Saturday, April 28, 2007
Friday, April 27, 2007
They have no physicians, but when a man is ill, they lay him in the public square, and the passers-by come up to him, and if they have ever had his disease or have known anyone who has suffered from it, they give him advice, recommending him to do whatever they found good in their own case, or in the case known to them; and no one is allowed to pass the sick man in silence without asking him what his ailment is.
Histories of Herodotus: A history source of Persian Empire of Achaemenian era.
Herodotus (c. 484-225 BC).
In our “knowledge-sharing civilisation” I wonder whether we have the equivalent of too many physicians, no public square, a lack of passers-by or just a lack of intellectual compassion?"
By allowing patients to share their PHRs online, we can get the best of both worlds !
"1. Personal content management tools -- to help people organize their personal information (and other information they've aggregated) their way, and identify who they will permit to access it under what circumstances ('permissioning')
2. Metadata tools (invisible to the user) -- to automatically reorganize this personal content for effective, permitted use by others
3 . Social networking applications -- to help people identify other people (inside and outside their organization) with particular expertise or shared interests, connect and collaborate with these people and with people in the individual's self-defined networks, via Simple Virtual Presence, browse and subscribe to others' permissioned personal content, and publish their own permissioned content."
The PHR would be the underpinning of this personal content. We then need develop these tools , so that patients can make intelligent use of their personal health data !
When Mark began receiving requests from friends to set up pages for other people, he decided to create easy-to-use templates so patients could create their own.
Now, with thebabyStatus.com, expecting parents can create web pages to keep family and friends updated on a pregnancy as well as show their new baby!
As theStatus.com grows, we are committed to providing users with simple, easy-to-use tools for creating personal web pages.
Technology is changing the way we communicate with family and friends and, now, staying in touch is easier than ever!"
“In every focus group we’ve done, there’s been no conception from anyone of what Web 2.0 is,” said Eric Dishman, manager of Intel’s Proactive Health Strategic Research Project, a five-year-old program that’s looking for ways technology can help seniors take better care of their health at home. “But when you show them what can be done, they immediately understand its impact.”"
Thursday, April 26, 2007
Danish doctors began relying on EHRs years ago, without government incentives. Some in the audience asked Kverneland how that happened, noting that U.S. doctors are struggling to adopt EHR systems, even with government support.
Kverneland answered, 'They gained money by using electronic health records.' Time savings translated into dollar savings, he said."
Wednesday, April 25, 2007
* Share complete and up-to-date health information with your providers
* Avoid potentially dangerous delays, mistakes and miscommunications when more than one health professional is involved in your care
* Use your time in the doctor's office more effectively
* Keep track of chronic illnesses
* Help family members manage their health care
As a communication tool Dossia enabled Personal Health Records will help cut down on medical errors and eliminate waste. This will improve the quality of the care you receive and reduce inefficiency in the health care system."
Wal-Mart said it would contract with local hospitals and other organizations to operate the walk-in clinics, which lease space from Wal-Mart and are run as separate businesses."
Doctors and hospitals can learn from Wal-Mart that if we give patients what they want ( friendly, inexpensive medical care, when they want it, where they want it) , we will all succeed !
Wal-Mart CEO Calls on Businesses To Step Up Health IT Efforts - iHealthBeat - Daily News Digest on Health Care Information Technology
'The time for politics in our nation's debate on health care has passed,' Lee Scott, CEO of Wal-Mart, said on Tuesday at the World Health Care Congress in Washington, D.C. According to Scott, it's time to take action, and businesses should be a 'catalyst for positive change.'
Scott said that businesses can further the effort to transform health care through three steps:
* Empowering consumers;
* Applying technologies; and
* Increasing efficiencies."
Making a baby needs only four things - eggs, sperms, a uterus and fallopian tubes. Unfortunately, since they cannot see any of these , they track the only thing they can see - their menstrual flow.
