Health IT May Save the Masses, but Not Necessarily the Individual

Is health IT a crystal ball? Nope; not yet. For all of its good, health IT still lacks in so many ways. Health IT may save the masses, but not necessarily the individual at this point. As it matures and grows, no doubt it will fill some voids, but as far as its current capabilities, the information collected in the form of electronic health records, for example, is still nothing more than a repository of information gathered from the past.

What we need are technologies that hint or predict health outcomes before they happen. I’m not talking about broad brush analysis, but individual predictions for each person with a record.

Who wouldn’t want their medical cases charted and entered into an EHR if it could help physicians determine which conditions were going to impact them down the road.

It’s not lost on me that on the current road map, if all healthcare data is aggregated, there’s a hope that a population’s data may provide insight into predicting what’s in store for the said population.

To cite IBM, “As digital records and information become the norm in healthcare, it enables the building of predictive analytic solutions. These predictive models, when interspersed with the day-to-day operations of healthcare providers and insurance companies, have the potential to lower cost and improve the overall health of the population. As predictive models become more pervasive, the need for a standard, which can be used by all the parties involved in the modeling process: from model building to operational deployment, is paramount.”

Even though current forms of data collection are merely meant to gather information to help establish standard approaches to most types of care in which the care system will use to treat the majority of patients (evidence-based care, essentially) as a way to reduce costs to the system (health insurance providers not excluded), there is little push for technologies that could actually help determine, at the individual level, what may affect us and how to treat it before it becomes chronic or life threatening.

Let’s be clear: I’m not talking about predicting the obvious. For example, in cases where years of overeating and lack of exercise are present, no one needs to predict what the outcome is likely to be. I’m referring to other types of conditions that are, for the most case, unavoidable: MS, cancer, Alhzeimer’s, and so on.

Whoever begins to develop these technologies is going to set the market and turn healthcare on its head. These people, or this person, will be considered genius and their effects on millions of lives great. It might be science fiction of me to think this will ever happen, but it gives me hope to think it could happen.

Until then, if such a day ever comes, we have to wait and hope for the best like a dear friend of mine who recently was diagnosed with brain cancer. Ironically, she has always been an advocate for healthful living, living an active lifestyle, working with a major organization dedicated to lobbying for and providing hope to those affected by cancer, and even championing healthcare technology as a means to improve patient health outcomes and our health as a society.

But given all of these efforts, despite the wise choices she’s made to live healthy and help others, there was little that could be done to predict that she too would be in this situation, where if predictive technologies existed she could have benefited.

Now, because there is not a predictive crystal ball, despite all the technological gains we’ve made, she, like everyone else, must react rather than act.

Sad to think that even after all the billions being spent in healthcare technology and with all of the apparent advances, as individuals, are we really better off?

No Surprise Here: Healthcare Mobile Technology is Changing the Industry

There’s no surprise that healthcare mobile technology is changing the industry. The movement has been underway for as long as the technology has allowed, and as the technology becomes more sophisticated, so do the ways the technology gets used.

In a recent annual research study by the Manhattan Group published by HIT Consultant, we continue to get a much clearer picture of how the U.S. physicians are using the Internet and mobile technologies in the workplace.

For the study, called “Taking the Pulse 2012,” 3,015 physicians in 25 specialties were surveyed.

Here are some of the high points.

In the United States, more than 85 percent of physicians use smartphones in the practice setting. This is up from 81 percent in 2011 and up from 72 percent in 2010. That’s 13-point jump in use of the devices in two years, but really, the number is not surprising. The devices help physicians in multiple ways, personally and professionally, there’s little doubt the increased use will continue and grow.

Next up: Tablet adoption among physicians has nearly doubled in the last years from 35 percent to 62 percent from 2011 to 2012. Clearly, that’s amazing. Of those, more than 80 percent are iPads.

Of all the tablets being used by physicians, more than half have used them at the point of care.

Regarding patient interaction and engagement, according to the Manhattan Group, 39 percent of practicing physicians communicate with patients via electronic means including email, secure messaging, instant messaging or video conferencing.

Personally, that number is higher than I expected, but it’s obviously only to grow much larger, especially as patient portals are implemented and meaningful use stage 2 looming.

Physicians also spend an average of 11 per week online for professional purposes, and those with three screens available to them – smartphone, laptop and desktop — spent more time in front of those screens than did their counterparts with just one or two screens.

