Kim Bellard

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No Forms For You!

What do you hate worst about health care?  It could be the uncertainty about diagnoses, or the impreciseness of treatments.  Or there is the opaqueness about the actual performance of our providers.  Maybe it is the drabness and/or confusing layout of many health care settings, or the interminable waiting we do in them.  But somewhere on the list has to be having to fill out all those forms, over and over, at practically every stop along the way. If only someone would do for health care what Amazon is trying to do with grocery stores with Amazon Go. If you've missed the many stories about Amazon Go, or don't want to bother with the above video, it goes something like this...

No Thanks, I Already Have a Number

Health care has a problem.  Well, of course, it has many problems, but one of them is that the various parties involved in the health care system can't agree on who we are. Twenty years ago HIPAA called for creation of unique patient identifiers to accomplish this task, but within two years Congress put this on hold until further notice, and we're still waiting. Everyone used to use social security numbers for this purpose, until we finally figured out the folly of that (especially since that number was never intended to be used as a national identification number).  The private sector continues to clamor for federal action, while CHIME launched a National Patient ID Challenge in order to come up with solutions. News flash; we already have a unique, non-government-issued identifier: it's called a cell phone number...

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?...

On The Positive Effect of Collaboration and Information Sharing Among Physicians

For better and for worse, our healthcare system is built around physicians. For the most part, they’re the ones we rely on for diagnoses, for prescribing medications, and for delivering care.  And, often, simply for being a comfort. Unfortunately, in 2023, they’re still “only” human, and they’re not perfect. Despite best intentions, they sometimes miss things, make mistakes, or order ineffective or outdated care. The order of magnitude for these mistakes is not clear; one recent study estimated 800,000 Americans suffering permanent disability or death annually.  Whatever the real number, we’d all agree it is too high.  Many, myself included, have high hopes that appropriate use of artificial intelligence (AI) might be able to help with this problem.  Two new studies offer some considerations for what it might take.

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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.

Revisualizing and Recoding Health Care

Two new books have me thinking about healthcare, although neither is about healthcare and, I must admit, neither of which I’ve yet read. But both appear to be full of ideas that strike me as directly relevant to the mess we call our healthcare system. The books are Atlas of the Senseable City, by Antoine Picon and Carlo Ratti, and Recoding America: Why Government Is Failing in the Digital Age and How We Can Do Better, by Jennifer Pahlka. Dr. Picon is a professor at The Harvard Graduate School of Design, and Professor Ratti is head of MIT’s Senseable Lab. Drawing on the Lab’s work, they write: “We hope to reveal here an urban landscape of not just spaces and objects, but also motion, connection, circulation, and experience.” I.e. dynamic maps. Traffic, weather, people’s moment-by-moment decisions all change how a city moves and works in real time.

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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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