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.
projects
Herald: Solving the Data Overload Problem for Doctors
Problem
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.
Reach: Text-Message Appointment Reminder System
Problem
In aggregate, community health centers account for the care of about 20 million people in the US. Over half of these patients represent racial or ethnic minorities and over a fifth (22%) prefer to speak Spanish rather than English.
Most CHC revenue comes from fee-for-service reimbursement paid by Medicaid (40%), private payers (7%), and Medicare (6%). This has led CHCs to pursue many of the strategies for maintaining solvency as other care centers across the US, including increasing patient visit volume and improving operational efficiency.
One problem all clinic sites face is the incidence of no-shows, patients for which an appointment is scheduled but that do not show up. It is estimated that no-shows account for 5-30% of appointments scheduled across the US and it is typically higher at CHCs. No-shows risk failing to deliver appropriate care to patients for whom they are scheduled in a timely or continuous manner, reduce access to scarce healthcare resources for those waiting for appointments, and represent up to 15% of lost revenue for the clinic.
Squire: Handheld Hospital Assistant
Problem
Effective hospital care requires coordination among multiple individuals including therapists, care coordinators, primary teams, consult teams, and nurses. Unfortunately, this coordination is costly to frontline staff often requiring much time and many steps even to identify the appropriate contact. Existing solutions have significant shortcomings without a highly-available best practice.
Cardiovascular Risk Calculator
Introduction
The 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk introduced a new risk assessment calculator based on aggregate data from several cohorts. According to these guidelines, a patient’s risk according to this algorithm is critical in determining if a cholesterol-lowering statin should be prescribed. Initially, this calculator was available only through a somewhat onerous Excel spreadsheet. Moreover, this was nearly impossible to access through mobile phones, a preferred modality. Continue reading
Symcat: Data-Driven Symptom Checker
Problem
When people get sick, they have several options for obtaining health care. These include going to the emergency room, urgent care center, or calling a doctor or nurse. However, 80% of people experiencing symptoms start with an Internet search. Unfortunately, searching on Google offers spotty results and frequently leads to undue concern. For example, one is 1000x more likely to encounter “brain tumor” in web search results for “headache” than they are to ever have the disease. Undue concern is a contributor to the 40% of emergency room visits and 70% of physician visits that are considered to be inappropriate.
How Motor Learning Generalizes
Introduction
Every movement we make requires our brains to predict what forces–gravity, an object we’re holding, a strong gust of wind–each of our body 
parts will experience in order to move in a coordinated fashion. No movement is ever exactly the same and so it is remarkable that we are not constantly tripping over ourselves. It is well-known that humans learn based on previous errors in their movements. My work at the Harvard Neuromotor Control Lab was to investigate how the brain learns to “makes generalizations” about movements and learn from its mistakes. Continue reading
Stroke in AVS App
Introduction
Each year, half a million patients present to emergency departments in the US with acute vestibular syndrome (AVS) characterized by vertigo lasting more than 24 hours. Though this is frequently caused by something benign such as a self-limited viral infection, it may also indicate a more severe condition such as stroke of the posterior circulation. Unfortunately, MRI can miss strokes when obtained early in the disease course meaning half of those with with posterior strokes are inappropriately sent home from the ER. Continue reading
Understanding Tracheostomy as a Risk Factor for Sternal Wound Infections
Introduction
Tracheostomy is an unpleasant, but effective means for transitioning patients off ventilatory support after prolonged periods of respiratory failure following cardiac surgery. There is, however, a perceived risk of patients getting infections of the surgical, sternal 
wound if tracheostomy is performed too early. This perceived risk means patients are often delayed in tracheostomy, including the benefits of ability to speak, reduced mortality, reduced ICU stay, and reduced delirium until the surgical wound is felt no longer at risk. Continue reading
Towards an Intelligent Stethoscope
Introduction
Though in some ways replaced by ultrasound technology, cardiac auscultation–using a stethoscope to listen to a patient’s heart–remains an important screening modality for recognizing heart disease. Auscultation serves as a cost-effective screening tool for heart disease and is of particular importance in several clinical scenarios. Less emphasis has been placed on training US clinicians in auscultation, however, making this something of a “lost art.” This may delay a patient’s diagnosis of heart disease. Continue reading
Craig Monsen 