What does all this data mean? You don’t need me to tell you that healthcare mobile technology is growing. It’s clearly safe to say that those of us (I’ll put myself in this group) that say healthcare is way behind the rest of society in technology use may not be able to make this claim any/much longer.

Mobile device use is exploding in all areas of our lives; healthcare is no exception. Physicians, like the rest of society, are seeing the benefits of the technology and taking steps to implement these devices into their work lives.

I believe we’re getting to the point where healthcare mobile technology will finally surpass the age of electronic health records and the shift in conversation will center around mobile health.

Like the conversations we been having for years about market/vendor contraction, the same goes for mobile health in that we’ve been talking about it for some time. Well, unlike vendor contraction, the days of mhealth are upon us and we’re seeing how a technology actually is changing a profession.

Taking the Pulse 2012

Healthcare Big Data a Catalyst More So than Electronic Health Records Ever Will Be

Healthcare big data is a big story, and it’s only going to continue being one. It’s a story I like and am intrigued by, but it’s not very sexy. Because of this, the only pieces of information about it seems to be very technical.

Until we actually see how big data changes lives, there’s just not going to be warm and fuzzy stories about it. So, cold and technical it is; nonetheless, I’m still fascinated.

In searching information about the subject, because I too want to know more from a ground floor level, it was nice to come across a nice piece about big data on the Cleveland Clinic’s website.

So, getting right into it, here’s an interesting piece of trivia about healthcare big data directly from the Clinic: “The amount of data collected each day dwarfs human comprehension and even brings most computing programs to a quick standstill. It is estimated that 2.5 quintillion bytes of data are created daily, so much that 90 percent of the data in the world has been created in the last two years.”

Healthcare big data is essentially large amounts of data that’s difficult to manipulate using standard, typical databases. Essentially, big data is very large pieces of information that ultimately, when captured can analyzed, dissected and used to monitor segments within a given sect.

Healthcare big data, it is thought, is what will drive change in care outcomes. What’s interesting, though, is that even though there’s a tremendous amount of data available for use, it’s just not being collected in a structured manner.

Collecting structured data is a must if we are going to begin putting some muscle to the bone of the new healthcare ecosphere we’re putting in place. You don’t have to take my word for it; IDC Health Insights research director Judy Hanover spoke of the same subject recently here.

But, to prove my position, I’ll let Cleveland Clinic make the point: “Unfortunately, not enough of this deluge of big data sets has been systematically collected and stored, and therefore this valuable information has not been aggregated, analyzed or made available in a format to be readily accessed to improve healthcare.”

Also according to the Clinic, if all of the data currently available were used and analyzed, it would be worth about $300 billion a year, reducing “healthcare expenditures by almost 8 percent.”

At the heart of healthcare big data is the hope that it can eventually help providers become predictors. Essentially, big data is like a big crystal ball, or so it’s been said.

According to Cleveland Clinic: “In this way, analytics can be applied to better hospital operations, track outcomes for clinical and surgical procedures, including length of stay, re-admission rates, infection rates, mortality, and co-morbidity prevention. It can also be used to benchmark effectiveness-to-cost models.”

Predictive analytics: That’s what it’s all about.

With all of the attention being given big data and warnings about being prepared for big data so it doesn’t sneak up on you – like meaningful use and ICD-10 – are valid and should be taken seriously.

Efforts are currently underway and available for big data processing and by managing data, “This dynamic data management technology makes data analysis more efficient and useful. Access to these data can also significantly shorten the time needed to track patterns of care and outcomes, and generate new knowledge. By leveraging this knowledge, leaders can dramatically improve safety, research, quality, and cost efficiency, all of which are critical factors necessary to facilitate healthcare reform,” writes Cleveland Clinic.

Big data is a catalyst for change, and without sounding caustic, will be a bigger deal than electronic health records currently are. Without a commitment to it, practices and healthcare systems will be left behind.

Tips for Managing Mobile Device Data in the Healthcare Environment

Regular readers of this blog will know that I spend a good deal of time focusing on managing mobile device data security in healthcare information technology, and the impacts of how breaches ultimately affect patients.

As such, I’m developing a strong interest in BYOD and the policies that need to be set in place to protect the information that all of us as consumers, myself included, hope remains safe.

