Category: Healthcare Data

Saving Lives Saves Money

Check this out. What you will see is an interesting, if somewhat odd, computation. As set forth in this working paper, social distancing in the U.S. for 3-4 months would save 1.7 million lives by October 1, 2020. Given the average statistical value of a life, that translates to a positive financial impact of $8 Trillion!!!

Bottom Line. One of the strange impacts of the COVID-19 pandemic has been the myriad strange statistical computations that have been put forth. Frankly, this strikes me as one of the strangest. I am still trying to figure out what I should do with this information, and with the drill down reporting that 90% of these financial benefits “accrue to people age 50 and older.” Where do we go to collect the $8 Trillion?  

Call me crazy but I am guessing that an additional 1.7 million lives being saved, with the vast majority of those being in my advanced age group, is benefit enough without the financial argument layered on top.  

Want to convince people that social distancing is worth practicing? Tell them that it can save their life, not that it saves money!  

Rating The Ratings

Check this out.  What you will see is a doctor who is clearly and understandably disenchanted by the extent to which everything in healthcare is now being “rated,” and the extent to which these ratings are being used as the basis for non-trivial purposes like driving compensation. Great vignettes here. Like medical students who were served cookies during one of their classes rating the class experience as being significantly better than those students who weren’t given cookies. And patients who received a prescription from a telemedicine physician being significantly more likely to rate that doctor highly than patients who didn’t get a prescription, even though the Rx was likely for an unnecessary drug. Etc. Bottom Line. I think the doctor has a very good point. You may recall that I have questioned this whole ratings deal in healthcare many times before. In psychometrics classes I took as part of my doctoral training in psychology, I learned about ratings. I learned that they are easy to administer. And provide nice, quantitative data. And are unreliable. And are subject to the “halo effect.” And…. When this whole ratings fixation thing came into vogue, I thought that it would be a passing fancy. That it would come and go. That it would sink under its own weight. Nope! What might straighten this out? How about teaching the healthcare decision makers who keep wanting more ratings the basics of the psychology of how ratings actually work? And don’t work.  That might help! 

When Slower Is “Better”

Check out this piece. What you will see is that the government database of drug, physician and hospital prices that has historically been updated annually has, under the current administration, not received any updates.  And yes, that means that it is out of date and increasingly less meaningful and useful. I am reminded of the interesting book Flash Boys, that describes how high-speed stock traders can make a fortune by getting information milliseconds faster than anybody else and placing high speed trade orders. Bottom Line. Fascinating. Slowing the flow of information can have important consequences, just like speeding up the flow of information.   What can we do with that little insight?

Googling UK Health Data

Google Health in the UK Check out this article. In it, you will see the announcement of an agreement that will provide Google’s artificial intelligence subsidiary with “huge” amounts of clinical data on patients passing through three of the UK’s largest hospitals. Apparently, the NHS believes that, in return, it will receive clinical insights from “big data” analytics that will help them to improve the quality of care and to reduce treatment costs. Maybe. But read between the lines and you will find that the parties involved in this deal were initially less than forthcoming in describing its breadth and depth to the public. While Google is without a doubt a leader in its ability to wring information/insights/action out of data, their aspirations in the healthcare space are also rather lofty, thus causing me some pause in terms of their motivations here. Bottom Line. I have a question. Who is going to be monitoring the legality and ethics of this arrangement, and others like it, as we go forward into the future? I really hope that we are pleased with the answer that we get on this one!

Sexual Health

Sexual Health Fascinating. Trojan (As this article says, “yes, that Trojan”) has once again commissioned a study of U.S. colleges to determine which schools of higher learning provide their students with the best “sexual health,” including providing them with condoms, STD testing, etc. The findings? Oregon State is the sexually healthiest among the 140 schools studied, and Brigham Young occupies the tail end of the list. Bottom Line. I am guessing that most students will not be selecting their colleges based on their sexual health scores. But that’s not the important thing. The important thing is that this study provides yet one more form of transparency, i.e., bringing important behaviors of public institutions into the sunshine for scrutiny. Even better? Schools in general have been improving over the 10 years the study has been conducted. All good!

