Kim Bellard

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Sometimes Innovation Requires Disobedience

The M.I.T. Media Lab is taking nominations for its Disobedience Award, which was first announced last year.  As the award's site proudly quotes Joi Ito, the Director of the Lab and who came up with the idea: "You don't change the world by doing what you are told." I love it. The site, and the award's proponents, make clear that they are not talking about disobedience for the sake of disobedience.  It's not about breaking laws.  They're promoting "responsible disobedience," rule-breaking that is for the sake of the greater good.  The site specifies...

The Big Get Bigger, Until They Don't

You may have missed it, but the Open Markets Institute released a report on what it calls "America's Concentration Crisis." The report begins bluntly: "Monopoly power is all around us: as consumers, business owners, employees, entrepreneurs, and citizens." As David Leonhardt wrote in his op-ed about the report, "The federal government, under presidents of both parties, has largely surrendered to monopoly power." Their associated data set details market concentration within 32 industries, several of which are health related. For example, in electronic health record systems, the top 3 firms account for 58% of the market, whereas in pharmacies/drugstores, the top 3 control 67% (and the top 2 alone have 61% share).

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The Business of Healthcare Is Business

Hmm, that headline doesn't seem right, does it? I mean, shouldn't the business of healthcare be, well, health? Or, at least, caring? Actually, shouldn't the business of healthcare be patients? After all, everyone in healthcare says it's all about patients. Everyone says they're patient-centered, whatever that means. But think about this: who in healthcare gets paid for you to be healthy? Or, conversely, who in healthcare doesn't get paid when you get sick, or when you don't improve under their care? Whether we planned it or not, whether we admit it or not, or whether we like it or not, our healthcare system is a business that has become about making money.

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The Good, the Bad, and the Ugly in Health Care

I hate being a patient. I have to admit that, although I write about health care, I am typically what can be described as a care-avoider. My exposure to the health care system has mostly been through my professional life or through the experiences of friends and family. The last few days, though, I unexpectedly had an up-close-and-personal experience as a hospital inpatient. I want to share some thoughts from that experience. Now, granted, any perceptions I gained are those of one person, in one hospital, in one medium-sized mid-western city. Nonetheless, I offer what I consider the Good, the Bad, and the Ugly of the experience...

The Microsoft Empire Strikes Back: Makes Major Inroads into Healthcare

It seems deeply ironic that a week after I wrote about how even giant companies eventually get surpassed, I'm writing about the resurgence of one such giant, Microsoft. Last week Microsoft won back the title of world's most valuable company (as measured by market cap), passing Apple. Apple had that distinction since 2012; Microsoft hasn't had it since 2002. Admittedly, Microsoft was only able to pass Apple because a recent tech stock downturn dropped Apple from its record trillion-dollar valuation, and, as of this writing, Apple has pulled back in front again, but the fact that it is a race again says a lot about Microsoft.

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The Most Important Health Care Jobs of the Future

Fast Company ran an interesting article The Most Important Design Jobs of the Future, predicting 18 of the most important design jobs of the future (at least 3 to 5 years out).  A couple of them were in health care, and arguably all of them would have some impact on health care, but I thought it might be fun to do a similar list specific to health care, and not limited to design. Let's hope no one comes back in a few years to show how wrong I was. I'll skip the usual suspects -- e.g., doctors, nurses, pharmacists.  Yes, those jobs will (almost) certainly still be around, but they may not be central as they are today.  And those jobs will evolve in ways that reflect the trends illustrated by the jobs I list...

The Pandora's Box of Gene Editing Is Now Open

The age of gene editing is upon us. Specifically, the use of CRISPR. Amazing things are happening, proving again how clever humans are. Whether we're smart remains to be seen. For those who are unfamiliar with it, CRISPR -- more accurately, CRISPR-Cas 9 -- is a new technique for gene editing.  It has allowed faster, more precise, and less expensive gene editing.  It can already do more than you may realize. CRISPR has been much in the news lately, due to a new study published in Nature. Researchers successfully corrected a DNA mutation that causes a common heart disease that is sometimes fatal, especially for young athletes. In what is believed to be a first, the researchers repaired viable embryos. Moreover, they repaired most (72%) of the embryos, which is much better than previous efforts...