So, I came across a piece recently by SecurEdge Networks that I think resonates, offering some of the best tips for managing mobile device data in the healthcare environment.

Though it’s a top 10 list, I’ll focus on what I think are some of the most important points. Feel free to let me know if you agree, or if you have other tips worthy of the list.

According to SecurEdge Networks, at number one of the list is basic security. It’s a must. Basic security typically comes down to simple use of strong passwords. In addition, staff members must be required to change their password after a certain amount of time, and a system must automatically lock after a certain period of inactivity.

Containerization of data, specifically on mobile devices, allows for the separation of personal and professional data. Setting up containers allows a personal device to be used in the workplace while protecting all of the company’s data in a secure container that can be wiped in the case of a lost or stolen device.

Next, limit which apps can be downloaded to a mobile device used in the workplace. There are tools available that completely block installation of outside apps on corporate and personal mobile devices, helping reduce the exposure to viruses or malware. According to SecurEdge Networks, “Having a corporate app store that has only pre-screened apps for the platform included is an effective tool for securing mobile devices that are used to access confidential information.”

Next up, one of the most basic steps one can take in a BYOD environment is to ensure that basic security software is installed. “Anti-virus and anti-malware programs should be installed and software firewalls should be put in place for each device,” cites SecurEdge Networks.

Finally, in what may be the most important tool available practices and hospitals engaging in a BYOD program is remote wiping. If a device is lost or stolen, having the capability to remotely wipe the device is essential. Some companies even go so far as remotely wiping any data on the corporate side of the device when it leaves a set geographical area. Since the data isn’t stored on the mobile device, this is an easier process. Personal data can also be wiped, which is attractive to employees who may have some initial resistance to having their devices accessed by their employer.

As noted by SecurEdge, employees who are allowed to use their personal devices in the workplace are often happier, more productive and always on. “Allowing employees to bring in their own devices can be an effective policy, boosting productivity and reducing operating costs.”

On this subject, there’s more to come; stay tuned.

Healthcare Crowdfunding Gets Hatched: Passion is the Possibility of Health Tech Hatch

Fund next year’s Post-it notes. You can. Through crowdfunding; which seems to have become one of the market’s hottest concepts.

There are other crowdfunding platforms available to the philanthropic among us who wish to contribute to the greater good however we can. Among them is the well-know mainstream effort known as Kickstarter. Then there’s Medstartr, the crowdfunder focused explicitly on healthcare products.

Enter Health Tech Hatch. Probably the newest kid on the block; perhaps or perhaps not the least well known in the space.

It’s approach to crowdfunding, to “fund next year’s Post-it notes” as it were, is one of the most inspiring I’ve seen on the topic. It’s a simple concept, but there’s a passion behind this one that I haven’t found elsewhere. It conveys to me the possibility that big ideas can become big things, and you, as a passionate supporter of a cause, can take part in the development of the idea for a contribution of a few simple dollars.

Health Tech Hatch is similar to others. Those with an idea can post a project to request funding for a variety of things including apps, programs and other items directed toward the betterment of healthcare as a whole.

Health Tech Hatch, though limited in scope and size, and seemingly with a limited track record for producing fully funded projects (I suspect it’s only a short time before that happens), the service is an effective and needed addition to the crowdfunding landscape. And, the service works exactly like its counterparts: Investors only pay if their project is fully funded, and Hatch works to bring entrepreneurs step by step through the process of finding funding.

Additionally, Hatch defines the process for a successfully funded project, including:

On top of this, Hatch provides for the opportunity to test a campaign, using the experience of its advisory committee, to ensure a project has the best possibility of funding success.

According to Hatch, “Crowdfunding is all about collaboration, pooling resources to support someone else’s efforts … the process is a two-way street: We help entrepreneurs carve out a pathway to present their ideas to the world, while enabling funders to provide feedback, offer moral support and above all, finance next year’s Post-It — in both the for-profit and nonprofit worlds.”

Given the overwhelming amount of attention services like Hatch continue to receive (this site not excluded), it’s apparent that crowdfunding will play an overwhelming role in the development of new technology designed to serve the healthcare community, be it patients or providers. We’re discovering that sometimes taking the lead means we have to get involved. Healthcare technology continues to evolve away from a single provider (vendors) of technology. Individuals want to move the market, and perhaps crowdfunding through sites like Hatch create innovation, and reinforce the concept that big ideas can create big things.

