Speaker after speaker at the recent Care Innovations Summit in Washington, DC concluded that increasing the quality and decreasing the per-capita cost of health care is the dominant political, social, and economic issue of our time. More than one expert called for a “jailbreak.”“Jailbreak” for me meant either an obscure English reality television show or an expression applied to overriding the software limitations deliberately placed on computer systems for security ...
Kent Bottles, MD
The rise of citizen scientists and patient initiated research
Whether you call it Health 2.0, Medicine 2.0, or e-Health 2.0, the Internet is changing medicine in ways that challenge the status quo. This article explores how a group of amateurs who call themselves "health hackers" and "citizen scientists" are trying to use the Internet to connect with other patients, run experiments, and conduct clinical trials on their own diseases.Dr. Gunther Eysenbach states “Medicine 2.0 applications, services and tools are ...
Patients and physicians in the digital age
The digital age has had a deep and likely permanent effect on the patient-physician relationship. I can’t tell you how many times I’ve had physicians beg me to provide them with a way to stop their patients from Googling their symptoms and diagnosing themselves before their first office visit and much to their chagrin, my answer is always the same, "You can’t stop them. Get over it."The Internet acts ...
Physicians should embrace patient engagement
The doctor/patient relationship is certainly changing and evolving. A term I hear a lot today is: “patient engagement/activation.” Why is this concept so important and what does it mean? What can physician executives do to make it easier for our patients to become engaged and activated?Judith Hibbard has pioneered the study of patient engagement, and she noted that one needs knowledge, skills, and emotional support to actively engage in one’s ...
A hospital board needs to understand generative thinking
Hospital systems and physician groups are faced with unprecedented change demanding decreased per-capita cost and increased quality in American health care. Boards of directors are underutilized resources that must be tapped more effectively in order for such organizations to survive in a time of industry consolidation. Generative thinking is a tool that can help organizations innovate in order to improve patient care and the financial bottom line.Generative thinking is ...
United States health care may need reverse innovation
The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low and middle-income countries. "Reverse innovation" describes the process whereby an inexpensive innovation is used first in countries with limited infrastructure and resources and then spreads to industrialized nations like the United States.The traditional model of innovation has involved the creation of ...
Will patients trust sociable humanoid robots?
Within in five years primary care providers will begin being replaced by sociable humanoid robots, avatars, and computer programs. Within ten years you will no longer hear any complaints about medical students choosing specialty residencies over family practice because the role of the physician will be completely redefined to complement a rules based approach to the diagnosis and treatment of many diseases. This transformation is inevitable because of demographics, economics, and ...
What would an ACO would look like if it was truly patient centered?
Health care leaders are busy talking to attorneys and consultants about how to set up Accountable Care Organizations (ACOs). A recent Advisory Board survey found that 73 per cent of hospital finance executives said that creating such an organization was a top priority for their health system.
Last year my most popular keynote topic was patient-centered medical home creation; this year everyone wants a presentation on ACOs.However not ... 
Google Health failed because consumers did not see the value of a PHR
To measure is to know.-Lord KelvinIf you can not measure it, you can not improve it. -Lord KelvinVersus:Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry. -Nassim Nicholas TalebTechnology is at its best when it is invisible. -Nassim Nicholas TalebHow can technology help us live healthier lives? Why did Google Health fail? Why are Klout and Twitter Grader publicly issuing a number to me ...
How robots will teach us who we are as humans
Recently, I took a Megabus from Philadelphia to Hunter College in New York City to attend Man-Made Minds: Living With Thinking Machines, a World Science Festival program.Rodney Brooks, who until recently was Panasonic Professor of Robotics at MIT and who now is Chief Technology Officer at Heartland Robotics, was the first expert to speak, and he emphasized a very practical approach that was not too concerned with any negative consequences ...
How Twitter changed the life of this physician executive consultant
Every morning at 5:30 AM, I am at my computer scouring the Wall Street Journal, the New York Times, the Philadelphia Inquirer, and other news sources for articles about health care and wellness.These articles are then summarized in 140 characters with a link to the original article and tweeted. As of today there are 3700 followers of my informal aggregated health care news service, and I hear about it if ...
Change of culture in a rapidly evolving health care environment
When a health system asked me to facilitate a Board discussion on physician alignment and integration on November 12, 2010, I was already committed to giving a keynote on the future of health care for the American Institute of CPAs in Las Vegas on November 11. Although I usually fly Delta or USAir where I have priority frequent flyer status, the only way I could get to the Board meeting ...
Comparative effectiveness research (CER) needs honest discussion
Comparative effectiveness research (CER) is suddenly a hot topic at all the health care conferences.How come? Everybody agrees that we have to decrease per-capita cost and increase quality. Why? Government programs like Medicare and Medicaid foot more than 50% of our nation’s health bill, and if everything stays the same these programs will go belly up (bankrupt) in 8 years. Big problem.Health and Human Services (HHS) has defined comparative effectiveness ...
Doctors should embrace feedback and learn from it
In Quality Measures and the Individual Physician, Danielle Ofri, MD, PhD questions the usefulness of feedback report cards for individual providers. She states, “Only 33% of my patients with diabetes have glycated hemoglobin levels that are at goal. Only 44% have cholesterol levels at goal. A measly 26% have blood pressure at goal. All my grades are well below my institution’s targets.”It would be better for Dr. Ofri’s patients if ...
Physicians must be aware of what they know they don’t know
St. Augustine: “Fallor ergo sum”
When I was in charge of the medical residency programs in Grand Rapids, Michigan, David Leach introduced me to the expanded Dreyfus Model of how physicians can progress from beginners to masters.I was always struck by how master physicians freely admitted their mistakes and used them as a teaching tool. As a young surgical and cytopathologist, my sanity was saved more than once by University of ...
Comparative effectiveness research (CER) in patient care
Recently, I was lucky to be invited to a New England Healthcare Institute discussion entitled "From Evidence to Practice: Making CER Findings Work for Providers and Patients" in Washington, DC.How to disseminate and implement Comparative Effectiveness Research (CER) so that patient care is really improved was the first topic tackled by the expert panel and the moderator, Clifford Goodman of The Lewin Group.The target audiences for CER findings include: patients, ...
Why technology and the Internet may not be good for patients
Paro the robot baby harp seal was the final straw.I had vowed to myself not to think about or write about “the internet makes you smarter, the internet makes you dumber” argument. Even when some of my favorite authors (Steven B. Johnson, Clay Shirky, Nicholas Carr, and Jonah Lehrer) weighed in, I thought it best not to participate.And then I read about Paro, either “a disturbing turn in our treatment ...
