Saturday, September 30, 2006

LifeKey - A Universal Portable Electronic Health Record

LifeKey - A Universal Portable Electronic Health Record: "Simply put, LifeKey is a medical device that will allow you to carry your entire medical history with you on your keychain, in your purse, in your wallet or in your pocket. Your medical records are stored in PDF format (the most universally accepted format in the world) and labeled by the type of visit that created the file. For example, if you are a heart patient, all of your EKGs would be in one section and each other type of document would be in a specific section. Once these documents are labeled, they are stored on a “USB Flash Drive” and sent to your home. You now have your LifeKey and can be sure that, in an emergency and non emergency situation, the physician(s) that are treating you are completely informed of all of the specifics of your medical condition.LifeKey is the only product that not only stores your records in PDF format, but also uses a patent pending technology to scan, label, save and write that information to the USB Drive. This process is what makes LifeKey the first truly universal electronic health record that is also portable."
Clever idea !

Electronic Medical Record? Electronic Health Record? What’s the Difference?

Electronic Medical Record? Electronic Health Record? What’s the Difference?: " What is the difference between an electronic medical record (EMR) and an electronic health record (EHR)?
A. While the industry has not yet come to a consensus, and several definitions exist for both electronic medical record and electronic health record, there is a clear and functional distinction between the two. An electronic medical record, the electronic replacement for paper charts, is the record of patient health information generated by encounters at one particular physician practice. This is the physician’s own electronic record of his or her patient’s medical care. When you purchase medical records software, you are purchasing an EMR system. An electronic health record is a record of a patient’s long-term and aggregate health information generated by one or more encounters in any care delivery setting. Stemming from the interoperability of multiple providers, the EHR is distinct from the software systems that directly support caregivers treating patients. Rather, the EHR connects the physicians and other caregivers. Included in this information are patient demographics, progress notes, problems, medications, medical history, immunizations, laboratory data, and radiology reports."
An EHR ( PHR) is owned by the patient !

Friday, September 29, 2006

Please come and say Hi ! to my mother

My mother's not well, and is stuck at home in her bed. While she is coping well, meeting people is something she enjoys a lot. However, many of my friends are reluctant to visit her, because they "don't know what to say". Actually, you don't need to say a anything other than "Hello !" Your company is a valuable gift - please share it ! Ill people feel isolated and cut off from the rest of the world - and visiting them gives them considerable pleasure. Also, do it for purely selfish reasons ! You can learn a lot from ill people ( if you keep your heart open). It will be your turn soon, and what goes around, comes around ! A great book to read is House Calls: How We Can All Heal the World One Visit at a Time
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Thursday, September 28, 2006

Are they smuggling out the babies after doing surrogacy in India ?

I am amazed by how much media interest there is in the "surrogacy boom" which is being reported from India. However, I have a number of worries about this, which have still not been clarified.

Today, surrogacy is technically legal in India ( since there is no law which regulates it). The reason why so many infertile couples from the US and UK are rushing to India for surrogacy treatment is that not only is IVF treatment much less expensive here, surrogates also charge much less ! Doing the surrogacy treatment in an IVF clinic is not a problem at all and any IVF clinic can perform this with ease , so this is not an issue.

However, the problems start after the surrogate gives birth. At present, there is no legal protection for surrogacy in India, which means there is no secure mechanism by which foreign couples can take their baby back with them to their own country.

Let's look at this closely and assume the treatment has been successful; the pregnancy has been uneventful; and the child is now born in an Indian clinic. Whose name is going to appear on the birth certificate ? How will the infertile couple claim parenthood ? How will they take the child back with them to their home country after the birth ? And what happens if the surrogate ( or her husband) changes her mind and refuses to hand over the baby ? Or blackmails you for custody ?

While many clinics talk about the " Indian Council of Medical Research ( ICMR ) guidelines for surrogacy"; and about how they make the surrogate sign an agreement to protect the infertile couple, what they do not tell the patient is that the guidelines are just a piece of paper which have no legal validity whatsoever !

I am still amazed ( and concerned) as to how foreign couples are taking their surrogate babies back with them , given the legal vacuum which exists today. Are doctors conniving with them to put false names on the birth certificates ( which means the obliging doctor puts the surrogate's name on the birth certificate, and not the birth mother's)? Or are they smuggling these babies out ?

The most worrisome is that effectively a "legal blackmarket adoption" channel has now been opened up ! An unscrupulous doctor could handover an unwanted new born baby ( from an unmarried mother, for example) to a rich infertile couple, and claim that it was actually genetically theirs because they had undertaken surrogacy treatment ! Not only would this allow couples to bypass the regular legal adoption channels, it would create an avenue for some crooked doctors to make a lot of quick bucks !

Why isn't anyone else worried ?

Tuesday, September 26, 2006

Why consider India for surgery ?

Why consider India for surgery ?: "Offering some of the best medical treatment in the world and with an excellent reputation in its private hospitals India’s health care sector has undergone an enormous boom in recent years and it has become a global health destination, with its medical tourism area growing by 30 per cent each year. Despite any prejudices about healthcare in developing countries, rest assured that the private hospitals and clinics in India are at the forefront of medical technology and equipped with modern state-of-the-art technology and highly skilled medical personnel. In fact, Indian doctors are considered to be among the best in the world and their high level of surgical expertise evolves from many years of training – after studying in India many doctors train and work in the UK, and become members of the GMC."

The Connected Patient

The Connected Patient: "Financial considerations aside, many physicians point to improved care as the best reason to engage patients electronically. Merely presenting graphs of critical lab values can be a dramatic reminder to patients struggling with chronic diseases such as diabetes. HealthPartners’ patient-accessible EMR “makes patients feel more responsible for their own care,” says Butler, the informatics director who doubles as a primary-care physician. “If you give advice, and patients own the information and are part of the decision, they are more likely to make the changes you recommend.”"

