Why your doctors should be working together and why patients shouldn’t have to integrate the data themselves.

Eleven years ago, my Mom passed away from MSA – Multiple system atrophy.

Multiple-system atrophy (MSA) is a neurological disorder associated with the degeneration of nerve cells in specific areas of the brain. This cell degeneration causes problems with movement, balance, and other autonomic functions of the body such as bladder control or blood-pressure regulation. The cause of MSA is unknown.

As the disease progresses three groups of symptoms predominate. These are:

  1. Parkinsonism (slow, stiff movement, writing becomes small and spidery)
  2. Cerebellar dysfunction (difficulty coordinating movement and balance)
  3. Autonomic dysfunction (impaired automatic body functions) including: postural or orthostatic hypotension, resulting in dizziness or fainting upon standing up, urinary incontinence or urinary retention, constipation, vocal cord paralysis,dry mouth and skin, sleep disorders and sleep apnea.

There is no remission from MSA and the average lifespan after onset of symptoms is 7.9 years. Source: http://en.wikipedia.org/wiki/Multiple_system_atrophy

My Mom passed away after 7 years so she was right inside the norm. Unlike Parkinson’s patients, MSA patients do not experience dementia or degeneration of cognitive abilities, they are clear to the end as their body fails them and they cannot talk or swallow as their caregiver and family are busy with multiple healthcare providers.

A typical MSA patient will see a neurologist, physiotherapist, speech therapist, dietician and social worker or psychologist – sleep disorders is a nice way of saying that MSA patients may have terrible nightmares and sleep apnea a nice way of saying that they may die in their sleep from choking. If the patient has heart issues (my Mom had CHF – congestive heart failure also), there will be cardiologists involved – not to mention hospital visits if the situation gets problematic.

In Israel, unlike some countries in Europe (I believe, Norway and Germany are good examples), the different physicians don’t work together in a single integrated clinical care team that collaborate with each other.

The caregiver and patient’s family have to coordinate and integrate the treatment plans between the different healthcare providers – essentially integrating the planning, execution and data collection themselves.

Clearly, this is a bad  situation that leads to mistakes, high costs and a great deal of friction in the patient’s family.

Collaborative medicine, where the doctors and nurses and physiotherapists work together in a team, coordinate and integrate a single treatment plan and integrate the data collection reduces life-threatening mistakes, saves costs and enables the clinical care team to focus on what it knows best – on therapeutic issues and the family and caregiver to focus on what it knows best – namely the patients’ personal experience: did they fall, did they have nightmares, did they take their Dopicar on time etc.

The border town of McAllen, Texas is one of the poorest counties in the US. McAllen also has one of the most expensive health care systems in the country, second only to Miami. In 2006, Medicare spent $15,000 per enrollee here, twice the national average. Despite the poverty, McAllen offers gleaming modern medical facilities. But health outcomes are relatively poor, compared even to nearby El Paso with similar demographics.

McAllen healthcare providers over-treat and under-prevent.

Doctors order lots of tests and treatments, while failing to encourage simple prevention, like monitoring of sugar levels with diabetic people. More surgical procedures means more risk, and worse outcomes. Motivation for over-treatment is financial, doctors make more as they build up busier practices and private clinics.

On the other hand, places like the Mayo Clinic provide world-class treatment at costs well below the US national average even though they are located in high cost locations. Doctors work in treatment teams, sharing data and equipment, tackling common problems like error prevention, and sometimes sharing reimbursements. At Mayo in particular, where doctors are on salary, whole teams of doctors evaluate patients.

Collaborative teams are good for patients and they also make good business – reducing costs and reducing error rates of mistreatment. Reduced error (especially in the US) reduces the number of malpractice suits – a cost saver for the health provider.

In collaborative medicine, there is a profit motive in prevention by using a different busines model. Instead of charging per transaction, charge for a fixed monthly retainer, like a gym membership or legal retainer. With a fixed monthly retainer instead of a transaction model, reduced costs in collaborative medicine drive up profitability and push the healthcare provider to keep patients health and out of the office.

If you or one of your loved ones has MSA, the prognosis is not good, but with a collaborative team model, at least you know that you will be getting the best quality care and your doctors will know that they are a) doing a good thing and b) saving costs for their healthcare organization.

We have the technology today with private social networking for healthcare to provide a secure and private service and create virtual teams, even if the doctors are not in a single facility like the Mayo clinic.   In the the private social network for healthcare, the team shares data, provides medical guidance to patients, patients provide data on their personal experiences to the team, reducing costs, reducing running around and improving healthcare outcomes.

Compassion, quality and reduced costs are a good thing, no?



Danny Lieberman is the authority in applying threat analysis to Governance, Risk, and Compliance (GRC) in healthcare. He is a sought-after speaker, prolific blogger on healthcare technology, and advisor on software security and privacy compliance issues to healthcare and medical device vendors. He is passionate about Pathcare: the private social network for a doctor and her patients. Danny is a solid-state physicist by training, professional programmer by vocation and avid amateur saxophonist and biker.

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