Author Archives: Barry O'Gorman

About Barry O'Gorman

Independent consultant. Focused on healthcare, construction and engineering. Interested in collaboration, semantic web/ web 3.0, social media/ web 2.0.

Attempting to provide guidance on imaging decision by physicians

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Interesting interview with Scott Howsill, VP of ACR Select – providing the background to their product designed to assist physicians in determining requirements for imaging.

In US they now have Radiology Benefits Managers – obviously a piece of software, incorporating all best practice knowledge around imaging (Appropriateness Criteria from American College of Radiologists) and integrated with the EMR (preferably in the CPOE workflow), must be better than making a phone call and awaiting an answer.

Essentially looking to have ACR Select  deployed in an EMR or CPOE workflow to order the right study at the right time for that patient for the specific clinical conditions for that age and sex.

 

 

Visit your GP online – telemedicine

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Have been thinking about this for some time.  Why do I need to visit the GP for many of my  ailments?  Could I not meet with the GP online?  With a structured way to follow up should a physical visit be required e.g. for physical examination, other tests, etc?  And some of these tests/ procedures would be routed to the appropriate location/ resource, rather than requiring meeting with the GP.

Obviously critical to have a shared record of the online meeting – but that is easily accomplished.

Seems to me that an approach which leverages potential of telemeetings between GP and patient should offer potential efficiencies for everyone – less travel/ waiting around/ requirement for waiting rooms, better focus of GP skills on relevant matters.

http://www.americanwell.com/index.htm seems to be an up and running version of this.  Am curious to understand patient and doctor experience of this environment.  But seems to me that it must become the norm as we move forward.

This will require investment, reorientation, expectation setting – all the usual in order to make it work.  But I think it’s going to make a lot osf sense for current and future generations who have grown up with online presence, social networking, etc.

Obviously all of this challenges the traditional model of the ‘family doctor’ and the special relationship between patient and her GP.  However much of this has been eroded anyway as general practitioners have consolidated for lost of sensible clinical and commercial reasons.

 

What can we, in healthcare in Ireland, learn from meaningful use experience in the US?

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Interesting to see how phase II of meaningful use will succeed with patients in the US.

This requires significant change in practice and in attitudes.  Without doubt it will make sense to make patient data available electronically for sharing between a patient and his/her carers.  But all parties must see value in the proposition and commit to working in a different way.  Temporary, artificial, financial incentives will neither change attitudes not drive sustainable change.

This paper by PwC provides an interesting analysis of some of the attitudes and some of the challenges.

Across the population there are still challenges around access to technology (25% of US people do not have internet access from home), awareness of electronic patient records, trust in technology, willingness to question medical personnel, difficulties defining the roles of patient and medical professional.

In Ireland The Health Service Executive (‘HSE’) recently issued a tender for a four-year national integrated services IT project using electronic health records to underpin its integrated service delivery plan.  This project aims to define  a platform for integrated service delivery.  However it will be interesting to see how the challenges outlined in the PwC report are anticipated and addressed.

 

What do medical apps for mobile devices offer in healthcare?

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Seems to me wherever I go people are looking to see what they should be doing about their apps strategy?  If all these potential customers are living on their mobile devices then I’d better move my applications to this world.  And so the focus on medical apps for mobile devices in healthcare.

And the craze seems to be big time happening in healthcare.  Not really that surprising.  In hospitals we have been looking for ways to make it easier to capture information, present information , share information.  And new devices, such as iPads, look like they offer part of the solution.  At least, they have created hope!

But are ‘apps’,per se, technology looking for a problem?

Read a very good piece by Brian Proffitt recently which is very cautious in its expectations for ‘medical apps’.

I’ve seen plenty of examples of hospitals looking to develop apps to increase their interaction with patients – with a view to improving likelihood that recovery paths will be followed e.g. post op physio/ exercise programmes.  And other initiatives generally aimed at improving on outdated websites – by providing more relevant, more easily accessible, information.

In his piece Brian Proffitt points out many of the challenges involved in developing applications which are subject to regulation e.g. FDA validation.  He alos references examples of ‘develop and they will follow’ – perhaps less time spend trying to develop the perfect application and more emphaisis on ‘the strong will survive’.

Personally I think the danger with much of the enthusiasm for apps is that proper analysis is skipped – people buy into the gadget, the new look and feel, but without real changes in process and commitment to change very little sustainable benefits will be realised.  Unfortunately, once again, there are no real shortcuts.

Drivers for rising healthcare costs in the US

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Rising healthcare costs are on the agenda everywhere it seems.