Accenture Knows What It Takes to Turn Your Organization into a High-performance Health Care Provider

Accenture Knows What It Takes to Turn Your Organization into a High-performance Health Care Provider: "
Accenture’s research strongly suggests that high performance in the health care setting is determined by how well health care providers handle the intricate handoffs of an extended 'patient journey.' The patient journey encompasses all the services and processes required to treat the patient, manage the required resources, obtain the necessary medical and financial information, and receive proper payment in a timely manner."

Accenture Knows What It Takes to Turn Your Organization into a High-performance Health Care Provider

Accenture Knows What It Takes to Turn Your Organization into a High-performance Health Care Provider: "
Accenture’s research strongly suggests that high performance in the health care setting is determined by how well health care providers handle the intricate handoffs of an extended 'patient journey.' The patient journey encompasses all the services and processes required to treat the patient, manage the required resources, obtain the necessary medical and financial information, and receive proper payment in a timely manner."

Medical Tourism v2.0

Medical Tourism v2.0: "PlanetHospital, we are more than just a medical tourism company. We are in the business of making healthcare affordable. We achieve this by finding the best and safest hospitals and surgeons around the world. We also achieve this with innovative solutions to healthcare such as our BEST OF BOTHWORLDS HEALTHCARE ™ plan which allows you to have an American doctor fly with you to another destination for your surgery. And our insurance programs such as the one we have established with United Group Plans whereby you could pay a small premium per month to receive surgeries abroad."
Medical tourism is being re-invented as clever entrepreneurs help patients to find the most cost effective healthcare for their needs. While USA used to export medical services in the pst, it's now exporting patients !

Infertility Treatment Often Chosen by Rich Couples

Infertility Treatment Often Chosen by Rich Couples : "Infertility Treatment Often Chosen by Rich Couples. An infertile couple's income makes a difference in whether they pursue an expensive technology such as in vitro fertilization. If advice is cheap, ART — assisted reproductive technology — is not, and the difference in cost has a significant effect on the treatments pursued by infertile couples in the United States. Not surprisingly, an infertile couple’s income makes a difference in whether they pursue an expensive technology such as in vitro fertilization."
The flip side of this is that poor infertile couples who need IVF cannot do IVF because they cannot afford it !

Monday, September 25, 2006

WellPoint's Settlement of Physician Lawsuit

IT WellPoint's Settlement of Physician Lawsuit : "In the class-action lawsuit, the physicians allege that many of the nation's largest insurance companies delayed or denied reimbursements for health services and illegally rejected claims for necessary medical treatments as part of a racketeering conspiracy (AP/Orlando Sentinel, 5/4). "
This is why physicians are so wary of "big business". Most corporates do not have a soul, which is why it's so hard to deal with them !

WellPoint Launches Online Price Tool

WellPoint Launches Online Price Tool in Ohio: "WellPoint, the nation's largest health insurer, on Monday launched an online tool in Dayton, Ohio, that enables members to compare hospital prices for total care episodes for several common procedures, the Wall Street Journal reports. WellPoint developed the tool at the request of General Motors, which has 70,000 WellPoint members in Dayton, according to the Journal. "
It's interesting, but in the USA, things get done only when money talks !

Why doctors edit the information they give to their patients

Doctors are supposed to be trusted infomediaries who are meant to intelligently apply their medical knowledge to our personal illness, and guide us as to how to treat it. However, one problem is that doctors can be very selective about the information which they provide to their patients . Sometimes they can do it for ulterior motives - for example , a cardiac surgeon who overpromises the benefits of cardiac surgery . However, the problem is much more widespread. As Dr Nuland points out, in his book, How We Die, “ even well-meaning doctors, in an attempt to maintain control , convince themselves that they know better than the patient what course is proper . They dispense only as much information as they deem fit ( a highly edited and sanitized version, especially for very ill patients) , thereby influencing a patient’s decision-making in ways they do not even recognize as being self-serving .” Many of them may do it with good intentions, but they often end up “overtreating” the patient; and disregarding the patient's personal wishes.

This is why I feel Information Therapy can be such powerful medicine. Since it is directly delivered to the patient without any censorship, the intelligent patient can interpret it accurately, without having to worry about whether the truth is being “sugar-coated”.

Sunday, September 24, 2006

Smart Care Via a Mouse, but What Will It Cost? - New York Times

Smart Care Via a Mouse, but What Will It Cost? - New York Times: "The electronic medical record seems an example of pure progress, a technology that yields only winners. So it has been cast as a geeky hero in health care policy circles."
If the New York Times says so, it must be true ! In my opinion, the costs will be minimal, compared to the benefits. Many of the technology tools are already available - it's just a question of a clever entrepreneur putting them together !

theStatus.com - helping patients talk to loved ones

theStatus.com - helping patients talk to loved ones : "theStatus.com was created when Mark Pearson, the company founder, set up a web site for his sister-in-law after she was hospitalized. Mark created the page because 'Mary' needed a way to communicate with friends and relatives without burdening herself or her close family. It became the main source of information, allowing Mary to spend less time responding to inquiries and more time recovering. Family and friends could get the latest update on her condition, see pictures of her, and get important contact information. The response was phenomenal. When Mark began receiving requests from friends to set up pages for other people, he decided to create easy-to-use templates so patients could create their own.Now, with thebabyStatus.com, expecting parents can create web pages to keep family and friends updated on a pregnancy as well as show their new baby! As theStatus.com grows, we are committed to providing users with simple, easy-to-use tools for creating personal web pages.Technology is changing the way we communicate with family and friends and, now, staying in touch is easier than ever!"

CarePages - social networking and patients

CarePages - social networking and patients: "CarePages Connect Friends and Family. CarePages are free, easy-to-use Web pages that help family and friends communicate when a loved one is receiving care. It takes just a few minutes to create a CarePage, share it with friends and family, and build a community of support.
CarePages help Families:
Create a virtual meeting place on the web
Share news and photos as often as needed
Receive emotional support during a time of need"

This is a clever use of technology to receive and provide emotional support during illness. Lots more patients and caregivers are going to start using social networking - and this will also help to improve the clout patients carry in the future ! If you said good things about your doctor and your hospital on your website, this would have a hugely positive "word of mouth" marketing impact !

