Saturday, December 30, 2006

Foundation for Integrity and Responsibility in Medicine

Foundation for Integrity and Responsibility in Medicine: "

Health care around the world is beset by

* rising costs
* declining access
* stagnant quality
* increasingly dissatisfied health care professionals.

Physicians fear their core values are threatened.

These values include:

* putting the interests of individual patients ahead of other concerns;
* practicing with honesty and integrity;
* keeping patients' information confidential;
* teaching the next generation of health professionals;
* practicing medicine based on science and scientific principles.

Strong but generally unrecognized threats to these values arise from concentration and abuse of power in health care systems, because:

* health care is increasingly dominated by large organizations;
* these are often lead by the ill-informed, the self-interested, and even the corrupt.

Thus, the results are:

* patients and physicians are caught in cross-fires between conflicting interests;
* patients and physicians are subject to perverse incentives;
* free speech and academic freedom are threatened;
* pseudo-science and anti-science are gaining ground."

Foundation for Integrity and Responsibility in Medicine

Foundation for Integrity and Responsibility in Medicine: "

Health care around the world is beset by

* rising costs
* declining access
* stagnant quality
* increasingly dissatisfied health care professionals.

Physicians fear their core values are threatened.

These values include:

* putting the interests of individual patients ahead of other concerns;
* practicing with honesty and integrity;
* keeping patients' information confidential;
* teaching the next generation of health professionals;
* practicing medicine based on science and scientific principles.

Strong but generally unrecognized threats to these values arise from concentration and abuse of power in health care systems, because:

* health care is increasingly dominated by large organizations;
* these are often lead by the ill-informed, the self-interested, and even the corrupt.

Thus, the results are:

* patients and physicians are caught in cross-fires between conflicting interests;
* patients and physicians are subject to perverse incentives;
* free speech and academic freedom are threatened;
* pseudo-science and anti-science are gaining ground."

Healtheva. The Community for Doctors, Medical Students, and Researchers

Healtheva. The Community for Doctors, Medical Students, and Researchers: " Healtheva is a community for physicians, researchers, residents, interns, and medical students.
Meet physicians and researchers from local academic institutions, hospitals, and private practice clinics."

MySpace for Doctors !

PHR and health insurance plans

PHR and health insurance plans : " Aetna has created a personal health record -- using the claims information it receives from providers -- that is placed on a secure website and is made available to its subscribers. So, for example, it will show your test results, inoculations, allergies, surgical procedures, hospital stays, chronic illness treatment patterns, and the like. Not only can a subscriber review information about his or her medical histories, but he or she can also authorize any provider to look at it as well."

Health Care Renewal

Health Care Renewal: "And here are the statistics. According to the article, the majority of people who work in doctors' offices, 1.8 million out of 3.3 million, do so in non clinical jobs. Nearly a majority of people who work in hospitals, 2.3 out of 5.5 million, do so in non clinical jobs. So currently almost 50% of people who work in what appear to be the most clinical settings are not doing clinical work.

Health care has been taken over by clerks, bureaucrats, and managers."

And the top guys get paid much more than the doctors do !

Healthcare Blogger Survey Report

Healthcare Blogger Survey Report Taking The Pulse Of The Healthcare Blogosphere: Key Results Summary

• Many bloggers are writing for altruistic or personal reasons, i.e., to share their experiences or educate others.
• A number of bloggers hide their identity to protect themselves, friends, family, patients and career."

Practice Fusion - Join Our Healthcare Revolution

Practice Fusion - Join Our Healthcare Revolution: "This is the reason Practice Fusion was established - to bring about a paradigm shift in healthcare IT by providing a revolutionary solution for physicians and their patients. Practice Fusion's model inherently addresses the challenges in the healthcare market by delivering a new breed of technology:

* FREE: We do not charge licensing fees for our application, nor do we charge for hosting.
* Integrated and Interoperable: Connecting physicians to other physicians, their patients, healthcare groups and RHIOs--delivering secure, shared patient information.
* On-Demand: Our Solution is web-based requiring no software to implement and manage. Provisioning is a fraction of the time of client-server solutions.
* One View: We provide unified, aggregated views into clinical data across the entire physician and patient community."

Vendor to offer web-based EHRs to docs in exchange for data

Vendor to offer web-based EHRs to docs in exchange for data: "Soon there will be a way for physician practices to have electronic health records at no cost, according to Ryan Howard, CEO of Practice Fusion, Inc. , a San Francisco-based company launched last August.

Practice Fusion is poised to announce that it will offer a free, “completely hosted, community-based model” of online access to EHRs, to be subsidized by the selling of de-identified data to insurance groups, clinical researchers and pharmaceutical companies, Howard said.

A key benefit to Practice Fusion’s product will be automatic synchronization, Howard explained. A patient’s records, which will be accessible online by several doctors simultaneously, will be maintained by the web-based host and continually updated in a central location. Howard claims that there will be virtually no start-up cost or inconvenience. "

Health Care in Crisis: Is HIT the Rx?

Health Care in Crisis: Is HIT the Rx?: "1. Focus on value. Consumers, providers, and payers must increasingly direct healthcare purchasing, delivery of healthcare services, and reimbursement monies based on value.

2. Develop better consumers. Consumers must make better lifestyle choices and become wiser purchasers of healthcare services.

3. Create better options for promoting health and providing care. Consumers must increasingly seek out more convenient, effective, and efficient means, settings, and providers.

The central theme running through these issues is the availability of reliable information. All stakeholders in the healthcare ecosystem—governments, employers, payers, providers, medical device and pharmaceutical companies, and patients—will need superior tools that provide unprecedented access to healthcare data in a secure and appropriate manner.

The ability to make value-based decisions regarding healthcare choices requires access to consistent data on cost, quality, and access. Becoming a better healthcare consumer means not only having access to information about providers, treatments, and other healthcare areas, but also having the ability to become better educated about various lifestyle options. And finally, new care delivery mechanisms that are decentralized and nontraditional (e.g., over the Internet, in the home, at the local food market,"

HealthBlawg: Why haven't consumer-directed health plans taken off?

HealthBlawg: Why haven't consumer-directed health plans taken off?: "The answer is the CONSUMER must be empowered to drive the market with their dollars. Letting the ones in power bring about change is an illusion. They're protecting their interests not yours.

This country was founded on finding a better way to do just about everything. A wise old doctor once told me 'Americans have always been educated about the capabilities of health care, they have just never been educated about the cost.' No one wants to pay the staggering high cost of cutting edge technology when they’re healthy, but let them get sick and they want the finest care someone else’s money can buy."

Health risk assessments reduce medical bills

Health risk assessments reduce medical bills: "Wellness programs and health risk assessments can reduce individual health care costs by hundreds of dollars per year, according to a new study from Thomson Medstat, which does consulting and auditing for employers.

Medical costs were between $101 and $648 less per year for Medicare recipients who participated in an employer-sponsored wellness program and used a health risk assessment, Thomson Medstat finds.

Retirees who used a health risk assessment and one other wellness program element, such as telephone-based lifestyle management counseling or on- site medical screenings, yielded an average annual savings of $442. Using a health risk assessment with two additional elements resulted in annual savings of $569, Thomson Medstat reports. Conversely, using such services without a health risk assessment yielded savings of just $30 per year.

“Strategic health care interventions can improve senior citizens’ health and reduce health care costs,” says Ron Ozminkowski, director of health and productivity research at Thomson Medstat."

The Top 10 Reasons for Soaring Health-Care Costs: The Naked Economist - Yahoo! Finance

The Top 10 Reasons for Soaring Health-Care Costs: The Naked Economist - Yahoo! Finance: "What's the most intractable public policy problem the U.S. faces? Health care. I don't think any other issue even comes close. Yet the system itself -- the process of providing care and allocating those costs -- is also stunningly complex.

Health care is increasingly expensive because of powerful, perhaps inexorable economic forces that make medical care different than all other goods and services in a modern economy. Here are my top 10 reasons for why health care is so expensive -- and likely to get even more expensive in the future, regardless of what patches we put on the system."

New trend scares health insurers… getting “cut out” by large employers

New trend scares health insurers… getting “cut out” by large employers: "One way to cut costs is to eliminate the middleman. That applies as much for health care as for widgets.

For some big employers — including Waste Management and Sprint Nextel — cutting out the middleman in health insurance has paid off.

Both firms have signed direct-contracting deals with medical groups instead of insurers.

Direct contracting works the way it sounds. Employers pay medical groups directly to provide health care to employees. This eliminates the need to wrangle with insurers over plans and rates.

Employees still have money deducted from their paychecks for care, though the money is used to pay the medical group instead of an insurer.

When employees need care, they pay a co-pay each visit.

“(Direct contracting) cuts out the middleman and extra layers of bureaucracy and cost,” said Don Fisher, a medical doctor and chief executive of the American Medical Group Association."

The Tech Doctor: Streamline Your Practice With Online Services

The Tech Doctor: Streamline Your Practice With Online Services: "Payers, software providers, and the manufacturers of high-tech gadgets are increasingly teaming up to offer physicians and their staff members online services that can streamline patient care and work flow, saving you time and money and increasing the quality of care you provide. Some of these services include:

# E-prescribing: Electronically generate prescriptions with your EMR and send them directly to a patient's local pharmacy. All your patient needs to do is pick them up.

