Thursday, November 30, 2006

Health care and IT | InfoWorld | Column | 2006-11-28 | By Ephraim Schwartz

Health care and IT | InfoWorld | Column | 2006-11-28 | By Ephraim Schwartz: "Think of the EMR as a health history repository for all of a person’s medical records, all in one place and accessible by any system at any medical office, hospital, outpatient facility, or EMR service.

Closely related to an EMR is an even newer concept called a PHR, Personal Health Record. A PHR might be stored on a USB key fob. Get knocked off your motorcycle as I did recently, and the tech in the ambulance might plug the USB device into a notebook and bring up your entire medical history, including past motorcycle mishaps!

Because an EMR has all the medical data in one place, it can, for example, chart the history of lab tests across time. If it detects a disturbing trend, it can send an alert not only to the doctor but also to the patient. If I get an e-mail that my cholesterol is trending up, I can take action immediately rather than waiting six weeks until my next doctor’s appointment. It might even link me to a site that offers low cholesterol diets."

A PHR can be smarter than your doctor !

Baby girls being abandoned in India : HindustanTimes.com

Baby girls being abandoned in India : HindustanTimes.com: "Even today we have an abandoned five-day-old baby girl in the maternity ward whose parents disappeared right after delivery. They even walked way with their medical records so we cannot trace them.

“Earlier, only illegitimate children were abandoned, but going by the fact that more girls are left behind than boys, I suspect people now see it as a convenient way to get rid of an unwanted girl child,” says Misra."

The purpose of the PNDT Act was to protect girls. It is a sad tragedy that a law which was supposed to protect female fetuses has ended up in couples discarding their baby girls . Who is responsible for this ? By forcing couples to have girls they don't want, whom are we really helping ?

I wonder what the plight of the third and fourth baby girls in poor families is . Even if they are not abandoned , are they being looked after well ? Why doesn't anyone care about what happens to them ? Is is fair to sacrifice individuals at the altar of a balanced sex ratio ?

Why medical specialists are biased

Most patients want to go to the doctor who has special expertise in handling their particular problem. They will spend a lot of time and energy tracking down the "biggest name in the feild" - and then leave everything upto the doctor. This can often be a short-sighted approach, because specialists are biased, and it's important to be aware of this bias.

While it's true that an expert has a lot of experience in dealing with a particular problem, this extensive experience also introduces all sorts of bias in the way he handles this particular problem. There are many reasons for this.

Because he is used to seeing complex cases which have been referred to him , he often cannot deal with simple bread and butter problems ! He also sees life through a distorted lens, and may not be able to see the big picture. Because he cannot afford to make mistakes, he often overtests and overtreats. He often asks for esoteric and expensive ( and painful) tests, to differentiate himself from the other ordinary doctors. He also usually bad-mouths alternative options of dealing with the problem - after all, this is his competition ! He is reluctant to refer cases which he canot handle, because this would damage his aura of omnipotence and omniscience.
Often, in the pursuit of narrow goals, he loses objectivitity; and is more interested in doing research rather than treating patients. Many experts are so used to seeing only sick patients, that they often cannot recognise a normal variant !

An excellent example of how many experts mismanage patients is the patient who has had recurrent pregnancy losses. These are "heart-sink" patients, who are often at their wit's end. Having suffered so many miscarriages, and visited many experts, they are emotionally very vulnerable and are eager to grasp at straws. The specialist - since he is a specialist and the "court of last resort" then needs to perform "new" tests - which no one else has done, in which he is the specialist. Often, these are tests which the specialist has invented himself, which means he has a lot of energy invested in them. A good example are the extensive battery of "immune testing" performed for patients with RPL.

Now, it's a mathematical certainty ( and simple common-sense ) that the more the tests you perform, the higher the likelihood that at least one will be abnormal ! If you perform a panel of over 20 tests for any woman, at least one ( or even more) are going to be "abnormal". This condition, when the result of the test is abnormal , but the patient is normal, is called a "false positive test". Unfortunately, because specialists are biased and often have blinkers on, they treat all abnormalities as true positives. He is very pleased that he has finally "diagnosed" the elusive problem - and then goes about treating it. Actually, the abnormal test result is just a red herring which has little to do with the illness - but the patient is also equally pleased that this new expert has cleverly found the problem which all the earlier experts has "missed".

The biggest problem is that many patients with recurrent pregnancy losses will then go on to have a healthy baby in the next pregnancy, even if they don't take any treatment at all. Now if a patient takes "immune therapy" and then has a live birth, she is happy to give all the credit to the expert - and the expert is happy to take the credit even though it is undeserved ! In fact, many patients go on to have healthy babies inspite of the treatment, and not because of it !

The patients who fail get discouraged and leave the specialist . They continue their quest for another expert with a new bag of tricks, as a result of which the specialist naturally gets the impression that his treatment is spectacularly successful, because only his success stories come back to him - the failures drop out ! This creates a vicious cycle, in which he goes about propagating his treatment at conferences - until other doctors try to repeat his successes - and fail miserably. It's only then that we realise the Emperor has no clothes !

All this causes a lot of harm. Not only is a lot of time, money and energy wasted on these unproven tests, they also cause a lot of emotional trauma. The purpose of a test should be to reassure a patient, but abnormal results create a lot of anxiety and distress in patients, which make a bad situation even worse.

Wednesday, November 29, 2006

Guide to medical tourism: Is treatment abroad for you?

Guide to medical tourism: Is treatment abroad for you?: " Medical tourism,as it is now known, is a growing industry and more and more countries are jumping on the bandwagon to offer tourists competitively priced elective surgery, cosmetic surgery, IVF and dentistry abroad. "

This excellent guide helps you to make a well-informed decision !

Large Employers To Launch EHR Plan

Large Employers To Launch EHR Plan : "Wal-Mart Stores, Intel, British Petroleum and other companies next week will announce a plan to provide and promote usage of portable electronic health records for their employees, the Wall Street Journal reports.

Last summer at the request of CDC, Wal-Mart and Intel joined together on the plan after meeting separately with the agency to discuss individual company efforts to reduce health costs. According to the Journal, the goal of the collaboration is to reduce health spending by having patients coordinate their own health care among hospitals, pharmacies and physicians.

According to the Journal, the "employers will insist that health care providers adopt electronic records and prescribing as a condition for future business." Wal-Mart will use its purchasing power to put bar codes on products intended for use in hospitals and clinics. The companies also expect employees to select physicians who are willing to use and update their records, although employee participation is not mandatory, according to the Journal."

EMRs are going to become increasingly prevalent - and if doctors won't adopt them on their own, large corporates and health insurance plans will force them too, sooner or later !

'Why I believe every parent has a right to choose their baby's sex' | the Daily Mail

'Why I believe every parent has a right to choose their baby's sex' | the Daily Mail: "If a couple have had three boys, for instance, and want to have a fourth child, why shouldn’t they have the option of choosing to give birth to a girl?

And in countries such as India, pre-conception sex selection might reduce the incidence of selective abortion and female infanticide.

Of course, sex selection is hardly the ideal way of dealing with such an iniquitous practice but, in the short term, it would be a far better option until there was a radical change in a culture which seemingly prefers boys to girls.

It has been argued that sex selection might significantly change the balance of the population. But I doubt whether there is the slightest evidence that this is true.

In any case, screening fertilised eggs is such a demanding, expensive and limited technology that it could never be widely used. And if, in the unlikely event that this technology was simplified so much that it became open to widespread access, any swing in the population balance would likely be temporary."

Tuesday, November 28, 2006

Our Cancer Treatment Philosophy - Patient-Centered Care

Our Cancer Treatment Philosophy - Patient-Centered Care: "Patient Empowerment Medicine (PEM) is a philosophy of care that puts patients first and in the center of their care. Aside from assembling a team of expert care providers who work within your schedule (and not the other way around), CTCA works diligently to uncover the things that patients need and value- long before they even enter our doors."

It's a sad reflection of our times that clinics have to tout marketing terms like " Patient Empowerment Medicine" as a USP ( unique selling proposition) . All medical care should be routinely patient empowering !

Cancer Coach Provides Hope: Helping Patients Navigate The Medical Maze

Cancer Coach Provides Hope: Helping Patients Navigate The Medical Maze: "After 51-year-old Carlos Pinto was diagnosed with an aggressive form of prostate cancer, his wife, Rebecca, launched an all-out search for the best treatment.

But the doctors she questioned all had different opinions and approaches. Her own sleuthing turned up conflicting information.

So the Pintos, of Wheaton, turned to a different type of expert: cancer coach Dennis Gibson.

Gibson, now in remission from both prostate cancer and lymphoma, helped the couple find a Los Angeles doctor who met their needs, he flooded them with reading material and he provided emotional and even nutritional support.

'There's so much contradictory stuff out there that you need the encouragement and the information on different levels; otherwise you just give up,' Rebecca Pinto said.

Cancer 'coaches' are not a new concept. The American Cancer Society's Reach to Recovery Program, which pairs a survivor with a newly diagnosed patient, has helped both women and men cope with breast cancer for three decades. Similar programs exist for other cancers.

But private coaches are jumping into the field to help patients cope with newer issues such as survivorship, complex and alternative treatment options and the health insurance maze."

These coaches are doing what used to be the doctor's job in the past.