The Next Round Of Apple Wearables

Apple Wearables The graphic above is drawn from a patent application that Apple has filed for a biosensor ring. Health, security and other applications are foreseen for this logical next step following the successful introduction of the Apple Watch. Take a look! Bottom Line. Yup! As we have commented previously, we can look forward to Apple and others introducing a continuous string of wearable hardware over the course of the next few years. The real question still remains, however, as to when the data forthcoming from these devices will be turned into information, insights and behavioral change. While Apple has been assiduous in introducing such accessories as new designer bands for the Watch, they have been far less productive in terms of demonstrating meaningful outcomes resulting from its use. Hopefully, their approach to the ring will be different. If not, they may be reinventing the “mood ring” popular in the 1970’s. Whoopee!!!

Ain’t Automation Wonderful???

Automation Remember the promise that EHR’s/EMR’s were supposed to deliver improved efficiency? If that held true, why are doctors increasingly complaining about the amount of time that they have to spend on “paperwork?” There is clearly a disconnect here. But physicians’ woes in this regard are becoming an opportunity for another group of professionals, “Medical Scribes.” Check out this article. Press the audio arrow at the top of the page and listen to a 4-minute NPR shtick on this topic, or read the narrative, or both. What you will find is that it is currently anticipated that the current ranks of 20,000 medical scribes in the U.S. will increase to 100,000 by 2020. What do these people really do? Is this the best way to do it? Does all of this really make any sense??? Interesting. As the NPR segment notes, one of Newton’s laws of motion is that “For every action, there is an equal and opposite reaction.” Thus, paradoxically, the move toward automation of medical records brings with it the need for more busy hands. LOTS more busy hands. Bottom Line. This is all amusing from a business perspective, but how about the impact on medical care? Note the quote from a medical scribe, indicating that keeping a straight face in the treatment room is one of the toughest parts of the his job! And what is the patient’s reaction to this undemonstrative presence? How would it make you feel?

Surgeon Scorecards???

University Hospitals We’ve spoken previously on attempts by ProPublica to inform the general public about what is happening behind the scenes in health care. For example, we’ve explored in depth the plusses and minuses of them telling us how much $ each physician in the U.S. receives from pharmaceutical companies in honoraria, meals and other goodies. Scroll forward. PP is now publishing a scorecard that purports to rate surgeons on the quality of their work. This article, on the other hand, calls into question (to put it mildly!) the validity of this offering. While the surgeon author obviously has his own act to grind, there seems little doubt that the points he makes are valid. Bottom Line. Be very wary of “scorecards” and other apparently simple metrics that people use to quantify complex things. They often assume “all other things being equal,” and that is very seldom the case. Most notable in this case are the different patient populations of the various surgeons under study. Does that impact outcomes? Damn straight!

Coercion???

Coercion Theoretically, participation in workplace wellness programs is supposed to be voluntary. BUT. When does the pressure applied by the employer to get you to join such a program legally become coercive? Are financial rewards for participation OK? Sure. How about penalties for nonparticipation? Maybe. And then there is this little matter of privacy of an employee’s health information. Employers aren’t allowed to ask questions about employees’ health except, you guessed it, under the banner of a workplace wellness program. Check out this new article from Kaiser Health news. What you will see is our old friends from EEOC (Remember them?) trying to come up with some “compromise” rules which will help to sort this all out. As my company’s attorneys used to remind me when we were attempting to settle a piece of litigation, you can tell you have reached a good compromise when everybody is a little unhappy. And that’s what looks like will happen in this matter as well. Bottom Line. Interesting. As we see employers moving away from being the sugar daddies of healthcare premiums, we see them stepping forward in other health related areas. Corporate on-site clinics, wellness programs, etc. are proliferating. Not easy to figure out what the operating rules should be here. Money and privacy seem to be the two big issues. Let’s see how close the EEOC can get to a fair “compromise.”

Computational Biology???

PLOS Frankly, I’ve never put those two words together before. But I sort of get what computational biology is all about. Especially with the example you will see when you link to this URL. However, if you want some more explanation of this area of endeavor, you can take a detour to read a little about the journal dedicated to articles about it.  Here’s the point. A recent study has found that usage levels of Wikipedia information related to influenza are accurate, “real time” predictors of actual geographically specific outbreaks. In fact, the accuracy and timeliness of this predictive methodology are both better than those of the traditional tracking methods historically utilized by the Centers for Disease Control. Bottom Line. Utilization Data. Think of the broader implications here. What other kinds of Utilization Data, collected on a real time basis and at very low cost, could provide us with extremely valuable predictive abilities?