A New Player in Healthcare Information

David Wagner, Managing Editor | 1/31/2013 | 14 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
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Rich Krajewski   A New Player in Healthcare Information   2/8/2013 12:18:48 AM
Re: The Third Option
I understand there is an adverse reaction reporting system in place now, but I'm not sure how high the level of compliance is in terms of religiously reporting adverse reactions. Perhaps a better healthcare information system could facilitate such reporting.
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...
Rich Krajewski   A New Player in Healthcare Information   2/1/2013 7:57:34 PM
Re: The Third Option
"and now any questioning of any recommended vaccine schedule bears someone getting categorized as crazy."

This is where I was hoping healthcare information systems could be useful, if physicians were required to enter baseline observations and testing into such a system before vaccination, or any treatment, and then enter post-vaccination observation and testing as a matter of routine. We would then start getting more "Phase IV" hard data on the safety of any treatment that way. The danger is that the data won't be made available, even in aggregated form, even where there is no breach of individual privacy. Physicians and researchers should insist on and be granted system-wide access to such data (on an aggregated basis). There would also have to be steps taken to guarantee its accuracy.
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.
Rich Krajewski   A New Player in Healthcare Information   2/1/2013 2:08:49 PM
Re: The Third Option
"As it is, the only ones currently managing safety research are those with conflicts of interest, conflicts of profit margin versus safety."

And this returns us to the idea that patients should be active participants in the healthcare process, and in healthcare information. Patients are currently providing the missing feedback mechanism for safety regulation in vaccines by staying away from vaccinations in increasing numbers. So, yes, the patient does need to maintain an active role in demanding more and better healthcare information.
Rich Krajewski   A New Player in Healthcare Information   2/1/2013 2:01:55 PM
Re: The Third Option
"(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."

As much as I respect the opinions of physicians, I can't agree with this conclusion. The reason I don't agree is that your scenario is currently being employed in the vaccine industry, with what I view to be disastrous results.

The vaccine industry in the US enjoys complete freedom from lawsuits over liability for their products. This freedom was granted by the Legislature, approved by the Executive, and recently confirmed by the Supreme Court. The result, in my opinion, has been complete removal of an important feedback mechanism that would otherwise help to assure better emphasis on safety. As it is, the only ones currently managing safety research are those with conflicts of interest, conflicts of profit margin versus safety.
Rich Krajewski   A New Player in Healthcare Information   2/1/2013 1:53:01 PM
Re: The Third Option
"So, it's the physician who should lead, not the CFO, the CIO, or the healthcare information system."

On the other hand, to get back to the blog, the patient should work hand-in-hand with the physician, and be able to question and influence the physician's diagnosis. As best representative of the patient's own interests, the patient has to be respected. However, I would not let popular opinion or cost-cutting fads blind me, as a patient, to employment of tools that are used in ways I might not be trained to recognize.

Here's a problem for you from a recent medical school exam. If you can't answer it, then maybe it's time to think again about what medical opinion and discretion mean.

Approximately 1 in 14 men over the age of 50 has prostate cancer. The level of 'prostate specific antigen' (PSA) is used as a preliminary screening test for prostate cancer.
7% of men with prostate cancer do not have a high level of PSA. These results are known as 'false negatives'.
75% of those men with a high level of PSA do not have cancer. These results are known as 'false positives'.
If a man over 50 has a normal level of PSA, what are the chances that he has prostate cancer?
A 0.7%
B 0.5%
C 5%
D 7%
E 25%
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