Minimally invasive surgery: Discussion with Covidien’s Chief Medical Officer

Dr. Mike Tarnoff, Covidien's Chief Medical Officer

Dr. Mike Tarnoff, Covidien’s Chief Medical Officer

Minimally invasive surgery (MIS) has been broadly available for well over a decade, yet penetration is widely variable. Open surgical approaches are still common for many surgeries including hysterectomy and colorectal.

In this podcast interview, I asked Covidien’s Chief Medical Officer, Dr. Mike Tarnoff to explain what’s going on with MIS adoption in the US and around the world, and what role doctors, patients, and industry should be playing.

By healthcare business consultant David E. Williams of the Health Business Group

 

Trashing Charlie Baker on outsourcing –uncalled for

Charlie Baker (R), candidate for Governor of Massachusetts

Charlie Baker (R), candidate for Governor of Massachusetts

The mud-slinging continues in the campaign for Governor of Massachusetts. This time Democrat Martha Coakley is attacking Republican Charlie Baker for outsourcing jobs when he was CEO of Harvard Pilgrim Health Care back in 1999. This is on top of the previous accusations of “raising premiums, cutting coverage for seniors, and tripling his own salary to $1.7 million.”

It’s an unfair attack. Baker should be praised instead.

Harvard Pilgrim’s IT systems were a mess in the 90s. They couldn’t pay claims in an accurate or timely manner, and as a result the company couldn’t figure out if it was making or losing money. As it turned out they were losing, and on their way to bankruptcy. Baker stepped in and righted the ship.

Outsourcing to Perot was a good move. Perot hired the existing Harvard Pilgrim IT staff in Massachusetts. In 2006, Perot hired about 200 employees in India to serve the account. Apparently this is the basis for the Coakley attack, but it’s a pretty weak one.

It’s not Harvard Pilgrim’s job to boost employment in Massachusetts. Instead the primary goal should be to deliver excellent service and value to customers. They seem to have done a good job, since they consistently rate at or near the top of the best health plans in the US.

I assume the Coakley campaign knows that the allegations about raising premiums are not to be taken seriously. Health plans have been raising prices forever –there’s no reason to single Baker out for that. And Coakley would like us to believe that Baker cut benefits for the elderly, making him sound like Paul Ryan taking a knife to Medicare. The reality is much less exciting and newsworthy. And sure Baker got a big salary boost, which is a pretty modest reward for rescuing a major company. If it had been a for-profit company you can bet the rewards would have been a heck of a lot bigger.

Baker isn’t perfect. But attacks on his competence and wisdom as a healthcare leader deserve to backfire.

To read or listen to my interviews with all the candidates for Governor of Massachusetts, check out my coverage from earlier this year.

By healthcare business consultant David E. Williams of the Health Business Group

iPad EHR Drchrono gears up for HealthKit

Apple's HealthKit and Drchrono's OnPatient will work together

Apple’s HealthKit and Drchrono’s OnPatient will work together

Drchrono bills itself as the “original mobile EHR built for the iPad.” With that in mind, I decided to ask the company’s co-founder and COO, Daniel Kivatinos for his thoughts on Apple’s entry into the healthcare space with its new Health app and HealthKit development tool. Here are my questions and his replies:

What is drchrono? How is it different and better than other EHRs?

Drchrono was the first to develop a native EHR solution for the iPad and Google Glass. Our technology is disruptive in that we fuel the easiest, most-innovative patient care experience on the market today. Our platform has dramatically improved the patient point of care experience by allowing doctors to communicate face-to-face with patients (rather than behind a PC), improved the flow of information between doctors and patients, and reduced the time spent on charting and other historically time-intensive tasks.

We have over 70,000 doctors and 3 million patients benefiting from our platform. That number continues to grow rapidly. We were voted the top EHR two years in a row by Blackbook Rankings, and recently joined the INC500.

What does it mean that Apple itself is moving into health? What are the broader implications for the market?

Apple has some of the best designers and engineers in the world, and having them put mindshare into healthcare is a big deal. Apple serves both business and consumers, but I think we’ll see the most evolution in consumer-facing technologies, namely those that make logging wellness data and taking action easier.