Why are doctors so rude ?

One of the commonest complaints patients have about their doctors is that they are impolite or rude. I feel this is especially true for doctors who have a hospital-based practise. Hospitals tend to breed rude behaviour. Even polite doctors tend to become arrogant once they have spent a few years in a hospital.

For one thing, doctors in hospitals are very busy and they often just don't have time for the common pleasantries which we take for granted in our daily life. Many of them are brusque and down-to-earth because they need to get on with their serious job of taking care of their patients, and they simply cannot afford to chit-chat with patients or their relatives. This is why they put on a shield which protects them from having to spend too much time with one patient. They cultivate an aura of superiority and aloofness to allow themselves to accomplish their tasks effectively.

They are usually accompanied by a retinue of assistants and juniors - and they often spend more time talking to them than to patients. Since nurses and juniors are deferential and respectful, patients are expected to toe the line and follow suit !

Hospitals can be hot-beds of political rivalry amongst doctors, most of whom have large egos and play a superb game of one-upmanship. They often have to show how much busier they are than the other doctors, so appearing to be overworked and rushing around from bed to bed ( because they have such a heavy workload) is considered to be an asset. This makes them even more unapproachable.

Today, because doctors try to take as many hospital attachments as possible ( to augment their income), they are so busy rushing around from hospital to hospital, they they have even lesser time to spend with an individual patient.

Finally, many hospital-based doctors do not have a personal relationship with their patients. Patients often come to them because of the reputation of the hospital in which they work , so they rarely bother to establish a rapport with them - every patient they treat is like every other patient.

Unfortunately, this sort of behaviour does exact a toll - and many patients and families resent the doctor's high-handedness. This damages a doctor-patient relationship - and leads to lawsuits when things go wrong.

It's been proven that doctors who take the time to sit and talk to patients ( even if it's for just a few minutes) are seen to be much more caring and thoughtful than those who don't - and these doctors do much better in clinical practise too !

Should patients be obsessive-compulsive ?

I am a firm believer in the importance of information therapy and I believe that patients should become experts in the treatment of their own illness. Health is too important to be left upto a doctor, and an active partnership is key to ensuring you get good medical care.

However, as with everything else, too much of a good thing can be bad ! Some patients become obsessive-compulsive - and often end up harming themselves. They often become too aggressive or demanding, as a result of which they damage their relationship with their doctor. Unhappy doctors are unlikely to provide a sympathetic ear or a shoulder to cry on - which means that even if they get high quality medical care which is technically adequate, they often get little emotional support.

It's not a good idea to ruffle your doctor's feathers - and a high EQ ( emotional quotient) is as important as a high IQ ( intelligence quotient) when you are a patient.
As the Buddha said, The Middle Path is often the best !

Monday, November 27, 2006

Consumer Health World Blog >> Marketing to the New Healthcare Consumer

Consumer Health World Blog >> Marketing to the New Healthcare Consumer: " Let’s start by defining just who is this “new health care” consumer. They are defined by the following four characteristics:

1. They are skeptical of institutions, such as their government, the FDA, healthcare companies/providers, and big brand pharma companies...

3. They are changing relationships with traditional healthcare providers – a sort of “Democratic Revolution.”

Patients are not fools - treat all patients the way you would treat your wife ( with apologies to David Ogilvy).

Indian Medical Register Database - www.medclik.com

Indian Medical Register Database - www.medclik.com Patients can now search this huge database of Indians doctors, to confirm that their doctor is qualified and is registered with the Indian Medical Council. The Indian medical profession is finally entering the 21st century !

Consumer-driven healthcare equals more physician IT use

Consumer-driven healthcare equals more physician IT use: "The FCG report concludes that if physicians are to find success in the CDH environment, they must learn to manage the “customer experience” in ways akin to the sales management process in non-healthcare industries. To do this, practices may turn to customer resource management technologies, which are not widely used in physician practices at the present.

Electronic health records will be a necessary first step for physicians wanting to compete in a CDH environment. FCG recommends, however, that physicians should purchase an ambulatory EHR system that has e-prescribing, decision support capabilities, and can support the ability to report on performance as a byproduct of documenting care. To be truly useful to physicians dealing with CDH, an EHR must also have the ability to accept data from, and provide data to, external systems.

“Just having an EHR system will not be enough,” said Brandman. “You must be able to get data from outside sources.”

Brandman added that Web portal technology might also be critical to physician success in the CDH world. She said that portals will enable physicians to exchange member and claims information with health plans online, and that patients will use portals to pay account balances. Modified portals might also allow for online consultations, or “e-visits.” "

Use of Mobile and Wireless Technology Jumps in Hospitals :: Bio-IT World

Use of Mobile and Wireless Technology Jumps in Hospitals :: Bio-IT World: "Even though adoption of electronic health records (EHR) and other clinical IT remains fairly anemic, at least one aspect of health-IT has taken giant steps forward in the last few years: the use of mobile and wireless technology where choices are proliferating.

"Now everyone is looking at the shiny, new devices that provide those integrated capabilities," Gotsis says. "You try to reach the physician or the clinician wherever they are."

And practitioners want to be reached. "As a neurosurgeon, I'm all over the hospital," Martin says. "I guess I'm the ultimate mobile professional." And he needs more than vmail. Martin needs access to images when consulting on patients in critical care.

An MRI or CT scan viewed on a PDA or smartphone may not be diagnostic-quality for a radiologist, but for a neurosurgeon or other specialist helping to treat life-threatening emergencies, the resolution is just fine, according to Martin. He says that a smartphone screen just happens to be about the size of one square of a 12-image MRI film, which is good enough for him. "

Plugged In: Fertility industry booms online | Health | Reuters.com

Plugged In: Fertility industry booms online | Health | Reuters.com: "More and more people have literally found life on the Internet as the estimated $3 billion fertility industry moves increasingly online.

But as with all online commercial ventures, shopping on the Web can carry risks.

In this case, the Internet may provide consumers -- often people desperate to have a child -- a faster and more discreet way to find egg or sperm donors. But it can also lead to lost money and broken dreams, say fertility experts.

Other experts say hopeful recipients may be asked by less reputable egg donor sites to pay large, nonrefundable sums upfront to see profiles, or be made to wait for months for donors that never materialize."

Don't let anyone take you for a ride - caveat emptor still applies !

Wednesday, November 22, 2006

Welcome to Conceiving Concepts

Welcome to Conceiving Concepts: "Q: I just turned 38. History of endometriosis; it took birth control of many years to control it. I was told years ago I have one tube blocked. I got pregnant once 10 years ago at age 27, but miscarried at eight weeks. I have been off the pill for 1.5 years now. My periods have been erratic, 23 days one month and 42 then next. For a few months I was very regular (27 days), but was taking the herb Vitex. I stopped just over a month ago and now, all of a sudden, my period was very heavy, spotted for seven days afterwards, hot flashes started and now my period is two weeks late. I have had blood tests done; I am not pregnant and my hormone levels are apparently normal. Can you please advise what you think is happening and what you think my chances of getting pregnant are? Thank you.



A: I am worried about your advanced age and your hot flashes. This suggests poor ovarian reserve, which is also known as the oopause. You can read more about this here. You need to measure your blood levels of FSH, LH, PRL and TSH on Day 3 of your cycle, so we can find out what the reason for your irregular cycles is. This may show you have high FSH levels, which will confirm the diagnosis.

Dr Aniruddha Malpani, MD"

Like most doctors, I enjoy helping patients - and I find answering patient's queries very rewarding. I do this for a website called Conceiving Concepts; and replying to patient's queries helps me to update my knowledge and polish my communication skills as well !

Cancer care often uncoordinated - USATODAY.com

Cancer care often uncoordinated - USATODAY.com: "Cancer patients often suffer from a lack of information, Stovall says. Many long-term survivors — who commonly suffer side effects years after treatment — have trouble reconstructing exactly what was done to them. Over time, doctors may relocate or even pass away.

That's why Stovall says every cancer patient deserves three key documents:

•A care plan, written shortly after diagnosis, outlining how doctors plan to treat their cancer.

•A treatment summary given to the patient at the end of their therapy, outlining all their surgeries, radiation and drugs, including specific dosages.

•A plan for ongoing care, describing how survivors should monitor their health, including guidance on screening tests, follow-up visits and potential long-term side effects."

This should be true for all chronic diseases !

Tuesday, November 21, 2006

E-care - Health care hits the Web

E-care - Health care hits the Web: "E-mails and phone calls paid at least in part by insurers are a fast-growing solution to a common ailment in health care: the unnecessary visit to the doctor's office.

Doctors have used phone calls for years to cut down on these visits — to tell patients with simple colds to stay home, counsel patients with chronic diseases or prescribe obvious treatments. But now clinic groups and insurers have begun to make this a more formal medical service. And insurers have agreed in the past year to pay at least for medical advice via e-mail, also known as e-care.

'The future is going to require us to do this,' said Dr. Michael McGrail, associate medical director of HealthPartner's primary care division. He cited estimates that up to 40 percent of office visits are unnecessary.

Clinics and their leaders said they have an additional incentive to use e-care: They need to increase the speed and convenience of their services so they won't lose patients with simple infections or illnesses to the growing number of retail walk-in facilities such as MinuteClinics."

