Death By A Thousand Clicks: Leading Boston Doctors Decry Electronic Medical Records | CommonHealth

WBUR  

May 12, 2017

By Drs. John Levinson, Bruce H. Price and Vikas Saini

It’s death by a thousand clicks, and it happens every day.

We are frustrated by EMRs because they pull us away from our patients. We are driven mad by the fact that EMRs in different locations do not talk to each other. And we think it’s just wrong that much of the EMR’s busywork is about optimizing billing for the hospital.

Who is to blame? Start with EMR manufacturers, who lobbied Congress to require every hospital and doctor’s office to install an EMR system; hospital administrators who bought technology that conveniently pushed billing duties onto doctors and nurses; and federal regulators, who imposed on EMRs numerous quality metric requirements that do nothing to improve care.

We do not want to go backward. We believe that computing is essential to the future of medicine. We simply want all EMRs to live up to their promise of improving care and making patient information readily available.

Thousands of doctors in Boston and across the country are expressing the same frustration, through gritted teeth, between exasperated sighs, and in resignation letters. EMRs are driving too many health care providers to hang up their scrubs and white coats in search of work that is less infuriating and more fulfilling.

The sound of medicine is not the click of a mouse. It is the human voice. Let’s bring it back.

To do this well takes time and undivided attention.

Making sense of a patient’s blood panel means knowing the patient’s work and eating habits, and where he or she may have traveled. We need to know if the patient is experiencing a traumatic life event, like the death of a parent or domestic abuse, in order to interpret an elevated blood pressure.

Instead of making this easier, most EMRs create extra work. A lot of extra work, thanks to endless prompts with multiple choice answers that hardly ever fit the facts and that demand click after click to get anything done.

Want to order a simple test? That requires getting through multiple prompts. Need to write a prescription -- an exercise that used to take less than 15 seconds? Another set of clicks.

Typing, filing, mailing results and placing referrals all used to be done by assistants. Now, EMRs put that burden on clinicians, and we must do it during office visits, or “encounters,” as EMRs call them. And when the wrong button is clicked, the wrong test or drug is ordered, or it does not go through at all, delaying medical care.

It’s death by a thousand clicks, and it happens every day.

We are frustrated by EMRs because they pull us away from our patients. We are driven mad by the fact that EMRs in different locations do not talk to each other. And we think it’s just wrong that much of the EMR’s busywork is about optimizing billing for the hospital.

Who is to blame? Start with EMR manufacturers, who lobbied Congress to require every hospital and doctor’s office to install an EMR system; hospital administrators who bought technology that conveniently pushed billing duties onto doctors and nurses; and federal regulators, who imposed on EMRs numerous quality metric requirements that do nothing to improve care.

We do not want to go backward. We believe that computing is essential to the future of medicine. We simply want all EMRs to live up to their promise of improving care and making patient information readily available.

Thousands of doctors in Boston and across the country are expressing the same frustration, through gritted teeth, between exasperated sighs, and in resignation letters. EMRs are driving too many health care providers to hang up their scrubs and white coats in search of work that is less infuriating and more fulfilling.

Death By A Thousand Clicks: Leading Boston Doctors Decry Electronic Medical Records | CommonHealth

Cyber-attacks are real. Every day thousands of intrusions are attempted. Thanks to modern operating systems almost all are thwarted. However if you are still using old or obsolete OS such as Windows XP, Vista, Windows 7 or 8 those systems do not have adequate protection from viruses, trojans, or malware.

The first investment is to upgrade to Windows 10 which has frequent updates for new viruses, trojans and/or malware. Chrome also has regular updates as needed which load everytime you start Chrome.

The video above outlines the progress of the attack this past week which brought down many systems in hospitals and other businesses.

 Remember no matter how well you think you are protected, hackers will find ways to usurp   your system.

The latest in "ransomware".  The hacker will install an encrypted hack. When the user attempts to log in they will receive a message such as this one.

