RWL #194
telemedicine, hospital at home, AI, newsletters, and more!
Greetings from the University of New Hampshire! We are chugging along through the semester here. The students are doing a great job being compliant with the social distancing requirements. I’ve had a few self-quarantine, but no one has gotten sick, which is great.
Picture above is from me in my office working for the first time since before spring break, more than six months ago. I’ve run through a few times to get books or files, but I had not stayed and worked. We had a repair person coming to the house, and I needed to record some audio, so I decided to go in because I knew it would be quiet. It made me sad. I felt like I was some sort of intruder, trespassing. I really miss my office and having the casual hallway chats with my colleagues. I am not the “yay, I can work from home” type. If I lost my office, but I could still go to a coffee shop or someplace like that, it wouldn’t be so bad, but even that has been taken away. I’m ready for this to be over. Sadly, it won’t be over any time soon, I am afraid. I really feel badly for the parents of small children. I can’t even imagine.
Anyway, thanks to those of you who took the time to fill out the survey last week. Here’s a link to the results: https://drive.google.com/file/d/1TS7MucsAeZ5XFMd2q8ix9gmvvIIkLDBf/view?usp=sharing
A few of you said you would like some sort of searchable archive. I’ll think on that. In the meantime, I can provide you read access to my Google Drive folder where I keep all of my drafts. This should be searchable. I started composing my drafts in Google Docs around RWL 108, so there are 86 newsletters available in the folder. The folder is here: https://drive.google.com/drive/folders/1jwGLdjsb1WKtgH_2C-_3VvrYCtqLplFO?usp=sharing
Stay well and stay safe.
Read
What: Concord Monitor, As The Dust Settles, Looking At Telehealth Post-Pandemic
https://www.concordmonitor.com/Granite-State-News-Collaborative-36330444
Why: Nice article about telehealth in the Concord Monitor (one of our local papers). I have been on a task force for a couple of years here at UNH trying to develop a center to study and promote telehealth. Pre-COVID it was a really great tool to increase convenience of access, especially in a mostly rural state like NH. Now it's a matter of safety. But it really just makes so much sense regardless of whether you are rural or not, under contagious disease conditions or not. I’m eager to have my provider embrace telehealth.
*
What: FastCompany, The $1 trillion quest to bring hospital care to your home
https://www.fastcompany.com/90546914/the-1-trillion-quest-to-bring-hospital-care-to-your-home
Why: I take issue with the article’s assertion that 68% of a hospital’s costs are to cover “brick and mortar overhead.” You can look at an income statement for pretty much any hospital and see that isn’t true, so I’m not sure where that number is coming from. But setting that aside, there are some costs that could be squeezed out if more care was given outside of the hospital. Maybe. There would be some fixed costs - the hospital would have to have mobile equipment - and there would be more variable costs - especially more people to move the equipment around. More important than cost is the experience, and maybe improved safety. Hospitals are dangerous places that provide opportunities for superbugs and other hospital-acquired infections (nosocomial infections). From the article: “The largest meta analysis, which is a look at all of the studies on hospital at home, suggests that hospital at home reduces costs by 25%, reduces readmission by 25%, and, the really fun part for me, it reduces mortality by 20%.”
As with telehealth, the main problem to widespread adoption of hospital at home is the government being slow to accept the delivery modality: “But the hospital at home model still has one main hurdle: reimbursement from Medicare and Medicaid.”
I think this is an exciting innovation. Unfortunately our commitment to fee for service, and in particular government managed insurance, is slowing down all sorts of innovations like telehealth and hospital at home.
*
What: MIT Ideas that Matter, Why restrictive immigration may be bad for U.S. entrepreneurship
Why: Immigrants are good for the US economy. Here’s one more argument: “Immigrants thus exhibit a 80% higher entrance rate into entrepreneurship. Moreover, immigrants start more firms of every size. They do not just start many small firms, but produce a firm size distribution that looks very similar to native-born entrepreneurs.” Entrepreneurship is where the dynamism of the American economy comes from. It’s not the big firms that you hear about, it’s the little firms running between the ankles of the big firms, biting them from time to time. We need to do whatever we can to increase the number of those ankle-biters, whether that is making business formation easier, or allowing more immigrants into the country.
*
Watch
What: Marc Talluto, TEDxIWU, The Terminator, SkyNet and Alexa: The Present and Future of A.I.
