Hacktivate

I highly recommend this excellent article in the NYTimes about how we can use data to create healthcare protocols that dramatically improve outcomes and reduce overall costs. (This is what we were trying to do in Malawi and what I am trying to introduce in the Philippines)

Here are the key points that I want to remember:

To enter mainstream use, any such treatment typically needs to clear a high bar. It will be subject to randomized trials, statistical-significance tests, the peer-review process of academic journals and the scrutiny of government regulators. Yet once a treatment enters the mainstream — once we know whether it works in certain situations — science is largely left behind. The next questions — when to use it and on which patients — become matters of judgment, not measurement. The decision is, once again, left to a doctor’s informed intuition.
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“Guys, it’s more important that you do it the same way than what you think is the right way.”
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Whenever possible, the guidelines are also embedded in the hospital’s computer system. Doctors and nurses are presented with a default choice — how much of a given drug to prescribe, for example — and have the option of overriding it. Most important, the electronic records system allows both committees and doctors to track patient outcomes.
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He could not simply tell Intermountain’s doctors what to do, no matter how much research he brought to bear. Doctors have a degree of professional autonomy that is probably unmatched outside academia. And that is how we like it. We think of our doctors as wise men and women who can combine knowledge and instinct to land on just the right treatment.
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Perhaps the clearest example is the Pronovost checklist. As many as 28,000 people in this country die each year from infections that come from intravenous lines. Several years ago, Peter Pronovost, a Johns Hopkins physician, developed a simple list of five steps that intensive-care doctors should take before inserting an IV line, in order to prevent the introduction of bacteria. The checklist reduced the infection rate to essentially zero at 108 hospitals in Michigan where it was adopted. Pronovost published the results in The New England Journal of Medicine
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But in our current health care system, there is no virtuous cycle of innovation, success and expansion. When Intermountain standardized lung care for premature babies, it not only cut the number who went on a ventilator by more than 75 percent; it also reduced costs by hundreds of thousands of dollars a year. Perversely, Intermountain’s revenues were reduced by even more. Altogether, Intermountain lost $329,000. Thanks to the fee-for-service system, the hospital had been making money off substandard care. And by improving care — by reducing the number of babies on ventilators — it lost money. As James tartly said, “We got screwed pretty badly on that.”
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As long as doctors and hospitals are paid for each extra test and treatment, they will err on the side of more care and not always better care. No doctor or no single hospital can change that. It requires action by the government.
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Yet somehow, both doctors and patients have come to imagine that a physician can accomplish far more than any human being reasonably can. As a result, modern medicine is accomplishing far less than it reasonably should.