CMS Increases Price and Quality Transparency
CMS has announced plans to launch a database to compare the quality and price of health care services for Medicare beneficiaries (Health Data Management story).
Performance Measurement and Reporting System will be designed to offer
physician-level performance results via a Web site and other methods of
data dissemination. CMS will analyze deidentified Medicare claims to
determine performance, as well as rely on existing public performance
data from provider organizations.
The new rule will go into effect next month.
Joint Commission Contemplates Health Care Wiki
Modern Healthcare reports that the Joint Commission is piloting the Wiki concept for collaboration on health care topics.
providers, administrators, researchers and other professionals could
develop a collaborative environment and share ideas, said Jerod Loeb,
executive vice president of quality measurements and research for the
Joint Commission department of health services research.
So, I visited the Joint Commission's health care wiki. The set up and organizational framework around their wiki is impressive. The JC has obviously put a lot of time and effort into this pilot. As of this afternoon there are over 1,700 registered users.
Unfortunately, the only topics allowed on the site are Smoking Cessation Counseling Programs and Smoke Free Hospital Campus (yawn). Both topics are funded by grants – I guess to ensure that someone will actually contribute content. A pretty conservative approach.
An important factor in the success of Web 2.0 sites is the credibility
of the site and the group behind it. The JC has a leg up in this regard, as the number of registered users attests. The site has received numerous suggestions for additional topics, ranging from those centered on National Patient Safety Goals (a natural for a site like this), to the more unlikely (Micro Ionized Water and its effect on acid-alkaline balance for disease prevention). In the spirit of things, I suggested the topic Reporting Adverse Events and Near-Misses, something that must improve significantly if we're going to improve patient safety.
For all their credibility, and the apparent interest in participating, the JC doesn't seem committed to making the site a success. According to the site:
The initial focus of the pilot is smoking cessation, and a decision has
not yet been made with respect to when additional topics, such as those
suggested below, will be added to the site (i.e., during or after the
pilot project). Stay tuned, and keep your suggestions coming. Thanks.
The JC wiki is going to get a lot of traffic over the next few days. If they don't quickly provide topics beyond smoking to draw participants the site will lose momentum. You've got to figure only a subset of those visiting in the next few days will even bother to return later to see if the JC is really going to do the wiki and open it up to additional topics. The percentage of those returning a third or fourth time to check will quickly decline to almost nothing. (The JC does have the email address of everyone who's registered, so they could notify that subset of folks – and they could do another press release later announcing a “launch”.) The point is that users won't wait around for the JC to make up their mind, and the interest level generated by another press release later announcing the “go live” likely won't match the interest level right now.
Treating their new wiki like they do national patient safety goals will be the kiss of death. So, let's hope the JC takes the plunge in true wiki fashion and opens new topics ASAP.
The Paradox of Patient Self Management
The father of HU (or at least the man who coined the term), Mike Barrett, spoke on the paradox of patient self-management. His presentation was titled, “Don't Ask: Information Aversion and Patient Self-Management.” Behavior economics are making real contributions to HU, both heuristics and biases and what they mean for patient self-management tools. There are 3 interrelated challenges to patient self-management: compliance, potential technology solutions, and living the aging process.
Information aversion, a form of what the economists call loss aversion, undermines self management of chronic disease. Research and experiments in behavioral economics suggest effective responses.
Reminiscent of Al Franken and the “Al Franken Decade,” Mike used himself as an example of a potential chronic disease train wreck in the making. Referring to the poor decisions many of us make regarding our health, Mike asked the rhetorical question, “why is Mike so dumb?”
Perhaps the better question is why does so much patient self-management appear to be irrational? There are many models of compliance, Mike referred to one from WHO. WHO touts an Information-Motivation-Behavior (IMB) model for promoting compliance, in which information, while insufficient by itself to bring about effective self-management, is necessary to build motivation and guide behavior. So, information is necessary to motivate and guide compliance, but Mike avoids information that may be negative. Isn't that dumb?
Economists and psychologists have collaborated to generate empirical data on behavior economics. This field of research was started by Daniel Kahneman and Amos Tversky in 1979 and won a Nobel in 2002. This field of study integrates insights from rational actor theory, and is also known as prospect theory. The theory asks the question, “How do individuals evaluate uncertain prospects – potential losses and gains?”
Last year Mike talked about how people edit prospects using heuristics, mental shortcuts which simplify the job. This year the focus was on how people evaluate prospects for gains and losses in ways that depart from economic rationality.
As humans we do not experience a weight gain the same as a weight loss. Loss aversion is much stronger psychologically than potential tangible gains. Research is now being done to apply loss-aversion and prospect theory to health care decision making. Aversion to negative information expresses a selective human preference for ignorance.
