Tag: EHRs

Bots Rush In Where IT Fears to Tread

Guest post by Edgar Wilson.

Edgar Wilson
Edgar Wilson

Sherlock Holmes famously captured the popular imagination with his uncanny ability to make wild, but accurate, leaps of logic to solve mysteries. By observing Dr. Watson’s suit jacket sleeve, upon their first encounter, he was able to deduce that Watson was in fact a surgeon, in the British Army, and had recently returned from Afghanistan, where he had sustained an injury.

When he slowed down to explain his reasoning, it was easy to follow; what made his deductions impressive was how quickly he would skip from observation to conclusion. I’m no Sherlock Holmes, but it seems to me that chatbots are poised to take over much of modern healthcare.

Following the Clues: The Chatbots Did It

The reasoning goes something like this: As we’ve adopted EHRs across a dominant share of the healthcare system, a parallel push for greater patient engagement and data transparency has led to widespread use of patient portals. So, EHRs lead to patient portals.

As more data is moved to portals through EHRs and digital documentation, there is increased patient interest in and demand for other digital and remote encounters and health resources. This, along with improving technology and competitive solutions, is helping increase adoption of telehealth. So, patient portals lead to increased telehealth adoption.

Finally, although part of the premise and value of telehealth is enabling face-to-face encounters between caregivers and patients without respect to geography, hospital waiting rooms, or other physical barriers, it changes certain expectations. Like all mobile and web-based services, telehealth feeds a consumer mindset that expects everything on-demand, all but instantaneously, and highly customized at that.

While portable patient records facilitated by EHRs and interoperability can help this, customization and on-demand healthcare doesn’t just put pressure on records and data. Patients want fast and personalized answers. As customer service centers, tech support, banks and virtually every other consumer-facing industry has learned, a lot of the on-demand load can be pushed onto increasingly sophisticated chatbots.

So, telehealth leads to growing expectations for on-demand clinical encounters and chat, which is provided by chatbots.

The Case for Chatbots

Retail has previewed much for healthcare: See how customer service upgrades have turned everyone into “The Most Important Person Here” wherever they go, in person or online. Consumers demand personalization, expedition, authenticity and they want it all exactly when and where they want it. And now, see how AI is not yet taking over the world, but is making FAQs and other routine customer service interactions painless for those answering, and interactive enough for those asking.

Retail is even making inroads to healthcare, as consumer-facing devices promise to measure and track all manner of health metrics. Statistics-loving sports fans witness the increasing digitization and quantification of athletes, games, injuries and training, and they want a similar level of insight and precision for their own care. Mobile technology is redefining and disrupting even the oldest and most stable of markets and industries, bit by literal bit.

So how long until the dry, repetitive questions doctors routinely must answer in check-ups and physicals are ethically and effectively offloaded onto chatbots programmed to triage and educate patients without wasting valuable human resources? How long until using telehealth to keep nonemergency patients out of the emergency room merges with using chat and AI — the basic recipe for chatbots — to keep healthy but curious or concerned patients from wasting time and money going through full encounters simply to get their general questions answered?

It doesn’t take a lot of sophistication to realize the benefits of AI at scale. Google has all but taken over the modern world by connecting searchers with answers to their questions; Wikipedia has all but bankrupted the encyclopedia industry with free, accessible, general knowledge. In a world where health literacy is so lacking in the majority of the population, some interactive resources could go a long way to chipping away at ER overuse and healthcare overconsumption, just by giving people an alternative to seeing the doctor.

Automation of Care, Automation of Crime

As quickly as potential benefits can scale, very real risks and both moral and financial hazards scale even quicker.

The growing popularity and implementation of chatbots has given hackers and cybercriminals a new way to scam, defraud, and generally abuse unwitting consumers. Sometimes that means hackers take over a company’s chat system with their own bot and solicit data. Sometimes fraudsters attract visitors with a spoof website, then use a bot to similarly extract volunteered data at scale from misled visitors. However it is done, it scales almost as well as a more conventional data breach, and can be harder to detect or track.

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American Health Data: Not Hackers’ Only Target, but Still Their Easiest

Guest post by Edgar Wilson.