I am sure patients would be happy to pay for this ! Who wants to go to a doctor's clinic and wait around to see the doctor for a routine problem ( most medical problems for which patients go to a doctor are routine , simple and self-limited ) which could be managed sitting at home !

Silicon Valley should lead in cutting patient paperwork

Silicon Valley should lead in cutting patient paperwork: "The quickest way the governor can substantially cut health care costs is by insisting the state bring medical forms and documentation of patient history into the 21st century. Converting the state's antiquated system for keeping medical records could cut the costs by as much as 25 to 30 percent.

As an added bonus, the use of electronic medical records will cut down on the number of patient deaths caused by medical errors, help doctors spot disease outbreaks faster, reduce the number of repetitive medical tests and efficiently provide essential information to medical professionals in the event of a disaster, such as a major earthquake."

And where California goes, the rest of the world will follow !

U.K. Dept of Health: Prescription for Disaster

U.K. Dept of Health: Prescription for Disaster: "The inspiration to digitize this far-flung bureaucracy first surfaced in late 2001, when Microsoft's Bill Gates paid a visit to British Prime Minister Tony Blair at No. 10 Downing St. The subject of the meeting, as reported by The Guardian, was what could be done to improve the National Health Service. At the time, much of the service was paper-based and severely lagging in its use of technology. A long-term review of NHS funding that was issued just before the Blair-Gates meeting had concluded: 'The U.K. health service has a poor record on the use of information and communications technology—the result of many years of serious under-investment.'

Coming off a landslide victory in the 2001 general election, Blair was eager to move Britain's health services out of technology's dark ages. Gates, who had come to England to tell the CEOs of the NHS trusts how to develop integrated systems that could enhance health care, was happy to point the way. 'Blair was dazzled by what he saw as the success of Microsoft,' says Black Sheep Research's Brampton. Their meeting gave rise to what would become the NPfIT."

We can all learn from this disaster. It's not enough to have a good idea - implementing it on time and inexpensively is equally important ! Top-down approaches never work well - and this is why PHRs ( owned by patients) rather than EMRs ( owned by the healthcare providers) make so much more sense as an entry point to digitising medical records.

Healthcare IT budget boost good news for Linux - vnunet.com

Healthcare IT budget boost good news for Linux : "Projected increases in healthcare IT spending spell opportunities for open source vendors, according to the Open Source Development Lab (OSDL).

The consortium dedicated to accelerating the adoption of Linux and open source software cited a Rand Corporation study suggesting that IT budgets average just two to three per cent of overall healthcare expenditure.

In contrast, IT spending comprised between 12 and 15 per cent in other industries. As a result, healthcare IT spending is expected to grow at a faster rate than overall IT, increasing the appeal of open source software.

'Linux and open source software have become pervasive in vertical markets such as retail and financial services,' said Stuart Cohen, chief executive at OSDL.

'The healthcare market today is positioned for major growth, and managers are in a position to take control of their IT strategies and to have a significant impact on their organisations and the overall healthcare industry with open source technologies.'"

America bails out on HMOs | Chicago Tribune

America bails out on HMOs | Chicago Tribune: "The shift away from HMOs appears to resolve a long-running debate about whether saving money is more important than retaining control of medical choices. Consumers are indicating that the cost saving is not the only important factor."

Fortunately, this is one American innovation India has not yet imported ! HMOs have become Health Mismanagement Organisations - but we still need to come up with an idea which works well !

Monday, November 20, 2006

Electronic medical records use may rise - Yahoo! News

Electronic medical records use may rise - Yahoo! News: " Federal officials last month paved the way for hospitals to come to the rescue, allowing them to donate medical record systems to physician practices to blunt some of the financial bite.

In addition, those inside the industry recently agreed on technology standards that allow software from different companies to share data, taking some of the fear out of the purchasing decision.

Those moves are apparently loosening purse strings as medical software makers say they've seen a surge in new interest and new customers and predict this may be the spark they needed to pull the $1.5 billion electronic health records industry into the medical mainstream."

This is good news for patients !

Medical Rudeness

Medical Rudeness: "To give medical professionals specific ideas of where to focus their attention, Humphries sought to define what respondents perceive to be the most rude behaviors, the behaviors most admired and appreciated, and people's responses to both.

The most rude behavior reported by seventy-four percent of respondents was being ignored upon arrival by indifferent staff; the second was rudeness on the telephone, and the third was disrespecting people's time with long waits, overbooking, and rushing care.

In addition, the survey asked what behaviors people admire, appreciate, and respect. 68% percent reported a quick, friendly greeting, 62% said, respect and individualized care, and 32% said a helpful staff who will listen. When respondents were treated with respect, 64% percent said they became respectful, appreciative, and cooperative, and 29% would return and tell others."

These are such simple things to do - why don't we all do them all the time ?

Saturday, November 18, 2006

Medical tourism: India is 'nation of choice' for medical tourists

Medical tourism: India is 'nation of choice' for medical tourists: "India's minister for tourism and culture, Smt Ambika Soni, has highlighted the need for the country to promote itself as the emerging medical value travel destination for overseas patients.

Speaking at the launch of the new Incredible India brochure on Medical Tourism, Smt Soni said that both private and public hospitals needed to combine their efforts in order to promote the country as the medical destination of choice and to assure tourists of the best quality treatment at competitive costs.

According to Smt Soni, India's healthcare sector is now the largest in the service sector, contributing 6.2 per cent to GDP."

Medical tourism: India is destination of choice

Medical tourism: India is destination of choice: "India is the top global destination for medical tourism, according to a new market research report.

A study on the Indian Healthcare sector, conducted by RNCOS, has revealed the country's medical tourism market to be worth over $310 million, expected to rise to $2 billion by 2012.

Medical infrastructure and technology in India are accepted to be on a par with the UK and the US and the efficient services and affordable hospital expenses make it an attractive choice for patients seeking treatment abroad. "

GetWellNetwork - Enhancing caregiver satisfaction - Monitor patient satisfaction - patient centered care

GetWellNetwork - Enhancing caregiver satisfaction - Monitor patient satisfaction - patient centered care: "It’s time for a new approach to interactive patient care. Today's health care organizations are driven by two powerful dynamics: Quality Improvement and Service Excellence. These dynamics arguably sit at the forefront of every hospital's strategic priorities as they seek to deliver optimal outcomes and patient satisfaction. Despite investing billions of dollars on clinical systems to improve quality and new facility construction to improve the patient environment, hospitals have not achieved the outcomes originally expected.

In response, GetWellNetwork® was founded on the principle that by engaging patients and families into a hospital’s service excellence and quality initiatives, hospitals will achieve the outcomes that they desire. The GetWellNetwork PatientLife:)System™, including Patient Pathways™, helps hospitals empower the patient and family and engage them into the care process in ways that have never been done before. "

Using technology to reach out to patients in hospital has been a relatively neglected area so far - and one which is ripe for change !

Patient Navigation in Cancer Care: Guiding patients to quality outcomes™

Patient Navigation in Cancer Care: Guiding patients to quality outcomes™: "Patient navigation trains individuals or “navigators” to help cancer patients get timely access to care and treatment by anticipating and avoiding potential barriers to care:
• Financial
• Communication
• Information
• Transportation

It is a low-tech, highly effective program where cancer patients are provided one-on-one attention that guides and navigates them through a very complex health care system."

We all need patient advocates to help us when we are sick - and any help with navigating the complex healthcare system is always welcome !

Personal Health Desk - Free Software Downloads and Software Reviews - Download.com

Personal Health Desk - Free Software Downloads and Software Reviews - Download.com: "Take control of your and your family's health. Record details of your medical history including allergies, diagnoses, tests, procedures, immunization, medication, and pregnancies. Record new health events of any type (e.g. BP check, weight checks, new symptoms/signs, doctor visits). Use a variety of tools to simplify adding data. View and print summaries. Use medical calculators to monitor your health e.g. BMI, ideal weight, cardiac risk, growth charts, child development hints. Create health monitoring plans to record your health checks and to add reminders."

It's not really free - but $ 29 is a good investment to make to help you take care of your health ! Check it out !

Create Custom Preventive Care Reports During Patients’ Office Visits

Create Custom Preventive Care Reports During Patients’ Office Visits: "The new Electronic Preventive Services Selector (ePSS), which works with a personal digital assistant or desktop computer, allows physicians to access the latest recommendations from the AHRQ-sponsored U.S. Preventive Services Task Force. AHRQ is an agency of the U.S. Department of Health and Human Services. Designed for use at the point of care, the ePSS contains 110 recommendations for specific populations covering 59 preventive services topics. You input a patient’s age, gender, and selected behavioral risk factors — such as whether the patient is a smoker — in the appropriate fields. The software then cross-references these patient characteristics with the applicable AHRQ task force recommendations and generates a report tailored for that patient.

The report has information on screening tests ranging from mammograms to ultrasounds for detecting abdominal aortic aneurysms, as well as counseling topics and preventive medicine.

You can download the ePSS for free."

An ounce of prevention is worth a pound of cure - and this tool will help doctors to "prescribe prevention" !