# Online Pharmacy Services: Using technology certified by an online service, you can check a patient's pharmacy eligibility, his payer's drug formularies, and his medication history — all within a matter of seconds.

# Insurance Verification: Check a patient's insurance coverage before her visit using the practice management software you already own.

# Electronic Remittance: Receive electronic receipts for all claims you submit through an online service offered by some payers and practice management systems."

These online services are going to help doctors improve their bottom-line , which is why they will be adopted very quickly ! As a result of this, many more physicians will start using EMRs to improve the clinical care they provide. Once this happens, PHRs will become increasingly important. Just like your bank statement assesses your financial health, your PHR assesses your medical health - and it's my prediciton that will soon become equally routine !

About DailyStrength

About DailyStrength: "DailyStrength was built to enable people facing life challenges to:

a) simply and easily communicate their progress with friends, family, supporters, and have those people respond with encouragement and help.
b) find others facing the same circumstances, and exchange experiences treatments and even hugs within a safe community setting.

We've developed many unique, customized features to serve our users, including:

* A Community For Everyone: We have over 500 communities dedicated to specific medical and life challenges, so that people can find others who really can help. If we don't have your challenge, let us know and we'll create it.
* 24/7/365 Group Support: At any time of the day or night, DS members are online and available to help and talk.
* Supporters and Advisors: Our communities feature not only people living with a challenge, but also family, friends, people who have experience with that condition, and even medical and other experts
* Wish Em Well: When someone's in a particularly bad place, we make sure to alert the community so that other community members can take action and help.
* Treatments: Find other folks using the same tools to make themselves better and read their experiences."

When we are ill, we need to reach out to others. Virtual support from someone who has "been there, done that" can be as effective as real-life supoort !

Social netowrking for patients

Social netowrking for patients - Wall Stret Jounral : "At DailyStrength.org, patients and caregivers dealing with hundreds of issues, including asthma, celiac disease and depression, can join a support community, start a wellness journal, share advice and recommend doctors, link to news stories and Web sites with disease information, and even send other members a virtual hug.

The social-networking revolution is coming to health care, at the same time that new Internet technologies and software programs are making it easier than ever for consumers to find timely, personalized health information online."

They would find it much easier to network if they had an online PHR !

Healthcare Without Boundaries: Integration Technology for the New Healthcare Economy

Healthcare Without Boundaries: Integration Technology for the New Healthcare Economy: "Information Technology (IT) in the healthcare industry is not integrated. Five important parts of the healthcare industry need to share information. They are provider organizations and physicians, pharmaceutical and medical device companies, government and private-sector employers, health insurers, and consumers. But communication can be difficult because of different IT environments, many of which are based on older mainframe systems. Microsoft® .NET technology can bring these different systems together without requiring changes to existing programs."

Using Open Source Software to do this would be even better !

Wednesday, December 27, 2006

Adopt a Doctor: Program Overview

Adopt a Doctor: Program Overview: "Adopt A Doctor is a New England-based 501(c)(3) non-profit organization seeking to reverse the brain drain that is drawing experienced physicians away from the poorest countries in the world.


Many of the world's poorest countries are finding it difficult to attract and retain experienced physicians because salaries are so low. In Malawi, for example, a doctor earns on average just $70 USD per month and thus practices medicine in the country for an average of only 3 years. Physicians are leaving developing nations such as Malawi in droves to seek more reasonable pay and better resources in other parts of the world.

Adopt A Doctor aspires to solve this problem of high turnover rates and unavailability of experienced physicians by providing financial aid and other critical resources to physicians already working in these poor countries so that they can continue to work there. "

Gutsy Doctors in India

The Gutsy Doctors in India : "In this part of rural Chhattisgarh, plastic soapcases travel—in thousands. Health workers in remote villages hand them over to schoolchildren, who walk them to the highway, where a bus driver collects them on his daily route, and honks loudly outside a medical centre in village Ganiyari. Lab staff here know what they have to do. Examine under a microscope the blood smears contained in the cases, and send back the result—malaria positive, or negative. By the same route, in the same soapcase.

The people behind this amazing scheme aren't short of ideas. Their Jan Swasthya Sansthan (JSS) in Ganiyari buzzes with energy and inventiveness—a Rs 40 safe-baby delivery pack, diagnostic kits, cheap drugs, outreach clinics deep in sal forests where a tribal woman 100 km away from a motorable road can see a doctor, get her blood tested, and take home medicines at one go."

These doctors can teach the rest of the world a lot ! How to provide quality healthcare with love and devotion - for a fraction of the cost !

How banks will help improve healthcare

How banks will help improve healthcare: "Lately, financial leaders have begun to investigate how to use their transaction expertise to transform another industry: healthcare. While bringing their own houses to an unprecedented level of automation, financial institutions have long cast a covetous gaze at healthcare’s inefficient billing, collecting and reimbursement. Now, as the employer-based health insurance model continues to deteriorate, consumers are shouldering an increasing percentage of costs and playing a growing role in healthcare decision-making. Such consumer engagement means the healthcare sector is paying closer attention to goals such as transparent pricing, standardized quality measures and electronic medical record-keeping.

But as mass media outlets focus on skyrocketing premiums, they’ve largely missed a strong underlying shift--that financial institutions may soon wield heavy indirect influence in healthcare through their custodianship of health savings accounts. "

Their first priority will be to digitise medical records . And if payment to the doctor is conditional on his having electronic medical records, all doctors will fall in line very quickly !

Monday, December 25, 2006

Lumenos - Consumer Driven Health Plans

Lumenos - Consumer Driven Health Plans: "Lumenos is changing the way health care works, by providing health plans that actually help consumers maintain and improve their health.

All our plans start with healthy ideas like these:

* It’s your health; you should control some of the money.

* Your health plan should make it easy for you to do the right things.

* Your health plan should pay for care that keeps you healthy, even when you’re not sick.

* No one should get between you and your doctor.

Then, we cut out the fat of typical plans – like restrictions on what doctors you can see. The result – healthier health plans."

Today, it's usually the employer who decides what health plan the employee gets. Once patients start spending their own money on getting health insurance cover for themselves, the smarter health insurance companies which offer value for money and "put patients first" will do very well for themselves !

Humana -- Guidance when you need it most

Humana -- Guidance when you need it most: "MyHealth Record.
Store information about medications, immunization history, doctor visits and other important details in one secure, private location that's accessible any time you need it."

Most health insurance plans will follow Humana's lead in providing their members with a PHR, because doing so will save them a lot of money ! This will be a major catalyst in the widespread adoption of PHRs !

Making Patient-Centered Care a Priority

Making Patient-Centered Care a Priority: "... attributes of patient-centered primary care:

1. Superb access to care. Patients can easily make appointments and select the day and time. Waiting times are short. E-mail and telephone consultations are offered. Off-hours service is available.
2. Patient engagement in care. Patients have the option of being informed and engaged partners in their care. Practices provide information on treatment plans, preventive and follow-up care reminders, access to medical records, assistance with self-care, and counseling.
3. Clinical information systems that support high-quality care, practice-based learning, and quality improvement. Practices maintain patient registries; monitor adherence to treatment; have easy access to lab and test results; and receive reminders, decision support, and information on recommended treatments.
4. Care coordination. Specialist care is coordinated, and systems are in place to prevent errors that occur when multiple physicians are involved. Posthospital follow-up and support is provided.
5. Integrated and comprehensive team care. There is a free flow of communication among physicians, nurses, and other health professionals. Duplication of tests and procedures is avoided."

Sunday, December 24, 2006

Rural surgery in India - Battling against odds

Rural surgery in India - Battling against odds: "Speakers who followed proved that rural surgery was not an easy game; nor was it the last resort of the unsuccessful. A rural surgeon had to battle against enormous odds. He trained his own nurses, paramedics, and junior doctors; he worked in operating theatres where lights were faulty, facilities minimal and air-conditioning a distant dream; he bought his own equipment and struggled to maintain them. The rural surgeon spends precious time, energy and money because of indifferent suppliers. Then there is electricity, water, oxygen, drugs. Money. What about the family? Kids? Education and entertainment?

Dr. Shrikande of Mumbai, in his guest lecture titled 'Excellence in Surgery' reinforced the time-honoured dictum of simplicity. The surgeon's duty to the patient is to improve the quality of life. Only that. She/he must question him/herself constantly and not be afraid to change when change is necessary. He was critical of the over-dependence on scans and x-rays and the diminishing strength of clinical acumen among doctors. The essence of surgical leadership, he said, is a combination of courage, skill, experience, knowledge — and humanism.

This is a much-needed brush with reality. It's great to talk about medical tourism - but we also need to set our own house in order ! "

IndUShealth - A New World of Care

IndUShealth - A New World of Care: "If you or a loved one have a health problem that is causing concern about the cost and quality of available care, IndUShealth suggests you consider the excellent, high-quality treatment options available to you in India at a fraction of the cost in a U.S. hospital.