"Your system has been locked and encrypted. It can be restored by sending a payment of XXX via bitcoin.  Click here to begin."

Many users will capitulate and pay the ransom. In business time is money and the amount of time lost can be damaging to reputation and income

Prevention:

Do not DOWNLOAD OR OPEN email attachments from unknown sources
Use current operating systems.
Avoid suspicious emails or websites.  Modern browsers will search for certificates and other indications that the web site is suspicious or has been reported to be carrying malware or trojans.

Meanwhile:

HAPPY MOTHER'S DAY

How Telehealth can add to Precision Medicine

Telemedicine offers speed, convenience, and efficiency but isn't right for every situation. Making the right call for cardiology consults should rests in the hands of primary care physicans making the referral together with the patient, says Jason Wasfy, MD.

In this exclusive video, Wasfy, director of quality and analytics at the Massachusetts General Hospital Heart Center in Boston, discusses how such an e-consult system has worked at his center.

So, there are some patients that need to come into the office. They're complicated, they need a physical examination, they may need to be followed with time, but there [are] other patients where their question for cardiologists is very discrete and limited, and what they really need is to know the answer as quickly as possible. There was probably a time in medicine where doctors would brag about how long their waiting list was, that the doctor that had the longest waiting list to get in to see them was the best physician, and I think that's the old days. We want to deliver care to patients as quickly as possible to relieve anxiety, to make sure that they have the input they need as quickly as possible.

So, e-consult allows us a mechanism to get discrete information about a clinical question, from the cardiologist to the primary care doctor, who can then share with the patient. But because we're accommodating some of the questions that way, we also have more bandwidth in our clinics to see the more complicated patients -- for example, people who need caths or people who need procedures. So, we find it a very effective mechanism of addressing patients' needs in the way that they perceive their own needs.

There are different ways to do e-consult. One is sort of an active referral mechanism, where all the referrals coming into our office, a cardiologist can triage them and say, "Oh, I'll see that one in the office, but this question I can answer without seeing the patient." We do not take that approach. We empower our primary care physicians, together with the patients in the office, to decide what they think is most appropriate for the clinical question. And we really think that's important. Because there are some times when I'm getting a referral that I think I can answer the question about the EKG, but I've never met the patient in person, and I don't understand that they're anxious and that their father had a heart attack at a young age, and these sorts of intangible points that are really hard to know until you meet the patient. That's why instead of going through an active referral process, where you go through the referrals and say I can answer this one via e-consult or I'll see this one in the office, we give that choice to the patient and to the primary care doctor. We allow them that choice.

We've done detailed surveys of our patients and our primary care providers just to make sure that they're happy with the mechanism, and we had have very high satisfaction rates, both among referring doctors and patients. And we think part of that is because we empower them to decide upfront, do they want an electronic consult where they get an answer in 48 hours or are they willing to wait a little longer for an in-person evaluation? We'd like to customize the care we deliver to the patients' preferences and the patients' needs.

Patient engagement is a major factor. Within the bounds of safety...what does your patient want?

Pearls From: Jason Wasfy, MD | Medpage Today

Mom’s Policy, Medicaid Or A Health Exchange Plan: What’s A Grad To Do?

Graduating students now have several options for insurance plans. The Affordable Care Act has introduced several options.

As graduation approaches for thousands of young adults this spring, sorting out your health insurance options may seem more daunting than any political economics problem you faced at school.

You may not think it’s a high priority, but remember: Even healthy young people wind up in the emergency room for all sorts of mishaps, and having health insurance will let you get preventive care, including contraceptives, without paying for it.

As graduation approaches for thousands of young adults this spring, sorting out your health insurance options may seem more daunting than any political economics problem you faced at school.

You may not think it’s a high priority, but remember: Even healthy young people wind up in the emergency room for all sorts of mishaps, and having health insurance will let you get preventive care, including contraceptives, without paying for it.