Sites like Hatch help us believe that with a little effort and a little involvement, individuals can actually create the Post-It notes of tomorrow.

“Best” EHR Misconceptions Still Floating About

The misconceptions about healthcare information technology, specifically electronic health records, are rampant even as the technology matures and begins to saturate the market.

More of the technology’s capabilities are known now by the average healthcare insider (physician, practice or hospital leader, for example) than even two years ago (before meaningful use). That’s understandable; however, those darned misconceptions continue to fly.

No matter where you look, there’s a top five or a top four and even a top three list of the biggest misconceptions about the technology.

So, today I thought I’d take a look at some of the “best” misconceptions about EHRs floating about the health IT stratosphere.

Electronic health records won’t save a practice any money: Though they alone may not save money from the moment go, over time and if implemented properly, they can help a practice save money in the long term. Ultimately, they create internal efficiencies such as reduced paper, easier and safer transfer of records to patients and specialists, reductions in the number of tests that need to be ordered, greater coordination of care. Plus, for some practices utilizing EHRs they’ve been able to increase the number of patients seen because of improved administrative functions.

Using technology in the exam room distracts patients and reduces the quality of the visit: Frankly, this is nothing more than a statement made without substance, and there’s really no difference between taking notes on paper or through a piece of technology from the patient’s perspective. Additionally, we all live in a technology filled world and patients are accepting of technology in their lives. In many cases, patients see technology in the exam room as a way to engage their physicians in their care. Physicians should see it the same way.

Electronic health records are not as safe and can be hacked: Never say never, and yes, there’s a bit of truth to that statement, but the fact is that paper records are simply easier to access than their electronic counter parts. And, since most data breeches are inside jobs, at least electronic health records allow for electronic auditing which can determine who, when and how often a record has been accessed.

EHRs are hard than paper to use: Perhaps depending on your comfort with your system, this may be the case, but clear investment in learning the system will pay long-term dividends. Electronic health records allow for searchable records with data that can be viewed, shared, downloaded and “filed” without having to print, manually scan, review and file the documents.

Electronic health records were created to facilitate meaningful use: Quite frankly, this is false. Clearly, EHRs have been available long, long before meaningful use was even a concept. They do facilitate meaningful use now that the process has been put in place for the program to thrive.

An electronic health record assures a practice of meaningful use: Not so. An EHR is the first step in the process. Meaningful use is about the process of using the technology and about using the data gained to improve patient health outcomes. Seeing the patient populations’ data allows physicians to begin to make changes to their approach to care, especially as it relates to chronic conditions.

Electronic health records are not available for every practice: There’s no way to objectively respond to this misconception. Truth is, there are hundreds, maybe even thousands of systems on the market, some of them designed for specialty specific practices. If you have been dutiful in your research and still determine that nothing meets your needs, either you aren’t ready or willing to make the switch or you are impossible to please.

 

Engaging in Social Media Engages Patients: Reasons Not to Be Anti-social

There’s no doubt social media is currently dominating every corner of the business world, and in healthcare, given the new focus on patient engagement, this form of communication is clearly having an impact.

Those of us who continue to be intrigued by the art form (I like to think of it as an art form because there are no hard rules for participating in the online social scene) we try to engage an audience, carry on conversations with others and do our best to disseminate useful information that will keep the world engaged. What you say and Twitter is no different than what you say in person, except that it has the potential to be heard around the world. But, plainly put, how you portray yourself online or in person is how you will be viewed and judged.

If you say something stupid, there’s a great chance that you’ll be seen as stupid.

For healthcare professionals (for anyone, really), social media is a great way to gain exposure and to attract new patients to your practice. Plus, social media can be a great way to engage your current patients. Social media channels allow you to communicate, and it allows patients a way to contact their physicians and caregivers.

According to EMR Experts, this means that “health and well-being becomes something that patients can think about daily rather than once a year at their annual checkup.”

This is a classic case of in sight, in mind. If patients are seeing your information, there’s a great chance they’re thinking of you of their care.

Social media, as you most likely, is not a tool to simply be ignored. It’s a communication force to be reckoned with because, in most part because patients are already online seeking information about their health and their care. By implementing a program, you’ll likely engage them, so who better than to connect with than their own docs.

Again according to EMR Experts, “By using social media sites such as Facebook, Twitter and Google+, physicians are able to keep in touch with the majority of their patients and to provide them with accurate medical resources that they might not be able to find elsewhere online.”

