A recent article reported the results of a study showing wide variation in the cost of lab testing in California hospitals (see: Charges for 10 common blood tests at California hospitals). This is not news to anyone involved in the management of clinical laboratories. Below is an excerpt from the article:
Researchers studied charges for a variety of tests at 160 to 180 California hospitals in 2011 and found a huge variation in prices. The average charge for a basic metabolic panel, which measures sodium, potassium and glucose levels, among other indicators, was $214. But hospitals charged from $35 to $7,303, depending on the facility....The biggest range involved charges for a lipid panel, a test that measures cholesterol and triglycerides, a type of fat (lipid), in the blood. The average charge was $220, but costs ranged from a minimum of $10 to a maximum of $10,169....The smallest range in charges was for a blood test that checks an individual’s red and white blood cells. It cost $37 to $278....Most consumers with health insurance won't pay those prices; most often, their health plans have negotiated a lower price with the hospital or provider. But patients without insurance face the full brunt of the charges, especially if they don’t qualify for a hospital’s charity care discounts....In general, county hospitals and teaching hospitals had lower prices than non-teaching hospitals, not-for-profit and for-profit hospitals, she said.....The majority of hospitals were not-for-profit, urban, non-teaching hospitals....One factor that researchers weren’t able to measure was a hospital’s investment in higher quality facilities or supplementary services.....The bottom line, according to the study, is that hospitals recoup losses in other areas from third party payers to cover overall costs. “This often results in some services subsidizing others, with their charge increases generally unrelated to their value,” the study concluded.
I have blogged about hospital costs and charges a number of times. One of the most relevant notes dates back to December, 2008 (see: Why the Prices Charged by Hospital for Inpatient Care Are Irrelevant). The basic point I made then was that hospital charges are not worthy of analysis because they are have no relevance to the cost of services. In short, a charge of $7,303 for a basic metabolic panel is set by the hospital and has nothing to do with the cost of the test. Although articles such as the one above are shocking, they simply emphasize the extent to which hospital pricing systems are out of whack.
The process by which hospitals get reimbursed for their services is by tallying up their costs for patients in a disease group and then negotiating with health insurance providers for reimbursement for that cost plus some profit margin. Certain activities like a stay in an intensive care unit are labor intensive and the charge for the service is far less than its true cost. Lab testing, on the other hand, is highly automated so the charges are far more than their cost. The last couple of sentences in the excerpt above explain all of this: [Hospital billing practices result] in some services subsidizing others with their charge increases generally unrelated to their value.
So what is the value of articles such as the one quoted above? The key take-home lesson is that hospital billing needs reform. However, all of the key players like hospitals and health insurance companies are used to the system so that chance of reform is probably slim. The only people who get mauled by hospital billing is the uninsured and those with high co-pay policies. A number of hospitals, particularly in California, offer steep discounts to the uninsured but these discounts need to be negotiated at the time of admission (see: Hospitals in California Offer Steep Discounts to Uninsured Patients; Texas Web Site Lets Healthcare Consumers Shop Around).
The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Investing in an electronic health record (EHR) is largely based on the decision to improve patient safety, align with clinical guidelines, enhance revenue cycle times, and capture government-based incentives. But without a proper EHR adoption plan in place, healthcare providers risk never optimizing their investment and achieving their intended goals.
Once an EHR is implemented, healthcare organizations must continue striving toward their goals to optimize their systems. Improving workflows, establishing best practices and increasing overall proficiency of end-users in this application are all components of optimization. Healthcare organizations that are able to maintain this level of focus will see improved clinical and financial outcomes.
This process isn’t easy and requires a commitment to the initial performance metrics that drove the healthcare organization to purchase the new system. Today, nearly half of all healthcare organizations use an EHR, but many struggle to ensure it provides clinical value across the organization. They carefully select and implement systems but fail to make the tool work as originally envisioned. Just because they bought a new EHR doesn’t mean it is serving their patients, providers, or bottom line.
A parallel comparison can be made with buying a high-end, a mobile exercise device to track aerobic and anaerobic steps. Individuals seeking a healthier lifestyle invest in these devices, hoping it will help them achieve their personal health goals. After making the initial investment and adapting daily habits to wear the device, one can begin to adopt the technology to achieve improved health goals. But realizing these goals takes work and commitment. If performance is not monitored, results can plateau and, in some cases, regress. This could result in a growing waist line for the person trying to lose weight, an ironic and unfortunate twist. For healthcare organizations, their growing waistline is unhealthy organizational performance, visible through increases in adverse drug events, recurrent admissions, revenue cycle times and government penalties, all symptoms of goal misalignment. The more healthcare organizations look away from their initial performance goals and utilize EHRs for data storage only, the more noticeable the symptoms become. Both individuals and healthcare organizations can benefit from the process of system optimization to make the tool work for the betterment of the individual or organization.
Extensive research has been conducted by The Breakaway Group (TBG), A Xerox Company, to identify elements that lead to optimization. TBG reports the key adoption elements exhibited by healthcare organizations that optimize their EHRs:
Engaged and Clinically Focused Leadership
Healthcare organizations must demonstrate engaged and clinically focused leadership. Clinical leaders must align their EHR by refining workflows, templates, utilization, and reporting to meet their organizations’ clinical and financial goals. The Chief Medical Information Officer (CMIO) is well suited for this venture.
Targeted Education and Communication
Healthcare organizations must provide targeted education and communication. When system upgrades are released, organizations must effectively and efficiently educate end users to alleviate reductions in proficiency and productivity.
Healthcare organizations must be able to use EHR data. Organizations must move past the superficial use of an EHR and begin to analyze what is entered. The EHR is of little value, if the data is neither clinically valuable nor used.
Sustained Planning and Focus
Healthcare organizations must sustain planning and focus. Change occurs frequently in healthcare, so system optimization requires preparation, adjustment and real-time communication.
With these adoption elements, healthcare organizations can make their technology work as originally intended—to improve patient and financial outcomes. To overcome the EHR implementation plateau, they must focus on their original performance goals to truly optimize health information technology systems. This process isn’t easy. It requires endurance, but the payoff is worth it. It’s time to “Breakaway” from the status quo and work IT– by optimizing use of HIT systems!
Xerox is a sponsor of the Breakaway Thinking series of blog posts.
The first time I saw someone wearing Google Glass was at HIMSS14 in Orlando. My initial reaction: that guy looks like a geek. Not that I have anything against the geek look but I couldn’t imagine myself ever wearing Glass goggles while walking about in public. I’ve progressed a bit and no longer giggle when I see someone wearing a pair, yet I wasn’t impressed by the Glass-wearing guy (definitely a Glasshole) that I recently noticed driving in a car next to me.
