The Prognosis for Medical Innovation – NYTimes.com

A good short piece on innovation in healthcare, and how sometimes the big, shiny and new can be overshadowed by smaller, incremental changes that deliver better outcomes (e.g., checklists, smartphone home monitoring applications, and progress towards electronic health records). The key point is to have good data to know which new technology and/or procedures result in greater improvement in outcomes, to assist investment and use decisions.

The Prognosis for Medical Innovation – NYTimes.com.

Destroying Medicine to Rebuild It: Eric Topol on Patients Using Data – The Atlantic

A good interview on some of the potential for ‘creative destruction’, given increased data and technology. While some of this borders on obsessiveness (the ‘quantified sellers’), having ubiquitous real-time information can be helpful to some.

Those concerned with their health will use the increased data and tools, but will be the broader population be influenced by increased data? I think not – data on obesity has not changed trends, and common sense in terms of healthy diet, exercise etc is not that common!

But some of his points are all too true. Each time I go to the clinic, we follow the return of weighing me and taking my blood pressure, both which I track at home, and the lack of electronic health records, shared with patients, is frustrating to say the least.

The reviewer correctly notes the challenges of creative destruction:

I came away wondering, however, if there was going to be a Creative Destruction, Part II that delves more deeply into exactly how the destruction and rebooting Topol proposes will happen. As Thomas Kuhn wrote in The Structure of Scientific Revolutions, changing paradigms is not easy. “No part of the aim of [traditional] science is to call forth new sorts of phenomena,” Kuhn wrote, “indeed those that will not fit the box are often not seen at all.”

 Worth reading

Destroying Medicine to Rebuild It: Eric Topol on Patients Using Data – David Ewing Duncan – Health – The Atlantic.

How adopting an EHR is like treating cancer

An advocacy piece on faster use of Electronic Health Records, targeted at doctors, and using their language (diagnosis, staging, treatment and prognosis), and making the analogy to cancer. Not sure how effective it will be with the target audience but I just loved the para below so wanted to share it:

If you happen to be diagnosed with cancer, you will most likely be subjected to years of unpleasant treatments. You will be injected with poison and irradiated with more poison. You will lose your hair, suffer bouts of vomiting and diarrhea and be physically debilitated to the point where you cannot leave your bed. You will most likely have to go through painful surgeries, take all sorts of medications that were shown to kill thousands of rodents and never recover your old self again. And this entire ordeal will cost you a medium size fortune. The fact that some lucky patients go on to win the Tour de France is not really an acceptable rebuttal. Most do not. And there really is no excuse for such incompetence in this day and age when one little pill can cure you of an yeast infection in 24 hours and a $4 course of antibiotics will render you as good as new if you happen to develop a sinus infection. Not to mention the innumerable vaccines that will miraculously prevent you from contracting the plague.

How adopting an EHR is like treating cancer.

Six Major Disruptions Still Ahead in Healthcare

Not a bad list of things that are coming. Rather than just focussing on the technology, the list also addresses the incentive and organization issues (particularly no. 6):

  1. Conversion of physicians to electronic health records 
  2. Sharing information across networks
  3. Genomic signatures as part of the medical record
  4. Health care delivery to where the patient is
  5. The rise of health avatars
  6. The change in physician compensation from fee-for-service to fee-for-outcomes

Francine Hardaway’s Blog.

What the Healthcare Industry Can Learn From Technology Start-Ups

A more reflective piece on the differences between the healthcare and technology industry, the limits to apps (a lot will be flash in the pan), and the need for a new group of people who have a better and more sophisticated understanding of healthcare challenges and behaviour. While it is not conclusive – hard to be given the results to date – good discussion.

What the Healthcare Industry Can Learn From Technology Start-Ups – David A. Shaywitz – Life – The Atlantic.

As someone who uses some healthcare apps (weight and blood pressure tracking in particular, in addition to Evernote for notes and articles), the issue is less the technology than the personal determination to use them to influence lifestyle changes (much as runners use tracking tools for their performance). As always, the human dimension is the critical one; the app just makes it easier.

6 Major Disruptions Still To Come In Healthcare | Fast Company

An interesting article, written for the US context but with some more broadly applicable insights, on the ‘disruptions’ to come to healthcare:

1. Conversion of physicians to electronic health records.

2. Removing the responsibility of records-sharing from the patient.

3. The rise of the genomic signature as part of the medical record.

4. Moving the responsibility care and outcomes from the provider location to the consumer location.

5. The rise of health avatars.

6. The change in physician compensation from fee-for-service to fee-for-outcomes.

I think the article understates and estimates the institutional and other factors that make some of these highly difficult to say the least given the mixed history of eHealth and other initiatives, and any shifts in compensation are notoriously hard to negotiate and achieve, but of interest nevertheless.