IndUShealth's case managers and alliance of physicians in North America are ready to work with you to evaluate your needs and provide the necessary guidance that will help you take advantage of the exceptional care options available to you at one of our partner super-specialty hospitals in India.

At IndUShealth, we strive to make each patient's experience nothing short of an outstanding success."

Medical tourism companies are flourishing - which means patients now have many more options than they did in the past !

The Globalization of Health Care: Can Medical Tourism Reduce Health Care Costs?

The Globalization of Health Care: Can Medical Tourism Reduce Health Care Costs? " In September of 2004, I accompanied Howard Staab to New Delhi, India for the heart surgery he
needed but could not afford in North Carolina where we live only minutes from major medical centers of international reputation. Dr. Naresh Trehan replaced Howard’s mitral valve at Escorts
Heart Institute and Research Center for a total cost of $6,700 (as opposed to the estimated $200,000 at our local hospital). We stayed in India for one month. In a few months, Howard was
back at work full time, and his cardiologist in Durham reports that he is just fine. But the fact that everything turned out well for Howard, and that India is a good alternative for medical care, is not why I am here today. I am here to tell you how our own country’s healthcare system (supposedly the best in the world) failed us, and why we were forced to travel halfway around the globe."


This has now become such an important issue that even the US Senate is discussing it !

NEJM -- The "Dis-location" of U.S. Medicine -- The Implications of Medical Outsourcing

NEJM -- The "Dis-location" of U.S. Medicine -- The Implications of Medical Outsourcing: "When a patient in Altoona, Pa., needs an emergency brain scan in the middle of the night, a doctor in Bangalore, India, is asked to interpret the results. Spurred by a shortage of U.S. radiologists and an exploding demand for more sophisticated scans to diagnose scores of ailments, doctors at Altoona Hospital and dozens of other American hospitals are finding that offshore outsourcing works even in medicine. . . . Most of the doctors are U.S.-trained andlicensed — although there is at least one experiment using radiologists without U.S. training."

The fact that the New England Journal of Medicine is featuring articles on medical tourism and medical outsourcing means this has now become a mainstream trend.

How Health Insurance Inhibits Trade In Health Care -- Health Affairs

How Health Insurance Inhibits Trade In Health Care - Health Affairs: "How Health Insurance Inhibits Trade In Health Care
Aaditya Mattoo and Randeep Rathindran

A range of health care services are tradable, in that consumers can travel abroad for treatment. In this paper we first estimate the gains from trade. An international price comparison of fifteen procedures reveals that there could be savings of around $1.4 billion annually even if only one in ten U.S. patients choose to undergo treatment abroad. We then identify a key impediment to realizing these gains: the nature of existing health insurance plans, which discriminate explicitly or implicitly against treatment abroad. We propose that coverage should be neutral to provider location and that reimbursement should include travel costs."

NEJM -- America's New Refugees -- Seeking Affordable Surgery Offshore

NEJM -- America's New Refugees -- Seeking Affordable Surgery Offshore: "The mainstream media have begun to highlight the plight of some new refugees: seriously ill Americans who receive treatment at advanced private hospitals in low-income countries. These patients are not 'medical tourists' seeking low-cost aesthetic enhancement. They are middle-income Americans evading impoverishment by expensive, medically necessary operations, as health care services are increasingly included in international economic trade"

Wired 14.03: A Nation of Guinea Pigs

Wired 14.03: A Nation of Guinea Pigs: "A Nation of Guinea Pigs
There's a new outsourcing boom in South Asia - and a billion people are jockeying for the jobs. How India became the global hot spot for drug trials."

IVF.net - Restrictive fertility law forces Italian patients abroad

IVF.net - Restrictive fertility law forces Italian patients abroad: "Thousands of Italians are being forced to travel abroad for assisted reproduction or preimplantation genetic diagnosis (PGD) treatment, because of Italy's highly restrictive legislation. The results of a new survey carried out by the Reproductive Tourism Observatory show that the number of couples travelling to other countries for such procedures has increased four-fold since the law was passed three years ago. The ban on PGD - testing embryos to identify those free from serious genetic disorders - was challenged unsuccessfully in a court case held earlier this year.

'Sadly, the ban of preimplantation testing is favouring procreative tourism among the wealthiest and abortions among the poorest couples', Dr Monni said."

IVF.net - IVF twins in demand

IVF.net - IVF twins in demand: "According to the UK's Sunday Times newspaper, a high proportion of couples seeking fertility treatments ask the clinic to help them have twins, rather than have one baby at a time. The Sunday Times describes this as producing 'an instant family with just one pregnancy'."

While some IVF doctors consider a multiple pregnancy to be a complication ( which is why they transfer only one embryo at a time), for many IVF patients, a twin pregnancy is a bonus !

Saturday, December 23, 2006

A Book for People with Any Life-Threatening Illness

A Book for People with Any Life-Threatening Illness: "Unless we fully accept the inevitability of death, it's hard to enjoy this interval called life. ('This strange interlude,' as Eugene O'Neill called it.) In other words, unless we get over our fear of death, we'll never really appreciate life. Unless it's okay to die, we'll never really live."

We learn best from from adversity - and an illness is one of life's most powerful teaching tool. It helps you to confront your own mortality, so you mature very quickly. It also teaches you empathy , and can bring out your best human qualities - if you are willing to learn the lessons your disease brings with you.

Read this superb book - it's full of inspiration !

HOW TO SURVIVE THE LOSS OF LOVE

HOW TO SURVIVE THE LOSS OF LOVE : "Let's take a moment to view loss in the larger perspective. In nature, loss is an essential element of creation--the rose blossoms, the bud is lost; the plant sprouts, the seed is lost; the day begins, the night is lost. In all cases, loss sets the stage for further creation (or, more accurately, re-creation).

So it is in human life. It's hard to look back on any gain in life that does not have a loss attached to it.

With this firmly in mind we can examine the various losses in life. (Without this overview it tends to become awfully depressing.)"

The full text of this wise and compassionate book is available online, free of cost ! It's one of my favourite books, and is especially helpful for caregivers.

How to Heal Depression

How to Heal Depression: "Because of the stigma of depression, many people think that seeking help implies some sort of personal lack--a lack that should be overcome by strength, fortitude, or gumption.

This is not the case.

Seeking help for an illness (any illness) does not imply a lack of mental, physical, emotional, or moral character.

To the contrary, it takes great courage to admit something may be wrong. It is a sign of deep wisdom to consult professionals, seeking their advice and direction."

You can read this marvellous helpful bestseller online right now - free of cost ! It's very helpful, and full of pearls of wisdom.

Consumer Directed HealthCare (CDHC) - Decision Support Tools

Consumer Directed HealthCare (CDHC) - Decision Support Tools: "Decision support tools provide users with needed information on their conditions, medications and treatment alternatives, expected costs of care, metrics on provider quality, etc.

HealthFrame is a powerful decision support tool that leverages knowledge of an individual’s entire health information to deliver relevant decision making information.
HealthFrame supports the delivery of health care content directly to consumers in a way that is:

* Private:Users do not have to relinquish their privacy to gain access to relevant medical information and advice.
* Appropriate: Users only view information that is personally relevant to them. HealthFrame leverages rules-based logic to publish content that is appropriate to an individual’s specific medical information such as gender, age, conditions, family history, medications, treatments, etc.
* Integrated: Personal health management information is integrated with the delivery of content, in a seamless, user-friendly way."

The PHR can become the central organising principle for providing quality healthcare !

Personal Health Records (PHRs) - Overview

Personal Health Records (PHRs) - Overview: "PHR is short for 'Personal Health Record'. A Personal Health Record is more than just a copy of all your medical information, collected from all of your doctors, hospitals, and health insurance providers etc. It also contains all of the other information which is so important to your health that doctors are usually unaware of - like your dietary habits, sleeping habits, activities (such as smoking, or skydiving), your symptoms, and reactions to medications, etc. It contains anything YOU want."

Friday, December 22, 2006

Sick and Scared, and Waiting, Waiting, Waiting - New York Times

Sick and Scared, and Waiting, Waiting, Waiting - New York Times: "Yet while little can be done about the fact that test results can be scary, health care researchers and doctors say a lot can be done to improve the delivery of results so patients are not left waiting for days or even weeks. And a lot can be done to improve waits for appointments and in doctors' offices and emergency rooms."

If patients could access their lab reports and scan results online
( through their PHR), this would make their waits much less !

In the Hospital, a Degrading Shift From Person to Patient - New York Times

In the Hospital, a Degrading Shift From Person to Patient - New York Times: "Entering the medical system, whether a hospital, a nursing home or a clinic, is often degrading. At the hospital where Ms. Duffy was a patient and at many others the small courtesies that help lubricate and dignify civil society are neglected precisely when they are needed most, when people are feeling acutely cut off from others and betrayed by their own bodies.

Larger trends in medicine have made it increasingly difficult to deliver such social niceties, experts say. Many hospital budgets are tight, and nurses are spread thin: shortages are running at 15 percent to 20 percent in some areas of the country. Average hospital stays have also shortened in recent years, making it harder for patients to build any rapport with staff, or vice versa.