Thursday, November 16, 2006

When Blind Faith in a Medical Fix Is Broken - New York Times

When Blind Faith in a Medical Fix Is Broken - New York Times: "A blocked artery is not a good thing. Public health campaigns have drilled that message into the national psyche. Surely, then, whenever doctors find a closed artery, especially in the heart, they should open it.

Maybe not. A major study, presented Tuesday at a medical conference in Chicago, challenged the widespread use of tiny balloons and metal stents in people who had suffered heart attacks days or weeks before.

Although such treatment can be lifesaving in the early stages of a heart attack, the study found that opening the artery later did no good at all. It merely exposed patients to the discomfort, risk and $10,000 expense of an invasive procedure.

The new report is the latest example of a rigorous experiment turning medical practice on its head by proving that a widely accepted treatment is not the great boon it was thought to be (except maybe to the bank accounts of doctors, drug companies and makers of medical devices)."

More is not always better !

Backlash at bills for medical mistakes | Chicago Tribune

Backlash at bills for medical mistakes : " If you go to a restaurant and get a bad meal you probably won't have to pay for it. And lemon laws allow consumers who buy cars that never work right to get their money back.

But in health care there is no tradition of rebates--even when a hospital surgical team leaves a sponge in a patient's chest cavity after open-heart surgery, or when a mix-up of a patient's medication causes a prolonged illness, employers and insurers say.

Tired of paying for botched medical-care procedures and low-quality medical care, some of the nation's largest businesses Wednesday called on U.S. hospitals to agree to apologize and waive costs related to 'never' events--medical errors these employers say should never happen."

Pay for performaance - and no-pay for non-performance !

Tuesday, November 14, 2006

Personal Health Records

ersonal Health Records: " The notion of keeping personal health records to facilitate access to healthcare services is not new—a Harris Interactive poll found that 42 percent of adults maintained some sort of personal or family records. But keeping those records electronically is another matter. Of the survey respondents who kept records, only 13 percent did so electronically. Concerns about privacy and accuracy deter many patients from utilizing PHRs despite their potential benefits to patient and provider alike, including more efficient care delivery, improved patient-provider relationships, cost savings through improved documentation, and increased patient safety. As personal health information portability becomes an increasingly crucial component of healthcare quality, a growing number of providers are looking to PHRs as the best way to make health information interoperable and secure."

An excellent overview of the options and obstacles with the PHR today.

MedCases Educational Resource Centers

MedCases Educational Resource Centers : " MedCases Educational Resource Centers provide physicians with a wealth of information and a variety of features to help them stay current with a medical topic or disease state. MedCases Educational Resource Centers provide physicians with the opportunity to interact with a community of their peers—connecting physicians with information and each other."

Clever use of technology for teaching doctors. This could easily be adpated to teach patients how to talk to their doctors too !

SmartMoney- 10 Things Your Hospital Won't Tell You

SmartMoney- 10 Things Your Hospital Won't Tell You: "'All hospitals are not created equal.'

How do you tell a good hospital from a bad one? For one thing, nurses. When it comes to their own families, medical workers favor institutions that attract good nurses."

Business Blogging for Health Professionals

Business Blogging for Health Professionals: "Welcome to my blogsite for the book Business Blogging for Health Professionals Using TypePad™. My blog (below this entry) is not just a sales Website for the book, it's also intended as a valuable resource for professionals who want insights into how to use the most modern technologies to advance their careers and enhance their reputations. I will be posting continual updates as I learn more myself about business blogging and as things change in the Blogosphere. I'm committed to providing a new post containing useful how-to information on a weekly basis (if not more often!)."

This book should serve as a useful guide and catalyst for many doctors who would like to start blogging !

10 ways to avoid outrageous hospital overcharges - MSN Money

10 ways to avoid outrageous hospital overcharges - MSN Money: "If there are items you don't understand, call the billing department and your insurer, and ask them to explain. The medical coding workers screw up all the time. Don't accept bills that use terms like 'lab fees,' or 'miscellaneous fees.' Demand an itemization. If you don't get satisfaction from the hospital billing department -- and you probably won't -- appeal in writing to the hospital administrator or patient ombudsman."

Even if your doctor's treatment makes you better, your hospital bill will make you ill !

How to Check-up on Your Hospital Bills

How to Check-up on Your Hospital Bills: "Don't assume that your hospital bill is correct. Duplicate billing, code errors and charges for unrequested items are mistakes that occur far too often. Why pay hundreds or even thousands of dollars more than you have to?
Probably the last thing you want to do after a hospital-stay is fine-tooth-comb the confusing computer codes and odd abbreviations on your bill. But it's worth the time and effort to review hospital bills carefully--you may be shocked at the number of costly errors you'll find. And if you think you don't have to worry about hospital charges because you're insured, take a close look at your policy. Most insurance companies require that patients make a co-payment (usually 20 percent of the total bill). Even if your policy says it covers 100 percent, that usually means it will pay for what the company considers to be 'reasonable and customary.' Anything above that amount comes out of your pocket."

Sometimes making sense of hospital bills is even harder than making sense of your doctor's handwriting ! I think the "healthcare industry" takes pleasure in obfuscation ! If hotels can go a good job with billing, why can't hospitals ?

Issues in infertility: finding out what the public think

Issues in infertility: finding out what the public think: " Issues surrounding infertility and reproductive medicine are rarely out of the news - delaying motherhood, egg and sperm donation, embryo testing and access to fertility treatment, to name just a few. But the published opinions triggered by this extensive media coverage have tended to be those of a select few doctors, scientists, patient representatives and pressure groups. To date, there has been no concerted effort to find out what most people think about these often controversial topics - even public consultations tend to trigger responses from stakeholders and those with a particular interest in the subject.

In an attempt to address this gap, the UK charity Progress Educational Trust (PET) recently commissioned a survey to measure public opinion on a wide range of these issues. Over 4,000 people responded to the 70-question survey, which was conducted by YouGov, and the results were released last week. They reveal many interesting, and sometimes surprising, findings. "

Monday, November 13, 2006

NetAnatomy.com

NetAnatomy.com
" NetAnatomy is designed to teach human anatomy to students of the health professions, including undergraduate medical, health sciences, and nursing students."

It's also a great site for curious humans who want to see what lies under the skin !

Kiosk monitoring station puts health in a box

Kiosk monitoring station puts health in a box: " Virgin Life Care is blending a rewards program and kiosks to lure its subscribers toward healthier lifestyles. The company’s HealthZone health monitoring station features a scale, body fat indicator, blood pressure cuff, and touch screen that let users measure and track their key biometric data on the spot. Part of Virgin Life Care’s HealthMiles, a health rewards program, the stations are placed in offices, health clubs and retail stores.

'As obesity and other preventable health conditions reach epidemic proportions in the U.S., consumers are looking for useful and practical ways to help them take control of their health,” said Stephen Thornton, CEO of Virgin Life Care. “The HealthZone is a convenient and effective vehicle for consumers to self-manage and self-monitor their health and well-being and make informed decisions that will ultimately lead to healthier lifestyles.'"

An adult version of video games to help keep them healthy !

24/7 access to medical records from your mobile - the doctor's dream !

24/7 access to medical records from your mobile - the doctor's dream ! :

"The Scenario.
You just got out of the office, you've sat down at the table of your favorite restaurant and ordered your meal. Your pager goes off. One of your patients has been admitted to the ER and they need a decision from you, now. Lucky for you, you've been using the Life Record EMR, and have access to EMRAnywhere. You pull out your SmartPhone and promptly log in to your Life Record LivePractice EMR via EMRAnywhere. Within seconds you have the answer you need. Luckily the patient is having a minor allergic reaction and can be treated easily. You use EMRAnywhere to write a prescription from your phone which is instantly transmitted to the pharmacy via LivePrescribe, the free e-prescribing system for the Life Record EMR. Just as you finish writing the prescription, your salad arrives and you enjoy the rest of your evening.

The Solution.
It sounds like something out of a futuristic movie, but it's here - today. The Life Record EMR is a web enabled application, which makes it incredibly easy to access from almost anywhere. When combined with the Life Record LivePractice Edition utilizing EMRAnywhere technology, it puts your entire patient database in the palm of your hand. "

One day, all doctors will be able to do this routinely !

Saturday, November 11, 2006

Online health coaching is effective and efficient

Online health coaching is effective and efficient"Online coaching has now been an area of exploration for the past five years by Hummingbird Coaching Services as well as by researchers around the country. Findings, to date, indicate that online coaching can work effectively and with comparatively great efficiency and convenience for consumers and coaches.

Online delivery has been tried with a number of different topics, including: weight management, exercise, parenting support, general life balance and satisfaction, smoking cessation, smokeless tobacco cessation, cardiac rehabilitation, diabetes management, HIV prevention, and Alzheimer caregiver support."


This method allows healthcare professionals to reach out to so many more people !

What Is Executive Health Coach?

What Is Executive Health Coach?: "Executive Health Coach is a confidential, proven executive wellness program. Executives are paired with an individual health coach and together they work to create a plan, set goals and achieve success.

By providing the tools to transform unhealthy behaviors into healthy habits, this program helps ensure that your high-performing executives remain that way.

Experienced coaches keep executives focused, help increase stamina and motivate executives to live a healthier lifestyle. As a result, executives feel reenergized, rejuvenated and renewed, and are able to achieve better life balance."

If health is wealth, this is a great investment for company's to be making !

