I had the opportunity last week to participate in a day-long meeting sponsored by the Heart Rhythm Society. The goal was to help HRS develop recommendations for physicians and industry on providing patients access to information generated by wearable and implantable cardiac electronic devices. The organizers invited me to provide the viewpoint of an educated patient.
I can’t say how HRS will ultimately craft the guidance (and I am not involved in writing it), but the discussion was lively, and I came away with a number of impressions.
First, device manufacturers understand that they must move to afford patient access to the data their products are generating, but they are limited in how quickly they can do so by a number of factors, including the slow pace of technical iteration created by close regulatory oversight, the uncertainty of what data patients want and how to present it, and concerns about getting out ahead of electrophysiologists (their traditional customers) on this issue. Nevertheless, I was impressed that there seemed to be unanimity of opinion among the manufacturers that patients should have access to the same data that doctors see.
Continue reading Getting There
Dear readers –
You have the chance to amplify the conversation that we have been having (well, OK, so I have been having) on this blog. Please consider supporting a proposal for a panel on the “digital disruption” of health care at the 2019 South by Southwest Conference. I am proud to be a part of this, along with colleagues from Kaiser Permanente, GE Ventures, and USA Today. As you may know, SXSW is way more than a world famous music festival. It is also an ideas festival – a place to learn and teach and collaborate. Here’s a brief description of what we hope to address:
Peer into any medical bag and you may see a stethoscope, which came into use 150 years ago, and a blood pressure cuff – a 135-year-old technology. While these tools advanced the practice of medicine, today’s technologies hold enormous promise for improving the health and well-being of countless lives. But what about the patient-physician relationship? A computer in the exam room may provide the physician with integrated and actionable information, yet interfere with the patient-physician interaction. So how do we optimize innovations to sort hope from hype? This panel explores bridging the digital divide to improve the quality of health care, lower costs and make health care more human. Technologies we’ll discuss include:
– Predictive analytics
– Machine learning
– Precision medicine
The program is developed, in part, through online voting for the presentations that people want to see and hear. Please consider supporting our proposal by going to the “SXSW PanelPicker” at: http://panelpicker.sxsw.com/vote/86636 and “vote up.” If you don’t have a SXSW account, it only takes a minute to create one and vote.
Thanks, and see you in Austin!
The Association of American Medical Colleges (AAMC) recently released a new report detailing their predictions for the physician workforce of the future. The accompanying press release highlighted the key finding of the report: by 2030, the US “physician shortage” will be between 40,000 and roughly 105,000 physicians. The projection is based on a few assumptions, including that the 2015 physician workforce was “in balance” (enough doctors to meet demand); the aging of the population; retirement trends among physicians; and improvements in access to care for traditionally underserved populations.
Mostly the report made me think of horse manure. Specifically, it reminded me of frequently quoted predictions, made in the late 19th century, that cities such as New York and London would, by the early 20th century, be buried in mountains of it. This has been dubbed “The Great Horse Manure Crisis of 1894” which, of course, never came to pass.
In retrospect, it is easy to see that the 19th-century alarmists missed the technological revolution that was about to replace horses with vehicles powered by internal combustion engines, which averted the “crisis.”
Continue reading Workforce Predictions and Horse Manure
I have written previously about the potential impact of mobile apps and ubiquitous computing on health and healthcare delivery, but I admit I did not see this one coming. The current issue of The New England Journal of Medicine has a report from a research group in Sweden that developed a system – and tested it in a randomized controlled trial – to use smartphones to alert CPR-trained bystanders when there was a nearby cardiac arrest. This figure from the paper describes how it works:
Continue reading Crowdsourcing CPR
I was disturbed by a recent article in the New York Times about the Texas Medical Board. The piece described the decision by the Board to sharply curtail the use of telemedicine in the state. Specifically, the Board mandated that telemedicine services could only be provided in the context of a pre-existing patient/physician relationship, and that such a relationship must be established face-to-face, and not via electronic means. According to the Times, the restrictions were strongly supported by the Texas Medical Association.
This seems to me to be a wrongheaded, backward looking and overall pretty lame attempt to stem the inexorable tide of patients and physicians connecting in new ways. I really wish I could believe the Board member who said he voted for the new restriction because he was “terribly, terribly worried about the absence of responsibility and accountability” in electronic encounters. It sounded to me, instead, that he was “terribly, terribly worried” about a new business model for medical care that provides greater convenience and lower cost to patients than traditional office visits.
Continue reading Patient Advocates? Really?
A recent piece in the New York Times profiled a young man with a remarkable medical history, and an equally remarkable approach to sharing it. I think it raises some profound issues regarding the self-monitoring movement and the “ownership” of patients’ health information, both of which have the potential to change our traditional practices in a big way.
The guy – Steven Keating – is not your average Joe. He is a graduate student at MIT who trained as a mechanical engineer and is working in the cutting-edge MIT Media Lab. He also had a brain tumor the size of a tennis ball. His website hosts all of his medical records, including his pre- and post-op brain scans and, believe it or not, a video of his tumor resection surgery.
Continue reading Whose Record Is It?
If you were the right age to have been watching television in the mid-1970s, you probably remember “The 6 Million Dollar Man.” The show was about an astronaut who is critically injured in a test-mission gone bad, and is “rebuilt” with bionic (nuclear powered!) limbs and sensors to be “better than he was.” The campy intro, complete with scenes from the operating room, is, of course available on YouTube. Continue reading Better than new
I felt a little sad when I read the “perspective” piece in the New England Journal of Medicine this week about the introduction of point-of-care ultrasound in medical education. Continue reading Death of the stethoscope?
For years, I have been hearing about how new technology will transform every day clinical practice, and I have been looking forward to it. Who wouldn’t want to be able to understand better the basis of human disease based on the “new taxonomy” of precision medicine? Or offer personalized therapeutics based on full genome sequencing? Or have the ability to predict better which patient will decompensate based on advanced analytics? And yet… most of us are pretty much doing what we have always done – diagnosing disease based on signs and symptoms, prescribing drugs based on their likelihood of efficacy in a population that more or less looks like the patient in front of us, and waiting for patients to decompensate and then reacting to it. Yes, we are doing all this while using (struggling with?) an EMR, but still, the basics are all pretty much the same. Continue reading The Future Arrived for Me Last Week