Give me a break

Give me a break : "Prompted by a number of tragic accidents and near misses during the late 1970s and 1980s the airline industry took stock and investigated the root causes. Of the critical incidents attributable in some way to human error, investigators found that in a large portion the cause could be pinpointed to the pilot or aircrew being hungry, angry, late, or tired—HALT. Simple personal factors, some of which were unavoidable, although many were not, were responsible for some of the worst aviation accidents in history."
Doctors need to remember this too . Many avoidable medical errors occur because of the medical staff being HALT !
One clever patient of mine always ask me - " Doctor, are you tired ? ". Not only is he acknowledging I work hard, he is also giving me a chance to get in touch with my own emotional state . By treating me as a human being, he ends up getting more personal attention from me !

"As easy as ABC": Therapeutic Writing

GilleBolton.com | "As easy as ABC": Therapeutic Writing: "It has helped groups as diverse as Vietnam veterans, psychiatric prisoners and sex offenders to deal with personal trauma. It has helped ease the symptoms in specific illnesses, such as asthma and rheumatoid arthritis. It has been shown to boost the immune system and in one study even helped unemployed Texans find new jobs. Most recently, it helped US students to come to terms with 11 September. There are no side-effects and it is available to anyone of any age, pretty much anywhere, over the counter. If it were a drug, this versatile little treatment would surely have a public profile to match Viagra. Indeed, the lack of a pharmaceutical company to promote it is perhaps part of the reason why its benefits are so little known. It's cheaper than any drug - the cost of a pen and paper. Because the miracle treatment is simply what I am doing right now: writing."

A Prescription for Therapeutic Writing: "The Best Medicine"

A Prescription for Therapeutic Writing: "The Best Medicine": "Apollo is god of both poetry and healing. Writers have probably always known the deeply healing power of writing, certainly since Sappho. But it has been a secret well kept from Western practitioners until recently. Now it is increasingly used in mainstream and complementary healthcare, medicine, and in therapy. Writing is powerful communication: perhaps even more powerful than speech, as it does not disappear on the breath."
Writing is effective medicine for both doctors and patients - and caregivers as well !

The "BEST" Communication Model

Clinical Cases and Images - Blog: The "BEST" Communication Model:

"BEST: a communication model.

Begin with non-verbal cues. Soften (smile, open arms, forward lean, touch with arm, handshake, eye contact, nod)
Establish information gathering with informal talk
Support with emotional channels
Terminate with positive note

Hopefully, this will make your patients feel better. If you want to feel better yourself, you can try following the

'MOTORS' mnemonic.

MOTORS of Your Life
Studies describe a set of wellbeing practices that are correlated with the feeling of happiness (BMJ, WJM). I tried to summarize them in the mnemonic MOTORS because the pursuit of happiness, in its altruistic sense, can be the motor of your life.

'MOTORS' stands for:

Meaning --> find a meaning in what you do for a living but don't forget to set limits around it
Outlook --> have a positive outlook on life. Be philosophical but also focused on success
Time --> spend quality time with F&F (Family & Friends)
Out of of yuppie values --> don't focus on chasing money or prestige
Religious / spiritual practices
Self care practices, like sports or meditation"

This is typical of most of us doctors. We need mnemonics to remember such simple truths :)

Managing medical mistakes: Let the patient beware!

" This is an article I wrote for the Times of India ( 21 Sept 2006). "
Medical errors remain one of healthcare’s pressing little problems. It is estimated that every year approximately 98,000 people die as a result of medical errors in the US. Though no statistics are available for India, the situation is no better, judging from the regularity with which news stories about angry mobs vandalising hospitals and beating up doctors appear in the media.
Clearly, the human and financial cost of medical errors is high. Not only do they take a toll on the patient, they also have hidden effects on the healthcare system. To prevent errors from recurring and to avoid volatile situations, many doctors and hospitals practise defensive medicine. As a result, patients are routinely overtested and overtreated, thus adding to the cost of healthcare.
While the scope for errors is high in operation theatres, intensive care units and emergency rooms, where patients are admitted with complex problems, there are certain other circumstances where errors are common. Such as in hospitals with poor resources—these tend to be illequipped and have overworked doctors; at night when the staff is tired; and when there is inadequate supervision, because there are only junior doctors on duty. In fact, the Institute of Medicine report, To Err Is Human: Building a Safer Health System, which was released in December 1999 in the US, showed that most errors result from faulty systems, not from incompetent providers. To prevent mistakes, hospitals and doctors need to be aware of these settings and be even more careful.
Doctors need to work on developing systems to prevent mishaps. A good example is the use of preprinted forms for post-operative orders, which simply need to be ticked and signed, so important orders are not forgotten. The use of technology can also help in reducing medical errors. For example, the use of electronic medical records will prevent errors due to illegible handwriting. And personal digital assistants can serve as peripheral brains, since they can be equipped with extensive drug and clinical databases.
If a patient dies, a calm-headed analysis is far more productive than giving vent to emotions, but this can only occur if there are systems in place to analyse these errors transparently and openly.
When an error occurs, most of us would like to be informed about it—we expect the doctor to provide an explanation or an apology, and to rectify the error. However, most doctors still react by covering up errors because they are afraid of being beaten up or being sued; and this often makes a bad situation worse. In fact, even in the US, which has such a poisonous litigious climate, there is now a nationwide movement to teach doctors how to apologise for medical errors. Their web site, Sorry Works, at www.sorryworks.net, has many examples of how this approach helps both doctors and patients.
Having said that, a lot lies in the hands of the consumers of healthcare—the patients. You need to become an active partner in your medical care. While any one doctor or nurse can make a mistake, a well-informed patient can prevent such errors by acting as his own last line of defence. This is why it is so important to seek more information. You can learn how to do so at www.thebestmedicalcare.com. Your doctor may forget and make mistakes, but a well-informed patient will not allow him to do so!

