Roji Intel Blog

Robert McNutt, M.D. 0
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Future of Health CareMedical Decision-MakingPatient EmpowermentResearch
February 21, 2017

For Patients, “Trust Me” Is No Longer Good Enough for Medical Decision-Making

It’s time to rethink ideologies of medical care that no longer make sense. The following may sound revolutionary, but are nonetheless true: Patients are the future leaders in medical care. Patients must and can make their own medical decisions after being informed. Patients can and must learn to discern useless from useful information. Science must improve to match the increasing abilities of patients. At present, none of these concepts are fully embraced by the business of medicine and, in fact, may be a 180-degree reversal from the way things work now. So, why are these statements important? Because getting the…
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Robert McNutt, M.D. 0
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Registry ScienceResearch
November 15, 2016

Bedside Viewpoint: Why Watson Will Never Know Enough to Replace Your Physician

Every conversation with a patient is an exercise in big data analysis. Your patient’s appearance, changes in mood and expression, and eye contact are data points. The illness narrative is rich in semiotics: pacing, timing, nuances of speech and dialect are influenced by context, background and insight, which, in turn, reflect religion, education, literacy, numeracy, life experiences and peer input. To all this, add personality traits such as recalcitrance, acceptance and personal philosophies. Taking a history generates a wealth of data. Mix in physical findings of variable reliability, laboratory markers of variable specificity, imaging bits and bytes, and you have…
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Robert McNutt, M.D. 0
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Performance ImprovementPersonalized MedicinePopulation HealthRegistry ScienceResearch
August 30, 2016

Personalized Medicine v Population Health: Opposites or Complements?

If personalized medical care is the goal, how does that fit with the concept of “population health,” the darling of the health care industry’s drive toward better results and lower costs? Are these two concepts really at odds, or do they work in tandem? This is not a rhetorical question; in the current environment of keeping costs under control, lives are at stake. How Personalized Medicine Should Work We know that best outcomes occur when individuals are appropriately assessed and allowed to make choices based on their personal characteristics. Personalized medicine is not a concept of averages; it is a…
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Robert McNutt, M.D. 0
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Future of Health CarePersonalized MedicineRegistry ScienceResearch
August 9, 2016

Personalized Medicine Can’t Wait for Genomic Data

Personalized medicine is off and running. The effort to enroll one million people who will volunteer their genomes for science by the year 2019 kicked off recently with an event featuring President Obama that included more than 150 of the first volunteers. But this effort is not for my patient. It will be either too little, or too late, and certainly not enough. While personalized medicine is an old concept, the new push for personalization focuses on genes or gene products. These, it is hoped, may be better predictors of an individual’s outcome of a disease condition. The new efforts may…
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Robert McNutt, M.D. 0
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Clinical Data RegistryRegistry ScienceResearch
April 19, 2016

Does Data Say All You Need to Improve Health Care Performance?

Can data lie? In a word, yes. The answer also depends on whom you ask. That goes for all forms of data analysis, including how we evaluate health care. This presents a tough dilemma for providers, patients and other stakeholders at a time when the industry and government are heavily invested in using data to compare provider performance, attach payment to “good” providers and penalties for the others. The fact is that the health care data “revolution” is in its infancy, and it is not so easy to identify two key facts: what causes outcomes, and what fixes them. Situations…
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Robert McNutt, M.D. 0
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Clinical Data RegistryFuture of Health CareMedical Decision-MakingPerformance ImprovementRegistry ScienceResearchValue-Based Health Care
March 1, 2016

First, Ask Questions: How to Harness CDR Data for Better Patient Outcomes

As more and better clinical data becomes available and demand grows for better outcomes, the Clinical Data Registry is positioned to fulfill the role of data manager—a vital mechanism for improving care. The CDR is the engine driving a smoothly running system toward better outcomes. This involves much more than data collection. A high quality management function for CDR data requires making inferences from the data it collects. But drawing inferences from present data sources presents significant challenges, no matter how big the data source. As a medical journal editor, I have reviewed many papers from countries with massive data…
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Robert McNutt, M.D. 0
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Clinical Data RegistryFuture of Health CarePerformance ImprovementRegistry ScienceResearch
January 19, 2016

The CDR Advantage: Why Registry Research Minimizes Study Bias for Performance Improvement

The Clinical Data Registry is a powerful research tool for improving patient health. But what makes Registry-based study design better than pre-post study design? The answer has far-reaching implications for how we will use data to determine treatment effectiveness in the future, as well as how we will meet the challenge of improving health outcomes. Research can be built on the case-control study, observational study designs, N-of-1 study designs, randomized trials or the N-of-1 population study. Most of these approaches—except those facilitated by a Registry—will be limited by small patient samples due to the patient selection process. But that’s a…
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Robert McNutt, M.D. 0
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Future of Health CarePerformance ImprovementRegistry ScienceResearch
October 27, 2015

How to Harness Clinical Data Registry Power to Improve Outcomes

At the center of Medicare’s Value-Based Health Care, the Clinical Data Registry (CDR) is introducing new possibilities for outcomes improvement. Under this month’s final rules, Medicare expanded the role of Specialized Registry and Clinical Data Registry reporting in its future Meaningful Use program. Specifically, CMS initiated provider reporting to a “Specialized Registry” in 2015 as an option to meet Stage 2 requirements, while establishing the CDR as the future avenue for capturing outcome data over time. The question now is: How can we use a CDR to improve patient health? Some providers may “check the box” on Meaningful Use objectives…
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Robert McNutt, M.D. 0
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Registry ScienceResearch
July 21, 2015

Are You Measuring Effectiveness of Your ACO’s Population Health Interventions?

It’s time to reboot your method of deploying population health initiatives, if you really want a return from your ACO efforts. Despite the intense focus on data and analytics in health care, most start-up ACOs adopt identical population health initiatives, such as intensive case management for high cost patients. The choice is not made because of proven outcomes and lowered costs from these initiatives, but because everyone else is doing the same thing. It’s ironic that we adopt evidence-based performance measures, but rely on anecdotal results in population health. With a research-capable Registry and reliable data, we can be smarter…
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Robert McNutt, M.D. 0
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Population HealthRegistry ScienceResearch
February 24, 2015

Population Health: What Should It Really Mean?

A long time ago, on my first day of an Oncology fellowship, my soon-to-be-mentors asked me if I had a research interest. “Yes,” I said, “I want to cure breast cancer.” Their kind smiles belied their recognition of my naïveté. In retrospect, thinking too broadly leaves one adrift. To navigate to your goal, you need to chart a specific, systematic course. Talking without specificity about “population health” can lead to thinking as murky as my claim to cure breast cancer. Population health is sometimes defined so broadly that it becomes meaningless.  Unfortunately, population health has also become synonymous, for some people, with…
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