Edgar Wilson
Edgar Wilson

The start of 2017 provided America’s health system with some global-scale schadenfreude when England’s NHS got caught up in a massive cyber attack. The “WannaCry” ransomware attack, which quickly spread across Europe from an epicenter in Ukraine, seemed to prove beyond any reasonable doubt that American EHRs and health data management systems were not unique in their vulnerability to hackers and thieves leveraging new digital weapons.

In time, this particular attack did manage to spread internationally from Europe over to America, but that only provided further evidence that ransomware, and cyber attacks more broadly, are a threat of seemingly unlimited potential. The failings of American healthcare to get its data safely organized look far less damning when the scale of cyber risk is made explicitly global, and even the NSA is caught off-guard by their own tools being turned into weapons in enemy hands.

Not Alone, but Not Ahead

Of course, that American hospitals weren’t the primary targets for once doesn’t remotely get them off the hook; nor does the jarring impact of this particular incident reflect a growing resilience among health data security in the U.S. American health data may not be alone in its vulnerability or attractiveness to thieves, but neither are our health systems leading the pack in protecting against ransomware, or any other form of cyber attack. Sadly, this wakeup call seems more likely to be heard outside of healthcare than within it; the scale makes it almost universally noteworthy, but otherwise it resembles a new status quo for data leaks in modern health systems.

Credit card data is relatively to protect; thieves are easily and quickly locked out of accounts, if not caught, thanks to everything from increased scrutiny by lenders and processing companies as well as consumer-facing transparency and 24/7 account monitoring via mobile credit card alerts and apps. Health data, by contrast, remains largely vulnerable. Clinics are not particularly good at recognizing fraud when thieves have a person’s medical data; hospitals have proven themselves no better at keeping that data secure in the first place. So compared to traditional identity theft leveraging plastic, digital health data presents a softer and more lucrative target end to end.

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Does Health Tech Innovation Reward Early Adopters?

Guest post by Edgar Wilson.

Edgar Wilson
Edgar Wilson

T-Mobile recently became the first cell phone carrier to offer free inflight Wi-Fi (in support of Wi-Fi texting, as cellular signals are still not yet allowed) to all its customers. Admittedly, this was technically on the strength of partnering with a third-party platform, Go-Go, but the carrier gets the glory of being first among its big four peers to take even this step.

In-flight Wi-Fi, Wi-Fi calling, and similar services aren’t necessarily new technology, but having support for limited internet browsing and texting, all delivered through one of the top carriers in the nation, makes for a reasonably good elevator pitch—especially if you happen to be a T-Mobile customer. But the importance of the development isn’t just the novelty of the technology or the value of the service on offer; it is planting a shining pink flag in the market and staking that claim of being “first.”

Early Adoption, Arrested Development

Being first hasn’t lost its luster yet, even in a time when consumer expectations are sometimes a generation or two ahead of current technology. Hospitals and their leadership recognize this, and so, despite uncertainty on everything from insurance market regulations to the future of EHR integration, many are taking strides to do as T-Mobile has done — and find a way to get there first on a variety of issues important to consumers. And like T-Mobile, being first doesn’t have to mean getting into the weeds of proprietary innovation and product development—although plenty of larger chains and clinics do take that route; for many hospitals, being first can be accomplished through strategic partnerships with tech-centric companies.

If there is one lesson out of Silicon Valley that has entered the American zeitgeist, it is that being the first out with something can give a company, product or even team of creatives a lot of leeway in terms of going on to iterate, improve, and generally tinker. But on the healthcare front, we see how the drive to be first—or even keep pace with the rest of the industry—can create a “hurry up and wait” situation where meaningful progress sometimes lags fanfare or technology.

That is why the top tech trends in healthcare don’t change much year to year; end users, hospital administrators, and tech developers are all still trying to figure out what works, what works best, and how to integrate new tools into the clinical workflow, the patient experience, and the regulatory environment governing it all.

That is the story of EHRs is a nutshell: a good idea, a rush to adoption (both willing and coerced), and then a lengthy period of reiteration as all stakeholders struggle to recreate or wholistically reconsider the context in which this new system can, and should, operate. But the rush to adopt first and configure later isn’t limited to high-technology in the healthcare sector; it pretty well describes the legal environment surrounding health insurance.

Industry Leadership: Being First or Being Best?

From how it affects patients to what it is still trying to influence in the provider space, the conversation about care and coverage is still shepherded primarily by fear, secondarily by outrage, and in most other respects by confusion. So it looks like we’ll be shopping the exchanges for a while longer, even under President Trump’s watch.