Some hospitals have worked to address patients' most serious grievances. But in interviews and surveys, people who have recently received medical care say that even when they benefit from the expertise of first-rate doctors, they often feel resentful, helpless and dehumanized in the process."

Hospital staff need to learn from 5 star hotel staff how to treat their patients as guests !

iPod access to health records launched in US

iPod access to health records launched in US: "New software called HealthFrame 2.1 has been launched in the US allowing patients to access their personal health records using an iPod.

HealthFrame is described as a software system designed to permanently record, organise and help users, and those to whom they permit access, to understand their personal health more easily and completely. Suppliers, Records for Living claim “2.1 is the only commercially available personal health record to support iPod connectivity.”"

Clever new uses of the iPoD !

Thursday, December 21, 2006

Health Data Management | Rx Records in Pocket, Purse

Health Data Management | Rx Records in Pocket, Purse "About 75 patients in North Carolina and New York will carry their medication history with them while participating in pilot programs of flash drive devices.

The patients will download to a flash drive their medication history from a secure Web site. Electronic prescription networking vendor SureScripts, Alexandria, Va., will compile the histories from patient data at participating pharmacies, including Brooks Eckerd, Kerr Drug, Rite Aid, Stop & Shop, and Walgreens. The flash drive also will store patient demographic and insurance information.

Patients can give the flash drive to clinicians to plug in a computer and access the data, which could include additional medical information inputted by the patient. The pilot project is using the Personal HealthKey flash drives of Newtown, Pa.-based CapMed, and embedded with the vendor’s personal health records software."

Evolution EMR - helping both patients and doctors

Evolution EMR - helping both patients and doctors: "Evolution EMR frees clinicians from administrative burdens and enables the practice to focus on their central mission of caring for patients. Evolution EMR includes numerous clinical and administrative productivity tools that save time, cut costs, and help reduce medical errors.

Finally, the browser-based software includes patient registration and history forms. Patients can use a kiosk setup in the waiting room to fill out these forms, or the front-desk personnel can enter the information after patients have filled out paper-based forms. Once this data has been entered into the system, it can be accessed from any handheld device or workstation in the office. With the optional patient relationship management module of Evolution EMR, patients can securely fill out these forms using the practice's Website. Letting patients enter their data directly into Evolution EMR eliminates double data-entry, which means less work for you!

Evolution PHR is the patient relationship management module of the E-Health Platform for use with Evolution EMR. It provides a solution that can nurture this important relationship during a patient's time of need. It enhances patient satisfaction by actively involving patients in the process of receiving medical care."

Why openEHR makes much more sense

Why openEHR makes much more sense: ".. it is shameful, all the same, that through diverse confusions and confabulations, the protection of the multi-billions that are now spent on not serving well the information needs of healthcare, end up with money mainly directed, largely unwittingly, and not in any sense by stupid people, in ways that have still failed to reach or be allowed near the heart of the matter. That is where considerations of quality, information and governance intersect in providing health services that people trust and value. In such circumstances, there are problems best approached through simplifying and withdrawing resource; Fred Brooks and his concept of the mythical man-month is salutary.

openEHR has never yet had external financial support; we, our research teams, colleagues and parent organisations have done it ourselves. Of course, it has been largely ignored on high, for as long as possible, because bottom-up and top-down motivated initiative is bound to encounter an uncomfortable collision layer in the real world. That collision is occurring right in the middle of changing patient care."

Here's a clever way of implementing the EHR inexpensively and reliably !

Enhancing the EHR

Enhancing the EHR " RecordPoint is the first of a new breed of system that supports a shared health record between multiple clinics and hospitals. RecordPoint includes an Electronic Health Record (EHR) for managing the shared record and a Registration System for managing the details about providers and patients who can access the shared record."

openEHR Foundation Aims

openEHR Foundation Aims: "openEHR aims to
* promote and publish the formal specification of requirements for representing and communicating electronic health record information, based on implementation experience, and evolving over time as health care and medical knowledge develop;
* promote and publish EHR information architectures, models and data dictionaries, tested in implementations, which meet these requirements;
* manage the sequential validation of the EHR architectures through comprehensive implementation and clinical evaluation;
* maintain open source 'reference' implementations, available under licence, to enhance the pool of available tools to support clinical systems; and
* collaborate with other groups working towards high quality, requirements-based and interoperable health information systems, in related fields of health informatics."

This is the way of the future, as EHRs can help us to improve the way healthcare is delivered !

Using technology to make EHRs patient-friendly and future-proof

Using technology to make EHRs patient-friendly and future-proof : "The advent of archetypes and templates should play a major role in empowering clinicians through allowing them to directly specify the clinical structure and content of EHR systems. Archetypes will also help to improve the quality of EHR data through in-built data validation and can potentially help to improve the flexibility of data input and presentation in EHR applications. They will certainly make EHR systems more responsive to change as new clinical concepts become available or old ones need modification.

There is much to be done but there are encouraging signs that major stakeholders are beginning to recognise that the very future of health systems depends on more efficient and effective information management. The EHR is arguably the most important foundation component in this pursuit. "

Assisted conception | Buying babies, bit by bit | Economist.com

Assisted conception | Buying babies, bit by bit | Economist.com: "IVF was originally intended to allow heterosexual couples to bypass problems with fallopian tubes or sperm by introducing eggs and sperm to each other in a petri dish. But demand has mushroomed among those with other medical problems as well as the single and gay. They need people to supply them with sperm, eggs and sometimes wombs; and the services of clinics who put the lot together.

Since the manufacturing of anything which is regarded as God-given—or at least natural—touches a moral nerve, governments tend to want to regulate the business. And because attitudes to the family vary from country to country, regulations about baby-making do too. Discerning baby-shoppers therefore assemble inputs from around the world—sperm from Denmark, an egg from Russia, a surrogate mother from California—to ensure that biology, for them, need not mean destiny. Some even switch countries midway through treatment, starting in Britain, say, and travelling to Russia, Spain or America at a crucial stage in the proceedings."

Wednesday, December 20, 2006

The problem with doctors having a monopoly on medical knowledge

The problem with doctors having a monopoly on medical knowledge : "'We're moving knowledge from its source. We've got all this knowledge from the medical literature and from the patients themselves. We're trying to move that to our everyday actions in medical care. And we said the way to do that is to put it in human heads and the human heads will take the actions,' Weed said, to hearty laughter. Comparing the chain of knowledge to an electric utility, Weed said, 'The voltage drop across that line is pathetic.'

The solution, according to Weed, is to let computers do the thinking, coupling knowledge to specific problems. (Problem-knowledge couplers just happen to be the thrust of PKC Corp., the software Weed founded in 1982 to develop clinical decision-support software.) 'New tools are everything,' Weed says. 'It's the tools we use that advance our civilization.'"

Give patients these tools, and they will do a better job than their doctors !

Making money with a PHR

Making money with a PHR: " PHRs to be made available by AHIP and the Blues will cover 200 million individuals by the end of 2008. The data will be based primarily on claims received by the insurance company and consumer inputs on such things as immunization and family medical history.

This will spur the software industry to begin cranking out applications which could be used by consumers to maximize the value of these PHRs, and to convince physicians and hospitals to make a long-delayed start at ramping up the office-based electronic health records systems which will be the prime beneficiary of PHRs in the era of real-time medicine."

The demand is there ! The companies who can supply this need will make lots of money !

Sun Microsystems' Healthcare Mantra: Reduce Cost and Complexity

Sun Microsystems' Healthcare Mantra: Reduce Cost and Complexity: "So we formulated this idea of the consumer-centric healthcare alliance. Today, 80 percent of the claims are filed on paper. How can we incent the primary care physician to file electronically, because if we get the claims in electronic format, we do get a lot of information that we need to build an electronic medical record about the patients. So how do we get an incentive? Well, the incentives for the primary care physician would be that he or she can get the reimbursement when they complete an electronic claims process a lot faster than they can get it today."

Money is a great catalyst for making doctors change their habits !

Outsource Model Key To E-Health Records

Outsource Model Key To E-Health Records: "A new study says that some doctors, if and when they do warm up to e-health records, may find technology outsourcing the only practical approach.

'Smaller levels of physician practices may be able to look at someone hosting these applications,' said Keith MacDonald, a First Consulting analyst. 'They don't have the data center expertise to set these things up and make sure they're secure.'

The idea is that someone else — a services vendor, physician association or hospital — houses and maintains the software. A doctor accesses it over a secure broadband Internet connection, perhaps paying a monthly fee. "

Real-time, point-of-service financial settlement: why health plans will lead the next revolution in healthcare

Real-time, point-of-service financial settlement: why health plans will lead the next revolution in healthcare : "Doctors are already requesting tools from health plans to help them with accounts receivables issues. Ultimately, health plans will bear the responsibility of providing the technology to make retail healthcare transactions a reality. This is because while the practice of medicine still takes place in the provider's office, the business of medicine now rests squarely in a health plan's information systems. And, as providers demand real-time patient and financial transactions, plans will feel pressure to provide these tools to keep the best providers in their networks, and to support members as they navigate the complex healthcare system.

