latest from my journal

More Doctors Taking Salaried Jobs

March 25, 2010 | in healthcare & careers

The trend away from small private practices is driven by growing concerns over medical errors and changes in government payments to doctors. But an even bigger push may be coming from electronic health records. The computerized systems are expensive and time-consuming for doctors, and their substantial benefits to patient safety, quality of care and system efficiency accrue almost entirely to large organizations, not small ones. The economic stimulus plan Congress passed early last year included $20 billion to spur the introduction of electronic health records.

Gardiner Harris (for The New York TImes)

Mind your data

March 11, 2010

But the buzz at this year’s HIMSS show was decidedly anti-Google. There was fear expressed in the aisles, fear I heard personally, that the company only wants your personal data so it can exploit it, make money with it. Google can’t be trusted was the summary.

Dana Blankenhorn

I can only speculate, but in the wake of “Google Buzz” perhaps this fear is not without warrant.

The Prescription Tablet?

January 07, 2010 | in medicine & technology

John Gruber offers a compelling framework for understanding the “Tablet” – a mythical device that, if rumors are accurate, Apple will soon unveil. Gruber’s framework does not paint an exact vision of the Tablet interface. Instead, it focuses readers on the central question: “If you already have an iPhone and a MacBook; why would you want [the Tablet]?” He speculates (somewhat boldly) that consumers would ultimately purchase the Tablet instead of a MacBook.

Following along Gruber’s framework, what I find most exciting about the Tablet is its potential: more than an e-reader, or movie player, or web browser. Not just a multifunction device, but rather a sandbox in which several creative ideas can flourish.

So, it comes as no surprise that Apple may be interested in deploying “tablet” devices in Hospitals, according to a report by Venture Beat. The mobile healthcare computing market is not new. As I learned from the report, at least one company has already made great strides. I’m also reminded of Microsoft’s vision in this area:

[video removed from YouTube]

My one bit of speculation: whenever Apple decides to announce an SDK for the Tablet, we should expect a showcase of healthcare-related apps designed to give doctors easy mobile access to their patient’s data. Note that Cedars-Sinai (the hospital referenced in Venture Beat’s report) deploys Epic software – a company whose desire for secrecy seems to match Apple’s.

An Amendment to Encourage Participation in Clinical Trials

December 14, 2009

Douglas Blayney, MD describes a new amendment introduced by Senators Brown and Hutchison. Insurers would be required to provide basic, routine care to cancer patients who participate in clinical trials.

This addresses what seems to be an important barrier to participation. And yet, one hopes that a surge in enrollment is balanced by sufficient counseling on the inherent risk of experimental treatments.

Jay Parkinson on Healthcare Pilot Projects

December 13, 2009

Responding to the New Yorker piece by Atul Gawande:

“Delivering healthcare to a large population of people in totally new ways paid for by totally different methods is uber complex, much harder than selling books online. Large scale pilot projects in healthcare have traditionally been much shorter than seven years. Why? Multiple reasons but mostly because pilot projects to rethink healthcare have been half-baked and small grant funded. Also, the amount of money people are potentially losing through experimentation is too large to risk a seven year investment and there’s little incentive to buck the system and create new ways of paying for or delivering healthcare.[…]

”[…]Healthcare experiments and pilot projects need to be rethought. We need the government to foster new platforms that markedly reduce communication overhead, much like Hello Health and the NHIN are doing.“ Jay Parkinson

Parkinson suggests a venture capitalist funding model – adopted from the technology sector, wherein the government would sponsor new and innovative methods for healthcare delivery. In other words, perhaps this is a mirror of the NIH funding model that powers biomedical research.

Of course, what emerges from these pilot projects may not be a single, unified model that works for every community. Rather, we might find that some communities (e.g with a unique socioeconomic structure, disease prevalence, age distribution, or pattern of genetic variation) will require specialized delivery models. As such, I hope that the government can provide not only funding, but also a critical review system that encourages well-designed, properly-controlled studies of healthcare delivery.