Medication costs make up over 10% of health care dollars and are the fastest growing source of medical expense. Many state and federal officials have called for action that would add cost transparency to the complex, opaque medication supply chain believing that this will lead to lower prices and higher value care. Though this may appeal to our intuition, evidence that medication cost transparency leads to higher value care is scant. In order to add to the evidence base, four other investigators and I embarked on a 9-month investigation designing and evaluating the effect of medication cost transparency decision support built into the electronic health record. Bottom line: it makes a difference. The results were recently published and are available on the JAMIA website: https://academic.oup.com/jamia/advance-article-abstract/doi/10.1093/jamia/ocz025/5445905.
Digital Health: “What’s taking so long?” Part 2 of N
For all the ways that technology has visibly transformed our lives as consumers over the last decade, it has seemed like just a matter of time before the excitement of big data, social, local, mobile, process automation, artificial intelligence, and blockchain (nb. use of buzzwords intentional) will make their way into helping us meet the aims of precision medicine and population health. Though I am quite convinced that health care as an industry can be one of the most rapidly changing, I think it is fair to say that the health care consumer (ie patient) experience has remained fundamentally unchanged during this period. It feels, if anything, that the gap is only getting wider. What’s taking so long?
Operationalizing NLP to Support Value-based Care
Summary: A majority of the patient information patients and care teams use to make health care decisions is effectively “locked” in clinical notes such as those written or dictated by physicians. Natural Language Processing techniques have been maturing to extract these concepts, fill information gaps, and support health care’s clinical, operational, and financial objectives. I delivered this webinar to summarize some of Atrius Health’s work using the Linguamatics I2E platform.
Looks like we have ourselves an old-fashioned Technological Revolution (in health care)
It’s been a while, partly because these posts still can take a while for me to write. I wanted to experiment putting a few thoughts down more informally (read: no links) and originally intended to elaborate on one of the often-overlooked problems with applying advanced statistical methods/ML/AI/”cognitive computing” to health care. That will have to wait though, because I’m realizing that there is some important background that I would like to elaborate on first. I’m going to preface this by admitting that I am no scholar on innovation, but I do consider myself a student. My thinking begins with a few practical (and very much borrowed) theories of innovation.
Forget Big Data. It’s Time to Talk About Small Data.
With all of the talk of “big data,” it can be hard to remember that there was ever any other kind of data. If you’re not talking about big data — you know, the 4 V’s: volume, variety, velocity, and veracity — you should go back to running your little science fair experiments until you’re ready to get serious. Prevalent though this message may be, it has, at least in health care, stunted our ability to focus on and capture the hidden 5th V of big data: value.
Problems and Promise of Medical Vocabularies
A few of my previous projects, have engendered for me a love-hate relationship with standardized medical vocabularies, particularly diagnosis codes. I was recently asked to provide some thoughts on diagnosis codes and how their input could be improved. Here were my answers.
Why the stakes are so high in the open data debate
It is hard to understate just how much of a currency data has become in medicine. Whether talking about evidence-based medicine, precision medicine, or genomics, the ability to collect and distill data into information, transform it into knowledge, and use that knowledge to drive effective action is at the heart of what modern medicine seeks to accomplish. The centrality of data to this process has created well-entrenched stakeholders, which is why it comes as no surprise that the conversation around open sharing of research data following publication has shifted into controversial territory.
Herald: Solving the Data Overload Problem for Doctors
Doctors are overwhelmed with data. They spend 12% of their time looking up clinical data when they could be seeing patients and still information gets missed. In fact, the IOM has identified untimely access to clinical data as a leading contributor to the 3rd leading cause of death in the US: medical errors. Existing information systems and electronic medical records are better optimized for billing and documentation than they
are for making care safer. There has to be a better way.
The Opinionated Electronic Medical Record
This post also appeared on KevinMD.
Software has opinions. No, I’m not talking about opinions on the next presidential election or opinions about flossing before or after brushing. Software has opinions about how data should be displayed, opinions about users’ comfort with the mouse, even, in some cases, opinions about what you should have for dinner (see your local on-demand food ordering service).
We tend to view software as a tool that is either good or bad. Good when it lets us do what we want with as little frustration as possible and bad when it doesn’t. Maybe we should be a little nicer to software.
A good brainteaser is hard to find
I enjoy a good brainteaser, one that you really have to concentrate on and with enough revelations built in that make the end result a satisfying accomplishment. Here are some of my favorites. I made the answer text white so that you can’t see it unless you highlight (click and drag) over it.
Question: If you place 3 points randomly on the perimeter of a circle, what is the probability that all 3 lie on the same semi-circle?