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Is the Arrival of “Big Data” a Wave or a Tsunami?

September 9th, 2013
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With nearly the same trepidation often reserved for a major weather disturbance and its aftermath of health issues, hospitals and providers are dealing with the arrival of “big data.” While handling large amounts of information is hardly a new idea, now there are regulatory requirements to meet, and vast volumes of test results, patient records, and other data to harness and transform into actionable information.
 
The regulations:

Under the Affordable Care Act, Medicare is levying (or soon will levy) penalties on hospitals that don’t reduce 30-day readmissions of myocardial infarction, heart failure or pneumonia patients; don’t use electronic health records to determine outcomes; and don’t reduce hospital-acquired infections. In addition, the Patient-Centered Outcomes Institute will collect data on 12 million patients in a long-term program to match certain treatments with provable improved outcomes. Large quantities of data are becoming available about healthcare systems and institutions, along with requirements for using it.  Read the rest of this entry »

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By Any Other Name; Technology May Make Capitation in Healthcare Work

July 30th, 2013
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With apologies to William Shakespeare, in this post I ask: will capitation smell sweeter, if called by another name? A recent article by venture capitalist Abbas Gupta lays out the case for a new variant of capitation (i.e., fixed healthcare fees), called the Affordable Care Organization (ACO). This time, consumer-facing technologies that empower consumers and generate more precise profiles of consumer behavior may bring promise to the previously ill-fated payment system.
 
In the 1990s, capitation was reintroduced as a way to manage healthcare costs. Doctors able to keep costs under a certain level could keep the amount they “saved,” but they were not reimbursed for costs in excess of that level. Capitation failed partly because of the perception that doctors sacrificed quality of care (measured in procedures and tests), and partly because doctors eventually were better able to negotiate contracts by consolidating practices and leveraging their numbers for better reimbursement rates.
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Can Digital Health Technology Be Part of the Secret to a Long and Healthy Life?

July 12th, 2013
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A comprehensive study of American lifespans and health published in this week’s Journal of the American Medical Association, which has received much media coverage, shows that while Americans are living longer, those extra years are less healthy when compared to older people in other industrialized countries.
 
While the report notes that certain diseases, like strokes, colon and breast cancer, and AIDS, have seen decreases in incidence, most of the conditions leading to increased cost of healthcare (namely, obesity and its associated co-morbidities cardiovascular disease, diabetes, and asthma) are increasing, and can be prevented with behavior and lifestyle changes, earlier intervention and better management. But clearly, that prevention isn’t happening.
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Digital Health Stands Before the Chasm Between “Cool” and Customer Value

June 5th, 2013
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There’s no doubt that many components of digital health are revolutionary technologies. They are making healthcare more personalized, more easily available and more accessible to a newly empowered patient/consumer. But how well is digital health really catching on?
 
At Popper and Company and elsewhere, the evolution of digital health has been discussed in depth. Smart phones (particularly Apple’s iPhone) have an enormous amount of portable power, a smart interface, and a platform that anybody can use. At the same time, “wearable” devices and sensors ranging from accelerometers to blood pressure monitors are more convenient and less expensive for use by a broad audience. Finally, cloud computing takes advantage of improvements in cellular and broadband infrastructure with increased bandwidth and network speed to provide more horsepower to applications, so that today, any mobile device can tap into this power with ease and become a health monitor. (Of course, those apps in the wellness realm go out of their way to ensure they are not considered medical devices, thus avoiding scrutiny by the U.S. Food & Drug Administration, but that is a topic for another day.)
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In Healthcare, Reframing Ideas Can Yield Innovation

May 13th, 2013
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While the word “revolution” is used often during a period of rapid, intense innovation such as the one we are currently experiencing in healthcare, it can be helpful to step back to see what’s sparking the revolution. The answer may lie in the word, “frame.”
 
From a medical or scientific student’s traditional lessons in genetics (specifically, frame shift mutations), to changes in our perspective on a problem, frames make very significant impacts. Defined as a conceptual structure used in thinking, a frame helps us give an issue or problem borders, shape and structure.
 
This cognitive tool, while useful for our brains, also creates limitations. The linguist George Lakoff points out that every word in our language evokes a certain frame. And once evoked, other words reinforce that frame in our minds, until the image or concept is so strong that we can’t see through or around it.
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