RateMDs.com - Doctor Ratings and Reviews

RateMDs.com - Doctor Ratings and Reviews: "RateMDs.com allows patients to rate and read about their doctors. This is a fairly new website, so please add your doctors and rate them!"

I guess this is what 360 degree evaluation is all about !

Why We Like the Doctors We Like

Why We Like the Doctors We Like: "My point is that it doesn’t matter if you’re a young doctor or an experienced specialist. You can be compassionate or condescending toward your patients. You can take the same amount of time you have with a patient and either make it high quality or hurried and disrespectful. I was so impressed with Dr. Baker that I wrote him a thank you note. I took pains to describe why I liked him and what he did that made me feel good as a patient. I want him to never lose the wonderful way he behaves toward his patients."

It's so heartening to hear about patients who provide positive feedback. Most doctors hear only from patients ( or their lawyers) who are unhappy or dissatisfied. Any patient who writes such a Thank You note to their doctor will get even better medical care - it's a smart thing to do . Doctors are human, too - and respond to positive strokes, like all of us !

Personal Health Record Blog » About HealthRecordNews.com

Personal Health Record Blog » About HealthRecordNews.com: "Most on-line information about the various forms of electronic records is about features and technology. Wrong emphasis!!! Your record is about YOU, you want to know how having an personally controlled electronic record can benefit you, what it does for you today, how it potentially might even save your life. How it may even help your doctor - and how much it will cost (There are some excellent FREE versions)."

Reproduction revolution: Sex for fun, IVF for children - sex - 20 October 2006 - New Scientist

Reproduction revolution: Sex for fun, IVF for children : " Could we be moving towards an age in which entering nature's genetic lottery is no longer seen as a desirable way to bring a child into the world? Might natural conception even come to be thought of as irresponsible, as bad as smoking while pregnant?

Reproducing the traditional way is undoubtedly flawed. Worldwide around 1 child in 16 is born with a mental or physical disability due to a genetic defect, and most of us probably carry gene variants that predispose us to serious illnesses later in life. How much safer it would be to go along to the fertility clinic, have some embryos created and pick the one or two that will produce the healthiest baby.

IVF has become commonplace, and top clinics boast pregnancy rates of more than 30 per cent for each cycle - better than the 1 in 4 chance of conceiving the natural way and likely to improve further."

Is this the future of IVF ?

How to recognise problem patients

" Early recognition of problem patients is important for risk management. Problem patients may exhibit traits that include lengthy care histories from many providers, courses of care dominated primarily by emergency visits, constant complaints about past or current care, ongoing failure to pay for services, and consistent failures to adhere to advice and instructions. These traits are common in plaintiffs and litigious patients. Prudent practitioners who identify these traits early may discharge or not accept these patients. Often, such decisions save time, money, and aggravation. If you care for such a patient, document the care and issues of the problem. "

Good advise for all doctors - prevention is better than cure ! It's best to avoid "heartsink patients". Not only do they make the doctor's life miserable, they also end up harming other patients. Doctors get cynical and stressed out when dealing with these problem patients - and this affects the way they deal with all their other patients too !

Using Theater to teach doctors about patient safety

Patient Safety Theatre " creates a situation in which medical professionals can practice working through the very problems they are likely to confront. Each play is presented with some combination of interactive pre-show and/or follow-up activities, guaranteed to keep audiences debating the fine points long after the presentation has ended. "

Why Theater ? Because " nothing delivers new ideas with the impact of live performance. Because it entertains while it informs, theatre can help even the most critical audience members see their world from a new perspective. Whether scripted or improvised, what happens on stage has the power to engage, not just intellectually, but emotionally. In short, theatre is personal. "

Patients need to Speak Up !

To prevent health care errors, patients are urged to Speak Up. Speak up if you have questions or concerns, and if you don't understand, ask again. It's your body and you have a right to know. Your health is too important to worry about being embarrassed if you don't understand something that your doctor, nurse or other health care professional tells you !

Study: more Americans use Internet for healthcare info

Study: more Americans use Internet for healthcare info: "Mark Bard, president of Manhattan Research, said the results represent “a significant increase” in visits to health plan sites over a relatively short amount of time. “Health plans have succeeded in getting consumers to view their portals,” Bard said. “When you talk about giving people more control over their healthcare decisions, technology is critical in making this happen.” Nearly 45 million consumers reported visiting their health insurance company’s website in the past 12 months—double the number from two years ago, according to Erica Alexander, director of marketing and client services at Manhattan Research."

Websites are one of the best ways by which health insurance companies can reach out to their customers. Not only can they help them with business operations ( for example, customers can renew their policies online); they can also be used to provide health information and patient education on a proactive basis, to help their customers remain healthy. This would help insurance companies to cut down their medical claim payouts. It's a great ROI - yet few companies in India have bothered to use the technology. It's a great opportunity, waiting to be tapped !

Dr Google - use of Google as a diagnostic aid

Dr Google - use of Google as a diagnostic aid: " As internet access becomes more readily available in outpatient clinics and hospital wards, the web is rapidly becoming an important clinical tool for doctors. The use of web based searching may help doctors to diagnose difficult cases."

This study, published in the prestigious medical journal, BMJ, shows that Google can be helpful for solving medical googlies ! Of course, the caveat, GIGO still applies, which is why having a good doctor ( who know what to look for ) is still so important.

Friday, November 10, 2006

Professionalism: TEN common courtesies that count

Professionalism: TEN common courtesies that count : " As physicians, we believe we are “professional”. When you move out of your current domain and begin exploring other fields, keep in mind that professionalism is defined by how well you interact with everyone: peers, supervisors, staff. The common courtesies in human interaction significantly affect both how you are perceived and how effective you will be as a manager or leader.

Here are TEN behaviors that spell professionalism:

1. Keep meetings and appointments
2. Arrive at meetings on time
3. Listen before speaking
4. Ask before telling
5. Return phone calls within 8 hours
6. Reply to email within 24 hours
7. Express your views in a way that would NEVER embarrass another person
8. NEVER use foul language
9. Be brief and to the point
10. Say THANK YOU"

All simple stuff - but we often tend to forget it ! It's useful to be reminded of this eveyr once in a while !

BBC NEWS | Health | 3D computer map pinpoints pains

BBC NEWS | Health | 3D computer map pinpoints pains: "People in pain could soon use a 3D computer program to explain how severe their symptoms are. It has been developed by a team at Brunel University to help wheelchair users log, from home, how they are feeling during the course of a day. Currently, patients have to detail how their pain has been on pen and paper during their visits to the doctor. The program, which only requires a standard portable computer, can be uploaded by doctors at any point. It means doctors can build up information on how pain changes and the types of pain a patient has."

This type of medical data input could be done through the mobile phone ( which so many of us carry 24/7) as well !

Wal-Mart drug program boosts Internet sales,

Wal-Mart drug program boosts Internet sales: "Wal-Mart Stores Inc.'s price reductions on generic prescription drugs have prompted a surge in orders to the company's Web site, said Walmart.com.'s chief executive officer.

The program, in which a month's supply of 314 generic drugs sells for $4, has been introduced in 27 U.S. states beginning in September. The company's online pharmacy has had ``triple-digit growth,'' the strongest increase in the Web site's history, as customers place drug orders and refills for pick-up in stores, said Walmart.com CEO Carter Cast.

More shoppers are going to Wal-Mart's Web site to buy prescription drugs."

Online shopping for drugs is going to be a major growth area. Not only is it far more convenient for patients, it will help to reduce costs ( as patients can shop for the cheapest option); and also improve safety ( clever online computer programs can prevent harmful drug interactions, and also alert patients to dangerous side effects). They can also help drug stores to increase their sales, because these programs can be used to email patients to remind them to refill their prescriptions !

Wednesday, November 08, 2006

Head of Kaiser's digital project quits - problems with the EMR

Head of Kaiser's digital project quits - problems with the EMR : "The executive overseeing Kaiser Permanente's ambitious $3-billion push toward computerizing the medical records of its 8.6 million members resigned Tuesday, a sign of the challenges facing the project.

The resignation of J. Clifford Dodd, a senior vice president and chief information officer for Kaiser, came four days after another Kaiser employee sent a scathing e-mail to most of the company's 140,000 employees about his concerns over the high-profile technology project, known as HealthConnect.

In the e-mail, Justen Deal, a Los Angeles project supervisor who has worked on the new system, said Kaiser's switch to electronic medical records was proving far more expensive and unreliable than anticipated.

In an interview, Deal said cost overruns were common and that data showed the new software system breaking down so frequently that doctors and patients were often left for long periods without access to medical records.

He said 'the company is wasting hundreds of millions on the project and should consider scrapping it for a better one that can handle the scale of a company like Kaiser.'"

This is why an open source system which allows patients to control their medical records ( a PHR) linked to an EMR makes so much more sense ! Hopefully, other hospitals will learn from these expensive mistakes and not make them !

Running on Empty: Healthcare

Running on Empty: Healthcare : "Worse, healthcare is 1/7th of the economy and 1/11th of its job market. If this sector develops a large demand-resource mismatch and becomes financially unstable, the disruptions could cascade to and destabilize others sectors, threatening the national economic security.

