Editor Discusses Most Promising Initiatives in Medicine

Having attended the National Patient Safety Foundation (NPSF) annual meeting this month as well as HPSN and AUA and having listened to many excellent speakers and dedicated professionals discuss what is happening in medicine as well as daily readings of journals , blogs and other media sources it is evident there is a great deal going on worldwide to “fix” medicine; initiatives ranging from the 20 year old patient safety movement to the documented shortage of trained healthcare providers; to how to better train medical students. The following will highlight what seem to be the most promising ventures and initiatives.

In a global study published in 2013 in BMJ Quality & Safety, Dr Ashish K. Jha, Department of Health Policy & Management, Harvard School of Public Health, and others, reviewed literature published worldwide since 1976 and found that an estimated 421 million hospitalizations occur annually, and approximately 42.7 million adverse events. These adverse events result in 23 million disability-adjusted life years (DALYs) lost per year. Approximately two-thirds of all adverse events, and the DALYs lost from them, occurred in low-income and middle-income countries. However, these findings suggest the importance of critically evaluating the quality and safety of the care provided once a person accesses health services. The data should be a call to global health policymakers to make patient safety an international priority.

WHO’s prominent initiatives include the ‘Safer Surgery Saves Lives’ campaign, which documented the global volume of surgery and gaps in operating room supply and pioneered a simple checklist to improve intraoperative safety. Other efforts include tools for patient safety research and quality improvement and a consensus conference to develop international core competencies for patient safety research.

The global problem of inadequate health care and the set of causes that underlie it, motivated Dr. Jha and others at Harvard to start an online course to focus on global healthcare quality and safety. The MOOC (Massive Open Online Course) uses data as a key cornerstone for the project. They were able to assemble a world-class faculty and because it was a new course they had the freedom to write a fresh syllabus specifically for online learners, consisting of conversations on pressing topics; interactive sessions where students create content and experts dialoging, answering questions and discussing issues.

Through this course they will “crowd source the first global ‘atlas’ on healthcare quality and have a resource that will map the world’s journey toward a safe patient centered healthcare system.” Dr. Jha predicts.

The Association of American Medical Colleges estimates that the United States will face a shortage of 130,000 physicians during the coming decade. This projected shortage, coupled with the nursing shortage, which has been recognized by governments, academia and health organizations, could mean limited access to care for many worldwide.

In a study conducted by Rand, a non-profit research organization in the United States, they suggested using different models of care to lessen the effects of the doctor shortage. One model uses nurse practitioners and physician assistants to provide primary care and the other was patient centered medical homes. Both models are being used in the US but account for less than 20% of providers.

For these models to grow there will have to be widespread changes in policy, state licensing laws as well as fee structures and payment and reimbursement regulations.

Shiv M. Gaglani and Ryan Haynes wrote a fascinating article in the Annals of Internal Medicine entitled ‘What Can Medical Education Learn from Facebook and Netflix?’ The medical students chose the title because they realized the algorithms they were using in medical school were much less sophisticated than the ones being used by Amazon, Netflix and Facebook. They hypothesized that if the same tools being used by these social media sites, such as machine learning-based recommendations, intuitive interfaces, etc. were used in medical education they could transform how medical students and other healthcare providers are educated.

An example they used was how Amazon recommends products based on prior purchases. They felt supplementary resources in medical education such as videos, references, images, mnemonics and even patient cases could be used to supplement what students are learning in the classroom or clinic.

That is the premise behind  Osmosis, Shiv and Ryan’s start-up company. Osmosis uses data analytics and machine learning to deliver the best medical content to those trying to learn it, as efficiently as possible. Since its launch the company has delivered over two million questions to more than 10,000 medical students around the world using a novel push notification system that syncs to student curricular schedules.

The program uses adaptive algorithms and an intuitive interface to provide the best, most useful customized content to those trying to learn.