On the other hand, plenty of folks in the health IT world were quite impressed with Dr. Rafael Grossmann, the first physician to record a surgery wearing Google Glass. Since that landmark event about a year ago, a small number of companies have popped up offering healthcare solutions that leverage Google Glass. It’s perhaps too early to tell which ones will still be around next year but here’s a short list (in alpha-order) of some that are making in-roads:
APX Labs – APX has built a robust, horizontal data-integration platform optimized for smart glasses. They promote their solution for a variety of industries in addition to healthcare, but the clinical applications focus on telemedicine, first responders, nurse and clinical EMR interfaces, vitals monitoring, administrative visibility, and medical education. From what I can tell, they either don’t have any healthcare customers yet, or, they are still opting to fly well under the radar.
Augmedix – Augmedix claims to be the world’s first Google Glass start-up and their application focuses on improving the clinical documentation process. In January the company conducted a pilot with the California-based Dignity Health, who provided three family physicians with Google Glass and Augmedix’s physician documentation app. After four months the doctors reported a drop in the amount of time spent documenting from 33 percent of their day to nine percent and an increase in time spent directly engaging with patients from 35 to 70 percent of their day. Compared to some other vendors, the Augmedix application appears to be more narrowly focused.
ContextSurgery – The Context-aware software is geared to the operating room and includes a Surgical Dashboard that pushes relevant patient information to Glass-wearing providers. The HIPAA-compliant application also supports video-sharing. I assume that the company is still in the development stage as they are looking for additional betas to test their product.
CrowdOptic – ProTransport-1 recently announced it will deploy the CrowdOptic Google Glass broadcasting solution in its ambulances and mobile medical machines to broadcast real-time video of patients in transport. UC San Francisco is also testing CrowdOptic software to enhance physician training through the use of live video streaming from Glass devices.
Pristine – Pristine offers the EyeSight product as a HIPAA-compliant, first-person audio/video streaming solution optimized for Google Glass. Currently their platform is in use at several facilities, including UC Irvine Medical School and Houston Methodist Hospital (to allow physicians to broadcast procedures to students or for continuing education purposes) and Rhode Island Hospital (for remote dermatology consults). The Chicago-based MedEx Ambulance service also recently acquired Pristine’s technology to allow Glass-wearing paramedics to transmit live video and audio from an ambulance to an ER doctor.
Remedy – Remedy has launched a pilot study with three Harvard hospitals in which Glass-wearing PAs will connect with doctors (usually at night), allowing the supervising physicians to “see” the patients. Remedy is targeting its application for use by residents, medical students, general practitioners, nurses, and PAs to extend the reach of specialists.
Wearable Intelligence – Physicians at Beth Israel Deaconess Medical Center are using devices from WI as a means of gaining hands free access to patient charts. The company also promotes a procedural checklist application and telehealth and video recording options for healthcare. In addition to the high-profile BIDMC, the multi-national oil services firm Schlumberger also uses WI’s Glass applications.
I’m impressed by the number of big-name health systems that are giving Google Glass a test drive. It’s also interesting to note the diversity of applications, from telehealth, education, remote consults, and EMR access. By the time HIMSS15 rolls around next April I am sure we’ll have a clearer idea of which vendors have figured out the formula for success.
And regardless how hot the market gets, I doubt I’ll be Glass-adorn any time soon.
“Isn’t it obvious?” (the PACSMan) asked. “Here’s the deal. No one knows where healthcare is going, so we’re all going to start enjoying Thanksgiving again for the first time in 75 years. Instead of freezing our asses off, we’ll do an interactive virtual conference with scheduled demos and everything. No muss, no fuss, and no ‘free’ meals. As a bonus, system prices will drop 30% because vendors won’t have to pay for RSNA. It’s sheer brilliance, I tell ya!"Mike was referring to the vendor extravaganza at RSNA, but I think this applies to site-visits as well. There is simply no need to haul people across the countryside (or country, for that matter) to see the scanner. They all look pretty much the same, and decisions are not made on the basis of their appearance. (Bore size and other specs are important, but that's all in the specs.)
Excuse a moment of somewhat personal commentary, but this story in the New York Times has been making the rounds. Basically, the boards full of smiling babies in a doctor’s office are considered a privacy violation. Here’s an excerpt from the article:
Under the law, the Health Insurance Portability and Accountability Act, baby photos are a type of protected health information, no less than a medical chart, birth date or Social Security number, according to the Department of Health and Human Services. Even if a parent sends in the photo, it is considered private unless the parent also sends written authorization for its posting, which almost no one does.
When I read stories like this, I ask myself “Have we lost all common sense? Can’t we be human?” I get how privacy is important. I’ve written this blog for 9 years and so I know the consequences of HIPAA breaches. Although, I think Dr. Moritz covers my view really well:
“I think we have to have some common sense with this HIPAA business,” Dr. Moritz continued. “To leave medical records open to the public, to throw lab results in the garbage without shredding them, that makes sense” to prohibit. “But if somebody wants to post a picture of something that’s been going on for a millennium and is a tradition, it seems strange to me not to do that,” he said.
I know there are ways to comply with the law and preserve the baby board. Have the parents sign a release form when they drop off the picture. I think you could also add this note in your HIPAA notice that the patient signs before their first visit. However, I think this is missing the point. Isn’t it common sense that someone who sends a picture of their baby to the office isn’t afraid of having that picture shared?
Certainly this change is not life or death stuff. Although, I think the baby boards did provide some humanity to an otherwise sterile office. However, I hate the trend of where this leads. In far too many things we can’t be human anymore. Common sense is missing in so many areas of life and instead of giving people the benefit of the doubt we’re too easy to condemn people who had no ill intent.
I realize there are bad people out there that do bad things. However, they’re the minority and its sad when the minority is able to have such an impact on the majority.
Dalai's note: This piece is reprinted from today's American Thinker. It is one of the most eloquent, heartfelt, and most importantly, ACCURATE renditions of the Mideast situation today. It is a long essay, but well worth your time. Know the history. Know the TRUTH.
In a Receiver Operating Characteristic (ROC) curve the true positive rate (Sensitivity) is plotted in function of the false positive rate (100-Specificity) for different cut-off points. Each point on the ROC curve represents a sensitivity/specificity pair corresponding to a particular decision threshold. A test with perfect discrimination (no overlap in the two distributions) has a ROC curve that passes through the upper left corner (100% sensitivity, 100% specificity). Therefore the closer the ROC curve is to the upper left corner, the higher the overall accuracy of the test (Zweig & Campbell, 1993).Got it? Just remember that everybody's ROC is going to be different, with different blends of sensitivity and specificity.