“When you ask me to self-manage – go on a diet, take my blood pressure, monitor my blood sugar, etc. – you ask me to give up the gratification afforded by the bad behavior, and the blissful ignorance of the effects of the bad behavior,” said Mike. This relates directly to creating effective HU services and products.
Asking chronic disease suffers to accept bad news is a different problem than asking them to stop bad behavior, and needs distinctive solutions. Noncompliance is a process (rather than a discrete act) that begins with an aversion to bad news. Decision-making by both patients and physicians in conditions of uncertainty is subject to recurring errors, including loss aversion. Loss aversion is irrational – in terms of self-interest – and predictable. Consequently, patient self-management tools and strategies need to take these decision-making tendencies into account. Fortunately, counter-measures are available.
A key counter measure at this conference is automation. Starting with the alarm clock, subordinating self-management products “embody a general technology trend found inside and outside medicine: the shift from human-in-charge to device-in-charge.” The best solutions will not only use technology, but also social engineering to, “prod humans to do things that humans would otherwise not do.”
Pictured right is the thought provoking Mike Barrett.
Be sure to check out other posts from this conference here.
RFID: Rejected by Most Hospitals; Set to Grow Dramatically
Titled, Most Hospitals Reject RFID, a CHIME press release announces that, “A recent CHIME survey shows that the vast majority of respondents have
no current plans to implement RFID technology within their organization.” The survey, done last May, gathered responses from 119 CIOs and found:
not considering using RFID technology for asset tracking. Of those who
do plan to implement an RFID system, 16.5% are in the selection phase,
4.5% report being in production, and 4% said that an RFID system is
currently in use.
That sounds pretty negative, doesn't it? Perhaps iHealthBeat put it best: “RFID Use To Double Despite Lack of Adoption Plans.” That sounds closer to the truth. How about this? (emphasis in original)
million in the U.S. healthcare industry in 2007, are expected to
experience explosive growth over the next five years, reaching more
than $1 billion by 2010 and $3.1 billion by 2012, according to RFID Opportunities in Healthcare in the U.S., a new report by Kalorama Information.
Kalorama pegs the current worldwide RFID market in manufacturing and supply chain management at $27 billion – which makes the US health care RFID market pale in comparison.
It seems to me that CHIME's negative spin comes from the relative immaturity of both RFID technology and the health care market. More than a few CIOs are stubbing their toes on RFID deployments, and some vendors have aggressively over promised and under delivered. There have also been some wireless LAN infrastructure issues with a leading network vendor. On the other hand, Kalorama is probably way over the top. But then who wants to buy a market report for a market that's not about to undergo dramatic growth?
There's no doubt real time location systems can make a great impact on health care delivery – in productivity, outcomes and patient safety. The problem is cost and complexity – too much of both. The market has a ways to mature before all the pieces – the technology, applications, vendors and best practices – fall into place.
What do you think is holding back RFID in health care? Pictured right is the G2 Microsystems G2C501 board sporting their new system on chip for active RFID tags.
Site Update
I arrived in San Francisco last night (July 15) for the Healthcare Unbound conference. The event's at the airport Marriott, which was a nice short shuttle bus ride away. We were dropped off at what appeared to be the rear entrance and were directed to an office in a trailer. Inside was the front desk (pictured right). There was only room for about 3 guests inside, the rest of us waited in line outside – it's San Francisco in July so it was only in the high 50s.
It turns out that the hotel's lobby was demolished a couple days before on July 14. Reportedly, they've been renovating the hotel for some time and the last area to go is the lobby. I can only imagine the surprise the organizers of the Healthcare Unbound conference experienced when they arrived!
In any event, it's all part of the adventure. Speaking of adventure, I spent most of last week recovering from a crashed hard drive and while trying to finish up a client project. What fun. Between back ups and disc recovery, I'm back up to speed. Anyway, I thought I'd explain the almost nonexistent posting last week – it's not like I planned to leave the post on Cisco up top for a full week.
UPDATE: My life has been cursed the last few weeks. I've gone almost 20 years without a hard drive failure – or computer failure of any kind (virus, physical damage, theft, etc.). I guess it's all catching up with me.
After restoring my files (at least most of them) on my laptop, I started writing posts to this blog. The posts were published via the RSS feed, but never went up on the actual web site. Then they disappeared from my blog software! While I restored my software (Userland Radio) properly, I learned after the fact that I needed to get a serial number from the vendor to restore full functionality. So, that's done and I hope all these technical issues are behind me.
Finally?
Okay, I think this blog is back. Since loosing my hard drive and restoring my system I had one last thing to do – get my content management software authenticated by the vendor. That took a while, and I got the code to enter into my system this morning.
Apparently all the posts that I've created since July ninth are lost – poof, into the bit bucket. Of course none of those posts appeared on the web site, but for some reason they did go out by RSS feed. Another reason to subscribe to the RSS feed.
If anyone has a copy of any of those lost posts, I would appreciate it if you would email them to me. Thanks.
