Diet and Nutrition. Natural Health, and Healthy Living

There are some folks in Washington who have made statements that we should delay investments in EHRs because current vendor products lack the functionality needed to support a coordinated healthcare system. Others have said that we lack the standards or security framework to implement interoperability. Here are my thoughts.

Take a look at the successes in Massachusetts and New York with commercial EHR products. We've implemented eClinicalWorks, which includes decision support, e-prescribing, administrative transactions with payers, clinical summary sharing across the community, and quality measurement (all the National Quality Forum high priority measures). It's web-based, using a service oriented architecture in a cloud computing environment. By implementing this product at BIDMC, we're meeting all the payer guidelines for delivering appropriate, coordinated, high value care. Vendor products from Epic, Allscripts, NextGen, GE, Meditech, eMDs, MedSphere, and other CCHIT certified vendors have similar features.

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The concept of participatory medicine is taking hold, fueled, at least in part, by what we see as two complementary forces, these being the patient-centered medical home (PCMH) and Health 2.0. Health 2.0 is very much a grass roots phenomenon, dominated by a small but significant group of patients who are testing the hypothesis that the wisdom of the crowd can rival the wisdom of physicians. The PCMH is a concept, not new, but gaining tremendous traction in the provider sector now as a best-try effort by some providers to be truly patient centric in their approach. The two should be complementary and mutually self-supporting. One might even suggest their respective champions should be collaborating right now, when the scent of health reform is in the air in our nation’s capital. But they are not. Lets examine why and explore ways in which to create a natural bridge between these two concepts and their champions.

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I have been blogging and twittering from the World Health Innovation and Technology conference this week while waiting to present today. The keynote speaker before me was Scott McNealy, the Chairman and founder of Sun Microsystems. He has a long and storied history with Sun, and a well earned reputation as the “human quote machine."

He delivered.

His talk started with several examples of his health care experience (long time user as a hockey player and father of four boys) and business experience had so many corollaries. The fight for standards. The fight for common interfaces. The fight for privacy and security. The find for high quality, low cost, and transparency.

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The Institute of Medicine just released its long-awaited report on trainee duty hours. It is well researched and balanced, and its recommendations appropriately reflect what we know vs. what we believe. Now the fun begins.

Let’s start with a little background, some of it drawn from my book Understanding Patient Safety:

Let’s be honest. Traditional resident schedules – on call every third night, staying up for 48 hours in a row, and working 120 hours per week – were both inhumane and immoral.

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Advances in medical technology, electronic medical education and the advent of digital tools in medical practices have led to a proliferation of digital multimedia content with educational merit.

Over the past decade, physicians have adopted cutting-edge imaging technologies to make diagnoses, capture clinical exam findings and monitor disease progression. On a daily basis, hundreds of research presentations, grand rounds and didactic lectures are created all over the country. Similarly, the medical and life sciences industries generate enormous amounts of peer-reviewed content to educate physicians and clinician scientists that go way beyond CME.

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Moody's, the credit rating agency, offers their post-election impressions in their special comment, "U.S. Healthcare Industry: Credit Implications of the U.S. Election."

Barack Obama's campaign roughed out principles for health reform across three issue areas:

Access and affordable health careCost reductionPublic health

Moody's took these as lenses over the state of health care in the U.S. to predict how these principles could play out in an Obama administration.

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Only a few months ago, Goldman Sachs was touted as an incredible bastion of strength in the face of the credit crunch. Sure some other institutions might have been suffering, but Goldman was savvy enough to earn record profits in 2007. The average bonus was a whopping $600,000 per employee. Then very suddenly Goldman and pretty much the whole industry collapsed. The federal government has stepped in, and a partial nationalization of the financial industry is underway. That’s not the free market, it’s socialism.

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The buyers of medical devices aren't very good shoppers. They lack the kind of information about technologies that would help them make value-based purchasing decisions, according to James Robinson in the most recent issue of Health Affairs.

This issue is so important because medical technology is the No. 1 factor driving up health spending in the U.S., according to the Center for Studying Health System Change in their recent report, High and Rising Health Care Costs: Demystifying U.S. Health Care Spending.

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We know the name of the 44th President of the United States: Barack Obama. As the next President's supporter Oprah Winfrey is known to ask, "What do you know for sure?" When it comes to health, there are a few things we know about a President Obama.

First and foremost, addressing challenges in U.S. health care will require a multi-pronged strategy which brings stakeholders together. The key health-aches to address will be:

Covering the uninsuredStemming rising health care costsWiring the health information infrastructure and getting electronic health records into medical practiceFunding what works, and de-funding what doesn'tEnsuring an innovative health discovery and commercialization environment.

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It’s fascinating when two of my passions collide in the opinion pages of the New York Times like they did over the last week. On Friday, October 24, some seriously strange bedfellows came together to write about, “How to Take American Health Care from Worst to First.” Strange enough that Newt Gingrich and John Kerry joined together, but the lead author was Billy Beane, often thought to be the pioneer in the trend toward data-driven major league baseball general managers.

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