So what is quality? I guess getting it right every time would be a good start. But that really isn't in the realm of human performance. No one has a vertical ROC curve. If you read enough X-rays and scans, you will miss something. The old saying goes that the only way not to miss anything is not to read anything. That's not very practical.
Who Is the Better Radiologist?By SAURABH JHA, MD
There’s a lot of talk about quality metrics, pay for performance, value-based care and penalties for poor outcomes.
In this regard, it’s useful to ask a basic question. What is quality? Or an even simpler question, who is the better physician?
Let’s consider two fictional radiologists: Dr. Singh and Dr. Jha.
Dr. Singh is a fast reader. Her turn-around time for reports averages 15 minutes. Her reports are brief with a paucity of differential diagnoses. The language in her reports is decisive and her reports contain very few disclaimers. She has a high specificity meaning that when she flags pathology it is very likely to be present.
The problem is her sensitivity. She is known to miss subtle features of pathology.
There’s another problem. Sometimes when reading her reports one isn’t reassured that she has looked at every organ. For example, her report of a CAT scan of the abdomen once stated that “there is no appendicitis. Normal CT.” The referring physician called her wondering if she had looked at the pancreas, since he was really worried about pancreatitis not appendicitis. Dr. Singh had, but had not bothered to enlist all normal organs in the report.
Dr. Jha is not as fast a reader as Dr. Singh. His turn-around time for reports averages 45 minutes. His reports are long and verbose. He meticulously lists all organs. For example, when reporting a CAT of the abdomen of a male, he routinely mentions that “there is no gross abnormalities in the seminal vesicles and prostate,” regardless of whether pathology is suspected or absence of pathology in those organs is of clinical relevance.
He presents long list of possibilities, explaining why he thinks a diagnosis is or is not. He rarely comes down on a specific diagnosis.
Dr. Jha almost never misses pathology. He picks up tiny lung cancers, subtle thyroid cancers and tiny bleeds in the brain. He has a very high sensitivity. This means that when he calls a study normal, and he very rarely does, you can be certain that the study is normal.
The problem with Dr. Jha is specificity. He often raises false alarms such as “questionable pneumonia,” “possible early appendicitis” and “subtle high density in the brain, small punctate hemorrhage not entirely excluded.”
In fact, his colleagues have jokingly named a scan that he recommends as “The Jha Scan Redemption.” These almost always turn out to be normal.
Which radiologist is of higher quality, Dr. Singh or Dr. Jha?
If you were a patient who would you prefer read your scan, the under calling, decisive Dr. Singh or the over calling, painfully cautious Dr. Jha?
If you were a referring physician which report would you value more, the brief report with decisive language and a paucity of differential diagnoses or the lengthy verbose report with long lists on the differential?
If you were the payer which radiologist would you wish the hospital employed, the one who recommended fewer studies or the one who recommended more studies?
If you were a hospital administrator which radiologist would you award a higher bonus, the fast reading Singh or the slow reading Jha? This is not a slam dunk answer because the slow-reading over caller generates more billable studies.
If you were hospital’s Quality and Safety officer or from Risk Management, who would you lose more sleep over, Dr. Singh’s occasional false negatives or Dr. Jha’s frequent false positives? Note, it takes far fewer false negatives to trigger a lawsuit than false positives.
I suppose you would like hard numbers to make an “informed” decision. Let me throw this one to you.
For every 10, 000 chest x-rays Dr. Singh reads, she misses one lung cancer. Dr. Jha does not miss a single lung cancer, but he recommends 200 CAT scans of the chest for “questionable nodule” per 10, 000 chest x-rays. That is 200 more than Dr. Singh. And 199/ 200 of these scans are normal.
I can hear the siren song of an objection. Why can’t a physician have the sensitivity of Dr. Jha and the specificity of Dr. Singh? The caution of Jha and the speed of Singh? The decisiveness of Singh and the comprehensiveness of Jha?
You think I’m committing a bifurcation fallacy by enforcing a false dichotomy. Can’t we have our specificity and eat it?
Sadly, I’m not. It is a known fact of signal theory that no matter how good one is, there is a trade-off between sensitivity and specificity. Meaning if you want fewer false negatives, e.g. fewer missed cancers on chest X-ray, there will be more false positives, i.e. negative CAT scans for questioned findings on chest X-ray.
Trade-off is a fact of life. Yes, I know it’s very un-American to acknowledge trade-offs. And I respect the sentiment. The country did, after all, send many men to the moon.
Nevertheless, whether we like it or not trade-offs exist. And no more so than in the components that make up the amorphous terms “quality” and “value.”
Missing cancer on a chest x-ray is poor quality (missed diagnosis). Over calling a cancer on a chest x-ray which turns out to be nothing is poor quality (waste). But now you must decide which is poorer. Missed diagnosis or waste? And by how much is one poorer than the other.
That’s a trade-off. Because if you want to approach zero misses there will be more waste. And if we don’t put our cards on the table, “quality” and “value” will just be meaningless magic talk. There, I just gave Hollywood an idea for the next Shrek, in which he breaks the iron triangle of quality, access and costs and rescues US healthcare.
If I had a missed cancer on a chest x-ray I would have wanted Dr. Jha to have read my chest x-ray. If I had no cancer then I would have wanted Dr. Singh to have read my chest x-ray. Notice the conditional tense. Conditional on knowing the outcome.
In hindsight, we all know what we want. Hindsight is just useless mental posturing. The tough proposition is putting your money where your mouth is before the event. Before you know what will happen.
This is the ex-ante ex-post dilemma. In case you want a clever term for what is patently common sense.
Dr. Singh is admired until she misses a subtle cancer on a chest x-ray. Then Risk Management is all over her case wondering why? How? What systems must we change? What guidelines must we incorporate?
Really? Must you ask?
Dr. Jha, on the other hand, is insidiously despised and ridiculed by everyone. All who remain unaware that he is merely a product of the zero risk culture in the bosom of which all secretly wish to hide.
The trouble with quality is not just that it is nebulous in definition and protean in scope. It can mean whatever you want it to mean on a Friday. It is that it comprises elements that are inherently contradictory.
Society, whatever that means these days, must decide what it values, what it values more and how much of what it values less is it willing to forfeit to attain what it values more.
Before you start paying physicians for performance and docking them for quality can we be precise about what these terms mean, please?