Why: This is a nice presentation on AI and Big Data. Talluto provides lots of interesting examples of what is currently being done with AI and where it is going. Big Data refers to the piles of data that we don’t know how to process and relate. The Internet of Things (IOT) is feeding these piles. Data is being collected from simple things - sensors in our various technologies - like FitBits and smart refrigerators. What is important is aggregation over time - the patterns you leave in the piles of data. Aggregating these patterns allows companies and governments to monitor and control you. What makes AI powerful is its ability to process through these huge piles of data, learning to ask questions we didn’t even know we wanted answers to.
The medical field is “awash in data” according to Talluto. Computers have the ability to scan for skin cancer with a 90% accuracy - better than any human doctor. More importantly, better than the median human doctor - which means you could replace half of the doctors doing this kind of diagnostic work and humanity would be better off (not so much the low end doctors).
This is the 4th Industrial Revolution. The potential is incredible, but the risk is we will create these programs and we won’t understand what they are doing.
*
Listen
What: A16z Podcast, So You Want to Launch a Newsletter: Tips From Writers
https://www.evernote.com/shard/s434/nl/190056673/b9c8d47d-bf9b-4f0e-b2a4-1ab55d2dc80a/
Why: Cool podcast on starting a newsletter using Substack. I will be migrating over to Substack ( https://substack.com/ ) from TinyLetter soon. I still have to finish some of the set up, but I already like the site better. I thought I’d include this link in case any of you have thought about giving this a try.
A little history lesson - this newsletter was sort of an accident. Back in 2016 I was assigned as the advisor to our class of 2019. I decided after their freshman year that, as rising healthcare professionals, they needed to stay in touch with their major over the summer. So I started writing them a weekly e-mail with things I thought they might find interesting and helpful for their development. The first letter I composed happened to have an article (read), a video (watch), and a podcast (listen). After I sent it, I thought, huh, that's actually kind of cool. It sort of hits all the different kinds of learners. So I adopted that format for future messages. I kept on sending the e-mails over the summer, and toward the end of the summer I heard about a free service called "TinyLetter" (http://tinyletter.com) that enabled you to write a newsletter that people could subscribe (or unsubscribe) to with a click. So I initially kept sending the e-mails to my advisees while also sending my TinyLetter-based newsletter. When fall came around, I told my advisees they could subscribe to the TinyLetter version, which by then had about 30 followers, but I would stop sending them the e-mail. As you might imagine, sophomores are actually not that interested in getting a newsletter from their professor, but I had some former grad students and colleagues who were interested (the 30). So since fall of 2016, I've accumulated more than 200 subscribers.
After four years of doing this, I still enjoy doing this. This newsletter is an extension of my classroom to me. But people write newsletters for all sorts of reasons. I’m providing this note as inform
TinyLetter has been great for me. It's pretty intuitive, and it's free. However, after testing Substack, I think it has a bit more functionality and I like it. So I’ll be moving the newsletter there.
If you decide to start a newsletter, or are interested in starting one, let me know. I’ll check your newsletter out.
*
What: The President’s Inbox, Pushing Back Against Beijing, With Aaron L. Friedberg
https://thepresidentsinbox.podbean.com/e/pushing-back-against-beijing-with-aaron-l-friedberg/
Why: Excellent interview discussing how the US and West should be dealing with China’s CCP. The CCP agenda is not just to “rise”, but to dominate its region and have all of the countries around it subordinated to it. It seems we should have learned that lesson from the “rise” of the Soviet Union. This is not just China bashing. Friedberg has some excellent insights into both military and economic steps we should be taking to protect our interests in the region, as well as protecting our allies. He has some good points about how the Chinese military has innovated to reduce the effectiveness of our power projection platforms without having spent excessive resources. It’s time, he asserts, for us to make them spend hard if they want to continue to move toward denial of access.
Why of interest to healthcare leaders? First of all, COVID should have reminded us all of our supply chains. China wants to control supply chains and be able to use them to impose their political will and authoritarian rule not only on their own people but the countries around them. This is a matter of real social justice, and could have direct impacts on our domestic well-being.
Thanks for reading and see you next week! If you come across any interesting stories, won't you send them my way? I'd love to hear what you think of these suggestions, and I'd love to get suggestions from you. Feel free to drop me a line at mark.bonica@unh.edu , or you can tweet to me at @mbonica .
Also, if you find these links interesting, won’t you tell a friend? They can subscribe here: https://tinyletter.com/markbonica
See you next Friday!
Mark
Mark J. Bonica, Ph.D., MBA, MS
Assistant Professor
Department of Health Management and Policy
University of New Hampshire
(603) 862-0598
mark.bonica@unh.edu
Health Leader Forge Podcast: http://healthleaderforge.org
'It is the small things, everyday deeds of ordinary folk, that keep the darkness at bay. Simple acts of kindness and love.' - Gandalf (The Hobbit: An Unexpected Journey)