined by agreed-on metrics. I can assure you that is almost unheard of, as most significant health system endeavors devolve into endless debates and deflected responsibility (everybody is empowered to say no, but nobody can say yes). I would also love to know more about architecture and technology deployment – when’s the last time you heard of an Epic site going down due to Epic’s software (rather than hardware, network, or remote access middleware)? Most of us in the industry have never attended UGM and the company’s close-to-the-vest culture means we don’t really know how Epic works or how its success might be replicated, which I suppose is a good thing from Epic’s perspective but bad for those of who want to understand the legacy of what Judy built. 

From Split Pea: “Re: big data. What do you think of this article?” Van Halen’s concert rider required promoters to provide dressing room M&Ms with the brown ones removed, not because they were self-entitled prisses (which they were, but still …), but so they could assess the likelihood that the promoter had read the agreement carefully and followed through on their commitments. Likewise, when I see that a paid author can’t spell the possessive “its” correctly, I assume their abilities are limited and I stop reading. I also avoid Facebook because it’s depressing to see so many comments that sound like they were written by an angry, bitter six-year-old. We might have been better off as a pre-social media society when you had to earn the ability to influence by first passing the scrutiny of a responsible editor or event organizer.

From Mister Bittermuch: “Re: HIPAA. I planned to use the light week to catch up on risk assessment work, but with the lapse in government funding, the NIST regulatory resources supporting HIPAA are unavailable. Maybe HHS will, as it has for recent disasters, issue a temporary emergency guidance suspending HIPAA because we can’t get to the necessary resource material (just kidding). Google and file reposting will keep us secure.” The positive aspect of having a dysfunctional government is that things can’t get much worse in its absence.

HIStalk Announcements and Requests

I rarely use the term “it will change your life” in describing a technology purchase, but I’m happy to say that Mrs. HIStalk’s brilliant Christmas gift to me of a Sonos Play:1 speaker will do exactly that for just $149. The 5x5x6 inch, four-pound speaker connects over WiFi to your mobile device using the Sonos app, which you then use to tune the Play:1 in a couple of minutes by walking around the room with your phone or tablet. The sound is incredibly powerful and rich and the app integrates your streaming music choices (Spotify premium, Pandora, and TuneIn Radio in my case) into a single user interface from which you can choose individual Spotify tracks or playlists, a Pandora station (like jazz for dinnertime or hair band screaming for household chores), or live radio from all over the country. The app works over WiFi rather than via Bluetooth or infrared, so you can control everything from anywhere as long as you’re on the same WiFi. She gave one to a relative as well and has already ordered a second one so they can use them as wireless surround sound rear speakers, while we’re getting a second one for ourselves so we can cover the whole house with music (either the same or different sources). It sounds and works a lot better than old-school speakers-in-the-ceiling home audio and is actually fun to set up in just a couple of minutes, not to mention that you can just unplug the power cord, move it to another room, and plug it back in to get back to the music. I’m pretty sure it has plenty of kick for a patio or back yard gathering, too. Meanwhile, I got Mrs. H an Apple Watch (the Series 3, which was a steal on Black Friday and offers nearly every benefit of the Series 4) and she’s trying to figure out how to incorporate it into her lifestyle beyond the obvious fitness tracking 

It’s a slow holiday time until after New Year’s Day, but even so, two companies have signed up as new HIStalk Platinum sponsors in the past week, obviously using their quieter time to reflect on their need to bolster their expensive HIMSS presence with a timely announcement, not to mention exposure that lasts a full year instead of three days and that reaches decision-makers rather than just booth booty seekers. Thanks for the support.

Webinars

January 17 (Thursday) 1:00 ET. “Panel Discussion: Improving Clinician Satisfaction & Driving Outcomes.” Sponsor: Netsmart. Presenters: Denny Morrison, PhD, chief clinical advisor, Netsmart; Mary Gannon, RN, chief nursing officer, Netsmart; Sharon Boesl, deputy director, Sauk County Human Services; and Allen Pendell, SVP of IS and analytics, Lexington Health Network. This panel discussion will cover the state of clinician satisfaction across post-acute and human services communities, turnover trends, strategies that drive clinical engagement and satisfaction, and the use of technology that supports those strategies. Real-world examples will be provided.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Sales

• FirstCare Health Plans will offer a virtual care program powered by MDLive.

Other

Odd: a study of 400,000 ICU patients in the UK finds that short men die at a higher rate than tall ones. The author has no idea what this means or what ICUs should do differently (if anything), but speculate that maybe it’s related to incorrectly sized equipment or erroneous drug dosing, providing this unhelpful advice: “The message from this research is for doctors to be more aware of people’s height.” I’ll also say that I’ve seen a few cases in which critical drugs were incorrectly dosed by doctors who failed to take into account a patient’s missing extremity due to amputation or birth defect.

A study finds that the vision of students in Japan is the worst it has ever been, which the government says is due to excessive time spent staring at smartphones and mobile games.

In India, a patient’s three sons trash the ICU and beat up security guards after she dies of lung disease. One of them says her treatments were performed incorrectly, the hospital pressed them to pay her bill every day, and employees as well as doctors demanded cash bribes to check on her.

Sponsor Updates

More than 1,000 Meditech employees in its Georgia, Massachusetts, and Minnesota offices participated in the company’s Holiday Giving program to help 60 underprivileged families.

First Databank employees volunteered at the South San Francisco Holiday Toy and Food Drive.

Definitive Healthcare and its employees donated $100,000 in cash and and hundreds of volunteer hours to 30 charities in its home state of Massachusetts in 2018.

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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