- Radiologists error rate reported at 30%
- >70% perceptual
- abnormality is not perceived, i.e. “missed”
- <30% cognitive
- Abnormality is perceived but misinterpreted
- Error does not equal negligence
- Negligence occurs when the degree of error exceeds an accepted standard
- Missed diagnoses are the major reason radiologists are sued
- Most commonly missed:
- Cancers (breast and lung are the largest percentacge)
- Spine fractures
- Retrospective error/miss rate averages 30% (i.e. hindsight is 20-20)
- “Real-time” error rate in daily practice averages 3-5%
I've got enough friends who happen to be litigators to know that two things drive a malpractice suit: anger and greed/envy, and they go hand-in-hand. (And as an aside, the majority of cases appear to reach the attention of a lawyer because ANOTHER DOCTOR told the patient that something wasn't done as well as HE would have done it.) As with the young lady driving the beat-up car, an accident or even an incident that approaches such is enough to promote rage in some of us, perhaps even most of us. It doesn't matter that the act was unintentional. I did not set out yesterday to trash some kid's little red jalopy. I think it's also reasonable to say that no physician decides some morning to cause harm to his patient. A missed finding, like a parking-lot collision, is an accident. It is not meant to happen, and everyone would prefer that it doesn't. This is where greed and envy can augment the madness of rage. The young lady above, at some level, realized that my truck was likely worth 8-10 times what her beater might bring, and no doubt this got her all the more riled. Why should that doofus have a nice car? Who gave him the right to almost plow into me? He must think he owns the road, having an expensive car like that. I'll show him!Hopefully the above discussion of sensitivity and specificity brings this all full-circle. You can see the pressures under which we operate. We are to produce the work with decisive reports one after the other after the other, functioning as Dr. Singh, but we are never to miss anything, wearing the Dr. Jha hat. Why not just do both? Because we are human and humans can't do that.
In the case of a miss or other adventure in medical errors, I think the same thing applies, although certainly with a little more justification. There is clearly a relationship between doctor and patient. If something goes wrong, the patient feels betrayed And the patient gets angry. Given the perception of docs as wealthy, the next step in the mental equation may become: he hurt me (or could have hurt me) and he's going to pay! He can afford it!
While a financial award could put a car back together again, it may not be able to fix what was broken by the medical error. Somewhere along the way, our society has decided that money can compensate for the damage, and maybe that is true. However, juries of our "peers" are wont to award huge sums as punitive measure to "punish" the "bad" doctor. And let us not forget the fact that the litigator might receive 30-50% of the proceeds.
This is wrong. The whole scenario is horrible, and accomplishes nothing but padding the pockets of the litigating AND the defending lawyers. It leads to millions and billions of dollars spent for "cover your ass" procedures and tests. And it's all predicated on the anger over an accident and the thought that there might be a gold-mine to be had having won the malpractice lottery. This must stop.
I want this to be Mar-Mar's legacy: we must forgive those who make honest mistakes. We need to remove anger, greed and envy (and lawyers) from the equation, and somehow set up some entity, some body or board, that would determine actual damages and arrange for those to be made as whole as possible, but without multi-million dollar punitive, redistributive, awards. I know this is next to impossible, as there is way too much money to be made by trying "rich" doctors in front of a jury of their "peers" who would love nothing more than to sock it to them. But it is the right thing, and all but those who profit from the malpractice industry, not just the lawyers, but the plaintiff whores who sell their testimony, know that I'm spot on. Mar-Mar would approve.
A recent press release about the collaboration between GenoSpace and Caris Life Sciences got me thinking about the future of the management of cancer genomics information (see: Caris Life Sciences collaborates with GenoSpace to advance cancer care through research). Below is an excerpt from it:
Caris Life Sciences...announced a collaboration with GenoSpace, a Massachusetts-based technology company that develops robust software solutions for genomic and health data. Caris will apply GenoSpace's population analytics offerings to uncover and better utilize key insights from the company's... tumor profiling service....The partnership also leverages GenoSpace's analytics architecture expertise to unlock key treatment insights from the Caris Registry, a database of clinicopathologic and outcome variables from consenting patients whose tumors underwent multi-technology profiling by Caris.... Caris' tumor profiling databases are comprised of multiple assay technologies performed in combination to achieve [a]...molecular profile of a tumor. The resulting analysis and insights, enabled in part by this collaboration, will create a HIPAA-compliant informatics platform that provides Caris' institutional partners the ability to investigate institution-specific profiling data....It also allows Caris to more efficiently and expediently isolate novel and/or critical drug-biomarker associations, ultimately providing better treatment information to oncologists and their patients.
We see here a collaboration between GenoSpace with its cancer genomic support and profiling tools and Caris with its cancer profiling technology. This relationship suggests to me that a new computing model is evolving for cancer genomics that is different from the preexisting LIS computing model. Here are short descriptions of the two models for comparison purposes:
Most of the processing in this new model takes place in the cloud. Reports are generated under this new model using sophisticated databases, analytic software, and algorithms that may not be available to hospital labs. This data and software non-availability is related, in part, to its status as the intellectual property of the genomic reference labs. Moreover, the software and data is also in a state of flux as the pool of knowledge about cancer genomic changes. In the old model, patient databases were created at the hospital level by analyzing patient serum samples that were then interpreted by pathologists and the test-ordering clinicians. In the new model, some of the information necessary to interpret the patient test results belongs to the vendor.
Painting with broad brush strokes, here is the IT architecture I see evolving to manage cancer genomic data, a process separate from hospital EHRs and LISs. The job of the EHR is largely to replicate the paper medical record, to document work flow pertaining to patients, and also to aggregate relevant clinical data generated at the hospital level. The IT nodes that provide cancer genomic analysis exist only in the cloud. In most cases, the hospital clinicians will access the cancer genomic reports for their patients via web readers supported by the EHR or via hand-held tablets and smart phones. Similar and parallel sophisticated cloud diagnostic nodes will also evolve for other diagnostic services like cardiology and radiology.
It may be relevant to refer to these specialized, cloud-based, diagnostic, computing nodes as SMAC diagnostic nodes (see: Time to SMAC the Healthcare Consumer). The term SMAC was described by John who blogs over at Chilmark Research in the following way:
SMAC – Social [i.e., Personalized], Mobile, Analytics, Cloud – is a popular framework for optimizing business performance through IT. The basic idea is that these four elements all play key roles in generating value from data through capture, storage, and application. Social [i.e., Personalized] refers to the consumer or end-user level, where data is created and collected. Mobile describes the shift to smartphone and tablet-driven computing. Analytics speaks to the growing ability and need to interpret and understand data big and small. Cloud refers to the advent of virtual computing through untethered storage and access to data, applications, services, and more.