There are several items to consider when choosing.

Take A Look At Your Parents’ Health Insurance.

In 2015, 29 percent of 19- to 25-year-olds were covered as dependents on their parents’ job-based plan, according to a Commonwealth Fund analysis of data from the U.S. Census Bureau’s Current Population Survey. It was the most common type of coverage for this age group.

Employer-sponsored plans are often more generous than an individual plan on the marketplace, with more comprehensive benefits and lower premiums and out-of-pocket costs. And parents can pass these benefits on.

Compare Coverage Through Your Employer.

Seventeen percent of young adults were insured by their own employer in 2015.

Large employers often offer insurance plans, called PPOs, that let workers choose their own doctors and providers from the insurer’s network and often allow them to seek care outside the network if the patient pays a larger share of the cost. A typical PPO plan offered by an employer with at least 500 employees paid for 87 percent of enrollees’ health care costs on average, according to data from benefits consultant Mercer. Compare that with the most popular silver-level plans sold on the ACA’s online marketplaces, which pay 70 percent of costs.

One benefit of an employer’s plan over your parents’: Buying your own plan may improve the odds that you’ll find doctors and hospitals nearby that are in your health plan’s provider network, said Erin Hemlin, director of training and education at Young Invincibles, an advocacy group for young adults.

If Employer Coverage Isn’t An Option, Consider The State Marketplace.

Twenty-two percent of young adults under 26 had marketplace coverage in 2015.

Marketplace plans must provide comprehensive coverage, including hospitalization, drugs and doctor visits. In addition, if your income is between 100 and 400 percent of the federal poverty level (about $12,000 to $48,000 for an individual) you could qualify for tax credits that will help cover the cost of premiums.

If you have a college health plan that ends when you graduate, you may qualify for a special enrollment period to sign up for a marketplace plan. But if you’re uninsured or insured through your parents, you probably can’t buy a marketplace plan until the next open enrollment period in the fall.

A key consideration: If your parents claim you as a tax dependent, you can’t claim the premium tax credit yourself, said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

Unemployed? Uninsured? Consider Medicaid.

In 2015, 15 percent of people between ages 19 and 25 were on Medicaid.

To date, 31 states and the District of Columbia have expanded Medicaid coverage to adults with incomes of about $16,000 or less.

If you don’t have a job or earn very little and you live in one of these states, you may qualify for Medicaid, which provides comprehensive coverage, typically without a premium.

Unlike marketplace coverage, there’s no open enrollment period for Medicaid. You can apply anytime through your state Medicaid agency, healthcare.gov or your state marketplace.

A key consideration: If your parents claim you as a dependent on their taxes, it could also affect your eligibility.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

What' a Grad to do?

Enzyme drives middle-age weight and fitness changes | National Institutes of Health (NIH)

At a Glance

• Scientists identified an enzyme in animal studies whose activity promotes weight gain and the loss of exercise capacity starting in mid-life.
• A drug that inhibits the enzyme prevented weight gain in mice, increased fitness levels, and reduced the incidence of obesity and type 2 diabetes.
• The findings could lead to more effective weight-loss medications.

Researchers have long known that losing weight and maintaining the capacity to exercise tend to get harder beginning between ages 30 and 40—the start of mid-life. Scientists have developed new therapies for obesity, including fat-fighting pills. However, many therapies have failed because of a lack of understanding about the biological changes that cause middle-aged people to gain weight, particularly around the abdomen.

Dr. Jay H. Chung, an endocrinologist at NIH’s National Heart, Lung, and Blood Institute (NHLBI), was always puzzled by the aging-weight gain paradox. An average adult in America gains 30 pounds from age 20 to 50, even though food intake usually decreases during this period. Chung and his associates thus searched for biochemical changes in middle-aged animals (human equivalent of 45 years). Their study appeared on May 2, 2017, in Cell Metabolism.