After gazing into the abyss that was Trumpcare, the still-evolving status quo that is Obamacare is more popular than ever. Here again, the power of being first seems to provide some residual sticking power to a law frequently and publicly dragged through the mud by people and organizations with at least as much visibility and influence as one like T-Mobile.

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How Are EHRs Eating Up Physicians’ Time?

Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.

Abhinav Shashank
Abhinav Shashank

Time is money, an adage the world follows. When providers realized paper medical records were time-consuming, Electronic Health Records were developed to make things streamlined. Early EHRs were only meant to capture basic clinical information, and over the time EHRs have taken the form of a digital version of paper medical records. In an industry as dynamic and as focused on value as healthcare, it’s not feasible to have physicians spend almost half their time on EHRs.

Challenges physicians face with EHRs

EHRs, in their current state, not only consume a lot of physicians’ time, but they also draw their attention away from their direct interactions with patients. Some of the several significant challenges physicians face are:

 Why can’t we do away with EHRs?

While EHRs are not without their own set of challenges, their implementation was necessary, and that still holds true. Only recently, under the Merit-Based Incentive Payment System (MIPS), providers have started to make an effort to enhance value in the care they deliver and the meaningful use of EHRs has been included in MIPS with other substantial quality reporting initiatives. Besides that, there are many offerings of EHRs:

EHR Optimization: Boosting your EHRs

EHR optimization is the process of enhancing and refining the operations of an already installed EHR, to enhance clinical productivity and efficiency. As more and more practices have begun the push for value-based reimbursement, they are demanding more integrated and efficient EHRs.

Opportunities for EHR optimization vary for every practice and range from simple to complex. However, the primary objective of every optimization is reducing the time consumed. Here are some ways healthcare IT platforms can optimize time spent on EHRs for improved patient outcomes:

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Rethinking EHRs: Actionable Insight Increases Usability (Part 2)

Guest post by Matthew Douglass, co-founder, SVP Customer Experience, Practice Fusion

Matthew Douglass
Matthew Douglass

In part 1 of this series, we reviewed the history of digital health tools and discussed why they are not yet fully satisfying the needs of many physicians.

If you think of the U.S. healthcare system as a vast nationwide transportation network, current electronic health record (EHR) functionality is the basic highway infrastructure. The American Recovery and Reinvestment Act of 2009 provided the incentives for those highways to be built and put in place the structure for ONC-certified EHRs to define the rules of the road via regulatory standards. The roads are now mostly in place: certified EHRs all offer roughly the same base functionality for use by physicians, store clinical information in standardized ways, and have the capabilities to securely communicate with each other.

Sixty-seven percent of medical practices in the U.S. are now using EHRs to run all or part of their daily operations. Patients’ vital signs are stored as discrete values for each visit. Encrypted messages between physicians and their staff are transmitted reliably. Chart notes are being digitally documented and can be shared confidentially with patients. Physicians that have chosen cloud-based EHRs can securely prescribe and refill medications from the convenience of their mobile phones.

Despite having this digital highway system in place, we haven’t yet reached a destination where use of EHRs achieves better patient outcomes or improved clinical experiences. Physicians want more from digital tools than simply receiving, storing, and displaying data values about each patient visit. Rather than devoting too much of their already limited time to data entry and retrieval, physicians want to provide the best patient care possible, and they expect technology to help them achieve this goal.

There is such a thing as too much data, which physicians are reminded of each time they open a digital chart. Clinicians very often are left swimming in more data than they can adequately process, which can erode the crucial patient-provider human relationship.

To address data overload and dehumanization challenges, software partners must go back to the drawing board and visualize dramatic innovations that can be built on top of the nationwide EHR foundation. Significant cognitive overhead is required to distill hundreds of disparate pieces of clinical data into a salient picture of an individual’s overall health. The vast amount of data now available in a patient’s chart is quite often far more than any medical professional, no matter how clinically experienced, can consistently and reliably assimilate.

Physicians and their staff need intuitive technology to be their always-available, intelligent assistant, from start to finish during a patient’s visit.

When a patient’s record is displayed on the computer screen, physicians shouldn’t have to dig for relevant information about that visit. Instead, the EHR should be able to display the pertinent clinical data and health insights for the physician to review and assess a patient’s health condition more quickly and effectively. For example, lab values and vital signs relevant to that patient’s chief complaint are likely already stored as discrete values in the patient’s chart. An EHR that learns along with the physician’s workflow preferences should display only the most relevant data through easily digestible visualizations.