Because health plans are uniquely positioned in the center of the healthcare supply chain, their IT systems must provide the backbone for real-time information exchanges with virtually every major healthcare constituent. That said, the technological challenges that health plans face are tremendous. Plans will need to deliver enormous amounts of administrative, clinical and financial information through software that is readily accessible to providers, yet secure. Data transparency—across medical records, members' financial accounts, claims history, and more—will be crucial.

Electronic health records are critical to this piece of the puzzle. These include two different kinds of records. The first is the patient's electronic medical record, which contains comprehensive medical information that can be updated from a variety of provider sources throughout the health plan network. The second is the member's personal health record, which is owned by the individual and maintained within the health plan's system."

Healthcare as a retain industry - treating patients as consumers

Healthcare as a retain industry - treating patients as consumers " More than just the high-deductible health plans
grabbing all the headlines,consumerism is about
moving healthcare toward a retail mindset,where
individuals make rational and informed purchasing
decisions."

This way, patients can make their own decisions with their own money. This will compel them to seek information and efficiency - and force doctors and hospitals to become competitive and transparent.

Electronic Medical Records (EMR) and Enterprise Practice Management Systems | NextGen Healthcare

Electronic Medical Records (EMR) and Enterprise Practice Management Systems | NextGen Healthcare: "All patient communications conducted through NextMD are integrated with physician workflow tools in NextGen EMR and safely saved directly in the patient's electronic chart. This unification results in enhanced operating efficiency, reduced costs and errors, lower risk, and increased revenue.

Highly secure and privacy-focused, NextMD is protected by a firewall, anti-virus and intrusion detection software, and encrypted communications, ensuring privacy and HIPAA compliance.

With powerful benefits for patients and providers alike, NextMD facilitates the exchange of meaningful health information, encourages patient compliance and proactiveness, and ultimately improves delivery of care."

Making medical information patient-centric

Making medical information patient-centric: "Wellogic Rapport is a secure, fully customizable web portal that links patients to their providers through an easily accessible interface. From patient education documents to the latest test results, Rapport offers patients a wealth of information while greatly reducing the volume of phone calls and mailings to and from the hospital, health system or office practice.

Rapport is fully integrated with Wellogic's award-winning clinical solution, Wellogic Consult. Consult is being used to enable anytime, anywhere access to clinical information and transactions across previously disconnected parties."

Traditionally, the medical record has been a document doctors used to provide medical care to their patients. However, it can and should be much more than that - and a Patient Health Record offers great promise , because it allows patients to own their own health data , so they can control their own health !

Wellogic — Healthcare Portals, EMRs/EHRs, RHIOs

Wellogic — Healthcare Portals, EMRs/EHRs, RHIOs: "Modern healthcare organizations are working hard to help their clinicians handle increasing patient loads, as well as to absorb and apply knowledge from rapidly emerging medical discovery. They are having to do so under increasing financial pressures, without compromising patient safety. Wellogic Consult provides a modern solution. Recognized for its unparalleled usability and secure and scalable architecture, Consult helps solve patient information and knowledge-sharing challenges.

Wellogic Consult is a web-based clinical application that provides solutions for:

* Clinician, Patient, and Payor Portals

* RHIOs and Health Information Exchanges (HIEs)

* Electronic Health Records (EHRs)

* Vertical Applications (e-Prescribing, Laboratory
Outreach, Smart Medical Devices, and more)



Consult unifies patient information across practice, hospital, payor, and pharmacy information systems, using this information to provide clinical decision support at the point of care. It enables communication among physicians and their staff, other healthcare providers, and patients, within and between organizations, in a manner that integrates seamlessly with clinical practice workflows. Consult enhances patient safety, protects patient privacy, and improves patient and provider satisfaction, all while reducing health"

MEDecision - Integrated Medical Management

MEDecision - Integrated Medical Management: "Used together, these 4 components create a common patient view that provides all the data, both historical and current, to the care managers and providers at the point of service. This common patient view provides actionable intelligence to both internal and external users, enabling them to make timely and accurate decisions, thereby improving healthcare outcomes and the affordability of healthcare.

Healthcare product integration strategies that specifically target improving the relationship between patients, payers and providers will have the greatest impact on the quality and cost of care. MEDecision’s Integrated Medical Management provides payers with the necessary tools to analyze, apply, administer and automate care management programs."

Leaving Microsoft to Change the World

Leaving Microsoft to Change the World: "The organization, Room to Read, is now one of the fastest growing, most effective, and award-winning non-profits of the last decade. John has been recognized in the worldwide media as a '21st century Andrew Carnegie,' building a public library infrastructure to help the developing world break the cycle of poverty through the lifelong gift of education."

This is an inspiring book - please do read it !

BBC NEWS | Health | IVF tourism

BBC NEWS | Health | IVF tourism: "British couples are turning to the internet for information on where to get fertility treatment abroad.

In the absence of official advice, patients are using message boards on support websites such as Fertility Friends to select clinics.

According to Guido Pennings, of Ghent University, Belgium, the web is a key factor in the boom in IVF tourism."

Blogs let families share details of their lives

Blogs let families share details of their lives: "David wrote the first updates as Iris began chemotherapy for a recurrence of non-Hodgkins lymphoma. Treatment eventually included a stem cell transplant.

'I didn't have energy to talk,' Iris recalls. But often she could type. And friends and family responded.

'Iris, thanks for letting us know what happened this week,' wrote her friend Miriam in Cincinnati, who had gone to school with Iris from sixth grade. 'You started this site, and now you have a responsibility to your loyal readers to keep it up.'

Iris felt that, and welcomed it during the long illness.

'It was really helpful to me to see the feedback I got from people,' she says. 'I had a lot of people on my team, but it was me in the ring. They just wanted to know how the fight was going, and I was able to give them that information.'"

Blogs allow patients to reach out to others - and also educate and inform other patients. P2P in healthcare refers to Patient-to-Patient Networking !

Tuesday, December 19, 2006

Paperless system: the cure for the harried physician

Paperless system: the cure for the harried physician : "It's almost ironic: The computer, tool of professional productivity, is enabling doctors to focus more on personal touch in their practices. Take, for instance, Karen Smith, M.D., who started her Raeford, N.C., family practice in April after years of being part of a hospital-owned practice.

'It was an amazing difference; the lifestyle change was dramatic,' she said. 'It's more than just monetary.'

Having an electronic medical record system has enabled her not only to spend more time with patients, but also to have more of a life outside her practice, she said."

An intelligent EMR can help the doctor to spend more time with the patient, and they can focus on developing a relationship !

Emmi Solutions: How Emmi Benefits Patients

Emmi Solutions: How Emmi Benefits Patients: "Emmi is an Internet-based, multimedia program that gives you a very clear sense of what to expect before, during and after your surgery. It will answer many of the common questions that you may have and you can type in other questions specifically for your doctor. You can view Emmi at your pace, learn about the condition and procedure and ask the right questions. You can also view Emmi with friends, family and those who will be supporting you during your surgery."

I like simple 3-step technique they use for educating patients about their surgery.

1. Explain the normal anatomy
2. Explain the abnormality the illness causes
3. Show how the surgery corrects the abnormality !

Ten Simple Rules for Meeting Patient Expectations

Ten Simple Rules for Meeting Patient Expectations: " The Institute of Medicine has issued these 10 “simple rules” for meeting patient expectations:

1) Care should be based on continuous relationships.
2) Care should be customized for patient needs and values.
3) Patients should be the source of control.
4) Knowledge should be shared and information should flow freely.
5) Decisions should be based on evidence.
6) Safety should be a given.
7) Transparency is necessary.
8) Patient needs and understanding should be anticipated.
9) Waste and duplications should be continuously decreased.
10) Cooperation among clinicians is a priority.

To these ten points, I would add: For a truly “patient-centered system,” understandable and timely patient education and communication at every point of health care interaction is fundamental if we are to build enduring patient-physician trust."

Using New Communication Methods to Manage Patients’ Moments of Truth -- HealthLeadersMedia.com

Using New Communication Methods to Manage Patients’ Moments of Truth -- HealthLeadersMedia.com: "In a consumer-driven health market, the key to success for payors, providers, and physicians will be managing moments of truth for patients. Patients will be the center of care. Health organizations that succeed will look at the system from the patient’s point of view for each health encounter--anticipating needs, providing information and meeting expectations every step of the way.

This new point of view will require shifting from paternalism to partnership--from payors, hospitals, and doctors “know best,” to informed patients who will “choose the best” based on information. To this end, the healthcare industry has an opportunity now to leverage new technology that communicates with patients more effectively and efficiently than ever before.

A new and important trend is upon us: using the Web to communicate with consumers and aggregate data at every step of the engagement or interaction with the health system. This trend requires patients to take an active role in authorizing medical decisions, understanding their condition, and complying with medical instructions.

Good care boils down to trust. Given the right information at the right time in the right way, patients can be trusted to do the right thing."

The information should be tailored to the patient's needs - and this can be best done using a PHR.