What is HealthKit and why does it matter? How does it relate to the Health App in iOS8?

HealthKit allows developers to plug into the “Health” app on iPhone. The iPhone “Health” app connects medical hardware and software alike, pulling in data from many sources. For example when an individual has an iPhone that connects to FDA approved devices such as blood pressure cuffs, thermometers, fertility monitors and glucose meter, the “Health” app can pull that data in if the person wants.

Drchrono just announced the launch of OnPatient, your personal health record platform. What is it and how does it tie in with HealthKit?

OnPatient allows patients to book appointments, fill-out forms, message their doctors and most importantly have access to their medical records at their fingertips. Our most recent integration with HealthKit lets patients import their wellness data (via Health) directly into OnPatient. Best of all, patients can share that wellness data in an easy-to-digest format directly with their doctors.

PHRs have never really caught on. What’s different about this new attempt?

People love their phones. They like being able to access banking, their social networks, email, and more in one place. Health information is no different. In the past, PHR’s generally required patients to enter their health data on the web manually. This took plenty of work…and busy people didn’t have the time to spend on data entry.

Our solution pulls in data from doctors, and now, information from Health…all without the patient manually entering a single piece of data.

How will it impact physician practice and specifically patient visits?

Our EHR impacts physicians every day by making their –and this will sound clichéd– lives easier. They have access to their entire practice’s data in one place, their iPad or laptop. Doctors can easily access patient data on the go, and as a result, provide better service to their patients.

Patients will have immediate access to their medical records, prescriptions, and now wellness data.

Does my doctor have to be using drchrono for a patient to use onpatient? If so, how do you overcome that barrier?

With this initial release, yes, but you can have your physician join Drchrono for free at your request.

The Apple Watch was announced but not yet released. What do you think of it? What will its rollout look like?

I am very excited about Apple Watch. It will be a great way to track more health data like heartbeat and steps. Doctors will be able to use the Watch in their practices: for example, to see a list of patients coming in for the day.

Big players, especially Epic, are gathering up more and more of the total EHR market. Is there room for a company like yours or is the battle hopeless?

Epic is going after a different market, they are going after hospitals. drchrono focuses is on smaller offices with one to 20 physicians.

By healthcare business consultant David E. Williams of the Health Business Group

 

 

 

 

Ebola and the bigger patient safety issue

Did somebody say #Ebola?

Did somebody say #Ebola?

A Texas hospital blames its electronic medical record for the release of an Ebola patient who was sent home from the ER with an antibiotic (useless for a viral infection) and later came back to the hospital and died. In Spain, the government is blaming a nurse for catching Ebola from a patient and defending how it handled the disinfection of the ambulance an Ebola patient rode in.

Fact is, these sorts of screwups happen in hospitals every day. Individual cases are being reported now because they’re Ebola-related and therefore newsworthy. I’m hopeful that a positive byproduct of the Ebola scrutiny will be a renewed awareness of patient safety and quality of care issues by hospitals and patients.

It’s worth revisiting a post I wrote back in 2006 (Going to the hospital? BYMOD). I’ve reposted it below:

By now, most people know that hospitals are dangerous places, filled with medication errors, infections, poor communications and generally bad service. In case anyone needs to be convinced, the Institute of Medicine has just released a report on medication errors, indicating –among other things– that the rate of medication error is about 1 per patient per day!

In the A Piece of Mind column in the July 12 JAMA, Dr. Frederick Hecht of San Francisco recounts the story about his daughter’s bout with leukemia four years ago and subsequent recovery. The story is about the extra burden of being a physician when a family member is ill –no blissful ignorance and wishful thinking for him.

But as with any true story about illness and hospitalization, there is a subtext of error and danger:

Several days into my daughter’s treatment, I observed that one of the pills she was getting had changed, and it didn’t match anything she was supposed to be getting in the Physicians’ Desk Reference, which I already had at her bedside. It turned out that she was getting cis retinoic acid (Accutane) rather than all trans retinoic acid (ATRA) due to a pharmacy error. An acne medicine had been substituted for a critical chemotherapy treatment.