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Rethinking EHRs: Why Aren’t They Useful Yet? (Part 1)

Guest post by Matthew Douglass, co-founder and SVP of Customer Experience, Practice Fusion.

Matthew Douglass
Matthew Douglass

Despite enjoying broad technological advances in their medical practices over the past decade, many physicians still find little pleasure in having to use electronic health records (EHRs). Reasons for low satisfaction run the gamut, from a litany of potentially distracting alerts to overwhelming features that are difficult to learn. This flagging usability, combined with the growing burden of data entry and documentation, impedes physician satisfaction.

Physicians do not begin their careers in medicine so they can spend a majority of their time wrestling with technology. A recent study found that physicians spend three times as many hours working on computers as they do providing direct patient care. It is no wonder that physicians are reporting record levels of burnout and deep job dissatisfaction.

There are practical workarounds to the challenges of using EHRs, such as programs pairing physicians with scribes that are pre-med students who assist those physicians or plugging in additional technologies that reduce direct documentation overhead. However, these practical workarounds mask the root problem rather than address it; EHRs have yet to provide consistently actionable insights that will help to dramatically improve clinical outcomes.

When a physician opens a patient record in her EHR today, she is probably no better equipped than if she were to open that patient’s paper record 10 years ago. All the data points she might ever need are available for her to sift through, but where is the insight? How is she supposed to interpret clinical meaning in individual pieces of data scattered throughout her patient’s history? How is the EHR assisting her in making better, more informed care and treatment decisions for her patients’ lives that she has been entrusted with improving?

EHRs were originally created as a digital recreation of the physical paper chart that accompanied a physician into the exam room during every patient visit. Vital sign collection sheets were recreated as vital sign fields on the screen. SOAP notes that physicians judiciously completed with pen and paper after every patient visit became digital SOAP note fields in the EHR that still have to be typed by the physician or a physician’s representative at the end of every patient visit. Billing one-pagers with pre-printed ICD and procedure codes have been replaced with nearly identical digital superbills containing point-and-click picklists of diagnoses and procedures.

Although we have created a digital system, the healthcare industry lingers in an analog world: Everything still operates like paper.

In the early 20th century, Henry Ford envisioned a future where transportation was dramatically better than what the main transportation technology of the time (i.e., horses) could provide. Confronted with this problem, he didn’t try to re-engineer horses to run 10 times faster. Thankfully, he set his sights on an entirely different and improved solution, experimented with a few ideas, and succeeded in completely altering the future of human transportation by introducing the first mass-produced automobile.

EHR vendors have a similar opportunity today, as they imagine the future of digital health technology that will be highly usable and incredibly helpful for physicians. Fortunately, EHRs are now broadly distributed enough that there is a solid foundation in place on which to build . Now that the vast majority of patient clinical information lives in a digitized form, we can look to the future and ask a novel, crucial question: How can this rich repository of clinical data evolve into upgraded tools that can be used to broadly improve patient health and physician satisfaction?

To best answer these questions, EHR vendors need to reevaluate the specific assistance that physicians can garner from digital health tools. First, clinicians and their staff must be intimately involved in the functionality discovery process in partnership with EHR vendors. This research can then be converted into success metrics and key questions that clinicians and vendors’ product teams utilize as benchmarks for measuring overall successful implementation.

Further, as physicians are evaluating which digital health technology vendors to partner with in their practice, there are a few advantageous traits they should consider. EHR vendors that operate in a secure cloud offer distinct advantages because they can roll out frequent updates that do not interfere with a practice’s day-to-day operations. If a bug or usability issue does arise, the problem most often can be addressed quickly and without interruption.

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The Health Threat of Tech

Guest post by Edgar Wilson.

Edgar Wilson

We put a lot of faith in health technology: to make us better, to save our systems, to revolutionize healthcare. We may be looking at it from the wrong side entirely.

The social determinants of health matter more than our ability to deploy doctors or provide insurance; physical and mental, health is always more social than clinical.

But most of our health tech that is supposed to be revolutionary is aimed at clinical factors, rather than the social determinants of health. Yes, telehealth can increase reach, but it is still just a matter of touchpoints, not a fundamental change to the lifestyles and cultures that determine health.