The headline of a tech startup blog I read pretty regularly caught my attention today, “Another day, another Chinese hack: 4.5M medical records reportedly accessed at national hospital operator“. The title seems to say it all. It’s almost like the journalist sees the breach as the standard affair these days. Just to be clear, I don’t think he thinks breaches are standard in healthcare, I think he thinks breaches are standard in all IT. As he says at the end of the article:
Community Health Systems joins a long list of large companies suffering from major cybersecurity breaches. Among them, Target, Sony, Global Payment Systems, eBay, Visa, Adobe, Yahoo, AOL, Zappos, Marriott/Hilton, 7-Eleven, NASDAQ, and others.
Yes, healthcare is not alone in their attempt to battle the powers of evil (and some not so evil, but possibly dangerous) forces that are hacking into systems large and small. We can certainly expect this trend to continue and likely get worse as more and more data is stored electronically.
For those interested in the specific story, Community Health Systems, a national hospital provider based in Nashville reported the HIPAA breach in their latest SEC filings. Pando Daily reported that “Chinese Hackers” used a “highly sophisticated malware” to breach Community Health Systems between April and June. What doesn’t make sense to me is this part of the Pando Daily article:
The outside investigators described the breach as dealing with “non-medical patient identification data,” adding that no financial data was stolen. The data, which includes patient names, addresses, birth dates, telephone numbers, and Social Security numbers, was, however, protected under the Health Insurance Portability and Accountability Act (HIPPA).
I’m not sure what they define as financial data, but social security numbers feel like financial data to me. Maybe they meant hospital financial data, but that’s an odd comment since a stack of social security numbers is likely a lot more valuable than some hospital financial data. The patient data they describe could be an issue for HIPAA though.
As is usually the case in major breaches like this, I can’t imagine a chinese hacker is that interested in “patient data.” In fact, from the list, I’d define the data listed as financial data. I’ve read lots of stories that pin the value of a medical record on the black market as $50 per record. A credit card is worth much less. However, I bet if I were to dig into the black market of data (which I haven’t since that’s not my thing), I bet I’d find a lot of buyers for credit card data tied to other personal data like birth date and addresses. I bet it would be hard to find a buyer for medical data. As in many parts of life, something is only as valuable as what someone else is willing to pay for it. People are willing to pay for financial data. We know that.
We shouldn’t use this idea as a reason why we don’t have to worry about the security and privacy of healthcare data. We should take every precaution available to create a culture of security and privacy in our institutions and in our healthcare IT implementations. However, I’m just as concerned with the local breach of a much smaller handful of patient data as I am the 4.5 million medical record breach to someone in China. They both need to be prevented, but the former is not 4.5 million times worse. Well, unless you’re talking about potential HIPAA penalties.
I’ve been looking at hospital supply chain automation and the IT surrounding it for a number of years now. Starting with Cardinal Health but then moving on to help a number of other vendors in the space, I’ve felt that there’s not been enough next-generation tech being applied to the low margin, high volume business of hospital supply management. Hospitals often spend tens of millions of dollars on EHRs and other IT systems that have little direct cost reduction capability but they ignore, often at their peril, supply management systems that can save immediate dollars. There seems to be a light at the end of the tunnel, though. Earlier this year I joined the board of Hybrent, led by founder and supply chain expert Harold Richards, because I instantly saw the value of what they were doing. While Hybrent is a startup funded by a couple of friends that I know have been successful in the past, I joined primarily because of Harold’s 21 years testing, applying, measuring and implementing supply chain strategies that have driven well over $50 million in costs out of the supply chain units where he’s served. While supply chain automation is often seen as an administrative activity, I’ve seen first hand that it’s actually directly tied to increase in patient & nursing satisfaction. I asked Harold to tell us a little about why supply chain automation is so important and here’s what he had to say:
Does Your Hospital Supply Chain Have Traits Of An Ant Farm?
You may have had an ant farm as a child and marveled at the cooperative efforts and precision of the ants as they went about their daily activities. Thanks to the panes of glass, you could see into the inner workings of the ant society at all levels and depths.
That same level of effort went into the anthill in the backyard – maybe even more due to the lack of protection. Yet it went unnoticed because it was underground. You only noticed problems when they affected ants that you could see at the top of the anthill.
So it is with the hospital supply chain, full of hard working individuals who run into daily challenges just as ants do. Both rely on excellent systems of communication to get things accomplished. However, ants do not have to deal with bureaucracy, integrating of mismatched systems, missing supplies and other time-wasting system failures (at least not as far as we can tell).
Front-line healthcare workers do spend precious time dealing with these problems, resulting in inefficiencies, higher costs, and potential poor patient outcomes. Spending 20% of your nurses’ time on supply scavenger hunts does not help anyone – certainly not the nurses.
Not only does this cause inefficient use of time, it causes inventory chaos – incorrect counts, hoarding supplies, missing orders and the like – that can snowball throughout your supply chain system. You have stressed and unhappy ants, so to speak.
These misfires cause turmoil within the ant farm and can lead to accidents like sentinel events. Looking at the bigger picture within healthcare, we are expected to do more with less. In my opinion this is a recipe for disaster.
Today, droves of patients are flocking to the ER’s like never before seeking treatment. As a result, emergency rooms all over the country are filled beyond capacity levels with less staff, more workload and higher expectations. According to USA TODAY, some hospitals are seeing 12% spikes. Purely from a metrics perspective this may not seem like much, but could result to patients dying while waiting for care.
With this increase in volume there now becomes a higher risk and demand for medical supplies & enhancement in supply chain efficiencies. The reality we live in is this; incorporating anything less than the traits of an ant farm will cause major mishaps in form of patients dying. It’s a sentinel event just waiting to happen.
Just imagine something as minor as clinical caregivers not having instant access to trauma, respiratory, and EMS supplies within a already busy emergency department while a patient is being triaged with chest pains. Quite a frightening forecast when you think about it. As they say, future behavior is predicated upon past behavior. The future outcomes of your patients weigh heavily on your actions.
As a hospital executive, your view may be that of the backyard anthill – you have surface information that gives you superficial knowledge, but without the overall view you need to fully anticipate or fix problems. Meanwhile, your care providers may be dealing with supply chain systems that hamper effective communication instead of enhancing it.
If you’re not doing these three things your patients are at risk and your hospital is losing millions of dollars in supply chain management:
The key is to get you the information and facts you need to make decisions when you need it, and not to overwhelm yourself with frivolous or useless information. If you can’t see the overall picture, and can’t interpret it, you can’t fix it. That is true at both the executive and care-provider level. Do you really know what’s going on in your “anthill” today?