Breast Cancer Victory- Did You Just Say “Breast Cancer”?

Breast Cancer Victory- Did You Just Say “Breast Cancer”?: "I will be using this journal to tell my story, to share the adventure with all of you, in hopes that my story will perhaps help someone else who may be struggling with this as well. I decided to deliver my story in real time, as it happens, in this journal. This is my therapy, and my way of sharing the story in its raw, unedited form. It is my hope that other people who encounter difficulties can read this and gain strength from knowing that they are not alone.
It isn’t just for breast cancer survivors, and it isn’t just for women either. It’s a story of one woman’s experiences with life’s hurdles, and how ordinary people can become extraordinary heroes in just a few brief moments when life brings unexpected change. If you’re wondering, when I say hero, I’m not talking about me. I’m talking about the people in my life who are my heroes. I’m also predicting that there will be many surprise heroes along the way, people who seem to come out of the woodwork when they are most needed. People who would never call themselves heroes, but they are, nonetheless.
This is the story of how my life changed in one instant, and how I am going to make this new life better than it was before… "
This is a brave attempt - and full marks to Sylvie for doing this. By helping others, she is helping herself - and there is a lot of evidence to show that patients who are "fighters" do better than those who are passive and give in. I'll be rooting for you Sylvie - best of luck !

Saturday, September 23, 2006

Making sense of medical records



One picture is worth a thousand words. These are some of my mother's medical records - and even though I am a doctor, trying to arrange them or make sense of them is a daunting task.
I wish we had a PHR ( patient health record) for her so we could have organised these properly.
Maybe it's too late for her now, but I do hope we can do it to help others !

Medical Tourism - Health Tourism - Medical Travel | MedRetreat

Medical Tourism - Health Tourism - Medical Travel | MedRetreat: "MedRetreat is...the leading, American owned and operated, medical tourism service agency facilitating the healthcare needs of North American medical tourism patients seeking all forms of medical travel programs. Incredible Savings Why do people travel abroad to undergo medical procedures? The answer is simple...Affordable healthcare. Not to mention a little peaceful relaxation in complete anonymity."
American patients now have a choice - and many of them are now putting their money where their mouth is !

Friday, September 22, 2006

Instant gratification - thanks to the internet !

In the past, ordering a cross-stitch pattern from the US or Scandinavia was hard work, and took 2-3 months. After selecting the pattern on the website, we would need to email them; they would need to send an invoice; which we would need to take to the bank; get a check in US dollars; and then post them a check; after which they would snail mail the pattern to us.
This time is just took a few hours. Since golden kite was not responding to emails, and their website did not list their phone numbers, I looked up Marcus's phone number in the online Swedish white pages telephone directory and called him up; explained the urgency to him; and emailed him my photo ( which was digital). He created the pattern which I approved; and then I sent him the payment through PayPal ( they don't accept credit cards yet). I got my confirmation, and he will courier the pattern to me today !

How far to push ?

Helping a chronically ill patient to deal with her daily tasks is hard work. My mother is often tired and sleepy; and does not feel like eating much. But if we let her be, she will lose even more weight and energy. We need to coax her to eat more and walk more - and this tires her out, so that she gets angry and irritable. Everyone in the family also has differing opinions about how to handle her. Is it really kind to just leave her alone ? Sometimes love needs to be cruel - but how much to push ? and when to stop ?

Chronic Care - Chronic Disease Management Resources, Tools, Training

Chronic Care - Chronic Disease Management Resources, Tools, Training: "
Effective chronic care depends on informed and engaged consumers - partnering with providers who consistently deliver evidence-based care. Chronic Care Group has designed a suite of evidence-based tools to improve patient engagement and provider delivery of recommended care. Unlike traditional patient education materials, these tools are designed to activate both patients and providers."
While this is better than just a basic patient education brochure, it's still an incomplete solution. Information Thrapy needs to be built in as part of the patient health record to unlock its complete value.

The Health Wisdom Blog™ (by OrganizedWisdom)

The Health Wisdom Blog™ (by OrganizedWisdom): "OrganizedWisdom.com, the new health-focused social networking site is now open to the public - and we would love your feedback...and your wisdom! In addition to providing the very best health knowledge from doctors and medical professionals, the backbone of our site is based on this simple premise: by organizing the collective wisdom from millions of people we can provide everyone with the very best health information available. To accomplish this mission, we have developed a system to make it easy for anyone to search and share health information on nearly any health condition, treatment, medical test, medication, or alternative medicine. By sharing your personal experiences with health issues, medications, treatments, doctors, diets, products, and so on you will inspire, provide practical guidance, and potentially save lives."
This is such a clever idea ! It marries information therapy; consumerism ; social networking ; the unsatisfied needs of the healthcare consumer; and our desire to help each other in our times of illness and need - and comes up a winner !

Will Banks Replace a Healthcare Provider’s Traditional Business Office?

Will Banks Replace a Healthcare Provider’s Traditional Business Office?: "It should come as no surprise that the same financial companies involved with managing a hotel’s front-desk and business office can also be involved with healthcare providers’ billings and collections. "
Lots of doctors now accept credit card payments. This can be logically extended to many more areas , and all financial transactions could be "outsourced" to the banks and credit card companies - after all , this is their core competence ! Doctors and hospitals could focus on providing healthcare and not worrying about collecting their payments.
Credit card companies could consider providing consumers with their personal health record on their smart credit card ; and banks could provide customers a PHR on their smart debit cards ! The smart card would become both a financial instrument, as well as a healthcare utility. And ATMs could be modified so that they could become part of the healthcare network to upload healthcare data !