Same with all our EHR systems creating more ways to record information, more ways to quantify patients, to put more emphasis on engagement and quality-based reimbursement. Even genomics and personalized medicine are taking a backseat to soliciting reviews and trying to turn the patient experience into  a number. It all puts greater focus on the clinical encounters, on how patients “feel” broadly about each minute aspect of their time in the medical facility.

A Digital Disease

As politicians trade blows on minimum wages and the ACA, the likelihood grows that insurance benefits and livable incomes (and lifestyles) will get pushed further out of reach for more people.

Modern work is tech-centric, which means lots of sitting, and manages to facilitate increased snacking without being particularly physical, a double-whammy that prevents employment or higher incomes from leading to healthier choices. For the less-skilled, normally accessible jobs are in the sights of automation and disruption. While tech is taking over medicine and opening up new possibilities, it is also transforming the labor market and closing countless doors to workers.

By extension, technology is changing the social framework that determines public health. Income inequality is growing, wage growth is stagnant, and no amount of awareness can change these front-of-mind concerns for people who may well want to eat better and exercise more, or even commit to seeing the doctor more often and following his or her advice to the letter.

Poor people can’t necessarily eat better as a simple matter of choice or doctor’s orders. Planning meals and purchasing healthful foods is a tax on limited resources–time as well as money. Working three jobs to pay the bills, many lower income individuals also don’t necessarily have time to exercise. And more likely than not, those working even high-paying jobs are sitting all day, sapping their bodies of energy and resilience, undoing the good of their intentions and smart devices  alike through attrition.

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Care Coordination 101: Evolving to Patient-Centric Care

Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.

Abhinav Shashank
Abhinav Shashank

The US healthcare is getting costlier every day, and it is without a doubt true that most of the US citizens live in fear that they won’t get access to the care when the illness strikes. The sad truth is that every year more than 100,000 deaths occur because of medical errors. All this when we see horrifying figures even after adjusting the America’s higher per capita GDP; US spends roughly $500 billion more than other developed countries.

The Problems with Coordination

13 years ago, way back in 2003, the Institute of Medicine had identified the most persistent problem in the healthcare industry, and it was coordination. The idea behind implementing EHRs was to create digital data that is easy to share, but that did not happen. According to a study, 63 percent of primary care physicians and 35 percent specialist are not satisfied with the information they receive from other physicians within the adult referral system.

The above graph shows how poorly coordinated care has affected the adults. The US stands second when it comes to high-need patients. This is when US spends more than $10,000 on one person’s health.

According to a research article, the biggest challenges Primary Care Physicians and Hospitalists faced were:

Besides these, a lot of problems arise when patients miss out on medications, follow-up visits or any other requirements. Thus, there is a need to create a process where neither do PCPs miss out on critical information nor does the patient stay unaware of the care plans. For this PCPs had identified the most successful care coordination components:

The most important aspect of healthcare is that when a care process is nearing its end, the patient should be in a better state. A patient-centric approach is must to make sure a patient gets the best treatment. Health Coaches ensure that the patients get what they need. They make sure that the

The Three Pieces of Care Coordination

More often than not care coordinators miss out on the essential information about the patients. In worst cases, they have no discharge information of patients creating gaps in care and indirectly increases the cost of care. Ideally, the three pieces of care coordination together can bring dramatic improvements in patient-centric care. The three pieces are:

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Technology: The Continual Disruption of Healthcare

Guest post by Edgar T. Wilson, writer, consultant and analyst

When we talk about technology disrupting healthcare, we aren’t just referring to changes in the accuracy of health records or the convenience of mobile care; the real disruption comes in the form of fundamental challenges to traditional scopes of practice.

What Should We Do?

Scope of practice, broadly, is determined by a combination of liability and capability. Lead physicians carry greater liability than the bedside nurses assisting in patient care, because the care plan is directed by the lead physician. Likewise, the extra years of education and practice are assumed to increase the capacity of physicians to lead their care teams, make decisions about how the team will go about its work, and parse all of the information provided by the patient, nurses, and other specialists involved with each case.