Here’s the good news: it’s easy to go social, and it’s free. The investment you make is time. To establish yourself as a respected source, you have to contribute regularly to your sites. From that point, like you might with your patient portal (link), you can begin to market your site on your practice’s collateral.

Perhaps the biggest question physicians have about social media is what they should post and what type of conversations should they engage in?

Here are a few ideas:

To recap, why is social media so important? Because it’s social and you don’t want to be anti-social. Put simply, being social not only serves you and your practice, it allows your patients a direct channel to communicate with you and lets them engage you.

For example, according to a recent HIMSS piece, Social Media for Engaging Consumers, patient consumers can:

Engaging in social media allows you an opportunity to engage in more in-depth conversations with the people you are charged with caring for. If for no other reason, direct communication with you patients as a potential opportunity to better engage them is worth any effort you are thinking of investing in a social media program.

Will Lack of Patient Engagement Cost Physicians Their Stage 2 Incentives? Yes, It’s Possible

Meaningful use stage 2 is moving in the direction of patient engagement. The next phase in the federal incentive program sets the bar for it, but certainly doesn’t leave it here. Certainly, patients were part of stage 1, but now, they must take greater ownership of their care; probably one of the only ways we’ll actually see the needle move in regard to long-term health outcomes changes for the population.

Engagement of the patients, it is believed, will move all patients toward better choices and possibly healthier lifestyles, which obviously makes for a healthier population.

But given all of the rhetoric on the subject, and the fact that each of us is subjective, aren’t we really talking about something rather subjective?

Say what?

Let me try to put it in terms that even I can understand: everyone talks about how patients must be more engaged – at the practice level, at the provider level and even at the vendor level (which is my belief) – but when it’s actually time to involve patients in their care, how is this done?

Well, one of the most popular answers is through social media sites like Facebook and Twitter. Bringing, or participating in, conversations about healthcare and interacting with patients online is considered to be a highly effective ways of reaching a broad audience, building a healthcare community, and educating and engaging patients.

But not everyone feels social media is the silver bullet. For example, I recently spoke with IDC Health Insights’ research director, Judy Hanover, who during our conversation said she thinks the healthcare community has become too infatuated with social media. She doesn’t see it as a truly effective means for engaging patients long term.

Certainly, social media has its place in building the physician/patient relationship, but its is limiting. Except for a very few people who like and want to share their personal health records online, most of us just don’t care to go into the specifics of our conditions in such a public forum.

So, the debate returns to healthcare information technology and the patient portal.

Online portals are designed to give patients anytime access to their health information. From a provider and vendor perspective, these tools have a great deal to do with meeting stage 2. For the patients, too, I suppose.

With the requirement that provider given patients access to online health information for viewing, downloading and transferring, and a second threshold requiring providers to push patient usage of this technology, it’s obvious the portal is a powerful player in this game.

I’ve written in the past about this issue and how the burden falls on the provider to engage patients through the portal to essentially secure incentive payments for stage 2.

Some do worry about their ability to meet the patient engagement requirement. I can imagine practices in rural areas or those that serve an older population may have some concerns.

Relying on a patient action to secure your incentive, especially after all of the work taken to meet the remainder of the MU requirements may seem like a blow to some. It would to me since my personality is one in which I like to have control of a project and not have to worry about outliers potentially derailing my progress (this sort of thing happens all of the time in school on group projects, right?)

So, how we do avoid this and encourage patients to use the portal?

What’s probably the best summation I’ve come across on the subject is in an interview Physicians Practice’s Aubrey Westgate conducted with Peter M. Kilbridge, a senior research director with The Advisory Board Company’s Information Technology. You can listen to it here.

Kilbridge’s perspective is valuable, and the tips he provides are easily accomplishable.

For example, to encourage use of the patient portal, practices should tell patients about it, and simply encourage them to use it and to talk about its capabilities. Highlight the portal’s capabilities, he says, and what it can do for patients and how it can make their live easier.

He says to highlight functions patients care about: viewing labs, sending questions, scheduling appointments. Follow it up by sending an email and paper mail reminder during about the upcoming visits or reminder

“Early success breeds confidence,” said Peter Kilbridge.

Still, the patients are truly empowered in stage 2, and all of the work invested on the part of the healthcare community might seem like it’s trivialized by the requirement needed to secure incentives.

