Friday, March 30, 2007
The purpose of Userhealth is to be your silent health and sleep supervisor! What UserHealth actually will do is provide you with regular health, pause, and go to bed messages. The messages can be displayed like small popup windows in the right corner (Almost like a MSN login popup) or if you prefer a topmost window or just sound feedback. The messages will contain suggestions about pauses and small exercise that the user can do to stimulate the body and to avoid Repetitive Stress Injuries (RSI). However the main purpose is to draw attention to the user that he or she has been using the computer for a long time and maybe need to take a break."
Excellently written - and should be read by everyone who writes - not just lawyers !
Thursday, March 29, 2007
- Support for a life-long health record
- True interoperability among all parties and systems used in patient care
- Intelligent decision support
- Domain size and rate of change
- Systems obsolescence
- Multi-contact healthcare system and mobile patients
- Multiple medical cultures, including developing world, asian
- Support for domain experts to have direct control over the information design and change management of their systems
This document discusses the challenges for health information systems of the (immediate) future, and offers some suggestions for how the work of both standards bodies and implementation efforts might be brought together in the form of global standards for health information systems, particularly EHR (electronic health record; note that in this document, the term EHR is used to mean all variants, e.g. CPR, EMR and so on).
Wednesday, March 21, 2007
Now Brian, 45, a lorry driver, and Wendy 41, have returned to Mumbai to introduce Freya to the doctors who helped create her and to undergo a second embryo adoption procedure. Wendy says: “It was an incredible moment introducing Freya to the Malpanis. One day we will tell her all about the story behind her birth.
“Freya’s conception happened because some wonderful couple had IVF treatment at the Malpanis’ clinic but allowed their leftover embryos to be kept in storage to help other childless couples."
I believe what sets us apart from most other IVF clinic is that we treat infertile couples as intelligent adults who are capable of making their own decisions for themselves. This is why we often treat couples who have been refused treatment by other doctors; and allow them to take an active part in formulating their treatment plan.
Insurance companies need to invest in patient education and Information Therapy !
Friday, March 16, 2007
Disruptive Innovation: Can Health Care Learn From Other Industries? A Conversation With Clayton M. Christensen -- Smith, 10.1377/hlthaff.26.3.w288 --
Medical tourism is going to shake-up the US healthcare industry and force doctors to become more patient-friendly and competitive !
In the beginning, I think the major reason was the fact that our prices were much more competitive than what clinics in the USA and UK charge. However, our major USP is no longer our labour arbitrage . I think what sets us apart is the fact that we are a "focussed factory" ( a concept described by Michael Porter and Regina Herzlinger). We run a lean and mean unit , which does IVF and only IVF ! Because we do so many cycles, we are very good at it; and because we do nothing else, we have to be very good at it in order to survive !
Thursday, March 08, 2007
The study, in Wednesday's edition of the Journal of the American Medical Association, reported that CT screening found three times more cancers than expected and resulted in nearly 10 times as many cancer surgeries. But there was no reduction in deaths from lung cancer."
The sad truth seems to be that there is little we can do to influence the natural history of the disease ! The "War Against Cancer" seems to have failed.
Monday, March 05, 2007
President Bush set 2014 as a target for all Americans to have e-health records. Health care providers could share those records via RHIOs."
Red Hat, the largest business Linux distributor, is teaming up with the health care sector's largest company, McKesson, an $88 billion-a-year pharmaceutical and IT supplier. Red Hat will provide a core of Linux and JBoss software geared to run McKesson's clinical applications."
Saturday, March 03, 2007
In order to get around this problem, many countries have passed a law which allows doctors to transfer only 2 embryos. While this dramatically reduces the risk of high order multiple births ( which is good for the government which would have to pay the bills for caring for the premature babies), this sort of "one-size-fits-all" policy can be harmful for patients who have a poor chance of getting pregnant with IVF - for example, the older woman; the one with poor quality embryos; or the one who has failed multiple IVF cycles in the past. Logically, they should be allowed to transfer more embryos, as their chance of getting pregnant ( even with a singleton) is pretty low in the first place, which means their chances of having a high order birth is extremely poor. Unfortunately, bureaucracy cannot formulate flexible policies, and this sort of rigidity is very patient-unfriendly !
It is my personal belief that patients should be allowed to decide how many embryos they want transferred - after all, they are the ones who are going the pay the price for whatever decision they take, so why shouldn't they be allowed to take this ? I feel it is very patronising and unfair to tell intelligent, well-informed couples what they are allowed and not allowed to do. They are adults who are capable of weighing the pros and cons, and making their own decision for themselves !
