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Mistreated : why we think we're getting good health care--and why we're usually wrong
\"Despite all the debate about health care, Americans tend to assume they are in the best of hands when they enter the hospital. This is inaccurate : American health care is in the bottom half of all industrialized countries. This is only the largest in a broad set of misperceptions. We appropriately worry about the security of technology, but fail to see how its absence kills hundreds of people every day from medical errors. We over-value the impact of intervention on saving lives and ignore the 200,000 people who die each year unnecessarily from diseases they did not have to get. We worry that end of life discussions and palliative care will lead to \"death squads,\" when research proves that people actually live not only better, but also longer. We demand modern information technology from our banks, airlines, retailers and hotels, but we passively accept last century's technology in our health care. It's not just patients who get things wrong. Physicians perceive that the dollars they take from drug companies don't alter their prescribing habits, but the data demonstrates that for every dollar the pharmaceutical world spends on doctors, they get $10 in return. Academic researchers deny that their results are influenced by which company funds the work, but in 95% of the cases, the outcome supports the funding source. Dr. Robert Pearl has seen these mistakes from all sides: as a concerned citizen, a patient, a health industry leader, and most importantly, a victim of bureaucracy, whose own father died due in part to medical error. In this book, Pearl explains why misperception is so common in medicine, both for patients and physicians. Solving the challenges of health care today including excessive costs, poor quality and the lack of convenience will require an understanding of this phenomenon, and an approach that aligns health care delivery with up to date information and data. It emphasizes the power of context, and how through integration, prepayment, information technology and physician leadership, superior outcomes can be achieve. It draws on other industries and companies like Amazon and Uber that were able to overcome customer fear, and shift perception, and provides a roadmap for the future\"-- Provided by publisher.
Book
Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices
BACKGROUND
Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination.
OBJECTIVES
We examine whether and how practices use commercial EMRs to support coordination tasks and identify work-arounds practices have created to address new coordination challenges.
DESIGN, SETTING
Semi-structured telephone interviews in 12 randomly selected communities.
PARTICIPANTS
Sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders.
RESULTS
Six major themes emerged: (1) EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging; (2) EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange; (3) managing information overflow from EMRs is a challenge for clinicians; (4) clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination; (5) realizing EMRs’ potential for facilitating coordination requires evolution of practice operational processes; (6) current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity).
CONCLUSIONS
There is a gap between policy-makers’ expectation of, and clinical practitioners’ experience with, current electronic medical records’ ability to support coordination of care. Policymakers could expand current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination. By reforming payment policy to include care coordination, policymakers could encourage the evolution of EMR technology to include capabilities that support coordination, for example, allowing for inter-practice data exchange and multi-provider clinical decision support.
Journal Article
Information governance for healthcare professionals : a practical approach
\"Like other critical organizational assets, information is a strategic asset that requires high level of oversight in order to be able to effectively use it for organizational decision-making, performance improvement, cost management, and risk mitigation. Adopting an information governance program shows a healthcare organization's commitment to managing its information as a valued strategic asset. Information governance serves the dual purpose of optimizing the ability to extract clinical and business value from healthcare information while meeting compliance needs and mitigating risk. Healthcare organizations that have information governance programs will have a competitive edge over others and contributes to safety and quality of care, population health, operational efficiency and effectiveness, and cost reduction initiatives. This is a much-needed book in the healthcare market space. It will explain, in clear terms, how to develop, launch, and oversee an Information Governance program. It also provides advice and insights from leading IG, cybersecurity and information privacy professionals in healthcare\"-- Provided by publisher.
Book
The creative destruction of medicine : how the digital revolution will create better health care
A professor of medicine reveals how technology like wireless internet, individual data, and personal genomics can be used to save lives.
Book
Denosumab Discontinuation
Purpose of Review
To review the pathophysiology, the clinical consequences as well as way of mitigating the effects of denosumab discontinuation.
Recent Findings
Treatment with denosumab (DMAB) is reversible and upon discontinuation there is a rapid increase in bone turnover and a subsequent bone loss. During this phase of high bone turnover, an increased risk of fractures has been reported. Therefore, treatment with DMAB could be considered life-long. However, side-effects may prompt the need for discontinuation and moreover, treatment with DMAB may have increased BMD to levels where continuing treatment does not provide further fracture risk reduction. Patients stopping DMAB should be offered subsequent antiresorptive treatment with an intense monitoring regimen during the initial year as most of the bone loss occurs within these initial 12 months.
Summary
In this review, we evaluated the literature published over the past 1 to 3 years investigating DMAB withdrawal with focus on bone turnover markers, bone mineral density, and fracture risk and the transition to other anti-osteoporosis therapies. Furthermore, we summarized the current recommendations of international guidelines.
Mini Abstract
In this review, we evaluated the literature published over the past 1 to 3 years investigating denosumab (DMAB) discontinuation and the transition to other anti-osteoporosis therapies. Additionally, we summarized the current recommendations of international guidelines.
Journal Article
Psychological therapies in primary care
This book introduces the case for the management of psychological therapy services in the NHS as a result of the recent and very significant changes in primary care commissioning and mental health strategy. It is practical and accessible and is written in short easy-to-access sections. This volume will not only be relevant to NHS managers and practitioners but also to other counselling organizations and clinicians, since many of the structural and clinical issues raised will be applicable in a wider context.
eBook