Thursday, November 30, 2006
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 !
“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 ?
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
This excellent guide helps you to make a well-informed decision !
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 !
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
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 !
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.
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 !
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
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).
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.” "
"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. "
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
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 !
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
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 !
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 !
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.
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.'"
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
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 !
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
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."
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
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 !
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 !
It's not really free - but $ 29 is a good investment to make to help you take care of your health ! Check it out !
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
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 !
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
An excellent overview of the options and obstacles with the PHR today.
Clever use of technology for teaching doctors. This could easily be adpated to teach patients how to talk to their doctors too !
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."
This book should serve as a useful guide and catalyst for many doctors who would like to start blogging !
Even if your doctor's treatment makes you better, your hospital bill will make you ill !
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 ?
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
'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 !
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.
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 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 !
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 !
I guess this is what 360 degree evaluation is all about !
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 !
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 ?
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 !
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. "
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 !
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 !
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
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 !
This type of medical data input could be done through the mobile phone ( which so many of us carry 24/7) as well !
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
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 !
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 !
" 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
3. repeat another IVF cycle with your own eggs and sperm
4. donor egg
5. donor sperm
6. donor embryo
( 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 !
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.
'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.' "
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 !
Excellent document - full of ideas which healthcare entrepreneurs can implement ! Why re-invent the wheel ?
Tuesday, November 07, 2006
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 ?
Obviously this is what you'd expect cardiologists to say ! After all, this is a question of their "bread and butter" !
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 !
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
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
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."
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 !
If you can't beat the, join 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."
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."
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.
To combat the rising costs of healthcare using medical banking principles and technology.
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 !
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
Are doctors going to lead the way ? Or are we going to be dragged, kicking and screaming, to the future ?
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 ?
|A guided tour of HELP, the world's largest patient education library|
Saturday, November 04, 2006
Journal of Medical Internet Research - Providing a Web-based Online Medical Record to Patients : Randomised Trial
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.
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 !)
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
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 !
This should inspire other doctors to do them same !