Their are 3 possible outcomes to any IVF cycle:
1. A pregnancy with a singleton or twins. This is a "good outcome", and is what all of us are aiming for ! Whether we achieve this outcome by transferring 1 or 2 or 3 or 4 embryos does not matter - it's not the number we transfer - it's how many finally implant, which is what matters. If the outcome is good, everyone is happy, so there's no need to discuss this any further !
2. No pregnancy. Unfortunately, this is still the commonest outcome for most IVF cycles. Treatment is financially and emotionally expensive , and for most patients, it ends in failure. This is a major personal disaster - but the only one who gets hurt in the process is the couple. The government does not really care - because this is a personal and private loss.
3. High order multiple pregnancy ( triplets or more). This is a major problem - for both the couple and the government ( who has to pay the neonatal intensive care unit bills for the premature babies). This is why the government does its best to prevent this particular outcome, and does not allow the transfer of more than 2 embryos. However, from an infertile couple's individual point of view, a triplet pregnancy may be better than no pregnancy at all - and they have a safety net, as they can still salvage the pregnancy by performing a selective fetal reduction.
Let's look at the individual case of a 38 year old woman who is doing her 5th IVF cycle after 4 IVF failures, and has 4 embryos in the incubator. The law will allow her to transfer only 2 - and she is forced to discard the other 2 ( which are not good enough to freeze). Imagine the heartburn and pain this must cause her if she fails to get pregnant ( once again). She will always be left with the dreaded nagging feeling that she might have had a baby if she had been allowed to transfer all the four embryos !
Is it ethical to force her to discard these embryos ? Shouldn't she be empowered to decide for herself ? If she is willing to take on the risk of a high-order multiple birth, shouldn't she be allowed this right ?
The body which has the longest track record for regulating IVF is the HFEA ( Human Fertilisation Embryology and Authority) in the UK. When it was set up, IVF was a very new enterprise and it was established with the best of intentions - to ensure that the human embryo was respected. However, IVF has now been around for over 25 years and has become a part of mainstream medicine. Patients - and their doctors - should be allowed to make their own decisions for themselves , just like they do in other complex areas such as the treatment of cancer. In factm the Department of Science and Technology even recommended the dismantling of the HFEA 2 years ago, because it felt that it has outlived its utility . However, no action was taken on this recommendation . After all, given the nature of the best, every bureaucracy will ensure that it will perpetuate itself for ever !
The biggest tragedy is that instead of learning from these mistakes, India seems hell-bent on repeating them all over again, and is in the process of passing a law to regulate IVF and IVF clinics. Who will this really help ?
1. Assess: Use a short, well-directed interview. Remember that selfreported
behaviors are usually underestimated.
2. Approach: A warm, empathetic, and non-judgmental approach is
better received by the patient.
3. Advise: Personalize the risks and benefits to the patient, while
emphasizing “quality of life”.
4. Agree: The patient will be much more willing to implement change if
there is a mutual agreement based on compromise. Ask “How
important is this change to you? and how confident are you that you
can make the change?”.
5. Assist: Self-management skills and resources are important. What
are her sources of additional assistance?
6. Arrange: Follow-up and resources. Patients are 30% more likely to
comply with treatment if they know there will be follow-up.
Thursday, March 01, 2007
EHRs — electronic health records — were the focus in the health information-technology industry when President Bush began pushing for standards to facilitate the sharing of health records across the nation.
But that was two years ago. Now, personal health records are the order of the day.
'The PHR movement is beginning to take solid root,' said Donald Mon, a vice president at the American Health Information Management Association.
A personal health record helps solve a big problem: Even if medical facilities create electronic health records, 'a consumer's health information is still going to be distributed across many health records,' Mon said. 'The PHR is the one place where you can accumulate all your health information in a consistent way to reflect your lifetime of care.'"
The good news for doctors is that patients may offset the cost of such a purchase: Fifty-one percent of consumers said they would be willing to pay for the service if the price was reasonable."
Hospitals now have an opportunity to supply target customers with differentiated, 'boutique' services that would offer easier access to and greater integration of health care2 and enhanced comfort and convenience during hospital stays. Some nonprofit hospitals have already begun to promote these services, but others are holding back, principally for two reasons—one philosophical, the other economic. The philosophical concern is that catering to affluent patients will diminish the quality of care for those unable to pay more.3 In reality, the extra revenues are likely to mean better service for all patients. "
The McKinsey Quarterly: IT remedies for US health care: An interview with WellPoint's Leonard Schaeffer
It's the same for all of the administrative stuff: someone smart will come in with better processes. For example, 'one-write' systems—take the patient's name once and never ask for it again. Every time I go to the doctor, I have to write down everything all over again and again."