The team focused on an enzyme called DNA-dependent protein kinase, or DNA-PK. This enzyme is activated by a specific kind of DNA damage, but evidence has been mounting that DNA-PK has functions beyond DNA repair. One such function is in metabolism.

The scientists looked at levels of DNA-PK activity in the skeletal muscles of rhesus macaques and mice. These levels were low over time until middle-age, when they rose significantly. Further experiments showed that DNA-PK activity promotes the conversion of nutrients to fat and decreases the number of mitochondria, the tiny organelles in cells that turn fat into energy to fuel the body.

Mitochondria can be found in abundance among young people, but the numbers drop considerably in older people. Researchers know that fewer mitochondria can promote obesity as well as loss of exercise capacity.

“Our society attributes the weight gain and lack of exercise at mid-life (approximately 30-60 years) primarily to poor lifestyle choices and lack of will power, but this study shows that there is a genetic program driven by an overactive enzyme that promotes weight gain and loss of exercise capacity at mid-life,” Chung says.

These findings could lead to the development of a new type of weight-loss medication. However, DNA-PK inhibitors have yet to be tested this way in humans. Middle-aged people who are fighting obesity should continue to reduce calories and boost exercise.

Maintaining health and wellness, preventing obesity will decrease diabetes and prevent many chronic diseases.

Enzyme drives middle-age weight and fitness changes | National Institutes of Health (NIH)

A UCLA study shows there could be a TREATMENT for Alzheimer's disease

What happened when Alzheimer’s patients were treated for the diseases we already have cures or treatments for  ?

Last summer, a research group from the University of California, Los Angeles (UCLA) quietly published the results of a new approach in the treatment of Alzheimer’s disease. What they found was striking. Although the size of the study was small, every participant demonstrated such marked improvement that almost all were found to be in the normal range on testing for memory and cognition by the study’s end. Functionally, this amounts to a cure.

These are important findings, not only because Alzheimer’s disease is projected to become ever more common as the population ages, but because current treatment options offer minimal improvement at best. 

Many proposed drug solutions have failed in clinical trials. Last July, a large clinical trial found little benefit in patients receiving a major new drug called LMTX. And after that, another hopeful drug designed to target amyloid protein, one of the hallmarks of Alzheimer’s disease, failed its first large clinical trial as well. Just two months ago, Merck announced the results of its trial of a drug called verubecestat, which is designed to inhibit formation of amyloid protein. It was found to be no better than placebo.

The situation is analogous in kind, if not quite degree, to the many other chronic diseases with which we now struggle, such as diabetes and cardiovascular disease. While we do have efficacious medications for these conditions, none work perfectly, and all have negative effects. Our understanding of the cellular processes at the root of these diseases is sophisticated, but technical mastery—the grail of a cure—has remained elusive.

The method isn’t entirely novel. Researchers have already shown that multi-faceted, comprehensive lifestyle interventions can significantly improve outcomes in cardiovascular disease, diabetes and hypertension. But it’s difficult for these approaches to gain traction for two reasons. First, these protocols are more challenging than simply taking a pill at bedtime. Patients need ongoing education, counseling and support to effect meaningful change. And second, the pharmaceutical mode of treatment is deeply embedded within our current medical system. Insurance companies are set up to pay for medication, not lifestyle change; and physicians are taught pharmacology, not nutrition.

The prevalence of Alzheimer’s disease is expected to triple over the next three decades, to nearly 14 million in the US alone. Diabetes and other chronic diseases are expected to follow a similar trajectory. Trying to confront this epidemic with medication alone will raise a new host of problems, from prohibitive cost to adverse effects, without addressing any underlying cause. We know that comprehensive lifestyle modification can work for many chronic diseases, in some cases as well as medication. It deserves more than passing mention at the end of an annual check-up—it’s time to make it a cornerstone in the treatment not only of Alzheimer’s disease, but of all chronic disease.