Ants are models of efficiency, and with a proper Supply Chain Visibility System, your front-line care providers will be as well. They will be thrilled with the ability to streamline their time and prevent supply chain snafus. They will probably forgive you for any ant analogies you want to draw – although you’ll have to gauge that for yourself.
Editor’s note: If you’re wondering what’s going on in your anthill, e-mail Harold to get a free 30 minute Supply Chain “Clarity Session” consultation, which consists of answering a few questions and getting some pretty impressive actionable intelligence in a short thirty-minute call.
Telemedical treatment has been a tantalizing possibility for many years, for reasons including a failure of health plans to pay for it and too little bandwidth to support it, but those reasons are quickly being trumped by the need for quick, cheap, convenient care.
In fact, according to research by Deloitte, 75 million of 600 million appointments with general practitioners will be via telemedicine channels this year alone.
While one might assume that this influx is coming from traditional primary care practices which are finding their way online, that doesn’t seem to be the case.
Instead,a growing number of entrepreneurial startups are delivering primary care via smart phone and tablet, including Doctor on Demand and HealthTap, which offers videoconferences with PCPs, and options like Healthcare Magic and JustAnswer, which offer consumers the opportunity to get written responses to their healthcare queries from doctors.
Primary care doctors going into direct primary care are also joining the primary care telemedicine revolution; a key part of their business is based on making themselves available for consultation through all channels, including Skype/Facetime/Google Hangout meetings.
To date, most of the thinking about telemedicine have been that it’s an add-on service which is far to one side of the standard provision of primary care. However,with so many consumers paying out of pocket for primary care — and virtual visits typically priced far more cheaply than on-site visits — we may see a new paradigm emerge in which victims of high-deductible plans and the uninsured rely completely on telemedical PCPs.
Rather than being merely a new technical development, I believe that the delivery of primary care via telemedical channels is a new form of ongoing primary care delivery.
It will take some work on the part of the telemedicine companies to sustain long-term relationships with patients, notably the use of an EMR to track ongoing care. And telemedicine PCPs will need to develop new approaches to working with other providers smoothly, as coordination of care will remain important. Health IT companies would be wise to consider robust, unified platforms that allow all of this to happen smoothly.
Regardless, the bottom line is that primary care telemedicine isn’t an intriguing sideline, it’s the birth of a new way to think about financing and delivery of care. Let’s see if traditional providers jump in, or if they let the agile new virtual PCP companies take over.
I have posted a number of previous notes about obesity (see, for example: No Nation Has Lowered Its Obesity Rate in 33 Years) because I think that it's one of the greatest health threats facing the U.S. as well as around countries. I came across an interesting article that speculates about the primary cause for obesity around the world (see: What’s Behind the Obesity Epidemic? Easily Accessible Food, and Lots of It) and below is an excerpt from it. It's worth reading because of the abundance of evidence it provides for the theory that the cause of most obesity is that food is to inexpensive and accessible.
Among the American public and even some policymakers, it has become conventional wisdom that poverty, a dearth of supermarkets, reduced leisure time, and insufficient exercise are key forces behind the U.S. obesity epidemic. Conventional wisdom is an unreliable guide, however, and in this case, much of it is wrong: The epidemic actually coincides with a falling share of income spent on food, wider availability of fruits and vegetables, increased leisure time, and more exercise among the general population. Of course, there are differences between individuals, but we need to explain the change in obesity over time, not why people differ. Some differences in body mass index (BMI) are associated with genetic makeup. But genes haven’t changed in the past 50 years, so differences between individuals don’t explain trends....The clearest change concerns food availability and cost. Since the 1970s, there has been a significant drop in the share of income spent on food—yet each food dollar buys a lot more....As the obesity epidemic has grown and food prices relative to income have dropped, Americans have been eating more of everything, including fruits and vegetables. In terms of macronutrients, most extra calories come from carbohydrates. U.S. markets have succeeded in largely solving the age-old problem of food scarcity, so the answer isn’t to return to higher food prices across the board. But with the solution to food scarcity contributing to a new threat, Americans need market forces to shift them in a different direction and help stem the obesity epidemic....Under the influence of conventional wisdom, many policy interventions focus on “positive” messages: Eat more fruit and vegetables. Get more exercise. However, given that fruit and vegetable availability and physical activity have both increased while relative food prices have plummeted and obesity rates have soared, reducing discretionary calorie consumption may be a more promising lever to reduce overweight and obesity.
So here is the most important message regarding control of obesity: reduce calorie consumption. This approach is sometimes referred to as portion control (see: Portion control key to fighting obesity, expert says). There are some tricks to this approach to weight reduction such as using smaller plates and avoiding "all you can eat" food buffets. In the final analysis, however, reducing the amount of food eaten requires self-discipline. This is difficult because companies that manufacture various types of foods load them up with the salt, sugar, and fat that we like very much (see: Some Salty Facts Keeping to a Healthy Diet; The Harmful Health Effects of Sugar; Next Steps?). I have been told that the theory behind diet programs such as Jenny Craig is portion control. Here's an article about how to learn portion control using the Jenny Craig prepared foods (see: How to Learn Portion Size With Jenny Craig). Learning portion control can be tough in this country, particularly if you commonly eat in fast food restaurants where there are lots of incentives to "super-size" your meal.
A girlfriend of mine recently posted the above note on Facebook. Not surprisingly, several women (and a couple of progressive men) expressed similar discontent with the procedure; a couple of commenters said they were sure that a man invented the technology, while another pointed out that more women would likely be compliant with screenings if the process was not so unpleasant.
While I can’t say I love getting a mammogram, there are definitely other aspects of my well-woman check-up that I dislike more. Lest your mind wander too far from HIT, let me clarify a few of the other annoyances:
The problem with mammograms, EMRs, patient portals, and other healthcare technologies is that too often the developers seem to have forgotten the patient experience. Case in point: EMRs. Having all of a patient’s visit record online is a tremendous benefit. Frequently, however, the EMR interferes with the patient exam because the physician seems to be paying more attention to finding the right drop down item than to the actual patient. Especially if I am sick, I want my doctor’s full attention and assurance that he/she is engaged and invested in my care.
I’m not just blaming the software developers. Some of the blame goes to the government for requiring all the meaningful data that can seem irrelevant to the visit, or items like a multi-page visit “summary” that is too verbose and confusing to be of much benefit to the patient. I personally love the idea of a visit summary, but it’s painful to read through all the medical jargon and other superfluous data. If I take my daughter to the pediatrician for an ear infection, I’d prefer a one page “summary” that includes a bottom line telling me, 1) give her antibiotics until finished and Ibuprofen for pain, and 2) call the office if symptoms get worse or she is not better in three days.