Consumer Health World Blog >> Blogs and Social Media: The New Rules of Healthcare Marketing

Consumer Health World Blog >> Blogs and Social Media: The New Rules of Healthcare Marketing: "The success of the consumer healthcare movement hinges on adoption of transparency, as the only way to make the healthcare markets work. Yet transparency means letting go of control and putting consumers in the driver seat. Many industry leaders rightfully feel uneasy or even outright scared about embracing openness.But is there a choice ? Not really ! Look how consumer-powered media already changed politics, news and entertainment - and healthcare is next to go."
If the healthcare industry doesn't do this on their own, consumers ( all of us !) will make them do it.

Trying to cheer my mother up

My mother is not doing as well as I'd like. She's at home and off all medicines, but still gets tired very soon, and does not walk around too much. While physically she's fine, I feel she needs to push herself more if she needs to recover, but she doesn't seem to have the motivation to do so. We have a physiotherapist who comes in daily, who helps her to walk around the house - but now we need a motivational therapist !

She loves doing cross-stitch, and is an expert cross-stitcher. She has done an excellent portrait of my dad, which most most people think is a photograph. They find it hard to believe it is actually hand-stitched ! She's wanted to do one of me, which I've been putting off. I finally got my photos taken; and she has short-listed one which she likes. I have requested Marcus from Golden-Kite to rush us a cross-stitch pattern for this photograph, so that once she gets it, she'll have something to look forward to doing every day ! It's a long-term project, and since she does elaborate and advanced designs, can take upto 6 months to complete. She wants this to be her parting gift to me - and I hope that doing this will keep her happy and cheerful !

Wednesday, September 20, 2006

Retail health clinics planned for region

Retail health clinics planned for region: "Take Care Health's push reflects the latest and fastest-growing trend in health care services: retail health care centers that typically treat a limited set of basic ailments such as sinus infections, poison ivy and strep throat for set fees under $75. Industry experts expect thousands will open in the coming years as consumers seek lower-cost care in more convenient settings.
'Consumers are paying more of their own health care costs in the form of higher premiums and deductibles, and are being forced to make decisions about how, when and where they seek medical services,' consultant Mary Kate Scott wrote in July for a report on retail health care for the California HealthCare Foundation."
Patients are going to demand value for money !

Electronic patient data paying off for doctors - Business First of Buffalo:

Electronic patient data paying off for doctors - Business First of Buffalo:: "Doctors affiliated with the Catholic Health System are being offered $350 a month for the next year to shift from paper to electronic medical records.The initiative is an important part of a larger project to improve treatment of chronic conditions most common among their patients. Electronic links will make the reporting of patient data fast and easy, and quicken the project's response to needed changes in care, officials said."
It's always better to use a stick rather than a carrot !

The Connected Patient -- HealthLeadersMedia.com

September The Connected Patient -- HealthLeadersMedia.com: "Musings about the impact of online patient services

“If the patient wants to communicate online with their physician, and the physician chooses not to do so, I would expect the patient to go to another physician.”

—John Butler, M.D., assistant medical director, informatics, HealthPartners

“This is a better way to practice medicine.”

—Ted Eytan, M.D., medical director of health informatics and Web services, Group Health Cooperative

“It is more convenient for physicians to respond to secure messages than a barrage of phone calls that interrupt them.”

—Ernie Hood, CIO, Group Health Cooperative

“If a patient’s labs are abnormal, I will message them to come in and see me. You don’t want to give a diabetes diagnosis by e-mail.”

—Beth Averback, M.D., associate medical director for care improvement, HealthPartners Medical Group

“We are a complicated health system. Just getting through a simple phone call to a physician can be hard. So we look where our pain is and try to fix it with technology.”

—Pam Landis, director of Web services, Henry Ford Health System

“In the near future, you will need a patient portal to survive. It will become a baseline expectation for how patients select their doctors. You can either lead this or chase this. I would rather be leading it.”

—Kevin Palattao, vice president of patient care systems, HealthPartners"

Smart doctors know that the best way to lead is to find out where your patients want to go, and then to take them there ! Early adopters will have an edge which they can capitalise on !

Insurers: Price is right for generics | Chicago Tribune

Insurers: Price is right for generics | Chicago Tribune: "Now private insurers are taking a page out of the brand-name pharmaceutical industry's marketing playbook.They are showering consumers with free generic drug samples, waiving co-payments and marketing directly to consumers in doctors' offices, where brand-name drug salespeople are omnipresent. They are there to encourage the use of cheaper, generic prescription drugs."
Clever way of fighting fire with fire !

Overattentive Families May Be Underrated - New York Times

Overattentive Families May Be Underrated - New York Times: "It’s every physician’s fear: the patient with the “involved” family, relatives who watch over everything, question everybody and make a nuisance of themselves. Yet, in today’s world of rapid-fire medicine, such relatives may be a patient’s most important advocates.The most effective families, it seems to me, are those who genuinely appreciate the efforts of frequently overwhelmed health care providers and who seek to work with them to help care for their relatives. At the same time, as a concerned family member, you may know the patient better than anyone else, and if you see something that doesn’t seem right, speak up. The doctors may not thank you, but perhaps they should."
This is why it's such a good idea to take a concerned family-member with you to the doctor and the hospital !

Tuesday, September 19, 2006

Happy to be alive

I enjoy playing tennis, and do so daily. Ever since my mother fell ill 2 months ago, I have not been able to play . Today was the first day I played again, and it was a great day. The weather was perfect, and it was fun to stretch out to hit the ball and I am happy to be alive. Mixed with this joy is regret that my mother will not be here to share this joy - and some guilt that I am healthy, while she is so ill.

I hope I will be able to learn to respect the valuable gifts life gives us daily - and not continue taking it for granted I have done so far.