So, exercise more, and eat your veggies












A UCLA study shows there could be a cure for Alzheimer's disease — Quartz

Individualized exam schedule for diabetic eye disease | National Institutes of Health (NIH)

At a Glance

• Researchers suggest a new exam schedule for diabetic retinopathy, a vision-threatening eye disease, based on individual risk level.
• The next step is for experts to consider modifying clinical guidelines for eye exams for people with type 1 diabetes. 

People with diabetes have blood sugar (glucose) levels that are too high. Over time, high levels of blood glucose can cause health problems, such as eye damage. The part of the eye most at risk for damage is the retina, the light-sensitive tissue that lines the back of the eye. Without treatment, retinal damage can lead to permanent blindness.

Signs of diabetic retinal disease (retinopathy) can be detected through a comprehensive dilated eye exam before symptoms occur and in time take action to prevent vision loss. Pupil dilation, or widening, is an important part of the exam because it allows a much better view of the retina. To diagnose diabetic eye disease while it is treatable, experts currently suggest that people with type 1 diabetes get an eye exam at least once a year starting three to five years after diagnosis.

Recent studies to find out whether the exam frequency could be tailored to individual risk, researchers analyzed 30 years of data from about 1,400 people with type 1 (insulin-dependent) diabetes. The study was funded mainly by NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIH’s National Eye Institute (NEI) and others also provided support. Results were published on April 20, 2017, in the New England Journal of Medicine.

 The researchers analyzed data from about 24,000 eye exams with retinal photography. The results enabled them to develop a model to predict the likelihood of an individual progressing to significant, vision-threatening retinopathy based on their current retina exam and blood glucose level.

The findings from the research gives pause to the current recommendation.  

The analysis showed that, among people with type 1 diabetes and recent blood glucose level near the normal range (as measured by an A1C level of 6%), those with no detectable retinal damage could be screened every four years. Those with mild retinal damage could be examined every three years without increasing the risk of vision loss. People with moderate or severe retinal damage, the researchers found, should be examined more often than the current recommendation: every six or three months, respectively. On average, this tailored schedule would result in fewer eye exams and earlier detection and treatment to save vision.  

Telemedicine offers more convenience with remote fundus photography performed in primary care physician offices using retinal fundus cameras connected to the internet, and having images read by a qualified ophthalmologist.

Individualized exam schedule for diabetic eye disease | National Institutes of Health (NIH)

Message Heard? Pain Med Prescribing Down Second Year in Row

Acetaminophen/hydrocodone, the opioid pain reliever commonly sold under the brand name Vicodin, was the most dispensed prescription medicine in 2007.

And 2008. And 2009. And every year after through 2013, according to the QuintilesIMS Institute, which tracks medicine use and spending.

Then, in 2014, this staple of the opioid abuse epidemic fell to second place behind levothyroxine, which treats hypothyroidism. By 2016, acetaminophen/hydrocodone was the fourth most prescribed drug in the nation, with the volume of prescriptions down 7.2% from 2015 and 34% from 2012.

This downhill story helps capture a trend for pain medications in general and the clinicians who prescribe them. The volume of dispensed prescriptions for all pain meds has decreased for 2 straight years now, falling 2.7% in 2015, and 1.7% in 2016, QuintilesIMS reports in its annual review of medicine use and spending, which was released today. Pain meds include both narcotic and non-narcotic analgesics as well as muscle relaxants and topical pain treatments.

The study attributes the decline to more controls placed on pain meds in response to the opioid abuse epidemic. These controls include more stringent prescribing guidelines in recent years, particularly a set issued for primary care in March 2016 by the Centers for Disease Control and Prevention (CDC). The CDC cautioned that opioids are not first-line therapy for chronic pain, and that clinicians initially should consider nonopioid pain relievers and nonmedicine options such as exercise and cognitive behavioral therapy. When clinicians do prescribe opioids, they should start patients off at the lowest dose possible and limit treatment for acute pain to no more than 7 days. In addition, clinicians should monitor patients to ensure the drugs are helping with pain and function without inflicting harm.