I am not sure who gets the blame for the whole explanation of benefits mess. I mean, who can glance at one and determine if and how much insurance is paying, if the provider is going to send me an additional bill and for how much, if the carrier is waiting on more detail from the doctor, if the patient needs to follow up with the doctor, etc.? And just when you think you are a semi-expert at reading an Aetna EOB, your employer switches to Humana – which of course has an entirely different EOB format.
Here’s a novel idea: let’s get patients more involved in the whole software design process. Not just those patients who love technology, but also my 79 year-old dad who still uses a phone book to look up phone numbers, or my sweet retired neighbor who loves to do her shopping from mail-order catalogs. I’m not sure how one builds a better mammography machine, but I am sure there are plenty of women out there willing to provide some input.
And yes, we do get to blame – and thank – a man, Dr. Robert L. Egan – for developing the modern-day mammogram
I’ve been getting many questions these days about big data tools and solutions, especially their role in healthcare analytics. I think that unless you’re doing large scale analysis of biomedical data such as genomics, it’s probably best to stick with traditional tried and true analytics tools. Online Analytics Processing (OLAP) can be invaluable for medical facilities to use when interpreting data and health informatics because most of that data is in relational, key-value, or hiearchical databases (such as MUMPS). I reached out to Ron Vatalaro, who works with the University of South Florida Morsani College of Medicine and writes about health informatics, to summarize which commercial tools are good to consider for modern OLAP architectures. Here’s what he said:
Online Analytic Processing (OLAP) is used in computing to quickly respond to multi-dimensional analytical queries. It is a subset of business intelligence, which also includes report writing, relational database, and data mining. OLAP tools make it easy to analyze data from multiple perspectives through one of its following three basic operations: consolidation (roll-up), drill-down, and slicing and dicing.
OLAP and data warehousing are interacting with and shaping health informatics by allowing for new analytical opportunities, in addition to the customary statistical approaches. It is one thing to collect vast amounts of data, but gaining insights as to how to best use the data to save lives and dollars is where the rubber meets the road. It is up to informatics professionals to glean meaningful information from the data sets and OLAP tools make it easier to breakdown and analyze big data.
Clinicians and hospital administrators can analyze the data for both individual patient care and to make optimized decisions to better serve all patients undergoing treatment at the facility. Dimension tables can be vital to testing hypothesis using textual, non-numerical data. For instance if administrators what to determine if the colors of walls or views from the window in patient’s rooms correlate to stay durations, nurse calls or return rates – these tools can assist in drawing such conclusions.
EHR and OLAP
EHR and OLAP work hand-in-hand to deliver across-the-board improvements in world-wide health reform. It is important to understand the role data plays in the healthcare business model, and in what ways EHR systems are capturing and relaying this data. When it comes to the massive amounts of information coming into the healthcare data infrastructure, the use of comprehensive analysis becomes invaluable. Thus when the output from EHRs can be meaningfully dissected the results can lead to the following benefits: better continuity of care, increased patient participation, enhanced practice efficiencies/cost savings, better accuracy, reduction of errors and more convenience for patients and healthcare providers.
The story your data is telling can present a double-edged sword. One of the benefits of being able to slice-and-dice down big data is to root out inefficacies; however, these same inefficiencies can lead to loss income due to meaningful use and pay-for-performance (P4P) policies. That being said, it is important to have comprehensive analytics to track and root out potential problems proactively, and to know what data third parties, such as insurers, are also looking at.
There is also the data healthcare providers cannot control, for instance, the decisions among patients to maintain their own health and well-being. There are government and insurance provider-backed incentives that reward “good behavior” among individuals who prioritize their health (not to mention the benefits of a healthy lifestyle). Categorizing and engaging individuals who do not care to advocate for their own benefit through unhealthy behaviors, (such as poor diet, alcohol abuse or tobacco use) and identifying any external factors that may exacerbate these issues (such and geographic, ethnic or socio-economic) can enrich lives and benefit the overall environment of healthcare. In these circumstances EHR and OLAP work together to the mutual benefit of society and the healthcare industry.
OLAP and Pharmacy Systems
To aid in pharmacological data management OLAP can play a major role in using the vast amounts of information from managed care organizations (MCO) management information systems (MIS) in a meaningful way. Information regarding member/provider functions, claims administration, clinical management, rebate administration and financial details are managed by systems generally referred to as online transaction processing systems (OLTP). Such systems have allowed the collection of billions of prescription records year-over-year. However, with the need for massive amounts of data to enable more effective drug therapy treatments, pharmacy management systems can fall short of the necessary processing power. That’s where OLAP systems step in to make decision support tools from the OLTP systems. These tools can interact with the data by making changes to the OLTP system, extracting data from the patient population and the prescribers of the medication.
OLAP systems are classified by the following groupings:
5 OLAP Tools Strengths and Weaknesses
There are a wide-variety of data management tools available to assist healthcare organizations in online analytics processing. There are
How OLAP fits with ‘Big Data’ Hype
As Shahid mentioned in his introduction, there has been a growing buzz around Big Data in IT (generally). Due to the massive influx of consumer information being shared openly over a variety of platforms, there has been a great deal of demand among businesses to capture that information to try and gain market insights and create customer profiles. This flood of information has many implications in healthcare, as tele-health and interoperability are gaining prominence. However, data quality is not the same a data quantity, and quantity (as the name suggests) is essentially what Big Data is all about.
Being able to capture standardized and actionable insights from large sets of data is the important distinction that OLAP brings to the table. Without the insights that structured data can bring, what you are left with is merely a technology (Big Data), rather than architecture (OLAP). That being said, there are differing schools of thought as to what role OLAP will play in the future of data management. It can be said that OLAP cubes lack the agility that a Big Data solution offers, although the presence of one does not mutually exclude the other.
The following is a guest post by Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts.
Eligibility verification has always been a challenging part of running a healthcare business. However, that challenge has become even more difficult as the Affordable Care Act has caused a wave of newly insured patients along with patients who are switching insurance carriers flooding into physician offices. Verifying and learning the details of the patients’ new insurance policies has created a lot of new work for a clinic’s staff.