This issue is being looked into, but currently there is no exception in place.

Is losing your incentive for stage 2 the price you’ll pay for lack of patient engagement? It certainly is a possibility?

At Home in Healthcare: Dr. Sumir Sahgal’s Calling a Success Because of Passion, and Mobile Technology

Dr. Sumir Sahgal

Dr. Sumir Sahgal moved into private practice in 1999, leaving the hospital setting for good. For some reason, he felt he could do more, contribute more positively to the community, as a care provider if he was running his own practice.

Since then he’s built a thriving medical practice, Essen Medical Associates, that has 25 healthcare providers who provide services in 20 medical facilities including nursing homes, hospitals and in one of five multi-specialty offices (with more coming online) owned by the practice.

Based in the greater New York City metro area, Sahgal’s practice, a certified medial home, serves more than 15,000 active patients per year. But true to his calling in that he wanted to do even more to provide care to patients, in 2005 he started down a new path that, at the time, most of the people he spoke with said he was making a costly mistake.

Of the population he’s served, there were several dozen (80 patients, in fact) that were home bound. Other than the random hospital visit, they received no care. That is until Sahgal opened EssenMED House Call Service.

EssenMED House Call Service primarily provides care for elderly home-bound patients in the Bronx, Manhattan, Brooklyn, Queens and Westchester. It is currently one of the largest private medical house call programs in New York.

“We opened a house call practice in the Bronx and everyone thought we were crazy,” Sahgal said. “We serve some pretty tough neighborhoods.”

After six months, the practice’s leaders evaluated the program. It made no financial sense to continue the service, he said, but there was an inherent value in the service his practice provided, and that’s all that mattered. The house call service fit his patients’ needs and they were receptive, and word of the program spread.

First slowly and then much more quickly. In seven years, the number of patients has doubled each year. There are now 1,800 being cared for by Essen’s nine caregivers.

“Through word of mouth, patients kept calling,” he said, “and eventually we had enough volume that it created efficiency in the program. Patients gravitate to where they can get the best care.”

The investments the practice made in electronic and mobile technologies also helped. Without his EHR, he currently uses eClinicalWorks, and being able to access patient data through iPad, the house calling practice is almost no different than the office-based practice.

“Healthcare technology helps create efficiency, and since we’ve moved to eClinicalWorks, our coordination of care has gotten much better,” he said.

All of the information needed to care for patients is on hand through mobile technology. In many ways, his staff is just as efficient in the homes of the patients as they are in the practice setting.

Much of the business’ success can be tied directly to the current technology in place.

All of the information is available wirelessly through the practice’s server including labs and documentation. “It’s like truly transferring the office to the home,” he said. “We can prescribe directly from the patient’s house.

The technology has helped him grow his practice and open communication lines with colleagues and share information, as would be expected, making for a much easier documentation process, especially for staff members in the field.

“The technology has helped us improve care and increase patient engagement. With improved patient engagement, patients have better access to their health information, access their medications and communicate with us, which helps us improve care,” he said.

As devices and capabilities continue to improve, Sahgal is confident that the same can be said for patient care, which he’s extremely passionate about. He’s in the business of practicing health to help people have better or more comfortable lives.

His approach is also saving money for the overall system. The more home care is available to patients, the less likely they are to seek care in the hospital. Likewise, the more comfortable patients are as they manage their conditions or approach the end of their lives.

The patient’s response to the technology has been overwhelmingly positive, he said, especially when he’s able to provide video consultations with patients through his iPad and perform remote triages and blood pressure checks from miles away. The services provided by Essen save patients from unnecessary hospital visits and many thousands of dollars in the process.

At this point, one of the next things that can be done to improve care is for interoperable systems to be fully engaged and useable by caregivers despite the vendor in which they employ. But, for now, the technology is in place to allow for the patient to be the central figure in this play, not the technology.

Serving patients in their space and in their areas of comfort is not a common business model and is much easier now than it has been in the past. Dr. Sahgal says his work is his calling, something he does because he loves providing care.

It’s not always easier either: “You are in the field, there are environmental factors to deal with; we have our war stories. But we’re able to provide TLC in the patient’s home, where they are most comfortable,” he said.

Dr. Anne Brooks’ Approach to Patient Care: A Concerned, Compassionate, M*A*S*H*-based Model