Patients are the largest untapped healthcare resource

Not only are patients the largest untapped healthcare resource, investing in patient education is also the one intervention which will provide the largest return on investment ( ROI) !

I feel we should focus on providing patients with tools which they can use to help them get better medical care from their doctor !

The reasons for this are simple.

1. They are many more patients than there are doctors !
2. Patients have much more at stake !
3. Good doctors will use the available tools - while bad doctors will never improve !

The key tool should be a patient health record ( PHR) ; and around this, we can provide patients with customised information, to help them manage their own illness.

Saturday, December 16, 2006

Health Care Systems - WHAT IS A HEALTH CARE SYSTEM?

Health Care Systems - WHAT IS A HEALTH CARE SYSTEM?: "There are many kinds of managed care organizations, but there are some common characteristics among them. All managed care organizations supervise the financing of medical care delivered to members. They all are concerned with cost-effectiveness, or saving money. By buying services in bulk, for many members at a time, managed care organizations can get lower prices with doctors and hospitals. Managed care organizations also reduce costs by limiting choice, which means providing members with a list of doctors from which to choose and lists of labs where tests can be performed. Even doctors are provided with lists of medicines from which to choose. Different plans have different restrictions on choice. Many people feel that limited choices are the downside of managed care. Generally, a member can expand the possible choices if he or she is willing to pay more.

At the same time, managed care organizations take care of the delivery system for their members. For example, they manage who provides the health care, where it is provided, and the different kinds of doctors in their particular system. Nurses, doctors, therapists, pharmacists, and hospitals are all a part of the delivery system."

This free online health encyclopedia has a lot of useful information !

Unit: Living with death and dying - OpenLearn LearningSpace - The Open University

Unit: Living with death and dying - OpenLearn LearningSpace - The Open University: "By the time you have completed this unit you should be able to:

* Relate beliefs about death to the meaning people attach to life
* Reflect upon the way in which death structures life
* Critically evaluate now encounters with death affect perspectives upon life
* Assess the quality of dying
* Critically examine the notion of a ‘good death’ in relation to individual experience
* Recognise the implications of the diverse values that people hold about death and dying for improving the quality of dying."

Here's an excellent teaching module if you want to learn more about death and dying !

Textbook Revolution: Better Health Care at Half the Cost

Textbook Revolution: Better Health Care at Half the Cost: "This book exposes many failures and successes of our modern health care system. Illustrations of what went wrong and what went right are taken from my personal and surgical experiences over the past fifty years. As the reader considers how and why we failed to control health care costs, she or he will surely think of new ways to achieve better patient outcomes at lower cost. My true tales should interest, amuse and appall. But only through such forthright reports can a lay reader comprehend the countless ways in which our antiquated health-care-review-and-reward-system elicits counter-productive self-serving behaviors from competent, hard-working, well-meaning participants—and how much money is wasted on costly unproven remedies or inefficient ideas like individually sold health insurance."

You can read it free online !

LEARN CPR - CPR information and training resources.

LEARN CPR - CPR information and training resources.: "Learn CPR is a free public service supported by the University of Washington School of Medicine. Learn the basics of CPR - cardiopulmonary resuscitation. Updated with new CPR Guidelines issued by the American Heart Association."

They've also got excellent videos you can learn from ! Save a Life !

Graphical Event Ticker for Infertile Couples

Graphical Event Ticker for Infertile Couples : "You can track your menstrual cycle day as well your ovulation day and days past ovulation count using this ticker. This particular ticker is designed for women trying to conceive and following their menstrual cycles to optimize their chances."

This is very clever !

BBC NEWS | Health | Donor crisis 'fuels IVF tourism'

BBC NEWS | Health | Donor crisis 'fuels IVF tourism': "British couples desperate for a baby are travelling abroad for fertility treatment because of a shortage of egg donors in the UK.

Patients blame the change in the law that gives children born through egg or sperm donation the right to trace their biological parents.

Some UK hospitals have closed their waiting lists because they are unable to recruit egg donors.

Women are going abroad or making their own efforts to find egg donors at home."

The McKinsey Quarterly: Paying health insurers for prevention

The McKinsey Quarterly: Paying health insurers for prevention: "Disease-management plans are nothing new, though to date most have failed because they were too costly. But emerging technologies that support the patient-management process could change all that. A full program can help coordinate care, encourage patients to follow their treatment plans, and provide warning as soon as problems develop. Germany is likely to be a test bed, since its government plans to compensate insurers for more of the cost of running such programs. Its experience will be keenly watched "

The McKinsey Quarterly: The 6 types of patients

The McKinsey Quarterly: The 6 types of patients: "We explored five themes: the patients' level of involvement and perceived control over their health, their knowledge of hypertension and its treatment, their level of concern about the disease, their beliefs about the safety and efficacy of medications, and the quality of their interactions with physicians. Survey respondents indicated their level of agreement with statements such as, 'I am very active in the management of my health' and 'My high blood pressure is not very serious.' In addition, the survey explored the patients' receptiveness to interventions that might influence their degree of adherence.4

When we analyzed the relationship between the attitudes and self-reported behavior of patients, six segments emerged (Exhibit 1, part 1). They ranged from proactive patients, who scored high on all five themes (Exhibit 1, part 2), to skeptical patients, who, for example, thought their condition was not serious, distrusted both physicians and medications, and adhered to their regimen as infrequently as 5 percent of the time. Likewise, we observed strong links between behavior and attitudes toward medication among the remaining segments: confident, concerned, confused, and resigned."

The McKinsey Quarterly: The market for health infomediaries

The McKinsey Quarterly:The market for health infomediaries.: "To develop these capabilities, payers are pursuing partnerships with companies, from outside the industry, that already have them. 'Infomediaries'—businesses that can advise consumers about their complicated treatment and provider options—would be one type of potential partner. In other industries (such as automotive, financial services, and personal computers), independent agents have emerged to give consumers information about the technical performance, reliability, customer satisfaction levels, and, of course, prices of products and services. These agents are now starting to emerge in health care. Partnerships with such independent advisers might help payers to overcome the consumers' current lack of trust in them."

The doctor can see you now

The doctor can see you now: "As physician practices convert their paper charts and files to electronic formats, checks are being put in place to prevent fraud and identity theft. Photographing patients is not a new idea, but is gaining popularity.

'If somebody wants to pick something up, it's another way to see that it is them,' said Cyndi McNutt, Orthopaedics Northeast front-office supervisor. 'It's very helpful for us to have a picture. We don't release anything without an ID.'

Now patient photos are helping the fight against medical record fraud and improper use of insurance information."

Infertility Customised Search Engine using Google Co-op

Infertility Customised Search Engine Using Google Co-op : "Infertility Search Engine searches 7 sites, including: www.advancedfertility.com, www.pcosupport.org, www.maleinfertility.org, www.drmalpani.com, www.ivf.com "

The beauty is that it only searches these sites, so users don't get lost looking for that elusive nugget of valuable information in millions of "hits".

You can now create your own customised search engines. This is a cool way for doctors to guide their patients to sites which they are confident are reliable and trustworthy !

Friday, December 15, 2006

Patient relationship management (PRM)

Patient relationship management (PRM) : "As practicing physicians, we develop a unique relationship with our patients since they put their life in our hands. The initial faith a patient has in a Doctor comes from the image we have in Society of being compassionate and trust worthy. We have to build on that initial faith. We have to make it stronger by paying extra attention to the relationship. The right prescription or the correct advice is just a basic requirement. That is why a patient comes to a Doctor but he or she comes back again & again only if they feel a sense of belonging with the Doctor. That is much more than just giving a good prescription. It all begins from the time the patient enters your clinic."

Thursday, December 14, 2006

Wyoming doctors want to re-locate

Wyoming doctors want to re-locate: "About one-third of Wyoming doctors are planning to relocate out of the state eventually, according to newly released data collected by the Wyoming Healthcare Commission.

Of those, more than half cited high malpractice insurance premiums as a factor.

Dr. Robert Monger, a Cheyenne rheumatologist and former president of the Wyoming Medical Society, said he was not surprised by the numbers.

'It is what I expected,' he said. 'When I've talked to doctors, a large number of them are very concerned about their malpractice rates to the point that they are considering leaving or planning on leaving the state.'"

What will happen to all their patients ? Who will care for them ?

Insurers Push Patients Toward E-Health Records - News by InformationWeek

Insurers Push Patients Toward E-Health Records : "While the push continues to get more doctors to trade paper-based patient medical records for electronic ones, momentum also continues to provide consumers with digital access to their own medical data.

Health insurers, which have troves of patient medical data from the billions of claim transactions they process annually, are hoping that they can help speed adoption of consumer personal health records.

Blue Cross Blue Shield Association and America's Health Insurance Plans (AHIP), which combined represent companies providing medical insurance coverage to 200 million Americans, said on Wednesday that they've created a 'health-plan based' personal health record model and portability standards that will enable consumers to transfer their data when they change insurers."

Insurance industry reps reveal PHR plan

Insurance industry reps reveal PHR plan: "Health insurance industry representatives announced Wednesday a web-based model for personal health records (PHRs) that they claim would incorporate core health data elements, maintain privacy, and enable patients to view and manage their health information.