In the perfect world, there would be an automatic verification system that would easily look up a patient’s insurance policy and the details of their plan. While some companies are trying to make automatic insurance verification a reality, it’s currently very weak and still requires a lot of human intervention and interpretation. Maybe one day the payers will fix that, but until then it’s important that a practice creates a smooth process for verifying a patient’s insurance. In many cases this includes hours browsing insurance company websites and internet payer portals or waiting on hold for hours a day on automated voice systems or insurance company call trees. Is that the best use of your staff’s time?
I don’t think I need to describe in detail why having the insurance eligibility and plan details as early as possible is important. If you don’t have this information, your ability to get paid by the patient for the services rendered goes down and your claims denials go up. Plus, many of these new insurance policies are high deductible plans where you’ll need to collect a lot more money than usual from the patient. One way to solve this problem is to know how much the patient owes before or at least while they are in the office. The best opportunity to collect from a patient is when they are standing in front of you.
While internal staff can do a great job verifying insurance eligibility and obtaining benefits summaries, this can be a challenging job while handling all of the other front desk or billing duties as well. One solution to this problem is to outsource the eligibility verification task. A list of scheduled appointments is supplied to the outside company and after verifying insurance coverage for the patients they put the coverage details directly into your appointment scheduler. Obviously the key business question here is to compare the cost, timing, and quality of an outside service against the cost, timing and quality of your current staff doing it.
One related challenge that many practices are facing with all of these new and changing insurance policies is the time staff spend educating the patients. Most patients did not spend time really understanding the insurance policy they were buying. They looked at the price and largely bought without reading the fine print. This often means your staff are tasked with sharing the details of the policy and dealing with any fallout. In some ways, this isn’t a new task. However, the volume has increased.
Another solution offices should consider is doing the eligibility verification well before their appointment. Then, using a secure messaging solution the practice can share a patients’ eligibility and plan details including any co-pays and deductibles with the patient before they even arrive at the office. This early communication gives the patient time to call their insurance provider instead of your practice for all the details. Plus, it makes the patient payment expectation clear before the patient even enters your office.
How much time is your office spending verifying insurance? What solutions are you using to improve your eligibility checking and communication workflow?
The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. Their Eligibility verification service is a great way to leverage technology and people to solve the eligibility verification problem. ClinicSpectrum also offers a secure messaging product called MessageSpectrum.
They were created by San Francisco-based designer Cameron Drake for his client Weiss Orthopedics.
Mr Drake began by uploading the raw footage to a video editor and trimming the clips so they revealed the precise motions made by the joints.
He then removed the individual patient details using Photoshop.
Once the clips were selected, Mr Drake duplicated the frames so they played on a loop.
'This was an excitement in and of itself as there is not much like it on the web and gave me an opportunity to do something cool,' he wrote on his website.
At birth, babies are born with 350 bones which gradually fuse together to complete the adult skeleton of 260.
Predictive analytics have been oversold in many areas. I’m not saying there’s not good use for looking for patterns and determining outcomes as there is but it is getting to the point to where anyone can create a model and claim “it works”. When the models are proprietary, there’s no way to check for accurate outcomes and decisions are made on such models. There’s a lot of false positives and nobody questions that element and thus so people are getting hurt when that occurs. In healthcare we have seen it for years with patterns that look for fraud with false positives when the parameters are nailed down too tight. That has been going on for years.
There is a direct correlation here with inequality as every time a score is made, and it can’t be verified, folks just assume well it must be right when in fact it is not. It certainly allows for more data to be sold whenever a score is created as now you have some new data to sell to someone else to assist in their decision making. I call the Attack of the Killer Algorithms, which it is when flawed data denies consumers access.
It even gets worse as sometimes there’s no science at all with models and data scientists or quants just guess..and consumer is denied access, on a “guess” of a number component of a formula. This FICO medication adherence is one of those as nobody can replicate the proprietary model. So you just believe any numbers and stats tossed at you? We sure have a lot of that today.
Almost a couple years ago I agreed with a banker too that due to this fact that half of the analytics purchased will be a waste of investment. We have too many folks looking for “Algo Fairies” when they don’t exist. A couple years ago I predicted this too and it’s here today with big data being used out of context with discriminatory practices against consumers as everyone just believes anything tossed at them.
It’s an interesting world indeed that is ending up to be the undoing of what we have developed as our culture over the years, one side hiding risk and other parts exploiting it. Is there any balance here when you bring in the error factors that are always there and fictional models? Of course not and it is making everybody crazy and this give a lot people a big area of control and moves a lot of money to the direction of very few in the US so the land of opportunity tends to shrink a bit. You have to deal with and try to make sense of the fiction that’s mixed in out here.
Again I have written my share of SQL queries and have been a query monster in search of value in querying everything I could get my hands on and did I find value in everything I queried..NO. There’s a lot of deception out there on where predictive analytics works and what context the numbers are used. After the fact you can stir up up any old story just looking at data and really miss what occurred. I just sat there with disbelief with the recent Facebook and OKCupid data scientist stories and scratched my head on how folks could think they could have any impact there at all. Code runs hog ass wild and you have no control as it’s there to make money and knows how to grind you day in and day out.
Here’s the cause to create a law to where every data seller would need to be licensed and disclose what kind of data they sell and to who. Scroll down and watch the 4 videos in the footer and the message in this post will become crystal clear as to what’s really going on behind closed server doors that you can’t see, touch, feel or talk to. Be a skeptic when you need to be and that’s becoming more frequent today as if you don’t, well you’re “Algo Duped” at your own risk. BD
This is getting to be challenging at times with consumers knowing which is which and for that reason some of them are opening up next to each other or in the same building. Folks are mistakenly going to a free standing ER, where they can get care but it’s going to cost a lot more than an Urgent Care Center.
Minor care needs should be referred to an Urgent care center but that doesn’t always happen and people get surprised with some very large bills. Even a respiratory therapist made that mistake and she’s in the business. The situation in Texas with a couple of firms seems to have caught quite a few people off guard and competition is driving it of course. BD
Where customers once lined up to rent Finding Nemo, they can now be whisked before a doctor before even finishing their paperwork. The gleaming new facility has the latest equipment, from a CT scanner to a portable X-ray. An in-house lab provides quick test results. There are free snacks and a Keurig coffee machine, and a well-appointed children’s examining room that has an original undersea wall mural and cartoons on the TV.
Critics of the doctor- and investor-owned ER centers recommend greater cost transparency to avoid sticker shock when the bill arrives.
Patients who aren’t experiencing a life-threatening emergency should be told in advance that the facility is an ER, not an urgent-care center, said Stacey Pogue of the Austin-based Center for Public Policy Priorities, a nonprofit that analyzes healthcare and other issues affecting low- and moderate-income Texans.
For many families, the decision to go to a free-standing ER is driven by convenience.