The Ransomware Attacks on Hospitals Are (Cyber) Criminal

One of the redeeming aspects of crises is that, amidst all the confusion, suffering, and loss, there are usually moments of grace, of humans showing their best nature... Unfortunately, crises also tend to bring out the worst of our natures... And then there are the cyberattacks. Last week the federal Cybersecurity & Infrastructure Security Agency, the FBI, and HHS issued a joint alert Ransomware Activity Targeting the Healthcare and Public Health Sector, warning that they have "credible information of an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers." I'll spare you the technical details of the expected attack strategies or suggested mitigation efforts, but I will note that they warned: "CISA, FBI, and HHS do not recommend paying ransom." Read More »

The Right to Repair Ourselves

Geoffrey Fowler wrote an interesting article in The Wall Street Journal: We Need the Right to Repair Our Gadgets.  He describes how manufacturers have made it difficult for us to fix our personal tech gadgets (The Guardian concluded the same earlier this year), and discusses how he's managed to overcome some of those obstacles. As I was reading it, I kept thinking, boy, replace "gadgets" with "our bodies" and "manufacturers" with "health care professionals," and he could be talking about health care.

The Robots Are Coming...to Healthcare!

Ready or not, there are robots in your future.  And some of them will be for health care. There has been growing concern that the rise of robots, along with artificial intelligence (AI), will create huge impacts on jobs.  Within the last few months both McKinsey and PwC have issued white papers on the topic.  The former found that nearly half of jobs have the potential to be automated (although most not totally), while the latter expects 38% of U.S. jobs at at high risk of automation within 20 years. Health care is not high on most lists of sectors whose jobs are soonest to be heavily impacted by robots, but it is on the list -- and it will happen...

This Actually Is a Test

When it comes to health care, testing is not what it used to be, or what it is going to be in the not-too-distant future. For example, confirmation of a cancer diagnosis is getting much easier.  The New York Times reported that blood tests -- known as "liquid biopsies" -- have now been shown to generally match the results of a tumor biopsy.  The blood tests look for DNA fragments from the tumor that signal its presence.  The liquid biopsies are useful for both detecting the presence of a tumor and its ongoing monitoring. The current generation of tests are not perfect, with as many as 15% of tumors not generating enough DNA to be detected, but they do offer the advantage of not requiring an invasive procedure...

To ER Is Human...To Build an App to Find the Right Caregiver Is...

I was prompted to think of ERs by a WSJ op-ed by Dr. Paul Auerbach.  In it, he argues that non-emergency visits to the ER aren't going to stop, much as we might wish patients to do a better job of evaluating when they are actually suffering an "emergency."  He notes the limited access to timely care from primary care physicians, and how it is not reasonable to expect people to make such rational evaluations when they or their loved ones are suffering. As he says, "You can't teach patients economics lessons when they don't feel well."

Towards a Fortnite Healthcare System or how Gen X and Millenials will demand Gamification in Medicine

The World Health Organization (WHO) just included "gaming disorder" as a new mental health condition, listing it is its 11th edition of the International Classification of Diseases. My first reaction was, oh, good, now I have a good excuse to write about Fortnite. A year ago I hadn't even heard of Fortnite. That's no surprise, because few had; it wasn't officially released until July 2017, and even then the free, most popular version -- Fortnite Battle Royale -- wasn't released until last September. It was an immediate sensation, with over a million players within the first month. It has been smashing numbers ever since.

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Towards a New EHR Metaphor - Or, How to Fix Unusable EHRs

News flash: docs hate Excel! In a recent study, which included researchers from Yale, the Mayo Clinic, Stanford, and the AMA, physicians rated it only at 57% on a usability rating, far below Google search (93%), Amazon (82%), or even Word (76%). But, of course, Excel wasn't their real problem; the study was aimed at electronic health records (EHRs), which physicians rated even lower: 45%, which the study authors graded an "F." If we want EHRs get better, though, we may need to start with a new metaphor for them.Lead author Edward Melnick, MD, explained the usability issue: "A Google search is easy. There's not a lot of learning or memorization; it's not very error-prone. Excel, on the other hand, is a super-powerful platform, but you really have to study how to use it. EHRs mimic that."

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U.S. Healthcare Is a Cadillac...Unfortunately

The good news: the U.S. healthcare is a Cadillac. The bad news: it's not an Escalade or even an XTS, it's a Cimarron, which is on most experts' list not only of the worst Cadillacs ever but also the worst cars ever -- expensive and poor quality. It was literally a Chevy Cavalier dressed up and trying to pretend to be a luxury car. You probably get the metaphor. There was a time when "Cadillac" was essentially a synonym for quality. Products aspired to be "the Cadillac of ____." It was a compliment of the highest order, understood worldwide. Foreign auto manufacturers tried to match its quality and make a dent into its market share. There was a time with U.S. healthcare had that kind of status too.

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