"The CDC guidelines have been very powerful in changing physician behavior because they've had a larger audience," said Steven Stanos, DO, president of the American Academy of Pain Medicine, in an interview with Medscape Medical News.

Message Heard? Pain Med Prescribing Down Second Year in Row

Senate bill expands the use of telehealth services, remote patient monitoring for Medicare Beneficiaries

6 senators of U.S. have launched legislation seeking to remove hurdles to the use of telehealth services and remote patient monitoring for Medicare beneficiaries.

“Telehealth is the future of healthcare. It expands access to care, lowers charges and assists more people stay healthy,” stated Schatz. “Our bipartisan bill will assist change the way sufferers get the care they need, improving the healthcare system for both patients and healthcare providers.”

The CONNECT for Health Act builds on the provisions of another recently launched Senate bill—the CHRONIC Care Act—which targets to improve health outcomes for Medicare beneficiaries living with chronic ailments by, among other provisions, expanding access to telehealth services.

For its part, the CONNECT for Health Act calls for:

• Expansion of telehealth services in accountable care organizations (ACOs) and Medicare Advantage, as well as for home dialysis and telestroke services for purposes of evaluating acute stroke
• Broadening the utilization of remote patient monitoring for certain high-risk, high-cost sufferers
• Bolstering telehealth services and remote patient monitoring services in rural health clinics, federally qualified health centers, Native American sites, and permitting global and bundled payments
• Developing direct authority for the Secretary of the Department of Health and Human Services to lift existing restrictions on telehealth when certain quality and cost-effectiveness criteria are met
• Expanding the utilization of telemental health by providing the HHS secretary the authority to lift restrictions for few mental health services

The legislation has been endorsed by more than 50 agencies, involving ACT|The App Association, American Telemedicine Association (ATA), College of Healthcare Information Management Executives and the Healthcare Information and Management Systems Society (HIMSS).

“The CONNECT for Health Act gives a carefully crafted approach to star assisting countless American Medicare recipients realize the benefits of connected health technology,” claimed Morgan Reed, executive director of The App Association. “By lifting arduous limitations on the use of telehealth and motivating Medicare physicians to use creative remote monitoring technologies, responsible and secure connected health solutions might be introduced more broadly throughout the continuum of care to make better the patient health outcomes.”

“Medicare beneficiaries deserve access to telehealth services already available within nearly every other health program involving Medicaid, Veterans Health, private insurance policies and most recently TRICARE,” stated Jonathan Linkous, CEO of the ATA. “This bill might be their best hope for this Congress.”

Likewise, HIMSS appreciated the bill and pledged their support for its reforms.

“We consider that the CONNECT for Health Act will modernize healthcare delivery for Medicare beneficiaries by removing obstacles to the use of telehealth and other healthcare technologies like remote patient monitoring, resulting in higher access to high-quality care, improved continuity of care and better value for sufferers and the Medicare program,” stated HIMSS in a written statement.

Telehealth promises to bring a sea-change to health care delivery and access.

Senate bill expands the use of telehealth services, remote patient monitoring for Medicare Beneficiaries

How to share preventative measures for Stroke Awareness Month

Stroke . Part II

How do you know if you or someone else is having a stroke ?  Much of it depends on the severity of a stroke.

A common warning may be a TIA (transient ischemic attack) This is short lived temporary slurring of speech or blindness, numbness, or even a loss of speech entirely.  This may last several seconds to several minutes, with a complete recovery.  A complete stroke may occur in minutes, hours, or days.

Stroke is not uncommon. Stroke is a medical emergency...call 911.  Do not attempt to drive to a hospital.

Being proactive and knowledgeable may save a life.

May is Stroke Awareness Month








How to share preventative measures for Stroke Awareness Month | Articles | Main

Free medical schools? | Arlen Meyers, MD, MBA |

Is it time to re-think the current model of medical school financing ?



