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Thoughts, comments, news, and reflections about healthcare IT from Microsoft's worldwide health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.

A “New Math” for Healthcare in America

A “New Math” for Healthcare in America

  • Comments 4

Ian Morrison hits the nail on the head with his newest commentary on Hospitals and Health Networks online site.  In “The New Math” Ian explains why business as usual in the healthcare industry just isn’t sustainable anymore.  While this has been obvious to many of us for some time, nobody so succinctly makes the case, or does it with such wry humor, as Ian.  If he hadn’t been born in Scotland, I would suggest that he should run for President.  He might not be able to solve our economic woes, but he certainly could make us laugh.

imageA while back I wrote a piece here on HealthBlog railing against the idea of putting “affordable” and “health insurance” in the same sentence.  My reasoning was the the rules of insurance (paying premiums to protect yourself against unlikely events) just don’t apply to cover something really, really expensive that each and every one of us will need a lot of in our lifetime.  It must have made some sense because it was picked up by ABC News and published widely on the web.  Ian and I have been saying the same thing, he just makes it more fun to read.

I suspect Ian’s “The New Math” particularly hit a home run for me today because of what happened in my own family last week.  My elderly, but otherwise healthy mother called me on the phone because she was having some unusual left-sided arm and shoulder pain.  It immediately raised my concern about possible angina.  Heart problems and heart attacks often present more subtly in women than men, and although not everything she told me raised a red flag, it was enough that I recommended she go to an urgent care center or call her own doctor.  She later phoned her doctor and talked to the physician on call.  He too suggested a visit to urgent care.  The doctor at urgent care was likewise rightfully concerned and sent my mom by ambulance to a nearby hospital.  I hopped in the car and met up with her late that evening in the ER.  Her ECG was just slightly abnormal, and it was recommended that she stay the night for further tests and observation.  I agreed.

imageThe next morning when my wife and I went to the hospital to visit my mother, we were told that she had been transferred to ICU during the night.  Her troponin (an enzyme associated with possible heart attack) had come back elevated.  Over the course of the day, several more blood samples were taken.  A physician’s assistant who worked for the consulting cardiologist came by to see my mother.  After examining her, he phoned in his report to his boss.  A short time later, I was asked to come to the phone to speak with the cardiologist.  He told me that based on the information they had, my mom had had a heart attack and was at significant risk of having another big one in the future.  As he put it, “your mother is a heart attack waiting to happen”.  So, we put in place plans to transfer her to another hospital where she could have a cardiac catheterization and possible stent angioplasty depending on what was found.

But wait, there’s more.  Much later in the day, we were called back to the hospital by the cardiologist’s physician assistant.  He told us that late in the afternoon he began to suspect that something just wasn’t right about the troponin levels.  Instead of the enzyme levels rising at a predictable rate, blood samples taken later in the sequence had come back negative.  The PA asked the lab to run all the samples again.  Guess what?  The machine in the lab had malfunctioned, and Mom’s enzymes were completely normal--zip, zero, nothing.  It was later determined that her ECG was also pretty much normal, and one final test (a radionucleotide stress scan of her heart) showed no evidence of blockage or heart damage.  Mom could go home.  It was all most likely a false alarm.

imageMind you, this took place in a very new, modern hospital with architectural elegance and patient-centered care.  The staff was marvelous, and yes, they had electronic medical records.  Despite all of this, an error happened.  An extra sharp PA picked it up, and Mom was saved the risk, discomfort and inconvenience of a cardiac cath.  None-the-less, when the bills start rolling in a few weeks from now I’ll bet this little misadventure will cost Medicare $25,000 dollars or more.  And Mom?  Well, she wasn’t even sick!

This is but a small and personal example of what is wrong with healthcare.  Don’t blame the docs.  They’re just practicing good (and defensive) medicine.  Don’t blame the hospital.  They had the technology and by golly they were going to use it.  And what might have happened if the patient was clueless and her son hadn’t been a physician?  I’ll bet the cardiac cath might have been done anyway, just to be “safe”.  But then, so long as Medicare is picking up the bill, does anybody really care?

And so it goes, and so it is……why “The New Math” is the order of the day in healthcare.  Thank you, Ian.

Bill Crounse, MD         Senior Director, Worldwide Health         Microsoft

  • It is not clear to me why you think this is an example of "what is wrong with healthcare".  Why do you think that a cardiac cath would have been done anyway?  Isn't there a risk in doing a cardiac cath if it is not called for?  This example seems to me to not really prove anything.  If the lab machine had not malfunctioned then they would have ruled out a cardiac issue.  It malfunctioned and the error was caught, seems to me that everything worked correctly here...

  • Mike,

    You are right.  The PA did his job and caught the error.  Even so, this hospitalization will cost Medicare a lot of money.  Had the cath been done, it would have cost even more, and Mom would have had an unnecessary procedure that carries some risk.  If I hadn't pushed back a bit on doing the cath, I believe it would have been done before the error was discovered.  Yes, either way we now know that Mom doesn't have heart disease.  That knowledge is comforting but it was also very expensive to obtain

    Bill Crounse, MD.

  • Bill,

    Firstly, I am glad your mother is fine and the tests came back negative.  Also, kudos to the PA for doing an excellent job in catching the error. I agree 100% on "What's wrong with Heathcare" on your side.

    Mike,

    Not knowing all the detals and being an outside non-biased yet concerned citizen, I can honestly say there are many issues here

    1.  Defective equipment....so what safegaurds were there?  I say the Manufacturer be held accountable

    2.  Perhaps procedures were being ordered in lieu of being covered by Medicare.  I am sure this is the mentality in other healthcare facilities as well.... so what can we do to control this?

    3.  The hospitals and hence the providers were orderings tests/procedure just to be "defensive"...in the event of lawsuits, or malpractice etc....what, actually how can we more effectively control such situations?

    4...I am sure I can name a few more..but the point is "A lot is wrong with Healthcare"

    Look, humans and machines will make mistakes, cause errors etc, but we as smarter technologists or providers need to go the extra mile to double check processess and procedures.

    What about the most important issue here...."What we put the poor soul through in terms of tests, mis-information etc"  But then that's life (so precious) and it goes on.

    Tomorrow, we will be a little smarter.

    Cheers

  • I really think that if the lady had not had Medicare or some type of insurance, she would had been sent home in the first place.  No insurance, no service.

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