GDP-Based Productivity in Ambulatory Healthcare: A Comparison with other Industry Segments, 1998-2005

Few studies have focused on productivity in healthcare, let alone in ambulatory healthcare. Measurement of productivity in various healthcare segments has generally shown that productivity has either decreased (over some time period) or has increased more slowly than in other industry segments. This study shows that labor productivity has increased in ambulatory healthcare between 1998 and 2005 (by ~24%), but that capital efficiency has not changed over that time period. The study compared this result with the same measurements in the auto and information industry segments (as defined by the Bureau of Economic Analysis) and found that labor productivity gains were highest in the information industry (34%) and lowest in auto (6%), and that capital efficiency increased 8% in the information industry but decreased 7% in auto. The study also found a strong linkage between changes in gross domestic product components for value-added and gross output and both labor and capital inputs in ambulatory healthcare. This linkage was not found in either of the other two industry segments investigated. This linkage implies that labor and capital input account for close to all of the productivity gains measured in ambulatory healthcare, but that other factors, such as labor quality, work process and structural reorganization, research and development investment and adoption of new technologies are not affecting this gain in productivity the way they may be in auto and the information industry. This result implies that addressing these factors may increase productivity in ambulatory healthcare even more than has been the case from labor and capital input increases

DRAFT Model Brokerage: Concepts & A Proposal

Effective & efficient utilization of models is essential for facilitating high productivity in many different types of organizations. If models could be shared across technical, temporal & organizational boundaries, much higher productivity could be realized. This would also be true if models could be combined in effective ways. This work presents a result from model theory showing that for complex models, a small number of axioms (true statements of the models contents) can be used as a representation of the entire model. An analogy with multivariate analysis shows that this small set of axioms can be shown to contain the majority of the information in the model. The implication is that much simpler models could be used for descriptive & predictive analysis, making these processes easier to compute & to understand

Deployment of Analytics into the Healthcare Safety Net: Lessons Learned & Unlearned

In October of 2013, I made a proposal to the RCHN Community Health Foundation to start a project that would deploy a contemporary analytic software capability into community health centers that volunteered for the project & to work with their IT & executive staffs so that the capability could be productively used as part of how the health center made strategic decisions . I wrote at the time: “Everyone agrees that “analytics” are/will be important for community health centers as they evolve to new organizational (participants HIEs, ACOs, HCCNs etc.) & sustainability (service providers, data providers) models. What this means & how to do it are hotly discussed topics, however, with no apparent tactic or strategy that seems feasible. There is no big bang in this effort. This capability will not spring forth complete & productive if health centers make the correct invocation or even spend a large amount of money. This memo specifies a program that would pilot an actual path for health centers (& other healthcare organizations with limited resources) to follow to begin to productively use analytics & to evolve a more & more effective capability in this area.” I also wrote that: “Complex analytics, multi-layered analytics and highly designed data warehouses are not necessary, and moreover, not appropriate if the questions that are asked aren’t relevant or don’t require them and the underlying data isn’t complete and reliable." That was just over two years ago. What happened with the project & what is going on with it now? What lessons have been learned? What lessons did we already know but needed to have reinforced by painful experience? Here is a project update

A Comparison of GDP-Based Productivity in Ambulatory & Inpatient Healthcare: 1998-2005

A comparison of GDP-based productivity in the ambulatory and inpatient (hospitals and residential treatment centers) healthcare segments shows that labor productivity, measured as GDP dollar contribution per compensation dollars, hours worked and full-time equivalent employees was strong in both actual value and in per cent gain (1998-2005). The actual values were higher in ambulatory with GDP contribution per hours worked ranging from $0.04-$0.06 (24% gain), per dollar of compensation ranging from $1.41 to$1.48 (4% gain) and per FTE from $71,000 to$94,000 (25% gain) as opposed to $0.02 to$0.03 (3% gain), $1.10 to$1.13 (3% gain) and $38,000 to$52,000 (42% gain) for inpatient healthcare. In contrast, capital efficiency was static for both segments over this period indicating that the use of capital was ineffective. Total Factor Productivity (TFP) was also calculated and showed a similar pattern with ambulatory healthcare having higher TFP throughout the period, but neither healthcare segment showing any gain (or loss) in TFP. The two segments have different profiles for the factors influencing TFP with inpatient healthcare having made both some R&D and substantial technology investments, mainly in medical devices. Neither segment has made large organizational or work process changes, and it appears that substantial, additional productivity gains could be made as these factors, R&D investment, technology acquisition and adoption, work process and organizational redesign, are emphasized

Patient access to complex chronic disease records on the internet

Background: Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine) available to patients over the Internet in a project involving more than half of renal units in the UK. Methods: Content and presentation of the Renal PatientView (RPV) system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrolments and usage were extracted from the webserver. Results: By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (<10 to >90 yrs) but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling. Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enrol each patient. Conclusions: Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular, providing an increased sense of empowerment and understanding, with no serious identified negative consequences. Security concerns were present but rarely prevented participation. These are powerful reasons to make this type of access more widely available

The role of dedicated instrumentation in total hip arthroplasty

Tissue-sparing surgery is a surgical strategy aimed to reduce tissue damage in joint replacement. This can be achieved by reducing soft tissue trauma, performing minimally invasive access routes and limiting bone removal with implantation of conservative prostheses. In order to facilitate mini-approaches, special instrumentation was developed to avoid impingement of the soft tissues and provide an easier and more correct placement of the components. We performed an analysis of the literature and a research of the instrumentation available today, to evaluate the actual utility of dedicated tools

Do Electronic Health Records Help or Hinder Medical Education?

Many countries worldwide are digitizing patients' medical records. What impact will these electronic health records have upon medical education? This debate examines the threats and opportunities