The average undergraduate student debt has risen to $30,000. The average medical student debt is about $170,000. Minorities are underrepresented, many deem the selection process as flawed and the debt burden has an impact on specialty selection and geographic maldistribution, the ability to buy a house and start a family and many other downstream effects. The effects are magnified when one indebted medical student marries another medical student, particularly if they get divorced.

While many are advocating for medical student education reform, changing the business model is lower on the list. Meanwhile, all of this is happening in the face of headwinds created by a lack of basic research funding, meager legislative budgets for state supported schools and decreasing reimbursement for academic clinical services. Many are looking to philanthropreneurship or innovation centers to fill the gaps.


Philanthropy already fills some of the vacuum for private medical schools. Scholarship, and grants are made possible by wealthy individuals who are alumni leaving a legacy gift to their alma-mater.  However, this is a relatively small fraction of an incoming class.  Military or public health funding is available for those willing to devote 4 or 5 years to military service. The amount can extend also to post-graduate residency time.


At one time, small cities, otherwise lacking medical care would select a deserving student for a grant, with the promise of returning to their home to practice medicine.


In the UK some years in the past  college was free. Since that time things have changed and students were demonstrating in the streets and the liberal establishment was pushing back against charging students to attend universities.


A recent analysis of the effects of charging tuition in the UK has analyzed the results. There are lessons to be learned that might apply to the medical school funding business model. The authors conclude that "rather than looking to emulate the English model of the 1990s, the U.S. might instead consider emulating some key features of the modern English system that have helped moderate the impact of rising tuition, such as deferring all tuition fees until after graduation, increasing students’ ability to cover living expenses, and automatically enrolling all graduates in an income-contingent loan repayment system that minimizes both paperwork hassle and the risk of default. No model is without its challenges. But the English experience suggests that making college completely free is hardly the only path to increasing quantity, quality, and equity in higher education. Indeed, the story we tell here shows how a free system can sometimes work against these goals."



Medical education needs a makeover. Here are some principles of medical education reform:

1. Whatever we recommend should be aligned with the vision and mission of the institution. 2. Teaching hospitals are but a part of a community of care and their roles are being redefined not just in the areas of clinical care, but research and education as well . 3. The goal is to create graduates who can serve the needs of the community by improving population health, reducing per capita costs and improving the patient and provider experience.  4. Education and research are step children to clinical care. Just follow the money.   5. Education is different than training.  6. Management is different from leadership, entrepreneurship and innovation.  7. Terms like innovation, value and disruption are used often, with great passion, misinterpretation and misunderstanding.  8. Those that don't walk the talk can only come back to the well so many times.  9. Teaching is not easy or free, only considered by those who pay the bills to be so. 10. What, who, when,and how we teach and measure outcomes is insufficient, costly and badly in need of innovation.  11. Education needs to be responsive to the forces driving the 4th Industrial Revolution .  12. Students should be selected based on their Steampathie (thanks Thomas Friedman) .  13. The business model needs to change to conform to the realities of the environment . 14. We need to address student demands for non-clinical career development, like entrepreneurship, and alternative work-life arrangements other than full-time employment .  15. Learning objectives and curriculum should be driven, in part, by market based determinants including digital health, value based care, interprofessional learning, team based care and cultural competence.

New York has just established "free universities" . Maybe we can learn some things from our friends across the pond when it comes to medical school financing and loan repayment models. Or, we can just sell the assets to private equity. 

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs

Free medical schools? | Arlen Meyers, MD, MBA | Pulse | LinkedIn

Neuralink wants to wire your brain to the internet – what could possibly go wrong?

The next step in human evolution. Credit: Shutterstock

Neuralink – which is "developing ultra high bandwidth brain-machine interfaces to connect humans and computers" – is probably a bad idea. If you understand the science behind it, and that's what you wanted to hear, you can stop reading.