Monday, September 18, 2006

Patching up cracks that whole patients fall through | Chicago Tribune

Patching up cracks that whole patients fall through | Chicago Tribune: "'I don't think there's a hospital in the country where [communication failures] don't happen,' Berlin said. 'The average physician gets hundreds of X-ray reports a month, sometimes a week. The problem is, in today's busy world, sometimes it is very hard to locate a doctor. It can be very frustrating. We have to do a better job of ensuring communication of abnormal results gets to the patient.' The takeaway lesson for the public, Berlin said, is that no news is not necessarily good news. Don't assume if your doctor doesn't call you with lab results that everything is fine. 'The real duty lies with the physician, but the intelligent patient leaves no stone unturned.' "
If patients had their own PHR to which their imaging scans could be uploaded ( after being verified by their doctor) , this would make life much more efficient - for patients and doctors !

NoMoreClipboard.com

NoMoreClipboard.com: "NoMoreClipboard.com is:
• your online personal health record, totally under your control.
• an easy, secure way for you to manage family medical information.
• a service that helps you avoid filling out 'clipboard forms' over and over at the doctor's office.
• a fast way for you to send accurate and complete information to your doctor(s).
• a way for physicians to receive personal health information, directly and confidentially."
Here's one useful benefit for keeping your own PHR. However, a comprehensive PHR can be much more valuable !

Insurer rolls out new technology - Pittsburgh Business Times:

Insurer rolls out new technology - Pittsburgh Business Times:: "UnitedHealthcare is preparing to introduce an innovative identification card that contains both the member's account information and medical history. The Philadelphia-based insurer will begin rolling out the cards in January, which will allow members, including some 130,000 people in Western Pennsylvania, to convey key health and account information with a swipe of the card. 'By combining health and financial information, we have greatly simplified a series of fragmented and time-consuming experiences for health care consumers,' John Prince, CEO of Exante Financial Services, said in a prepared statement."
This makes a lot of sense - smart cards can be very useful in improving health care !

Coping with dying

I find it easier to cope by reading and learning about death and dying, so I can prepare myself. I may never be able to prepare myself emotionally, but at least I can do so intellectually – and I think this will help. Friends tell me not to be morbid – but I am not being morbid. I am just being realistic !

Being a Hindu helps . Religions are always helpful when dealing with the unknown. I don’t have too much faith in the “power of modern medicine”. I am not a cynic, but often the weapons are better at hurting than at healing.

We have received medical care in one of India’s leading hospitals, with some of of India’s best doctors, and not all of it has been pleasant. Doctors tend to hide facts and sugarcoat reality , and this can actually be a disservice. There seems to be a conspiracy of silence - and they don’t use the “C”( for cancer) word – as if it’s the diagnosis which kills !

Also, they do not refer ill patients for hospice services. While no one can predict when death will occur, a good doctor's job is also to prepare the patient to die - and hospice services can be extremely helpful in doing so. A hospice referral is not a death sentence - just a fact of life ( and death) which needs to be treated as such !

I have found that doctors often tend to abandon dying patients, and you need to create your own support services. Thus, we had to approach V-Care, a cancer support group , and I have often wondered why the doctors did not refer us on their own.

We are trying hypnotherapy too. I agree that we may not be able to influence the biology of the disease , but we can influence your attitude and how you choose to deal with it.

House Panel Passes Bill To Require Electronic Health Records

House Panel Passes Bill To Require Electronic Health Records : " The House Government Reform Subcommittee on the Federal Workforce and Agency Organization on Wednesday passed a bill (HR 4859) that would authorize the Office of Personnel Management to require health insurers to establish two forms of electronic health records for the Federal Employee Health Benefits Program, CongressDaily reports. The first form of EHRs would include information currently tracked by health insurers -- such as hospital and physician visits, claims information and prescription drug records -- and FEHBP members could access them within four years of passage of the legislation. The second form of EHR would include personal health information -- such as medical history, symptoms and diet -- and FEHBP members would administer them. "
Smart insurance companies in India will offer this service on a pro-active basis !

Some tips for better patient relationships

From 101 Practical Tips to Enhance Your Practice, from Advisory Publications, a division of HCPro, Inc.

Good staff-patient relations can make or break a practice. You want your staff to make your patients feel special when they come into your office. Here are some tips to remember that will help build your practice and make patients feel connected to you and your staff:

Never act as though patients are interrupting your work. They're the reason you are in business.
Greet patients with a friendly smile.
Call patients by name.
Remember that to patients, each employee is the practice.
Never argue with patients. Be a good listener, agree with them when you can, and do what you can to please them.
Never say "I don't know."
Remember that patients pay your wages.
Make positive statements.Instead of saying a patient can't do something, phrase your advice as a suggestion like, "You might want to try..." or "It's good to do..."

Sunday, September 17, 2006

Living on hope

It's hard for most people to come to terms with impending death; and fighting it is a natural instinct. Friends and relatives, out of the goodness of their heart, will suggest the names of healers; miracle workers; alternative medicine institutes; and gene therapy centers, in order to try to "fix" the problem - even though often there's little which can be done.
How far should one pursue these leads ? While hope can be helpful, false hope can be cruel - and can actually hinder the process of acceptance. Is it better to come to terms with reality, so that we can all achieve emotional closure ? It's amazingly hard to get sound advise , and doctors are often the worst sources of information, because of their fear of death; and their inbuilt biases towards "giving-up".
When should one fight ? how hard ? against what ? to what end ? and why ?

The fear of death

The fear of death is universal . What happens to us after we die ? Is there a hell ? Is there pain ? suffering ? As a child, I had these fears - and still do. My mother always reassured me that death was like sleeping - and not something to be afraid of. How will I be able to cope with these fears now that she is dying ? And how will I cope with these fears after she is dead ? Will I be able to face upto my death as a man ?
Just like my mother has taught me about life and living , I am sure she will now teach me about death and dying - I only hope that I have the maturity and wisdom to learn !

