Kim Bellard

See the following -

Not All Snake Oil Is Digital

A different take on "snake oil" in health care was a thoughtful piece in Health Affairs, by David Newman and Amanda Frost, discussing the quality measurement morass in health care. They cite a study that estimated we spend some $15.4b annually collecting several thousand different quality measures, few of which have any meaning to consumers and all-too-few of which seem to be used to actively improve quality. It isn't that they don't think we should be measuring quality -- far from it -- but, rather: "Patients should not be able to choose substandard quality care, and substandard quality care should not be allowed to be offered in the market." Now, there's a novel concept!

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Not Just a Game

I fear the Apocalypse may be here. No, don't worry; this has nothing to do with our recent Presidential election.  Many others have already opined on that, from all perspectives, and I'll leave any further discussion about it to them.  No, what struck a nerve with me is something that drew much less attention: a U.S. university has given out what is believed to be the first varsity scholarship for esports. That's crazy, right?  We know what college sports are, and they're not esports.  Are esports even sports?  Why would a university be giving out athletic scholarships in them?...

Open Source Goes Corporate: Can Open Healthcare Be Far Behind?

If you aren't in IT, you may have missed the news that IBM is acquiring Red Hat, a leader in the open source Linux movement, or that, a couple days prior, Microsoft closed on its acquisition of GitHub, a leader in open source software development. Earlier this year Salesforce acquired Mulesoft, and Cloudera and Hortonworks merged; all were other open source leaders. I must confess, I had never heard of some of these companies, but I'm starting to believe what MarketWatch said following the IBM announcement: "open source has truly arrived." What exactly that means, especially for healthcare, I'm not sure, but it's worth exploring. IBM is paying $34b for Red Hat.

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Out With the Old...Wait, Not in Health Care

The last company still manufacturing VCRs announced it has ceased their production. VCRs had a good run, most households had one, but their time has passed.  Meanwhile, the stethoscope is celebrating its 200th birthday, and is still virtually the universal symbol for health care professionals. There has got to be a moral in there somewhere. VCRs revolutionized our TV viewing experience. We could record television shows to not only watch programs at our own convenience, but we could also fast forward through commercials! We could watch the movies we wanted, when we wanted to, in the comfort of our own homes. Video rental outlets popped up everywhere, from boutique neighborhood stores to wildly successful chains like Blockbuster...

Pandemics Are the Mother of Invention

Many believe that the Allies won WWII in large part because of how industry in the U.S. geared up to produce fantastic amounts of weapons and other war materials. It took some time for businesses to retool and get production lines flowing, during which the Axis powers made frightening advances, but once they did it was only a matter of time until the Allies would prevail. Similarly, COVID-19 is making scary inroads around the world, while businesses are still gearing up to produce the number of ventilators, personal protective equipment (PPE), tests, and other badly needed supplies. COVID-19 is currently outnumbering these efforts, but eventually we'll get the necessary equipment in the needed amounts. Eventually. What intrigues me, though, is how people are innovating, inventing new solutions to the shortages we face. I want to highlight a few of these:

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Patients Are Not Consumers...But Who Is?

It has become an article of faith in some health policy circles over the past 20 years that the "solution" for our health care system's woes is to make us better health care consumers -- the so-called consumer-driven movement. After all, we've known for at least forty years that increased cost-sharing does influence how much health care we consume, so, in theory, higher deductibles and coinsurance, plus better cost/quality information, should give us the right incentives to shop. Most health care professionals are equally convinced patients aren't, and are never going to be, "consumers" in any meaningful sense.  Health care is too scary, relies on too much specialized information, and is too often "consumed" at times when we are least able to make thoughtful decisions...

Practicing in an Age of Uncertainty

If you've ever had a hard time trying to decide what's best for your health (e.g., Sorry, There's Nothing Magical About Breakfast), perhaps you can take comfort in the fact that physicians often aren't so sure either. Or perhaps not. A new study in Annals of Surgery, and nicely reported on by Julia Belluz in Vox, focused on surgical uncertainty.  The researchers sent four detailed clinical vignettes to a national sample of surgeons, seeking to get their assessment on the risks/benefits of operative and non-operative treatment, as well as their recommendations. You'd like to think there was good consensus on what to do, but that was not the case...

Practicing in an Age of Uncertainty

If you've ever had a hard time trying to decide what's best for your health (e.g., Sorry, There's Nothing Magical About Breakfast), perhaps you can take comfort in the fact that physicians often aren't so sure either. Or perhaps not. A new study in Annals of Surgery, and nicely reported on  by Julia Belluz in Vox, focused on surgical uncertainty.  The researchers sent four detailed clinical vignettes to a national sample of surgeons, seeking to get their assessment on the risks/benefits of operative and non-operative treatment, as well as their recommendations. You'd like to think there was good consensus on what to do, but that was not the case...