But this is an absurdly simple narrative to spin about Neuralink and an unhelpful attitude to have when it comes to understanding the role of technology in the world around us, and what we might do about it. It's easy to be cynical about everything Silicon Valley does, but sometimes it comes up with something so compelling, fascinating and confounding it cannot be dismissed; or embraced uncritically.

Putting aside the hyperbole and hand-wringing that usually follows announcements like this, Neuralink is a massive idea. It may fundamentally alter how we conceive of what it means to be human and how we communicate and interact with our fellow humans (and nonhumans). It might even represent the next step in human evolution.

Neurawhat?

But what exactly is Neuralink? If you have time to read a brilliant 36,400-word explainer by genius Tim Urban, then you can do so here. If you don't, Davide Valeriani has done an excellent summary right here on The Conversation. However, to borrow a few of Urban's words, NeuraLink is a "wizard hat for your brain".

Essentially, Neuralink is a company purchased by Elon Musk, the visionary-in-chief behind Tesla, Space X and Hyperloop. But it's the company's product that really matters. Neuralink is developing a "whole brain interface", essentially a network of tiny electrodes linked to your brain that the company envisions will allow us to communicate wirelessly with the world. It would enable us to share our thoughts, fears, hopes and anxieties without demeaning ourselves with written or spoken language.

 However, unlike Tesla and Space X, Neuralink operates in a field where there aren't any other major players – for now, at least. But Musk has now fired the starting gun for competitors and, as Urban observes, "an eventual neuro-revolution would disrupt almost every industry".

 But this is an absurdly simple narrative to spin about Neuralink and an unhelpful attitude to have when it comes to understanding the role of technology in the world around us, and what we might do about it. It's easy to be cynical about everything Silicon Valley does, but sometimes it comes up with something so compelling, fascinating and confounding it cannot be dismissed; or embraced uncritically.

More criticism of Neuralink

Antonio Relagado, senior editor for biomedicine for MIT Technology Review, isn’t too impressed with Elon Musk’s claims for Neuralink. In particular, he explains that the 8-10 year time line for the first available implants is absurd and impossible.

Let’s deal with Musk’s time line first. A brain implant is a medical device that requires neurosurgery. Proving that it works requires a stepwise series of experiments that each takes years, starting in rats or monkeys.

Here’s a time line from the real world: a company called NeuroPace was started in 1997 to develop an implant that controls epileptic seizures. It actually senses a seizure coming and zaps your brain to stop it. The device got approved in 2013—16 years later. And that was for a very serious medical condition in which brain surgery is common.

Putting an implant in healthy people? That would require extraordinary evidence of safety. And that’s hard to picture, because as soon as you open someone’s head you put that person’s life at risk. We at MIT Technology Review know of only one case of a healthy person getting a brain implant: a crazy stunt undertaken in Central America by a scientist trying to do research on himself. It caused life-threatening complications.

Musk doesn’t seem to be considering the ethical problems at all. It’s cool tech, but I wouldn’t let anyone stick wires in my brain unless it was to treat a serious medical problem with tested procedures.

So it’s not crazy to believe there could be some very interesting brain-computer interfaces in the future. But that future is not as close at hand as Musk would have you believe. One reason is that opening a person’s skull is not a trivial procedure. Another is that technology for safely recording from more than a hundred neurons at once—neural dust, neural lace, optical arrays that thread through your blood vessels—remains mostly at the blueprint stage.

So what facts am I missing? What makes it even remotely okay that Musk and Facebook are promising the public telepathy within a few short years?

We criticize religions for making false promises without evidence; we imprison people for bilking people out of money on false pretenses; so yes, I agree, why do we give billionaire industrialists a pass when they make secular claims that don’t stand a chance in hell of coming true, and when they do it on behalf of profit-making companies?

  


Neuralink wants to wire your brain to the internet – what could possibly go wrong?