Maybe this was the hospital’s rendition of “live fast, die young, and leave a good looking corpse.” Anyway, he continues:

At another point, I noted a potentially life-threatening drug-induced hepatitis, which had been missed on her maintenance chemotherapy laboratory tests.

In other words, his daughter could well have died if she hadn’t had her father, the doctor, looking after her.

Don’t be lulled into trusting the hospital to take care of you. If you go to the hospital, try your best to take someone who knows what they are doing and isn’t afraid to speak up for you. If possible, BYOMD.

photo credit: cheerfulmonk via photopin cc

By healthcare business consultant David E. Williams of the Health Business Group

Falchuk, McCormick should be in the debate

Gubernatorial candidates Evan Falchuk and Jeff McCormick have been uninvited from the televised October 27 debate in Worcester. This despite the fact that Falchuk, and to a lesser extent McCormick, have been outperforming the Republican and Democratic candidates in recent debates and forums.

I’ve written to the organizers of the debates to share my views:

Here’s what I wrote:

Dear _________:

Earlier this year I interviewed all nine candidates for Governor about healthcare policy on the Health Business Blog. My objective was to encourage the candidates to address serious issues facing the Commonwealth, something that I feel was lacking in recent elections such as the Brown/Warren race. WBUR’s CommonHealth blog ran a story commending me for my efforts. http://commonhealth.wbur.org/2014/03/health-care-mass-governor

There are four serious candidates remaining in the race. (I don’t count Scott Lively.) Your upcoming debate in Worcester presents a great opportunity to showcase the different approaches to governing.

I understand that you have rescinded invitations to Evan Falchuk and Jeff McCormick, perhaps based on their low poll numbers. That’s a mistake and I urge you to reconsider. As you may have seen, Falchuk has jumped from 2% to 5.4% in the latest poll. His United Independent Party will qualify as an official party if he gets at least 3% —so his current level of support is meaningful and newsworthy. It’s also interesting to see how much he’s jumped now that more voters have seen him in action.

You’ll be doing the right thing for democracy by restoring your invitations to Falchuk and McCormick. Falchuk in particular has been eager to discuss important issues that Coakley and Baker ignore, such as the proposed Partners agreement.

Please let me know if you would like to discuss.

Regards,

David E. Williams

Ebola or Epic: Which do US hospitals fear more?

How's that for workflow?

How’s that for workflow?

I don’t laugh easily, but I did chuckle when I heard that a Texas hospital was blaming its electronic medical record for the hospital’s mishandling of the first Ebola case in the US –a patient who had flown in from Liberia. According to the hospital, the patient told the nurse he’d been in Liberia, she documented it, but somehow that information didn’t make it to the doctor due to a workflow problem. The patient was released, got sicker, may have exposed others in the community, and then returned to the hospital. Somehow I knew this explanation wouldn’t be the end of the story.

Sure enough, a few days later the hospital issued a “clarification,” stating that “there was no flaw in the way the physician and nursing [workflows] interacted.” But there was still no word on why the patient was discharged.

iHealthBeat (Dallas Hospital Issues ‘Correction,’ Says ‘No Flaw’ in EHR System) does a very nice job of summarizing the situation and speculating on what really occurred. Here’s my guess at the truth, in order of likelihood. I’ll also note that all of these factors may be true:

  • Doctors stumbled through an awkward EHR workflow. Responsibility for the mess-up is shared by the EHR vendor (Epic) and whoever supervised and trained the physicians using the system
  • Epic –big gorilla that it is– put pressure on the hospital to issue a retraction. (Epic denies this but I’m skeptical)
  • Doctors tend to ignore nurses’ notes. “They ignored them when they were on paper, and now they ignore them on the computer,” according to a Biomedical Informatics professor

It’s worth mentioning that cloud-based athenahealth adjusted its workflow right away to emphasize Ebola-related questions, something that would be a lot harder to do with Epic.

photo credit: Keoki Seu via photopin cc

By healthcare business consultant David E. Williams of the Health Business Group