While the regularity of the menstrual cycle is in fact a very good marker for ovulation, the quality of the menstrual blood flow ( duration; the presence of clots; the amount ; or how dark the blood is ) is completely unimportant. After all, the menstrual flow just represents the old uterine lining which is being shed.
However, misconceptions about menstrual flow abound - and because infertile women are often very poorly informed about their bodies, these myths find a fertile ground in their heads.
As it is , infertile women have low self-esteem and an inferiority complex because they cannot conceive. Their bodies have let them down and they feel flawed and defective. Their mind often plays games with them, and these doubts and concerns fester and proliferate. Minor inconsequential problems, which are normal anatomic variants ( and are often seen in fertile women) are perceived as being the cause of infertility ! While fertile women do not worry about variations in their menstrual pattern, infertile women do so all the time ! For example, many women believe that if the flow is scanty, the "bad blood" will accumulate in the body and the
" menstrual toxins " will cause infertility. This is why some women still ask the doctor to perform a D&C ( dilatation and curettage) to "clean the uterus".
Often their only source of information is their fertile friends, and when they compare notes, they often notice differences in their menstrual patterns - differences which are of no importance but which get magnified in their head, until this is all they can think about !
It's surprising how even well-informed women fall prey to some of these myths. For example, I had a doctor who was going through an IVF cycle. She had a lot of cervical mucus because she had grown a large number of follicles and had high estrogen levels. However, she was worried that the "leaking fluid" meant that her eggs had ruptured before we could retrieve them !
It takes a lot of counselling to explain to infertile women that they should stop worrying about their menstrual flow. Unfortunately, once a misconception has taken root, it's extremely hard to get rid of it !
“goodness” with integrity, safety, up-to-date medical knowledge and diagnostic skill, and the ability to form a good relationship with them. For them, good doctors are clinically expert and at the same time are interested in them, kind, courteous, empathetic and caring. All these attributes matter to them because they know that their doctors’ decisions can affect the outcome of their illness — even make the difference between life and death, or between enjoying a speedy recovery and suffering serious disability. "
'We call it the Amazon effect. But, frequently, all they can find is a little description of a book which they bring with them when they visit us trying to find more information,' Mr. Faulkner says. Recently, consumers have visited the store seeking information on topics ranging from autism to fibromyalgia, irritable bowel syndrome, premature babies and yoga.
'Consumers may find things on the Internet that are not from a reputable source and valid publisher,' Mr. Faulkner says."
A book is a book is a book !
Medical librarians have master's degrees or doctorates, often with special certification in health care. They are trained to distinguish good information from bad. Major hospitals have offered medical library services to physicians on staff for years. A new trend is the development of libraries that offer medical information to consumers.
"Librarians can save consumers time because they have a wealth of information resources available to them that are not available to the general public," says Jean Shipman, president of the national Medical Library Association in Chicago. "
I feel every hospital should have a patient education library ! Not only will this save the doctor's time
( because he can refer the patient or family to the library for more information); it will also help to keep patients much happier, because they are better informed !
Sunday, April 22, 2007
Key points about KP HealthConnect:
* Privacy of information is a top priority in designing and implementing KP HealthConnect. The design of the software ensures that sensitive medical information will be protected.
* Patient Safety will be enhanced by KP HealthConnect. Drug interactions and allergic reactions will be prevented by software that knows what medications the patient is taking and checks for conflicts. A patient's medical history will be available to every clinician who is involved in that patient's care--at the same time--even if the doctor is in Georgia, a nurse is in Colorado, and the specialist is in California.
* Relationships and personal care will be honored and enhanced by KP HealthConnect. One of the key goals of the project is to free up doctors' and nurses' time to spend with patients rather than on paperwork. Our own studies have already found that, for instance, having a computer in the exam room enhances communication between the doctor and patient.
KP is a beta test-site for the promises -( and problems ! ) of implementing an EMR system !
The fundamental principle of the new legislation is that the copy of a medical record stored in such an EHR bank is the only medico-legal copy. The record is sustained objectively by an EHR bank and all authorized parties can have access to it. Such a bank acts as a custodian/trustee. Multiple competing banks will be established by private enterprises (once the appropriate legislation will be in place), much like financial banks.