A theory of limits applies here. In a voluntary market, healthcare purchasers--employers or taxpayers--will tolerate only so much cost growth. Then they'll recede. It is preposterous to believe the well won't run dry.

The only option for meaningful change, then, lies in leadership from non-healthcare business, which stands to suffer from the tidal wave of healthcare's turmoil. Good reason for them to mobilize and act."

It's a difficult balance - especially because healthcare is such a sensitive issue and affects all of us !

Helping infertile couples to make decisions

I recently received an email from a patient who had had 2 miscarriages at 8 weeks of pregnancy after 2 IVF attempts.

" I feel so DONE with IVF that we are already considering adoption. I think my doctor thinks that I should try donor egg, but finding a Chinese donor is very difficult (so we've considered using a Caucasian donor and Chinese donor sperm), but I am very skeptical about spending $30000 (yes, I am attending one of the most expensive programs in the country, and I've only seen the doctor five times total) without a known cause for the miscarriages. Had the karyotypes came back abnormal, I think donor egg would be an option. But because once came back, at least in the mind of the lab, conclusively normal and the other came back "possibly" normal, we are left wondering. For the same reason, the thought of doing another round of IVF is staggering. With the medication and the facility fees, I am paying about $15000 per cycle.

Based on your website information, I am very impressed by the information you provide and also the costs relative to the costs in the US. Also, because of a great interest in spirtual pursuits, I would love to visit India.

I am conflicted between just moving on to adoption versus trying more IVF versus donor egg/donor sperm, although I am certain I do not want to pay my current clinic $15000 to $30000 more on top of the $30000 I've already paid. Please let me know if you believe that your clinic might be a good option for more IVF, or if you believe that I probably have an egg, sperm or egg/sperm quality problem. Also, please let me know if you believe that your clinic might be a good option for donor egg/donor sperm, or if you believe that the two miscarriages may be an issue even with donor egg/donor sperm. We are ok with adoption, and plan to pursue foreign adoption only, both because it is easier and we believe has many spiritual benefits. A not insignificant part of me feels that I am being spiritually selfish and arrogant for relentlessly pursuing a biological child, while another part of me would really like to have that biological connection with my husband and the child (as I mentioned earlier, we are both adopted, so have no known biological relatives)."

This was my answer.

" I think you have to accept that today's medical technology does not have the answers to your questions.

In any case, I feel the question should NOT be "Why did I miscarry ? " This is a good question, but we cannot answer it ! Rather, I feel the question should be be - What can I do in order to have a baby ?"

After all, no one cares about problems - we only care about results - about having a baby !

Let's first list all your options:

1. child-free living
2. adoption
3. repeat another IVF cycle with your own eggs and sperm
4. donor egg
5. donor sperm
6. donor embryo
7. surrogacy

( This is the McKinsey MECE technique - make a list which is mutually exclusive and completely exhaustive).

The absence of alternatives makes decision making easier - you are going to have to choose between one of the above ! What to choose will also depend upon what will give you emotional closure and peace of mind that you tried your best. This is a very personal decision - and you need to make it yourself.

I feel donor embryo IVF is a logical option, but only your own heart can tell you what's right for you."

Making decisions is always hard - especially for infertile couples, when there are so many options. I offer non-directive counselling - and tell patients to choose " the path of least regret", so that when they are 70 years old and are looking back at their life, they have peace of mind they gave it their best shot !

Why health insurance is a major opportunity in India today !

Why health insurance is a major opportunity in India today ! " Historically, the public sector companies have also not paid attention to developing proper underwriting criteria and they are not required to declare the operating results of this product line separately. Despite years of experience, they have not built proper databases and do not carry out systematic analysis of amongst other things, disease patterns, regional variations, age-related healthcare spending and/or claim distribution costs. The health portfolio that had a loss ratio of about 78 per cent in 2003 deteriorated to 98 per cent in the following year. These deteriorating loss ratios, as well as the competition from new private players, are pressuring these companies to more actively manage their portfolios.

Since public sector insurance firms regard health insurance as a loss leader to gain footholds in other more profitable lines, they have also not invested adequately in their customer service proposition. An indication of the low level of satisfaction is the large number of complaints from customers. According to figures published by the 12 Insurance Ombudsmen in the country, 70 per cent of customer complaints relate to health insurance, the most common point of contention being clauses related to ‘pre-existing illnesses’.

The introduction of new private general insurance companies is, however, beginning to make some difference. Five of the new private non-life insurance companies sell stand-alone health insurance products. These new companies have introduced a few innovations, such as direct tie-ups with healthcare providers, providing ‘cashless’ settlement as an option, the provision of pre- and post-hospitalisation benefits and coverage for pre-existing illnesses."

It's potentially a huge market, which has suffered from benign neglect. It's going to grow exponentially, as the Indian consumer earns more money and the population grows older.

Healthcare Market Review - India

Healthcare Market Review- India: "Health insurance is grossly underdeveloped in India. According to some estimates, only 3% of India’s population is covered under some form of voluntary health insurance. Thus, it presents a huge opportunity with some estimates suggesting that the potential health insurance market could be worth as much as 600 billion Rupees by year 2007."

Businesses May Move Health Care Overseas - Newsday.com

Businesses May Move Health Care Overseas : " Businesses and insurance companies are starting to eye the potential savings of outsourcing health care from the world's richest country to the developing world.

'It's just one of the many ways in which our world is flattening,' said Arnold Milstein, chief physician at New York-based Mercer Health & Benefits, who's researching the feasibility of outsourcing medical care for three Fortune 500 corporations. 'Many companies see it as a natural extension of the competition they've faced in other aspects of their business.' "

Virtual healthcare assistant

Virtual healthcare assistant" Remembering therapies and checking their interactions, choosing appropriate foods for our diets, communicating in real-time with our doctor for timely advice and suggestions: in the lives of each and every one of us, there is an increasing need for useful, safe, and personalized information, accurately selected based on our specific requirements and preferences.
The ultimate challenge of PIPS is; to exploit the most advanced information technologies in order to encourage healthier individual choices in our daily lives by providing the ‘individual’ precise information to improve one’s well-being and quality of life, to prevent and to keep under control diseases and also to guarantee continuous support to treatments after being discharged from the hospital or to chronically ill patients. PIPS, is an attentive, discreet, and loyal “virtual assistant”, always available: all you need is a computer, a mobile phone, and an internet connection."

It's like having a mother ( or loving wife) reminding you to take good care of your health - and showing you how to do this !

eHealth applications in Europe

eHealth applications in Europe" There was further confirmation that the vision of future healthcare delivery behind the European Commission support to eHealth is being realised.The eHealth area is now mature enough for implementation, and is confirmed as the third pillar of the health industry behind the pharmaceutical industry and the medical equipments industry; from 0.7% of the European healthcare expenditure in 1996, eHealth today represents 2.5% and is expected to reach 5% of this amount within the next five years. As a conclusion, it can be said that eHealth is growing in policy, scientific and technological importance and that this is now recognised not only throughout Europe but also increasingly worldwide."

Excellent document - full of ideas which healthcare entrepreneurs can implement ! Why re-invent the wheel ?

World Health Congress Report: Technologies Put Healthcare in the Hands of Patients

World Health Congress Report: Technologies Put Healthcare in the Hands of Patients: "Patients need to take more active control of their healthcare. This message was a recurring theme of presentations at The World Healthcare Innovation and Technology Congress, held from November 1-3 in Washington, D.C. Speaking on the last day of the three-day conference, David Lansky, Ph.D., executive director of the Personal Health Technology Initiative at the Markle Foundation, discuss the growing support for electronic personal health records. In theory these records, which come in many flavors, could make healthcare more efficient and safer."

Tuesday, November 07, 2006

The 99 Cent Health Info Download

The 99 Cent Health Info Download : " Perhaps Americans just don't value health information as much as they do the latest music download available on iTunes for 99 cents.

On the other hand, patients say they would like access to online services to communicate with their doctors. A recent Wall Street Journal/Harris Interactive Health Care Poll found that 77% of adults would like e-mail reminders from their doctors when they are due for a visit. Another three-quarters of adults said they'd like to schedule appointments online and use e-mail to communicate directly with their doctors.

But how much will they be willing to pay for such an 'on-demand' health services?

Not much. I base this assertion on a July study by Forrester Research, 'Seven Things Health Care Consumers Won't Pay $100 For.' According to Forrester, consumers 'remain largely unwilling to pay for solutions whose benefits are abstract and not immediate.' "

This is an opportunity ! Customers will pay for value ! The trick is to provide them with reliable personalised healthcare information they can use immediately - by tailoring it around their PHR and delivering it to them through their mobiles. And maybe their health insurance company would pay for it, if it would help them remain healthy ?

Cardiologists stand by stents: FierceHealthcare

Cardiologists stand by stents: FierceHealthcare: " Recently there have been reports that blood clots can form within drug-coated stents designed to keep arteries clear. But cardiologists at the Transcather Cardiovascular Therapeutics show say patients are 'far more are being killed each year by the failure of doctors to promptly clear coronary arteries and install stents when patients arrive at a hospital during a heart attack.' Experts say that many studies have proven the superiority of stents to clot-busting drugs, and that the risk of an adverse reaction to the stent is small in comparison to the risk of foregoing the treatment. One problem is that often, smaller hospitals don't have a cardiologist on hand who's trained to handle stents. Experts say that if a patient is sent to a hospital that doesn't perform the procedure, they should be immediately transferred to another institution that does."

