The Takeaways: Week 29 of 2022

A periodic review of articles and newsletters that I found interesting, inspiring, or otherwise worth remembering.

Newsletters

Brendan Keeler, Health API Guy. Amazon and the Presumption of Guilt (July 24, 2022)

Amazoncare is a connection of a live Carequality Implementer (Particle Health), which means that it can already pull records from any and all EHRs live on that network (as well as the connected Commonwell and eHealth Exchange networks) for the purpose of use of treatment. These networks equate to roughly 75% of the US population and include all healthcare organizations that use the largest EHRs: Epic, Cerner, Meditech, athenahealth, Nextgen, PointClickCare, and more.

If Amazon was interested in brazenly aggregating patient data in violation of the law, they certainly don’t need the 767,000 members of One Medical. They can, today, already pull a much broader dataset with deeper insights (such as inpatient stays and specialty care) whenever they want.

Ami Vora, The Hard Parts of Growth. Build leaders faster — share the ambiguity (July 20, 2022)

Navigating through ambiguity is one of the most important leadership skills in any changing industry. For my team to be successful, they need to feel confident making great decisions based on new information.

Figuring out how to share this kind of ambiguity with people was hard. A mental shortcut I’ve found is to treat everyone around me, regardless of level or experience, with the same transparency I’d offer my peers.

This openness can be jarring at first. The first time I shared some unexpected data trends with a new colleague, they told me, “I wish you hadn’t shared that info with me. Now I’m not sure I’m spending time on the right goals.” I worried I’d upset them for no reason. Imagine how thrilled and relieved I was when that person came back a week later, thanked me for being open, and shared that they had some new ideas on how to respond to the change if it persisted.

Articles

Alex Chan. You should take more screenshots (July 23, 2022)

Digital files exist in a context: they rely on particular hardware and software to be useful. The more time passes, the harder a context is to replicate. It is possible to emulate older systems, but it’s requires a lot of time and expertise; more than I’m going to spend for the sake of nostalgia.

The best time to take these screenshots is as I’m doing the work – when I have all the required context. And unlike the raw files, images are a stable format that I’ll be able to read for a very long time. I don’t need any context to look at an image; I just look at it in an image viewer.

Kate Jennings, Forbes. An Autism Therapy Company Abruptly Cuts Off Care To Children As It Lays Off Staff (July 21, 2022)

Elemy offers a combination of in-person and virtual therapy called applied behavioral analysis for its autism patients, delivered by two people: a board-certified behavior analyst who virtually devises a care plan and a registered behavior technician who goes to the child’s home to work with them in-person to implement it. In May, the company’s services were accredited by the Behavioral Health Center of Excellence.

For [Lisa] Rudisel and her son, the technician came to their house daily, while the analyst joined by video to check progress and recommend different interventions. The therapy, which relies on repetition to reinforce skills, was covered by their health insurance plan. For example, her son struggled with eating new foods, so they created a system where he would get “tokens” for taking bites of them. Those tokens would then earn him rewards like playing with an iPad. Rudisel says her son was making progress and had developed a special bond with his technician after working together for a year.

That made the abrupt shutdown of in-person services all the worse for her son. In the initial email, Elemy promised a “smooth transition,” which would include a list of other local providers and a copy of the child’s discharge report. In a follow-up email sent this week, Elemy said families can continue to get “ongoing clinical support” virtually from a behavior analyst, which will be “free of charge” until the end of the year or when a family finds a new provider. The email also said a virtual “family support team” would offer assistance finding and calling new providers. Rudisel was skeptical. “If we are not doing applied behavior analysis in my home, it does not help us,” she says.

Sharon Jhawar, Romilla Batra, Matthew Dinh, Eve Gelb, Timshel Tarbet, and Sachin H. Jain, Harvard Business Review. How One Health Plan Reduced Disparities in Medication Adherence (July 11, 2022)

But we didn’t just look outward for answers. We also held listening sessions with our Black and Hispanic pharmacy employees. Not only are they accustomed to discussing medications with members, they also brought a wide range of lived experience to the topic.

In all of these listening and interview sessions, we learned a number of things. Non-adherent members often didn’t know which prescriptions benefits we offered that they could tap into. They often trusted nurses more than doctors. They had difficulty understanding providers who spoke English too rapidly or couldn’t answer questions in their native languages. Their cultural philosophy toward health care put more emphasis on herbal treatments than medications. They had trouble getting transportation to their local pharmacy. And, most commonly, they simply did not understand what their prescribed medications were or how they would help improve their conditions.

Amanda Morris, The New York Times. For Blind Internet Users, the Fix Can Be Worse Than the Flaws (July 13, 2022)

Patrick Perdue, a radio enthusiast who is blind, regularly shopped for equipment through the website of Ham Radio Outlet. The website’s code allowed him to easily move through the sections of each page with his keyboard, his screen reader speaking the text.

That all changed when the store started using an automated accessibility tool, often called an accessibility overlay, that is created and sold by the company accessiBe. Suddenly, the site became too difficult for Mr. Perdue to navigate. The accessiBe overlay introduced code that was supposed to fix any original coding errors and add more accessible features. But it reformatted the page, and some widgets — such as the checkout and shopping cart buttons — were hidden from Mr. Perdue’s screen reader. Labels for images and buttons were coded incorrectly. He could no longer find the site’s search box or the headers he needed to navigate each section of the page, he said.

Molly White. Stop saying "They shouldn't have invested more than they could afford to lose" (July 22, 2022)

It’s apparently easy for some people to castigate those who’ve just lost everything by repeating this refrain, in the same way it seems to be easy for some people to only start pointing out the “obvious Ponzi” or “clear scam” projects only after everything crumbles. And it’s tempting, to those steeped in crypto, because it serves to place the blame with the individual, rather than with the platform, the particular segment of crypto that failed, or—God forbid—with crypto and its culture as a whole.

Doing this only excuses the messaging that we have been seeing everywhere we look—in crypto media but also in supposedly reputable news publications, in advertising, on social media and from influencers, and certainly from crypto companies themselves—that crypto is an “investment”, or the future of money, or the democratized version of finance that will finally give the average person a fair shake.