Creative Health Labs

With the near-record cold temperatures today, I was asked by Fox News to talk about the signs, symptoms and treatment of hypothermia and frostbite. Here's the video:

Many emergency rooms across the country may be sensing that their patient volumes are not as high as anticipated. This is a big issue for many emergency departments because staffing levels have to match expected patient volumes for financial reasons (overstaffed EDs will lose a lot of money and be unsustainable). It is very interesting to me that Google web searches by people for the terms "ER" and "Urgent Care" reflect what is happening in the market: more and more patients are searching for urgent care facilities for their unscheduled care instead of ERs. Here is a graph I created using Google Trends to show this trend:

The positive correlation between hospital costs and quality was debunked long ago, nonetheless it's still interesting to look at the data in new ways. Here I've combined two different data sets: first I took the hospital charge data that was published earlier this year  by CMS and compared it against patient satisfaction or "perception" data from HCAHPS: Learn About Tableau Let me explain the graph. Each circle represents an individual hospital. The x-axis represents patient satisfaction as measured by the HCAHPS question representing the percentage of patients giving their inpatient visit a score of a "9" or a "10." The y-axis represents the average charge (the amount the hospital billed Medicare, not necessarily the amount the hospital actually got paid) by the hospital for management of sepsis, which I am using as a surrogate measure for hospital charges overall. I chose sepsis because it is a common medical syndrome for which we have lots of...

Here are the twenty hospitals in America with the lowest recommendation rates by patients whom they serve, according to data from the official HCAHPS survey , accessed October 2013 from the Medicare data website : Learn About Tableau What is "HCAHPS"? HCAHPS is best explained by their own fact sheet : The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey is the first national, standardized, publicly reported survey of patients' perspectives of hospital care... While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there were no common metrics and no national standards for collecting and publicly reporting information about patient experience of care. Since 2008, HCAHPS has allowed valid comparisons to be made across hospitals locally, regionally and nationally.  Why is HCAHPS important? The answer is "money". Again, from the fact sheet: HCAHPS and Hospital ...

Learn About Tableau According to the latest data I could find  (last updated July 2013) Alaska has the highest rate of Central Line Associated Blood Stream Infections (CLABSI) in the country. CLABSI is only one of many hospital acquired infections. Here is the brief explanation of the data from CMS : The Healthcare-Associated Infections (HAI) measures - state data. These measures are developed by Centers for Disease Control and Prevention (CDC) and collected through the National Healthcare Safety Network (NHSN). They provide information on infections that occur while the patient is in the hospital. These infections can be related to devices, such as central lines and urinary catheters, or spread from patient to patient after contact with an infected person or surface. Many healthcare associated infections can be prevented when the hospitals use CDC-recommended infection control steps. There are four main Hospital Acquired Infections (HA...

As mentioned in this Marketwatch article , my ED group has just partnered with Simplee to create a beautiful, simple and easy way for our patients to pay their medical bills. It's very exciting and the way all medical billing should be done. Having met the Simplee leadership, I can say that you couldn't ask for a better team to tackle this problem.

SecondOpinions.com is offering telemedicine-based second opinions to patients looking for more reassurance or an alternate opinion of their medical condition or their radiological studies. What's really innovative is the ability to upload your radiology films (digital copies of x-rays, CTs, MRIs, or ultrasound) to their HIPAA secure server and then get a second opinion of your images. This is fascinating and awesome. There's currently no easy or affordable way to get a second radiologist to review your films with such a fast turn-around (as far as I know).

The future of medicine is in standardizing medical decision pathways for both diagnosis and therapeutics. Some resources that are valuable for helping find evidence-based medical guidelines include the National Guideline Clearinghouse from US Department of Health and Human Resources  and OpenClinical . The American College of Physicians also has a great list of Clinical Practice Guidelines . Tobacco cessation guidelines can be find here . AHRQ has a fabulous list of Clinical Preventive Services guideline s, which includes recommendations for all sorts of screening exams, including diabetes, cancer (lung, breast, ovarian, prostate...), depression, and AAA.

The telemedicine industry is expanding very rapidly and it's hard to keep up with all the new products out there. One very interesting service is CloudVisit  that provides a nearly turn-key solution for doctors to be able to easily set up their own telemedicine service. CloudVisit provides a SAAS solution for physicians to be able to easily set up HIPAA compliant video-based telemedicine with appointment scheduling, billing, notes, and secure session recording all built in.

Great article on Venturebeat  talks about the loss of efficiency (and therefore money) associated with certain EHRs. As I've said before, interface matters.  Here's some quotes: "EHRs are one of the main issues that make doctors worry about their profitability."  " EHRs are currently slowing doctors down ...  20 to 25 percent of doctors will be back in the market for better solutions surrounding EHRs." Venturebeat goes on with a fantastic second article titled " Nurses will never adopt your tech if the usability sucks ," which reinforces the same idea, interface matters .  “User experience it’s really critically important. Because of the consumer experience now is pretty slick, when you get into the walls of the hospital [consumer-grade experiences are] beginning to be the expectation, and we so don’t deliver it right now.” http://venturebeat.com/2013/05/21/carecloud-ppi/

The average adult spends $30-150 every 3 months to maintain their car, but what do they do to maintain their body, which presumably is more important? When's the last time you checked your cholesterol? (compare that with your last oil change) Blood pressure? blood sugar? triglycerides? percent body fat? Think about this: jiffy lube took the really cumbersome and long task of car maintenance and made it  routine, focused, and fast. Maybe the same could be done with health maintenance? Just like with cars, if there's something actively wrong, you have to go the standard route (see a mechanic/doctor/hospital), but if you're just doing routine maintenance, you don't need all that.  What if regular health maintenance check-ups raise your health awareness and end up motivating you to eat/act healthier? What if insurance companies offer cheaper insurance rates if you show a record of regular maintenance and good numbers?

The Center for Public Integrity  has a piece titled " Cracking the Codes " which is making waves in the medical world over the last several weeks, as it has revealed data indicating a massive increase in Medicare billing by hospitals and physicians ever since the federal government began incentivizing physicians and hospitals to start using Electronic Medical Records (EMRs). The immediate (and understandable) fear is that doctors are abusing the built-in efficiencies of EMRs to over-document and/or over-bill. For novice readers unfamiliar with ER billing, here is a quick primer: ER charts are coded into 5 separate categories (plus a sixth for critical care), based on the complexity and risk of the case. The complexity and risk is derived from the ultimate diagnoses, the number of history (the patient's version of his complaints) elements involved, number of physical exam elements (number of body systems examined) examined, and the medical decision making (MDM). MDM is co...