Obviously this is what you'd expect cardiologists to say ! After all, this is a question of their "bread and butter" !

LabCorp launches retail-based testing: FierceHealthcare

LabCorp launches retail-based testing: FierceHealthcare: " Welcome to the next phase of retail health. Not to be outdone by the MinuteClinics of the world, medical testing company Lab Corporation of America has announced plans to establish service centers in 20 Duane Reade drugstores in New York City. The new outlets will collect blood and urine specimens, then route the samples to off-site labs for testing. LabCorp currently operates 1,300 of its own patient service centers, as well as servicing a much-larger group of physician offices and hospitals.

This is the first time that LabCorp has tried the drugstore-based approach, though company officials say they hope to expand the program with Duane Reade or other partners. One way for them to do so may be to branch out to other Duane Reade stores, as the chain operates 250 drugstores across the United States, notes The News & Observer."

This is a win-win situation - and we are likely to see a lot more of these partnerships. Rather than get patients to come to you, it makes much more sense to go to where the patients are !

Contextualising Urban Healthcare in India using GIS

Contextualising Urban Healthcare in India using GIS : " This chapter is destined to provide an overview of GIS technology capabilities and limitations in the field of social sciences, and especially in health studies in order to build up a pertinent methodology in setting up our GIS. After briefly defining and describing the components of a GIS, we will focus on actual GIS implementations in these fields. The next part will present the main limitations appearing when resorting to such tools. We will then focus on actual use of GIS in India in the field of Health Studies. "

Health and Poverty

Health and Poverty " Let’s start with a brief discussion about what we routinely observe about the relationship between the health system and the poor. First, we generally see
that the poor suffer from poor health, often attributable to diseases that can be easily prevented and/or treated at an early stage by appropriate interventions. Clearly, there is some mismatch in volume or type between the services being supplied and what is “needed” or demanded. Second, looking at poor households, we usually find that families recognize the importance of good health, both for their general welfare and for its effect on earnings. But we see that households generally use less of services that appear to be “available” (that is, nearby and even affordable, counting direct prices) than public health
professionals would see as desirable to achieve a positive health outcome. We see that even the poor, who are typically seen as the target of governmentfinanced
actions in health, often opt for privately provided services--and that these services may not be seen by the public health community as the ones that are essential to good health. Third, looking at the health services themselves, we often see that government health services are not close to the people, or they do not function well, or they are unresponsive to the demands of the population--or all of the above! Finally, peering into the black box of public policy, we see that rhetoric about universal coverage, free services, priority dedicated to primary care and other worthy objectives are not matched by the patterns of spending."

IT Could Improve Health Care in India - iHealthBeat - Daily News Digest on Health Care Information Technology

IT Could Improve Health Care in India : " IT could improve health care access in remote areas of India, according to India's Union Health Minister Anbumani Ramadoss, the Times of India reports.

The technology should be included in disease surveillance and telemedicine programs, Ramadoss said last week after a meeting with Intel Chair Craig Barrett (Times of India, 11/3). Barrett was in Asia last week to discuss plans to provide rural health clinics in China and India with computers and Internet access, which will enable physicians to exchange X-rays and other patient data, the Wall Street Journal Asia reports.

Intel in May announced that it will spend $1 billion over five years to improve Internet access and train residents to use the technology in developing countries (Dean/Wonacott, Wall Street Journal Asia, 11/3).

Intel is working on a pilot program, called Aarogya Jaal, at a community health center in the Baramati and Pune districts of Maharashtra, India, according to Barrett. The goal is to replicate the pilot to improve the delivery system at community health centers and to promote the use of IT in health care, the Times of India reports."

IT will help to improve healthcare in India's cities too - and the ROI here would be far more, because there are so many more patients in the cities ! They should first learn how to make it work in the cities, before rolling out "model" IT-healthcare projects in the villages.

Monday, November 06, 2006

Location-based health information services: a new paradigm in personalised information delivery

Location-based health information services: a new paradigm in personalised information delivery: " Users' profiles and needs are definitely affected by where they are, and this should be taken into consideration when personalising and delivering health information to users in different locations. The main goal of location-based health information services is to allow better presentation of the distribution of health and healthcare needs and Internet resources answering them across a geographical area, with the aim to provide users with better support for informed decision-making. Personalised information delivery requires the acquisition of high quality metadata about not only information resources, but also information service users, their geographical location and their devices.

An online healthcare facility locator service can assist users in finding the nearest hospitals or clinics based on their location and health needs, and even provide them with driving directions and real-time traffic information. For example, a mobile patient checking on the availability of a dental clinic in a given city might access geocoding services that identify the location of the patient and nearest clinics, and would cull data from real-time booking services to check for clinics' working hours and book a suitable appointment, and from driving directions and real-time traffic information services to route the patient to the clinic."

Mobile Geographic Information Systems to reduce patient waiting times in the ER

Mobile Geographic Information Systems to reduce patient waiting times in the ER : " Memorial Hospital Jacksonville is one of 15 Florida-based HCA hospitals that's kicked off a program to re-direct non-emergency patients to nearby clinics instead of treating them in the ER. The new policy will help cut down on ER wait times and also save everyone involved the cost of expensive emergency care. In the first week of the program, 110 were initially thought to be non-emergency patients (Under the Emergency Medical Treatment and Labor Act [EMTALA], all hospitals must screen ER patients). After being examined by a doctor, 85 were given pamphlets directing them to local profit and non-profit clinics for treatment. The hospital has a few kinks to iron out though, as some of the clinic contact information was incorrect. "

Using mobile GIS ( geographic information systems) patients ( and their doctors) could use their mobiles to find out which the nearest ERs and clinics were - so they could go to the ones which were not busy. This would help in redistributing workload and also ensure that patients received prompt medical attention !

Providers see future with retail clinics: FierceHealthcare

Providers see future with retail clinics: FierceHealthcare: Retail clinics--nurse practitioner-staffed medical centers that are less expensive than regular doctor visits--began popping up five years ago in such stores as CVS, Wal-Mart and Walgreens. Now traditional medical providers are taking notice of retail health clinics and even throwing their hats in the ring in order to protect themselves from competition. Some health systems have staffed their own clinics, signed contracts to oversee clinic staff or set up referral systems with the in-store clinics. By partnering rather than competing with the clinics, physicians can enjoy a slice of the profits while at the same time easing critics' concerns about quality-of-care issues. Traditional health providers have recognized that the clinics' straightforward and less expensive approach to healthcare could revolutionize how many people, particularly the uninsured, receive medical treatment."

If you can't beat the, join them !

Your Disease Risk

Your Disease Risk "Welcome to Your Disease Risk, the source on prevention. Here, you can find out your risk of developing five of the most important diseases in the United States and get personalized tips for preventing them.

Developed over the past ten years by the Harvard Center for Cancer Prevention, Your Disease Risk collects the latest scientific evidence on disease risk factors into one easy-to-use tool."

Andy Grove and the PHR - KISS !

Andy Grove and the PHR - KISS !: "Specifically, Mr. Grove is a big fan of low-cost, walk-in clinics, the sort beginning to appear in stores like Wal-Mart. He says they provide basic medical care for the uninsured, and also take some strain off of America's overloaded emergency rooms. But one thing missing from this emerging clinic infrastructure is a good system of medical record-keeping.

Mr. Grove, naturally, thinks technology can help. But rather than designing an elaborate and technically sophisticated medical-database system, something virtually every tech company is now trying to do, Mr. Grove suggests the exact opposite. Shift left; keep the record of a patient's visit in, for example, a generic but Web-accessible word-processing file.

Just like the early PC, it will be far from ideal, but it will be a start, and it can get better over time. The alternative, he says, is to wait endlessly for a perfect technology.

Students of business history will recognize the idea of a plain-vanilla medical record as an example of a 'disruptive technology,' which is initially opposed by powerful incumbents with a vested economic interest in shifting ever-rightward."

The EMR: An Electronic Bridge

The EMR: An Electronic Bridge
Between Medicine and Science
The development of EMR systems presents a unique opportunity to support and further the nation’s health research enterprise. To date, the utility of health information networks has been seen as related primarily to reducing healthcare costs, limiting medical errors, and generally improving the standard of care. While these benefits are important, there is another critical element in the healthcare continuum that could greatly benefit from the development
of EMR systems: medical research.

COMBATing rising healthcare costs

COMBATing rising healthcare costs: "C.O.M.B.A.T. Mission:
To combat the rising costs of healthcare using medical banking principles and technology.
Objectives:

To implement a royalty-free, real-time administrative and clinical transactions testing architecture:

1. The technology will illustrate real time administrative transaction processing in healthcare.
2. The plan will fully embrace HIPAA and other policy requirements for the authorized exchange of medical records among banks, healthcare providers and consumers.
3. The testing platform will be tested in 3 or more Proof-of-Concepts.
4. After the testing phase, MBProject will host the platform for research and trading partner certification."

It's a shame that the medical records will be used only for facilitation payments in this model. It would be so easy to use them for improving medical care at the same time !