Representatives from America’s Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association (BCBSA) say that they worked together to develop a secure web-based tool that contains a consumer’s claims and administrative information as well as core health data."

The health insurance industry promises to be a powerful catalyst in the adoption of PHRs. Every health insurance plan should offer their clients a free PHR when they sign up. This would save them so much money which is presently wasted in transaction costs !

Patient Videos

Untitled Document: "The Patient Narrative Video series is produced by the Center for Communication and Medicine at Northwestern University Feinberg School of Medicine. This series is designed to help medical students, clinicians, and the public gain insight into patient perspectives on illness.

We provide patients with a video camera, show them how to use it, and ask them to share their thoughts and feelings. We edit the video footage, with their approval, to offer brief stories about illness experiences. "

I wish more patients would use Google video to share their experiences with the rest of the world !

Tuesday, December 12, 2006

Mirth Project - WebReach, Inc. Launches New Line of Health Information Network Appliances

Mirth Project - WebReach, Inc. Launches New Line of Health Information Network Appliances: "WebReach, Inc., a leading creator of open source Healthcare Information Technology solutions, today announced the launch of a new line of Health Information Network Appliances(tm) running the Mirth open source software, and backed by a full range of support and deployment services. Mirth products and services allow healthcare organizations and solutions developers to achieve interoperability with existing networks at a fraction of the time and cost of traditional health information interface solutions."

Open source software promises to improve healthcare efficiencies - this dream may still come true !

Tolven Healthcare Innovations - electronic PHR

Tolven Healthcare Innovations: "The electronic Personal Health Record enables consumers to proactively ensure that their health providers have the latest information to guide them in their decision making. An electronic Personal Health Record provides the consumer with an intuitive web-based application to create, view, store and share healthcare information about themselves or on behalf of those they look after (e.g., aged relatives, children and those with disabilities); to communicate with their care providers; and to access needed health-related information relating to their specific conditions through the power of the internet; and to simply perform mundane tasks, like re-filling a prescription for themselves or one of their dependents - all with a minimum of effort.

Uniquely, the electronic Personal Health Record is not simply a static record keeping device. The electronic Personal Health Record enables the consumer to selectively include information that a care provider has collected, thus allowing the consumer to easily and securely make a partial or comprehensive view of their medical information available to other care providers. Just imagine visiting your doctor's office and not having to complete any forms because all of the information needed is already available on-line. A consumer granting emergency service providers access to their personal health record will potentially avoid unnecessary risks and delays in treatment. "

Business Process Outsourcing (BPO) for administering self-insured programs

BPO for healthcare insurance: " Outsourcing is not a new trend or concept in the self-insured marketplace. Self-insured employers have long outsourced benefits administration to third party administrators (TPAs) and health plans. In turn, health plans and TPAs have often outsourced their claims entry, pre-certification, medical management and PPO access to third parties."

Healthcare outsourcing in India

Healthcare outsourcing in India: "The Healthcare and Life Sciences industry worldwide is witnessing rapid changes. The Medical and Life Sciences devices segment is moving towards open standards, interoperability, informatics and electronic patient records.

Healthcare providers and payers are contending with complex industry regulations, increasing costs and declining reimbursements. All these changes are driving improvements in IT and process effectiveness. Consolidation, escalating service levels and diminishing margins are also spurring payers to outsource data entry, claims processing and related functions. "

Medical tourism is attracting a lot of media attention because it's a form of healthcare outsourcing. However, Indian companies which provide healthcare business process outsourcing ( BPOs) already provide a considerable chunk of the "back office" operations of US hospitals - and this is going to increase exponentially in the next few years, because it's so much cheaper to perform these services in India. This is a billion dollar market !

A preview of Google's "health URL"

A preview of Google's "health URL": "He then sketches out the Google solution, which includes the creation of a 'health URL' for every patient:

Let’s put the patients in charge of their health and medical information. Let’s build a system which puts the people who are sick in control. For every single medical and health-related event, let’s make sure that patients can effortlessly retrieve and share their information in its totality and then use it to ensure that they get the best quality of care possible. It is their health. The people who treat, diagnose, test or dispense medications to patients should be required to deliver, instantly, over the net, at the speed of light, that information to those patients to use as they see fit. If these patients choose to share it with caregivers or health coaches or nursing services, that should be their right ...

Every ill person needs a “health URL,” an online meeting place where their caregivers — with express permission from the ill person — can come together, pass on notes to each other, review each other’s notes, look at the medical data, and suggest courses of action. This isn’t rocket science. It is online web applications 101."

Monday, December 11, 2006

Online Tools Help Cancer Patients Select Treatments - iHealthBeat - Daily News Digest on Health Care Information Technology

Online Tools Help Cancer Patients Select Treatments - iHealthBeat - Daily News Digest on Health Care Information Technology: "Computer program 'decision aids' are being used by cancer patients to help them choose the most effective treatment options, the Chicago Tribune reports. According to the Tribune, many of the computer programs 'can be accessed by patients on their own, though they are best used in consultation with a doctor.'

Adjuvant! Online and Numeracy, used by the Mayo Clinic, help translate technical information about cancer treatments into terms patients can understand, and Decision Board helps women with breast cancer decide between mastectomies and lumpectomies and provides an online calculator to help men decide whether to have biopsies to diagnose prostate cancer. The computer programs help cancer patients at a time when they 'have more information than ever' and physicians 'often have access to less time for counseling,' the Tribune reports. "

The Other Side of the Bed Rail -- Horn 130 (11): 940 -- Annals of Internal Medicine

The Other Side of the Bed Rail -- Horn 130 (11): 940 -- Annals of Internal Medicine: "It is a lesson in healing. Although my physicians may not be able to cure my illness, their encouragement, time, patience, and trust build bridges that enable me to cope one day at a time. Encounters such as mine with Dr. L., the antithesis of caring, could become more common as medical care becomes more fragmented and long-term relationships with patients become relics. Physicians are the vital human link that can give patients the strength they require. As the pace of change in medicine quickens, physicians who teach will bear a special responsibility to provide strong examples of empathy and professionalism to students and residents. After all, one day we may all find ourselves on the other side of the bed rail, and those young physicians will become what we model for them today."

Caring for Colleagues -- Penson et al. 6 (2): 197 -- The Oncologist

Caring for Colleagues -- Penson et al. 6 (2): 197 -- The Oncologist: "People are uncomfortable with their mortality. Physicians are no different. When they become sick, their prior experience rarely seems to prepare them for a uniquely difficult situation when their sense of immortality is shaken. "

Good article , written for doctors, on how to care for ill colleagues.

Patient-Network | The Patient Connection

Patient-Network | The Patient Connection: "Patient-Network.com is a FREE online support community for those living with, or recovering from, life-altering illnesses. Patient-Network.com is a free service that uses the Internet for online communication through an interactive network of user profiles, personal accounts & stories, photos, weblogs, web forums, and groups. Because we're an online support system, we welcome friends, family, medical professionals, charities and other support persons to become members of our community. Meet people from your hometown or from other countries who can relate with your health challenges. Make new friends and lend a supportive hand to others in similar situations. Patient-network.com is just that; a network for patients. Welcome to our community. "

CaringBridge: Free online service connecting family and friends

CaringBridge: Free online service connecting family and friends: "CaringBridge offers free, easy-to-create web sites that help connect friends and family when they need it most."

This is a good example of the clever use of technology to help patients reach out for support !

Overview: Personal Health Records – Current Landscape and Future Visions

Overview: Personal Health Records – Current Landscape and Future Visions: "Now, more than ever before, people need to be actively engaged in their health and health care and, consequently, in the management of complex health data. This active involvement, fueled by reliable information, often helps patients to more effectively manage their care and improve their quality of life and health outcomes. Patients’ engagement is best supported when information needed to make health decisions is available at the point of need—at home, at work or when consulting with health professionals.

Today, a patient’s medical information is likely scattered within records stored by different providers or institutions, which are often located in various cities or states. Patients’ efforts to compile comprehensive personal health and health care histories, and incorporate that data into the management of their care, can be challenged not only by distance but by the fact that many providers’ systems can’t easily or securely share medical records."

Be Well Mobile, Patient Engagement Software that works

Be Well Mobile, Patient Engagement Software that works: "With the day of the doctor’s “house” call having passed from the scene many decades ago is there a way that a cellphone can provide some of the essential services that house calls used to represent?

Can patients be empowered by using their cellphones to fill a gap in the healthcare industry?

How important is real-time management to case management and improving prevention and treatment?

One company, BeWell Mobile Technology, founded in 2004, has addressed these questions directly. BeWell provides patient engagement software for the healthcare industry and medical research community.

BeWell software leverages the ubiquity of cellphones, wireless data networks and the Internet to collect valid data and to help patients manage their health. "

Sunday, December 10, 2006

Checking a doctor's bedside manner in a blog?

Checking a doctor's bedside manner in a blog?: "Before choosing a doctor or starting a new prescription, imagine browsing Internet blogs to check a physician's bedside manner or read about other patients' experience with a drug."

For doctors and hospitals, this is what "word of mouth" is going to look like in the next few years.

