Comparative Effectiveness in Healthcare

You’ve either seen, heard or perhaps been involved in a situation where a family member asks to borrow money, and later you find out they took a weekend vacation that the lender could not afford.  It’s natural that when you lend money to someone, you have some interest into their spending choices.  Look at what happened to the auto industry executives who flew into Washington on private jets asking for money. Or the Northern Trust Bank’s golf tournament in California that raised such a hoopla.  I don’t have a position on the rightness or wrongness of either private jets or golf tournaments, just that when people receive funds from other people, those other people have a new found interest into what the receiver does .

The government is going to be putting lots of money into healthcare, and similarly, will have increasing interest into how that money is being spent.  Comparative Effectiveness Analysis of drugs, and devices is such a response.  From what I’ve read, comparative effectiveness likely makes sense, but being an American, it makes me a little uncomfortable as well.

Business already do a great deal of analysis on drugs and products to assure that they have a competitive advantage over existing treatment, and thus a market.  The cartoon below applies here as well.  There is a large “step 2″ to comparative effectiveness as to how and under what conditions it applies; that needs to be clarified.  One big element, it seems, is that comparative analysis assumes information technologies are in place through which to acquire the information and process the results.  One has to wonder about the operational possibilities.  How’s the miracle going to occur.

The Wall Street Journal has a nice piece on Comparative Effectiveness .

Just so you know, at the time this piece was written a query of Google for “comparative effectiveness” and healthcare returned 127,000 citations

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March 14, 2009 | Tom | Tags: | No Comments »

Health Care Reform From A Patient Level Perspective

In Ohio there are many small roads that go under train trestles. At the time train tracks were being laid, it was cheaper to simply dig down and have the road go under the train tracks, rather than building bridges over them.  The challenge is, many of these roads were built when cars were much smaller, as were delivery trucks much smaller.

As a child I read a story in My Weekly Reader, about one large semi truck that was going down a small road under a train trestle and got stuck; I mean really stuck.  As the story went on, there was a great deal of activity around the stuck truck as to how to get it dislodged; police, fire and train engineers all looking at the truct.  A little boy happened upon the scene on the way home from school, and stopped to observe the commotion.  After a while the boy had an idea.

The boy mustered up the courage to come up to a man with a white coat and hardhat.  Pulling on the mans jacket, he said “I have a way you can get the truck free” .  ”Look son”, the man said “we have lots of people here and engineers with a lot of experience; we can figure this out.  Why don’t you just move on”.  The boy stood around for a while, and again came up to the engineer, “Sir?” the engineer looked down, “son, you need to move along, we have this under control”.  ”But sir”, the boy shouted “If you’ll just let some of the air out of the tires, you an drive it out”. The engineer was stunned and did precisely that.

The engineer saw the problem from his perspective, looking at the trestle and the top of the truck, and the little boy viewed the same problem from his 4 foot 3 inch perspective, and ultimately arrived at a better solution.

What we are seeing in the world of healthcare reform are lots of smart people in white coats looking at the top of the problem, and missing the simpler solutions.  Every hospital I’ve been, and consulted with, is full of highly educated, well meaning and committed individuals.  The challenge hospitals face is that besides all the commotion of running a modern healthcare facility, there are patients to care for.  People like you, and me and family and friends.  And then there are the nurses, techs and support staff that are around 23/7.  These are the individuals who despite what happens around them, need to take care of people in need of care; very simple, while very complex.

We ought not forget those who interact with the technologies intended to improve their efficiency and the outcomes they produce..

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March 12, 2009 | Tom Coss | No Comments »

One Reason Why Economies Improve

What doesn’t stop or even slow down during an recession?  Depreciation.  Regardless of what we hear on TV in regard to the slowing economy, depreciation still continues.  Car breaks and tires ware out, computers break, even educations depreciate as new innovations develop and new skills are required;  and yes, even parts of people fall into disrepair and need mending.

The January manufacturers inventory index declined at 0.7% on top of an adjusted 1.5% in December.  In healthcare this is more of a challenge in that we don’t “inventory” procedures, this is good news and bad.  In healthcare services are both produced and consumed at the same time.  Replacing some of these parts can occasionally be delayed, but not forever.  Consider replacing an Aortic Valve, delaying that procedure has consequences, often more expensive. The challenge hospitals and some industries face, is that there are no “inventories” upon which to depend as a cushion when needs abruptly change.  In healthcare one is limited in the ability to quickly  “tool up” to meet clinical needs

Hospital’s and healthcare systems, need to be focusing on the fiew out the windshield and prepair accordingly.  This is no time to deprive ones self the talent required to meet demands that can improve so very quickly.  It’s time to turn positive

Tom

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March 10, 2009 | Tom Coss | No Comments »

Healthcare Reform and the Coss Conundrum

There are a lot of hopes placed upon the role of healthcare IT to address the ills of the healthcare industry, some are legitimate, many are not.  One such limitation I call the Coss Conundrum which goes like this.

Suppose for a moment that you and I are in a business arrangement in which your responsibility is to beat me unmercifully about the head and shoulders with a stick; my responsibility is to provide you with a stick.  Just how big a stick would you expect?  If you’re thinking anything bigger than a standard yellow pencil, you’re likely to optimistic.

Here in lies the conundrum.  The stick, in this case, is healthcare provider information, and it is here where the government’s efforts run up against the pragmatics of broad based implementation.  Why would any private practicing physician pay money for an information system if, like the conundrum suggests, the practitioner feels that the information may be used like a stick with which to later be beaten?  Few will speak of this out loud, but the issue is real and legitimate.  Any mishandling of patient clinical data, either to violate the privacy of the patient, or even to punish the choices of the practitioner, results in the same limitation.

Using information needs it’s own sets of ethics and guidelines.  The technology, thought considerable, for the EMR is not sufficient to understand, there remains the evolutionary psychology and professional ethics to provide the assurances required for adoption.

Tom

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March 7, 2009 | garrett | No Comments »