"Smart" medical debit cards on the rise

"Smart" medical debit cards on the rise :" New research is predicting that with the growth in consumer-driven health plans, the industry will come to rely on 'smart' debit cards linking clinical data, health plan coverage/eligibility information and personal identity details. The study, conducted by HealthLeaders/Interstudy, predicts that in time, a single card will have access to a consumer's bank, payor and provider systems. In this world, it will be possible for a consumer to see a provider, get benefits verified, a claim adjudicated and the payment debited from their health savings account. This could transform provider collection cycles from a months-long nightmare into an instant transaction, researchers noted."

It would be much more useful if they would also add a PHR to the smart card, so that it could be used for storing and accessing medical information, rather than for financial transactions only.

Sunday, November 05, 2006

Resistance is futile: The coming age of electronic health records

Resistance is futile: The coming age of electronic health records: " Electronic health records will soon be an integral part of every medical practice. The question is, will the medical community continue to be driven towards this technology by outside influences, or will providers overcome their fear of the unknown in time to adopt electronic health records on their own terms?"

Are doctors going to lead the way ? Or are we going to be dragged, kicking and screaming, to the future ?

The Computer-Based Patient Record: An Essential Technology for Health Care, Revised Edition (1997)

The Computer-Based Patient Record: An Essential Technology for Health Care, Revised Edition (1997): "Computer-based patient records and the systems in which they function are becoming an essential technology for health care in part because the information management challenges faced by health care professionals are increasing daily. Technological progress makes it possible for CPRs and CPR systems to provide total, cost-effective access to more complete, accurate patient care data and to offer improved performance and enhanced functions that can be used to meet those information management challenges. CPRs can play an important role in improving the quality of patient care and strengthening the scientific basis of clinical practice; they can also contribute to the management and moderation of health care costs."

This was written in 1997 ! We are still so far off from implenting computer-based patient medical records , even though everyone seems to agree it's the best thing since apple pie ! Why is this so ?

HELP - the world's largest patient education library

A guided tour of HELP, the world's largest patient education library

eBMJ -- How to read a paper

eBMJ -- How to read a paper This is an excellent collection of articles which will teach you how to read an article which appears in a medical journal. It's been written for medical students - but the intelligent patient will learn a lot from this as well !

Saturday, November 04, 2006

Journal of Medical Internet Research - Providing a Web-based Online Medical Record to Patients : Randomised Trial

Journal of Medical Internet Research - Providing a Web-based Online Medical Record to Patients : Randomized Trial: This is a scientific study of what happens when patients are given access to their medical records online. A trend was observed for better satisfaction with doctor-patient communication. There was no improvement in health status. There were no adverse effects from use of the system.

Use of a Patient-Accessible Electronic Medical Record : Patient and Physician Experiences

Use of a Patient-Accessible Electronic Medical Record: Patient and Physician Experiences: " At the start of the trial, patients were uniformly positive about the idea of having facilitated access to their records, and the experience of access did not dampen that enthusiasm. Although physicians expressed concerns initially, they viewed patient-accessible records much more favorably after none of these concerns materialized. "

This paper reviews the pros and cons of the PMR ( an EMR provided to the patient by the clinic) very well. It considers both the patient's point of view - as well as the doctors.

The potential downsides ( for the patient's point of view) were:
* More questions—Contact the practice with more questions between visits.
* Worry more—Read things that would make you or them worry more.
* Reports confusing— Find the lab and radiograph reports confusing.
* Notes offensive— Be offended by some of the things that the doctor wrote about them.
* Notes confusing—Find the doctors' notes confusing.

The upsides were:
* Feel more in control of their medical care.
* Better understand their medical conditions.
* Be better prepared for their doctor visits.
* Feel more reassured.
* Better understand their doctors' instructions.
* Better follow their doctors' recommendations.
* Trust their doctor more.
* Find mistakes which their doctors could correct in their records.

This article provides a "real-life" experience of what happens when PMRs are used in the real world, and is well worth reading. I especially liked the following suggestions for improvement.

1. electronic notification ( "alerts") when anything is added to the record so that he would not waste time reviewing his records when nothing was new.
2. some sort of aid that would help interpret laboratory and other diagnostic tests, so that they could better assess the significance of a laboratory or test finding.
3. attaching hyperlinks to define technical terms and providing some means for patients to annotate their records when they find errors.

Swiss Re set to restart health reinsurance biz - Times of India

" After exiting the health reinsurance business in 1998, Swiss Re is making a comeback. And it is betting big on India and China. Swiss Re decided to re-enter the business last year after it acquired GE Insurance Solutions (GEIS), which has a fairly substantial health reinsurance book. The reinsurer has already hired a number of professionals to build the business.
The company’s focus on the Indian health insurance market is not without reason. It estimates the market would expand from $400 million in 2005 to $3.5 billion in 2015.
“We see tremendous opportunity in both India and China. Swiss Re’s support will be in terms of capital, capacity as well as know-how in the risk management area, product design, pricing, underwriting and claims and risk management,’’ says Jean-Michel Chatagny, MD, strategic corporate development Asia, Swiss Re.
Medical insurance is expected to be one of the key growth drivers of the industry as health care costs in India rise at a rate of about 20-22% annually. General insurers are likely to shift their focus to other lines of business like health insurance once they get the freedom to set tariffs from January 1. Detariffing is expected to increase premiums to realistic levels as well as force companies to look at more comprehensive and innovative covers.
In this scenario, Swiss Re will be looking at supporting new products rather than existing ones with a history of losses. It is hoping to offer advisory services on product design and pricing, services to manage health care providers and patients. It would also establish provider networks and offer underwriting services. The reinsurer is, however, reluctant to talk about its budget.
“The idea will be to support the entire value chain from developing the product to the end customer, and claims management,’’ says Dhananjay Date, MD, Swiss Re Services India.
Rising health care costs mean retail consumers will be increasingly forced to buy covers against medical risks. At 75%, out-of-pocket expenditure on health care is the highest in India among Asian countries. In 2005, Indians purchased only $0.39 billion of health insurance. Compared to this, countries like China wrote premiums of $3.82 billion and Japan wrote $24.68 billion.
Swiss Re says unsustainability of state-run systems is a recurring theme in Asia and private insurance is needed. Since India is a developing market and extremely under-penetrated, there is an opportunity as players look for expertise to aid growth.
Last year, a working group on health insurance had recommended allowing stand-alone health insurance companies to be set up. Though only one company, Star Health and Allied Insurance, has set up shop, several others are waiting in the wings to make an entry as well. Anticipating the increased focus on health care and insurance, General Insurance Corporation last year created a dedicated health reinsurance department to support standalone health insurance companies and products."

Medical insurance is a "hot" area in India right now - and because patient education makes a lot of business sense for medical insurance companies ( many studies have proven that a dollar spent on patient education ends up saving the insurance companies over 10 dollars ( for example, by preventing unnecessary surgery), patient education is going to become increasingly important in the next few years.

Patient education is a powerful tool to promote health, manage chronic disease, prevent medical mistakes, achieve patient-centered care, improve health care system efficiencies, and improve the overall quality and experience of patient care. It's been neglected in India so far - but I am sure this dismal state of affairs will improve quickly ( money talks !)

Reinventing Print Solutions for Patient Education

Reinventing Print Solutions for Patient Education
With the strengths of both the Web and self-care
handbooks in mind, Healthwise took on the challenge
of redesigning the Healthwise Handbook to make it:
• More accessible to the average person.
• More useful for controlling costs.
• Better at engaging people and then moving
them to the more interactive tools on the Web.

The bottom line is that books and other printed
materials are still essential to effective consumer engagement strategies.

In other words, don’t throw
out the books with your bottom line. Instead, use plain
language to reach and engage more consumers, include
cost-savings tips to make print materials more relevant
in the consumer-directed health care world, and add
Go-to-Web innovations to motivate people to use the
in-depth interactive materials on the Web."

I agree. Books are portable, cheap and available 24/7. They are much more important for patient education in developing countries, where few people have computers. These are complementary solutions - not competitive !

Friday, November 03, 2006

14 Reasons Doctors Need Both a Logo and Marketing Materials

14 Reasons Doctors Need Both a Logo and Marketing Materials: " Experts urge small business owners to 'brand' their businesses with a logo and a set of consistent marketing materials. But they rarely explain the reasons behind this advice. Below are some of some of the benefits of having a professionally designed logo and identity system."

This article is for small business owners - and all doctors in private practise fit this description ! A small investment in marketing can go a long way !

A Nose for Business

A Nose for Business: " A pair of doctors with a thriving sinus practice recently started retailing their saline nose-wash nationally. At some point in an entrepreneur's career, a unique challenge may arise: the need to balance multiple businesses. Serial entrepreneurs are no doubt familiar with this blessing (or curse, depending on the outcome) of success. A pair of New York City doctors, Scott Gold and Robert Pincus, are currently facing the situation. They founded a thriving medical practice, the New York Sinus Center, more than 10 years ago and then developed a product aimed at clearing their patients' nasal passages. That product, SaltAire Sinus Relief, has recently been introduced into 3,350 Rite Aid (RAD) stores. Drs. Gold and Pincus spoke recently with Smart Answers columnist Karen E. Klein about how they juggle patient appointments with research and development. "

This should inspire other doctors to do them same !
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