In Ireland Minister James Reilly T.D. is not the first health Minister to find himself under major pressure.  His predecessors, including the Fianna Fail leader, should be able to empathise with him. But right now he finds himself under pressure on several fronts.

Interesting paper published in the US by the Bipartisan Policy Center,

What Is Driving U.S. Health Care Spending? America’s Unsustainable Health Care Cost Growth

Not too many surprises re drivers of rising healthcare costs:

  • Ageing population
  • Well paid consultants
  • Incentives to order tests
  • Drugs costing too much
  • Patient expectation of new technologies
  • Inefficiencies because of lack of coordination/ information sharing
  • etc.
Nonetheless I think the authors have done a good job of analysing the drivers and highlighting some issues which need to be addressed.  Unfortunately I would not be that optimistic about their chances of success.
Reading the document seems to me that recent changes (over the last number of years) in Ireland have removed one of the drivers – tax incentives to provide top quality health insurance.
Interesting discussion of the role of consultants – and the preference for single specialities.   Seems in the US there has been a huge increase in ration of consultants to general practitioners.  Would seem to suggest that the consultants believe that the payback on the additional investment in training is worthwhile – both in terms of job satisfaction and financial reward.

 

 

Any public cloud in healthcare?

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Am seeing plenty of examples of ‘private cloud’ in healthcare environments – with healthcare organisations running applications on their own dedicated platforms in data centres – with some limited cloud functionality.  But in most cases security and privacy concerns (underpinned by regulation) prevent such organisations from exploiting more generic opportunities of the public cloud.

Recent survey, not surprisingly, points to significant future growth in use of the cloud in healthcare.  And we need to look at both clinical and non clinical applications.  But the real challenge has to be to provide secure, risk justified, options to exploit public cloud in healthcare.

And there are areas of healthcare which may be addressed more efficiently using cloud technology e.g. sharing of patient information, sharing of images.

Patient access to doctor notes

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Missed the write up of this study at the time.

Very interesting – providing patients with direct access to the notes made at their visit to the doctor.  Would seem that, in general, patients favour this development, doctors have a  number of concerns (many of these relating to concern for the patient).

I can understand a range of concerns:

  • Potential misinterpretation by the patient
  • Potential unnecessary stress for the patient
  • Potential focus of doctors on less ‘frankness; in notes – given my be read by others (may lead to unofficial records being maintained)

However I do not see any way forward without moving to having access to doctors’ notes – in the context of individuals seeking to maintain long term health records – combining info from dentist, GP, specialists, physio, dietician, etc.

Obviously further systems investment and training required – before notes can be available more generally, in secure way.  But all part of the EPR/ EMR trend.

CEO checklist for healthcare providers

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Just read this discussion paper.

Difficult to argue with the credentials of the organisations behind the paper (Cleveland Clinic, Cincinnati Children’s Hospital Medical Center, Kaiser Permanente, etc.)

And the content of the paper makes lots of sense.

The checklist is as follows:

Foundational elements
• Governance priority—visible and determined leadership by CEO and Board
• Culture of continuous improvement—commitment to ongoing,
real-time learning
Infrastructure fundamentals
• IT best practices—automated, reliable information to and from the point of
care
• Evidence protocols—effective, efficient, and consistent care
• Resource utilization—optimized use of personnel, physical space, and
other resources
Care delivery priorities
• Integrated care—right care, right setting, right providers, right teamwork
• Shared decision making—patient–clinician collaboration on care plans
• Targeted services—tailored community and clinic interventions for
resource-intensive patients
Reliability and feedback
• Embedded safeguards—supports and prompts to reduce injury and infection
• Internal transparency—visible progress in performance, outcomes, and costs

 

For those of us interested in health informatics much of this speaks to streamlined and managed processes, information technology embedded in everything that happens, use of information technology to improve patient outcomes.  And the importance of an effective EHR is very much to the fore.

Well worth a read – would be interesting to see the views of healthcare provider CEOs.

 

Making the case for the cloud to GPs (or physicians)

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Liked this piece by Rosemarie Nelson dealing with the potential for Physicians to deploy EHR solutions in the cloud.

When you think about it you would think it must make a lot of sense.  A doctor running a busy practice does not want to be worrying about capacity planning, firewalls, patch management, backups, etc.  Yet her/his EHR solution is critical to the practice.

Naturally there will be the usual concerns re security/ confidentiality of patient data.  But why would a Physician be better at this that a specialist cloud operator?

Rosemarie Nelson, in the context of the US, provides some indicative pricing.  And there are obvious attractions in the opex v. capex model for any Physician running a practice.