My mom is dying

There – I’ve said the dreaded word. Sometimes the taboo associated with the 5-letter words, death and dying, is far worse than the condition itself. At least by writing about it, I feel I'll be able to get the wound out in the open, so it can heal better. Sometimes you need to be cruel to be kind.

I am not trying to be maudlin or emotional – after all, all of us are dying – only at different rates. Death is a fact of life - and who better to understand this than a doctor ? If I don't write about it, who will ?

Since I am an IVF specialist , what makes me an expert on death and dying ? Doesn't IVF have much more to do with birth and life ? But I also deal with death and loss and grief daily. A failed IVF cycle represents the loss of so many dreams; and going through a miscarriage is the closest any of us will come to living through death – when a part of you has died , but you go on living.
Being human means all of us need to become experts on death and dying - because all of us will be dead some day. So why not prepare for it now ?

The death of my mother is going to be an irreplaceable loss. As the elder son, we have always been very close. And I know that no one else will ever love me as much, and so unconditionally. She has advanced lung cancer – and has had her lower left lobe removed. For many months, the tests showed that she had a lung abscess, and the diagnosis was a rude shock. I guess we need to look for the silver linings now ; she is a doctor herself, and has accepted the diagnosis. She is now prepared to move on – and this has given us a chance to say our goodbyes. How well we will be able to do this, only time will tell.

Saturday, September 16, 2006

College of Law Practice Management

College of Law Practice Management"The College of Law Practice Management was formed in 1994 to honor and recognize distinguished law practice management professionals, to set standards of achievement for others in the profession, and to fund and assist projects that enhance the highest quality of law practice management."
What a great idea ! Why not have a College of Medical Practice Management ?

How to Succeed as a Lawyer

How to Succeed as a Lawyer: "Remember, don’t ever put your interest in the fee ahead of your interest in the case. Your future depends more on the manner in which you handle the case than on the amount of the fee you collect."
This is good advise for young doctors too !

Consumers hold the key to easing the healthcare crisis

Consumers hold the key to easing the healthcare crisis : " In America, consumerism is making an impact in nearly every corner of the economy but the doctor's office. Change is needed, and more is required than a Band-Aid fix. The answer is to unleash the time-tested and unmatched power of the knowledgeable and motivated consumer. In a just-published Position Paper, Destiny Health outlines a series of reforms it believes are required if true consumerism is to make its cost-reducing and quality-enhancing impact felt in the health care arena."
The question should not be - Are consumers smart enough to make their own health-care decisions ? The question should be - How can we provide consumers with the tools and the technology so that they can make their own health-care decisions !

Wednesday, September 13, 2006

Patient Education and Hospital Accreditation

Medical tourism is becoming a "hot and happening" area in India , and is attracting considerable investments and interest. The Confederation of Indian Industries ( CII) , India’s premier business association , which works to create and sustain an environment conducive to the growth of industry in India, has held National workshops on Hospital Accreditation Standards, so as to be able to attract foreign patients; and improve the quality of healthcare in India, since it realises the enormous scope India has to export medical services by treating patients from overseas.

I was very pleased to see that they have a session on Patient Rights and Education. I do hope this means that all large accredited hospitals in India will soon have their own Patient Education Resource Centers !

Value added services which clinics can offer to their patients

Diagnostic centers which perform executive health checkups and imaging studies have become very popular in India. While they generate a lot of medical information about their patients, much of this is under-utilised. It often ends up in the patient's medical file - to lie forgotten till the next checkup. A simple value-add service these centers could offer is to upload all this data to an online PHR ( personal health record) they could create for their patients ( if they wanted one). This will allow patients to share their medical, making it much easier for them to get a second opinion, i they wanted to.

Tuesday, September 12, 2006

Relatives often wrong about patients' wishes | Chicago Tribune

Relatives often wrong about patients' wishes | Chicago Tribune: "Don't assume you know what a loved one might want if he or she became incapacitated. There's a good chance you could be wrong. This humbling point is driven home by two recent studies examining end-of-life decision-making."
What scares me is that if relatives could be wrong, how much wronger could the doctor be ? This is why I don't think doctors should make decisions for patients, even if they think they are in "the patient's best interests" !

Personal health records pull patient's data to one file

Personal health records pull patient's data to one file: "A personal health record helps solve a big problem: Even if medical facilities create electronic health records, 'a consumer's health information is still going to be distributed across many health records,' Mon said. 'The PHR is the one place where you can accumulate all your health information in a consistent way to reflect your lifetime of care.'"
We all have health records which we carry in our heads or on scraps of paper - only for most of us they are incomplete, disorganised or out of date. A PHR will fix many of these problems !

E-mail accelerating the doctor-patient relationship | IndyStar.com

E-mail accelerating the doctor-patient relationship : "When Robin Uberta needs to fill a prescription for her 2-year-old son, Joey, she doesn't head for the phone to call his pediatrician. Nor does she start dialing when she has routine questions such as when to switch Joey to 2 percent milk. Instead, the Southport mom goes online. Within 24 hours -- and usually much faster -- she has an e-mailed answer from Joey's pediatrician, Dr. William J. Fisher."
Email is an excellent example of "appropriate technology" for routine queries and non-urgent consultations !

Sunday, September 10, 2006

A list of ways to save on drugs

A list of ways to save on drugs : "A list of ways to save money on drugs . Examples 1. Splitting pills 2. Buying from X sources. 3. Buying from X provider. 4. Getting drugs free or at reduced costs form X sources, for example, your doctor or a drug company’s study of their own or other company’s drugs. 5. Substituting one’s drugs for equivalent cheaper drugs 6. Being part of a particular drug study. 6. Taking smaller quantities of stronger drugs. 7. Government sources"
Information which is worth its weight in gold !