Print Me a New Arm, Please - Bionics and 3D Printing add to a Revolution in Medicine

I just realized that I hadn't ever really written about two hot trends in health care: bionics and 3D printing.  I better get to it before they become mainstream, or are superseded by something even newer. Let start with bionics.  According to Merriam-Webster, bionic means "having normal biological capability or performance enhanced by or as if by electronic or electromechancial devices."  Bionics is the science of this...Bionics is estimated to be an $8b market (2014), with a projected 13.2% CAGR that would bring it to $20.5b by 2020.   The artificial kidney market is said to account for some 60% of the market, with livers expected to be the fastest growing segment over the period.

Rise of Drones for Medical Supply Delivery

This is not going to all be about getting your books, or your socks, or even your new HD television faster. It is going to impact many industries -- including health care. And that impact has already started to happen. Zipline International, for example, is already delivering medical supplies by drone in Rwanda. They deliver directly to isolated clinics despite any intervening "challenging terrain and gaps in infrastructure." They plan to limit themselves to medical supplies, but not only in developing countries; they see rural areas in the U.S. as potential opportunities as well. Last fall they raised $25 million in Series B funding. Drones are also being considered for medical supply delivery in Guyana, Haiti, and the Philippines...

Robots in Healthcare - Will they do the Heavy Lifting?

There are already robots in health care.  Robotic surgery, delivery robots, robotic prescription dispensing systems, even therapeutic robots used in lieu of pet therapy  But we've just scratched the surface, because we still think of care as being something that is delivered by a person. People like to talk about the importance of the human touch, but when it comes to something like getting out of bed when I want to, I think I'd rather have immediate service from a robot than an indeterminate wait for help from an aide.  And there are some more unpleasant tasks -- like assistance with going to the bathroom -- where I'd prefer not to have to ask another person to help me at all.  Sometimes impersonal is better (just be gentle, please).

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Say Goodbye to Your Smartwatch

Just because Steve Wozniak takes a shot at Apple doesn't mean he's wrong. Woz recently declared that the current generation of wearables, including the Apple Watch, are "not a compelling purchase."  He says that his Apple Watch is "an expense that has brought me a few extra niceties in my life," but generally is frustrated that wearables don't have enough computing power and are mostly still dependent on a linked smartphone for many of their functions. He's not alone in his skepticism.  A trio of analysts from Pacific Coast Securities see trouble ahead for many wearable manufacturers, as "value creation shifts away from the thing itself, while the associated ecosystem, software and/or service tend to deliver the real intelligence that the things provide"...

Signatures are No Longer Required for Credit Card Transactions...How Come Most Medical Records Exchanges Still Require Fax Machines?

If you live in the U.S., you've probably had the experience of paying for a meal using a credit card. The server takes your card, disappears to somewhere in the back, does something with it that you can't see, and returns with your card, along with two paper receipts, one of which you need to sign. Everything that happens to me, I think, what is this, the 1960's?As of last week, the major credit card companies -- American Express, Discover, Mastercard, and Visa -- are no longer requiring that signature. As a Mastercard person told CNET, "It is the right time to eliminate an antiquated practice."

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So...Is Paying Ransom What Bitcoin Is For?

The tech, law enforcement, and privacy worlds are abuzz with the recent decision by Apple to refuse to help the FBI crack the security on an iPhone, even though the iPhone in question belonged to an alleged terrorist/mass murderer.  As fascinating and important as that story is, I was even more interested in another cybersecurity story, about a hospital paying ransom to hackers in order to regain access to its own computer systems. This was not the first such occurrence, and it won't be the last.

Solving Design Problems in Healthcare Starting with the Waiting Room

A few days ago ProPublica had a headline I wished I'd written: If It Needs A Sign, It's Probably Bad Design. Although the article started with a health care example (EpiPen of course, citing Joyce Lee's brilliant post), it wasn't focused on health care -- but it might as well have been. Health care is full of bad design, and of signs. Take, for example, the waiting room. When most patients enter a provider's office or facility, the first thing they are likely to see is a waiting room.  The waiting room probably has other would-be patients already waiting there, each full of their own health concerns.  In some instances, the initial waiting room is merely a staging area; once processed, patients may be sent to yet another waiting room to wait some more.  And, of course, once they eventually do reach an exam room, they'll probably endure some more waiting, no matter how long their wait has already been...