In every other industry, productivity increases come from technology enhancing the ability of individuals and teams to perform work. Email saves time and money by improving communication; industrial robotics standardize manufacturing and raise the scale and quality of output. Every device, app, and system allows individuals to scale their contribution, to do more and add more value. Word processing and voice-to-text enable executives to do work that might otherwise have been performed by a secretary or typist. Travel websites allow consumers to find cheap tickets and travel packages that would previously have required a travel agent to acquire.

In healthcare, technology is changing the capacity of the individual caregiver, expanding what can be done, and often how well it can be done. These improvements, along with a growing need for healthcare professionals and services, are challenging traditional notions of scope of practice–for good and bad.

New Beginnings

Some of the changes to scope of practice are positive, necessary, and constructive. For example, technological literacy is necessary at every point in the care continuum, because interoperable EHRs and the vulnerability of digital information means that everyone must contribute to cyber security. In a sense, caregivers at every level must expand their scope of practice to incorporate an awareness of privacy, security, and data management considerations.

By extension, all caregivers are participating as never before in the advancement of clinical research, population health monitoring, and patient empowerment simply by working more closely with digital data and computers. As EHR technology iterates its way toward fulfilling its potential, caregivers and administrators are being forced to have difficult conversations about priorities, values, goals, and the nature of the relationship between patient, provider, system, and technology. It is overdue, and foundational to the future of healthcare.

Is There A Nurse in the House?

The trend in healthcare toward prevention and balancing patient-centered care with awareness of population health issues puts primary care in a place of greater importance than ever. This, in turn, is driving a shift in the education of nurses to promote more training, higher levels of certification, and greater specialization to justify relying on nurses to fulfill more primary care roles. They are becoming better generalists and specialists, capable of bolstering teams as well as leading them.

The advancement of diagnostic technologies and understanding of the nature of disease, illness, and genetics has also thrust the clinical laboratory into the center of healthcare. It doesn’t necessarily change the scope of practice for the laboratory scientist, but does elevate the demand and scale of operations for these professionals must fulfill. Once again, the broadening demand has dovetailed with an effort to broaden the scope of practice for other clinical roles, particularly nurses.

Whether it is appropriate or practical for nurses–already understaffed and overextended–into all these critical blended roles is open for debate.

Man, Machine and Medicine

While cross-training is valuable for improving collaboration and breaking down siloes–both critically important to the future of healthcare–it blurring the scope of practice or between roles that comprise very different skills and responsibilities. Technology is expanding the capability of every clinical and non-clinical role, but is it not entirely clear whether it is keeping up with our expectations and demand for the people in these roles.

In addition to answering these questions about scope of practice, we need to look carefully at how technology can change the scope of accountability for patients. Technology may be a platform for engagement, but getting real patient participation requires a better foundation of health literacy–just as caregivers must develop a more robust technological literacy to take advantage of EHRs.

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What is Working in Healthcare?

Guest post by Edgar T. Wilson, writer, consultant and analyst.

Edgar Wilson
Edgar Wilson

In virtually every context that question might be asked, we struggle to give an honest, accurate answer.

It Works If You Believe It Works

Is the medication working? Difficult to say–it may be the placebo effect, it may be counteracted by other medications, or we may be monitoring the wrong indicators to recognize any effect. Is “working” the same as “having an effect,” or must it be the desired effect?

Alternative medicine confounds the balance of expectations and outcomes even further. Right at the intersection of evidenced-based medicine and naturopathy, for instance, we have hyperbaric oxygen therapy, or HBOT. These devices are as much in vogue among emergency departments (to treat embolisms, diabetic foot ulcers, and burns) as holistic dream salesmen (to prevent aging and cure autism, if you believe the hype). When the metric being tracked is as fluid as the visible effects of aging, answering whether the treatment is working is about as subjective as you can get.

As though the science of pharmaceuticals and clinical medicine weren’t confounding enough, you can hardly go anywhere in healthcare today without politics getting added to the mix. In the wake of Trump’s victory in the 2016 presidential election, you have observers and stakeholders asking of the Affordable Care Act (ACA): is it working?

There’s Something Happening Here

It is definitely doing something. It is measurably active in our tax policy, for instance: 2016 returns are heavily influenced by the incremental growth of the ACA’s financial provisions. Of course, the point of this tax policy (depending on who you ask) is to influence behavior. As to this point, there are some signs that, again, something is happening: among young people, ER visits in general are down, while emergency stays due to mental health illness are up. We changed how healthcare is insured, and that changed, in turn, how we access our care. But is it working?

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