Ask-the-doctor - using the doctor's expertise

There is no doubt that doctors are a scare resource. However, so much medical expertise is just wasted. Young doctors, who are at the peak of their professional competence know lots of stuff - but often waste months twiddling their thumbs, because they do not have any patients to treat. Senior doctors, on the other hand, are so busy and over-stretched, that they often do not provide personalised care to their patients. How can we redress this imbalance, to help both doctors and patients ?
I feel the PHR ( personal health record) would be a useful tool to do so.
Patients could publish their queries online ( just like they do at google answers, for example); and interested doctors could answer their questions, for which patients would pay. At present, the reason the "ask-the-doctor" system does not work very well, is because doctors often don't have important medical information about the patient - and it's very hard for patients to provide this. This often means that the answers the doctor provides are very generic - and not very helpful. On the other hand, if the doctor could refer to the patient's PHR, he would know enough about the patient's background, so that he could answer more intelligently, and provide an answer which was tailored to the patint's specific circumstances.
This would allow patients to get second opinions inexpensively - and not only would this improve medical care, it would also allow retired doctors and junior doctors an opportunity to make good use of their expertise.
I can vouch this works well from personal experience. As an IVF specialist, it often breaks my heart when I see infertile patients who have received poor quality treatment . I offer a free second opinion online - and have helped many infertile couples to have their own baby - simply by providing them with the right advise !

When nurses are better than doctors

I feel cancer surgeons are in a state of denial. When they treat a patient who has advanced cancer , rather than try to improve the patient's quality of life, they prefer to paint a rosy picture and provide the patient and family members with false hope. There's always something more to offer, such as radiation and chemotherapy - even though this may not help to improve life expectancy - and makes a patient much sicker than he already is. Oncology nurses are much more realistic - and more caring. All of us , whether we are patients or relatives - know that we all have to die some day. This is not a failure on the doctor's part, and a wise doctor will help a patient to face up to his death with courage and equanimity. Unfortunately, there are few doctors who offer this today. It's still much easier to refer the patient for chemo and radiation - which often ends up hastening the death !

Why do doctors under-use their charisma ?

The doctor can be a powerful healing agent - and often a visit from the doctor can improve a patient's morale and physical status considerably. Unfortunately, most doctors don't seem to be aware of the powerful impact their physical presence can have on patients and their families. This is especially true when a patient is dying. Most doctors treat death as a personal failure - and abandon the patient. While they cannot cure the patient, they need to remember that their presence can help to heal the patient and help them feel much better - and what greater gift can a human give another human being - especially one who is dying ?

Remote Control for Health Care - New York Times

Remote Control for Health Care - New York Times: "Medical device makers see patients like Mrs. Huntoon as harbingers of technology changes that will allow tens of millions of Americans with chronic problems like heart failure, diabetes and mental illness to have their conditions constantly monitored, remotely and virtually, as they go about their daily lives. The payoff for patients could be more effective use of drugs, fewer and shorter hospital stays, and longer stretches between routine visits to physicians’ offices."
This is a clever use of high-technology ! It would be possible to simplify and adapt a lot of this to Indian conditions, to allow nurses and primary care doctors to monitor patients at primary healthcare centers and send this data to doctors in hospitals, so they could reach out to many more patients inexpensively. All this date could be fed into a PHR ( patient health record), so it could be analysed with ease.

Friday, September 08, 2006

The Healthcare Innovation Sandbox

The Healthcare Innovation Sandbox: "For the health-care industry in India, the constraints are world-class quality, new price performance levels, scalability, and universal access (availability for people in rural areas in particular). A concerted effort is needed to identify these core constraints; there may be more or less than four in some cases, but there should not be many more (or less). Then, once the sandbox is defined, it can force unconventional thinking in several directions at once."
Excellent article by business guru, C K Prahalad,talking about some remarkably successful healthcare projects in India.

After a failed IVF cycle - what next ?

Every patient does an IVF cycle with the hope that it's going to work. When the IVF cycle fails ( as it does for the majority of patients), then it's important to analyse what you've learnt from it , so that you can pick up the pieces of your broken heart and move on.
The question we would all like an answer to is - why did it fail ? Unfortunately, most of the time we cannot answer this question. Embryo implantation is a "black box" we still cannot probe or dissect. Even though we expect that all good embryos should implant, the fact remains that the majority don't - and we still don't know whay certain embryos implant - and why others don't.
In nay case , the question should not be - why did the cycle fail ? The question should be - what do we do next ?
Remember that there are only 5 variable to analyze - eggs; sperm; embryos; the uterus ; and the IVF lab. Go through these one by one, so you can formulate your next step.
If you had good quality embryos which did not implant, it's reasonable to repeat the cycle again without making any changes.
If the egg quality was poor, you may need to consider changing the superovulation regime ( and this may involve changing the clinic); or using donor eggs.
If the sperm did not fertilise the egg, then you should consider doing ICSI.
If the embryos were poor quality, then it could either be a lab problem; or an egg problem.
If the uterus lining was poor or abnormal, then the option would be to consider surrogacy.
Of the 5 variable, you need to decide which ones performed well - and which did not; and then you need to think about which ones you are willing to substitute. Are you willing to change the clinic ? use donor sperm ? use donor embryos ? use a surrogate.
Use the McKinsey MECE formula ( make a list of mutually exhaustive and completely exhaustive options) and then work through these. Some will have a higher success rate, but if you are not psychologically prepared to use these, just consider them, and put them away as Plan B.
This sort of systematic planning will give you peace of mind you gve your IVF treatment your best shot !

Saturday, September 02, 2006

Evidence based medicine, rules and clinical experience

Evidence-based medicine ( EBM) is a hot topic in medicine; and seems to makes a lot of sense. Rather than practise medicine based on personal whims and fancies, doctors follow guidelines and rules based on evidence gleaned from clinical trials. While this is a great concept ( especially for bureaucrats and corporates, because this makes medical care so much easier to "manage") , the fact remains that clinical experience is an intangible which is hard to capture and pin down in the form of "evidence" and ""guidelines". Junior doctors learn all the rules - but the really good senior doctors learn when to break the rules - and for which patients ! This is why medicine will always remain an art !
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