Connecting for Health: A Common Framework for Networked Personal Health Information

Connecting for Health: "Connecting Americans to Their Health Care: A Common Framework for Networked Personal Health Information:
A white paper that describes a networked environment in which consumers could establish secure electronic connections with multiple entities that hold personal health information about them. The paper discusses how consumer participation in networked environments has transformed other sectors, such as travel and finance, and concludes that the health care sector would benefit greatly from a properly designed secure network that enables greater consumer engagement."

Medical records mashup would span a lifetime | CNET News.com

Medical records mashup would span a lifetime | CNET News.com: "'Right now, maybe I can't change doctors because it's a huge fuss,' he said. 'If I can show up with data that has the most recent history in a format that the doctor can drop straight in his file...that creates an economic effect of competition and striving for service and investment on the part of providers.'

As complicated as the architecture for this type of system is, Kleinke said the bigger challenges are rooted in the bureaucratic and political complexities of the health care system.

'In reality, a lot of health care organizations have every incentive not to share,' he said. 'They want lock-in. They want switching costs. They don't want employees to be able to switch plans.'

Once patients own their own PHR, they won't get "locked in" to their doctor - it'll be much easier for them to get a second opinion and to switch doctors !

Dossia as a model for the PHR

Dossia as a model for the PHR: "Dossia provides what is missing today in terms of portability, accessibility and transparency. It is based on the Connecting for Health Common Framework, a set of design and policy standards established by a collaboration of industry stakeholders, including consumer advocacy organizations, physician groups, insurers, technologists and privacy watchdogs.

Connecting for Health is funded by the Markle and Robert Wood Johnson Foundations. The goal of the Common Framework -- and of Dossia as its first real-world deployment -- is to provide a robust, secure and flexible data capture and authentication system through which consumers can aggregate their health information to create one independent, lifelong personal health record.

Dossia enables an individual to develop a personal health record via two means: entering the data themselves and enabling the system to search and securely aggregate their individual health data from various sources. Once Dossia is complete, it will begin drawing information from all available electronic sources within the health care system on behalf of each individual who requests it."

Omnimedix Institute - Personal Health Record Basics

Omnimedix Institute - Personal Health Record Basics : "Personal Health Record (PHR) Principles

Here are some principles to which we at Omnimedix Institute believe PHRs should adhere.
1. Personal

“Let's talk about me.”

Your PHR and the medical information in it should belong to you and not to your employer, your insurance company, your doctor or any other person or institution.
2. Portable

“On the web / On a device / On a five pound block of ice.”

* You should be able to see and use your PHR whenever and wherever you choose.

* You should be able to view your health record on portable devices and over secure internet connections.

3. Private

'Privacy is of the Essence.”

* You control access.

* You decide who sees your medical data and who does not see it.

* Only you can give access control to others.

4. Ready for an Emergency

'Always Prepared'

You should be able to preauthorize access to selected emergency medical information for use when you are unable to give consent.
5. Permanent

“Long Life, Long Memory”

* Safe from Disasters - You should never have to worry about your medical data getting lost or damaged. Your health facts should be encrypted, distributed and redundant."

Health care in America | Bit by bit | Economist.com

Health care in America | Bit by bit | Economist.com: "THE paperless hospital has long been a goal of health-care reformers. Plenty of studies have shown that America's bureaucratic approach to handling patient records inflates costs, wastes time and increases medical errors. A number of digital initiatives have even popped up in places like Indianapolis and Massachusetts, but these are tiny ripples in the ocean of medical data. A national, fully interoperable system of electronic medical records has remained a distant dream.

But that may be about to change. On December 6th Wal-Mart announced plans to launch Dossia, an online patient-information service, next year. The retail giant was joined by other big firms including Intel and BP's American division, representing some 2.5m employees, dependants and pensioners in total. Curiously, they are relying not on some Silicon Valley powerhouse but on the Omnimedix Institute, a non-profit firm based in Oregon, to build and run the new system.

Separately, Google has been making noises about entering this market, too. “Today it is much too difficult to get access to one's health records...our industry should help solve this problem,” wrote Adam Bosworth, who is developing Google's health-sector strategy, on his firm's blog last week. When Wal-Mart, Intel and Google start sniffing around a market, the time has probably come to take"

This is good news for all patients - and doctors, too !

Healthcare Informatics: April 2006 - Spanning the Globe

Healthcare Informatics: April 2006 - Spanning the Globe: "Lesson #2. Engage physicians and clinicians. Transformation demands that end users participate and contribute their expertise. They need to be involved from the get-go, as in England, helping to define requirements and being engaged as champions of change.

Lesson #4. Adopt standards for interoperability. Although early leaders may have benefited from having a national health service or a single payor, standards are no longer the sticking point they once were. We need to make interoperability between EHRs a top priority. It will not happen just because standards are 'out there.'

Lesson #5. Build a critical mass of users. A national EHR program has to offer technology solutions that meet its users' needs. Whatever the solution, its success depends on having a critical mass of users. Physicians need to have network access and computer systems in their offices -- and not all physicians do."

Mobile eHealth Interventions for Obesity

Mobile eHealth Interventions for Obesity: "Cell phones would be the preferred hardware platform for eHealth obesity interventions for reasons of both enabling effective intervention design features and for promoting rapid public adoption and acceptance.

We conclude that the appropriate model for obesity and weight management is the tailored informational intervention modified according to design principles suggested by Social Cognitive Theory and the Social Marketing Model. The health behaviors to target are self-monitoring of diet and physical activity. The devices are Web-enabled “smart” cellular telephones and wireless PDAs. Given the lack of effectiveness of other interventions to prevent or treat obesity in a sustainable matter, trials of these persuasive, ubiquitous technologies are required without delay."

What a great idea - helping patients to lose weight with the help of their cell-phone !

HealthNex: Patient-Centered Care

HealthNex: Patient-Centered Care: "For the past several years the Amercian Academy of Family Physicians (AAFP) has spoken out loud and clear about a broken U.S. health care system that dispenses high-cost, low-quality care in an inefficient system driven by sub specialists rather than primary care.

Finally, someone is listening. IBM, the world's largest information technology company -- with some 329,000 employees in 75 countries -- is working with the Academy on designing a health care system that will keep IBM employees healthier with a lower price tag.

'This is watershed, historic moment,' said AAFP President Larry Fields, M.D., of Ashland, Ky. 'It's the first time a large employer and a medical specialty society have collaborated to design a cost efficient, quality, affordable health care system for employees.'"

Web 2.0 -- A Brighter Future for Health Care

Web 2.0 -- A Brighter Future for Health Care: " For families and individuals to be better connected with each other as they sort through this information and engage in joint medical decision-making, they will need to be linked in new, organic ways. Strong, health-centered support communities will need to grow and thrive online…and the social networking qualities of Web 2.0 can deliver."

Saturday, December 09, 2006

Good Medical Practice

Good Medical Practise This is an excellent guide for doctors, written by the General Medical Council of the UK. Not only does it tell doctors what is epected of them, it also tells patients what they can expect of their doctors !

Friday, December 08, 2006

Overview: Personal Health Records – Current Landscape and Future Visions

Overview: Personal Health Records – Current Landscape and Future Visions: "Indeed, the power of a personal health record lies in its potential to be coupled with alerts, reminders and other decision-support tools that help people take action to improve their health or manage their conditions. From this perspective, the personal health record can be seen as part of a broader personal health record system. Health care and technology pioneers are beginning to develop solutions that harness the power of PHRs to create consumer-friendly tools people can use in their daily life to stay healthy and better manage illness."

Project HealthDesign for PHRs

Project Health Design for PHRs: "Project HealthDesign supports technology pioneers to design the next generation of personal health record systems in ways that empower patients to better manage their health and health care."

This is an excellent initiative; and we are going to see a lot of activity in this area !

Thursday, December 07, 2006

Narrative Medicine

Narrative Medicine: "Narrative medicine brings a useful set of skills, tools, and perspectives to all doctors. Not only does it propose an ideal of medical care -- attentive, attuned, reflective, altruistic, loyal, able to witness others’ suffering and honor their narratives -- that can inspire us all to better medicine, it also donates the methods by which to grow toward those ideals. Any doctor and any medical student can improve his or her capacity for empathy, reflection, and professionalism through serious narrative training. More and more medical schools and medical centers are adopting narrative methods of study in reading, writing, reflecting, and bearing witness to one another’s ordeals. It is hoped that the research to understand the outcomes of these practices will keep pace with their growth. Ultimately, narrative medicine may offer promise as a means to bridge the current divides between doctors and patients, between doctors and doctors, between doctors and themselves, illuminating the common journeys upon which we all are embarked."

One of the core skills of a good doctor is being able to listen to patient's stories !

Wednesday, December 06, 2006

Providing quality medical care using a mobile at the point of use

Providing quality medical care using a mobile at the point of use"Lexi-CLINICAL SUITE™ includes five (5) databases specifically combined to support the information needs of residents and physicians as they manage patients and optimize outcomes. Below is an overview of this comprehensive software package using a case presentation format to demonstrate its features and clinical application in daily practice."
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