A New Player in Healthcare Information

David Wagner, Managing Editor | 1/31/2013 | 8 comments

David Wagner
CIOs have a potential new ally in the constant push and pull over unnecessary testing: consumers.

At least the considerable audience of Consumer Reports, which has just started reporting on the value and accuracy of cancer screening tests. With more results from Consumer Reports surely coming, CIOs have to decide just what they think of all this.

The first thing to note is that Consumer Reports didn't start a medical lab and start posting their own studies. What they've done is taken the data from the US Preventive Services Task Force (USPSTF). The USPSTF is run by the Department of Health and Human Services and Consumer Reports backed up that presumably good data with searches through leading medical journals.

The second thing you need to know is that Consumer Reports didn't think current cancer screening was very good. Of the 11 most common tests, only three got high marks, and then only for certain groups. The rest are considered either not very accurate, not cost effective, or both.

The fact that these tests are suspect isn't new. The medical community has known the data. But this is the first time the information has been aimed at consumers, and given the amount of media effort towards early detection, the information is, at the least, inconvenient.

And this is where the CIO becomes involved, because as usual they find themselves stuck between cultures.

If doctors have known these tests aren't very good, why do they keep making their patients get them? Chances are it is either to pad their bill or just to be sure they didn't miss something. Let's be kind and assume it isn't bill padding.

The doctor's job is to protect his patient and also to protect himself and the hospital from litigation from mistakes. The CIO's job is to use technology to cut down waste, cut costs, and build revenue for their hospital. See the problem?

You can either a) side with the patient, help spread this information, and get your doctors to stop running tests they don't need to be running, or b) bury it and keep your doctors happy.

Since we're all about the bottom line at E2, I'm going to assume you picked "a" and help you figure out how to use this to your advantage.

Big-data -- When trying to figure out where to prioritize spending, tie your big-data initiatives to tests that Consumer Reports and other advocacy groups cover before moving on to other tests. Both patients and doctors are prone to over-testing because patients want to always know they're OK and doctors want to avoid mistakes. If you track overuse of a test by a certain doctor or class of patients, Consumer Reports can be your ally. Readable media discussing why it isn't always helpful can help patients and doctors change their habits.

Marketing -- Once you make a dent in unnecessary testing, partner with your CMO (sadly, marketing is a major aspect of hospitals these days) to market yourself as a place that saves money for patients by eliminating tests. Transparency is a major aspect of hospitals going forward. Making sure your hospital is meeting the standard of care while avoiding surplus testing is a great way to make points as hospitals become more transparent.

Track savings and revenue closely -- One of the saddest problems about fewer tests is that it means lower revenue. Labs and tests are a cash cow. How will the CFO feel about you cutting back on tests? She'll love it if you can point to shorter lines or lower labor costs in your labs. She'll love it if you can track higher bed counts to increased reputation. If you can't, she's just going to see the numbers of her lab going down and blame you.

Of course, you can only do so much with Consumer Reports or any other advocacy information. Tracking the testing and procedure habits of your doctors will go much deeper. And sometimes, medical opinion will differ from consumer opinion. Big data and consumers can't trump medical opinion. But what you can do is use the data to help your doctors see habits and methods that might be hurting the hospital and help them make the decision to change. And you can partner with the consumer to empower them on their own healthcare. Media is just a small piece of the puzzle, but it can make a great ally, especially when paired with good data.

View Comments: Newest First | Oldest First | Threaded View
Susan Nunziata   A New Player in Healthcare Information   2/7/2013 7:35:56 PM
Re: The Third Option
@Rich: It's quite true the data used in aggregate could go a tremendous way toward improving research and outcomes. I personally would have no problem with my health data being made available to researchers on an anonymous basis if it meant improving progress on learning about diseases or new medications. As you note, though, bad data in bad data out. So we have to make sure the systems are in place to assure accuracy.
Henrisha   A New Player in Healthcare Information   2/2/2013 3:27:50 AM
Re: The Third Option
I agree that it's very important to keep the patient in the loop in every step of the process, since they're central to the entire thing in the first place. Patient consent should be obtained especially if what's being done involves sharing or showing his or her records to someone else, even to another doctor or healthcare professional.
batye   A New Player in Healthcare Information   2/1/2013 10:49:30 PM
Re: The Third Option
Joe, I trust secound opinion is in order, but patient need to be informed each step of the process what is going on... as being informed is a must...
Joe Stanganelli   A New Player in Healthcare Information   2/1/2013 4:27:49 PM
Re: The Third Option
And it is worth mentioning (though I can't find the link at this time) that an independent study did show a definite link between Hep B vaccines in infants and subsequent health defects, for example.

The problem is that those that question vaccine conventional wisdom also find themselves lumped in with loud shouters who have no idea what they're talking about, and now any questioning of any recommended vaccine schedule bears someone getting categorized as crazy.
Joe Stanganelli   A New Player in Healthcare Information   2/1/2013 3:50:48 PM
Re: The Third Option
Speaking as an attorney, nay, I say.

Medical malpractice is already an extensively legislature-limited area of negligence law.  There is no good reason for negligent doctors to be any less off the hook for negligence than anybody else who negligently harms someone.

("Negligence" does NOT mean "accident."  Competent, non-negligent people (including doctors) can have accidents.)

Extensive testing?  So what?  I recently had a test done, and when the test came back negative but with an anomaly that made the true result uncertain, my doctor laid it on the line and said, "Look, this is very unusual, but it's very probable that this is nothing, but I would recommend a second test just out of an abundance of caution."  She was very diligent in going over all of my options and all of the risks.

The issue isn't overtesting.  It's overtesting without truly informed consent.

Additionally, Rich brings up another good point about the vaccine industry and vaccine law.
tekedge   A New Player in Healthcare Information   2/1/2013 12:19:58 PM
Re: The Third Option
"As for me, I'm all for reducing unnecessary testing -- especially expensive testing that involves sharp, pointy things aimed at my person"


I couldn't agree more with Curt on this. Also off late I have also started noticing that there are far more additional tests done when blood is drawn for example the Vitamin D test. A couple of years ago this was not a part of the routine tests. Now a days I see it is and I hear that evryone seems to be defecient in Vitamin D.Sales of the vit D pills has gone up multi fold.
David Wagner   A New Player in Healthcare Information   1/31/2013 10:33:28 PM
Re: The Third Option
@curt- Fair enough. i also think there are other reasons for over testing including peer pressure, the expected "standard of care," and the perception that even if something only works 10% of the time, when it does work it saves a life.

But even without litigation, I think we'd still ohave over testing so I took it out of the equation.

I suppose, however, that more media attention on over testing will help shark proof doctors though.
CurtisFranklin   A New Player in Healthcare Information   1/31/2013 10:30:09 PM
The Third Option
@Dave, you list (a) and (b), siding with either patients or doctors when it comes to tests. I think we're missing another group with an important stake in all this: (c) attorneys. If we could take (c) out of the equation, then I think that the interests of (a) and (c) would be much more closely aligned.

The extent to which excessive testing is "shark repellant" is tough to know precisely, but I hope that this particular role of testing can be minimized very quickly.

As for me, I'm all for reducing unnecessary testing -- especially expensive testing that involves sharp, pointy things aimed at my person. I've had quite enough of that sort of thing for one lifetime.

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