Healthcare providers could reduce their costs of medical records archiving as this function will be carried out by the EHR banks. Insurers will support it as it will improve the quality of care their customers get. Privacy will be better protected as no global patient identifiers will be needed since a bank account number will be the only access key that the individual needs."
This is an interesting concept - and we may need this to overcome initial teething problems, to help patients overcome their fears about privacy and security.
Fortunately, there is a growing movement to change that, using electronic information technology. While only 24 percent of providers today use electronic health records in their offices, that figure is increasing rapidly. More doctors are using computers to order diagnostic tests and treatments. Gradually, institutions are building systems with common coding systems that allow them to exchange data.
In our view, the single most important benefit of electronic records is that they make it possible to deliver information to your doctor at the moment he is making decisions about your care. Instead of having to read through what can be hundreds of pages in your medical record to find a particular test result, he now has the data available in an instant."
There are 2 ways of achieving this goal.
1. Top-down, where the government provides the funding to implement this on a nationwide system, as the NHS is trying to do in the UK ( and failing miserably)
2. Bottom-up, where individual doctors, hospitals, clinics and patients do this for themselves. I feel this is far more likely to be succcessful and effective , if we adopt the open-source model.
Rather than grassroots, the word Rennie uses to describe such organisations is 'astroturf'. Originating in the black arts of politics and public relations, astroturfing is the practice of disguising an orchestrated campaign as a spontaneous upwelling of public opinion."
Whom can you trust ? The only solution is to become well-informed - and to analyse all the information you receive critically.
You can help. If your doctor uses drug company giveaways, bring a stack of writing pads and inexpensive pens to your next office visit. If your doctor asks why you are giving these to him, smile and say, 'It just looks better.' Your doctor will get the point. Be nice about it. It's tough for anyone to turn down a freebie. Doctors are no different. At the same time, doctors' first allegiance is supposed to be to their patients. A word from a patient can have a lot of influence."
Saturday, April 21, 2007
'The business model we use in health is based on an industrial enterprise where the focus is often on the management of physical resources with very little attention to the management of knowledge,' he said.
'In business, high priority communications is handled electronically but in health care it is pen and paper delivered by hand. 'No less than 25 percent of all Australians suffer from a chronic illness and nearly every one of them would be better off with improved knowledge sharing and more effective management of patients.'"
Wednesday, April 18, 2007
Starting at the end of March, Blue Cross of Northeastern Pennsylvania, known as BCNEPA, will begin providing 100,000 of its members--and later to all 600,000 members--secure electronic access to their own and their dependents' personal health records. The information, which includes recent diagnoses, prescribed medications, allergies, and immunization history, will be culled from the insurer's claims data as well as information that the member supplements."
* Internal medical disorders
* Symptoms and signs
* Congenital and inherited disorders
* Infectious diseases and organisms
* Drugs and medications
* Common haematology and biochemistry investigation abnormalities"
Great starting point when you are hunting for information !
Could this technology be incorporated in a cellphone ?
This makes sense. Just like supermarkets allow customers to choose their own goods, thus replacing store clarks, this clever technology replaces the medical admission clerical staff, by allowing patients to DIY !
'When you talk to clinicians about what they need in terms of making a more accurate diagnosis, they will tell you they need lab results, medication history and access to diagnostic images from radiation technologists,' he said. 'This is really about presenting an individual history to the right provider at the right time to improve the outcome. That's what this is all about.'
The project's aim is to have every physician's office in the province hooked up to the system, with ready access to individual medical records, although only with patient consent. 'The more this is used, and the more people on the system,' Mr. Canham said, 'then the more valuable it becomes.'"
* patient-centred: one EHR relates to one subject of care, not to an episode of care at an institution;
* longitudinal: it is a long-term record of care, possibly birth to death;
* comprehensive: it includes a record of care events from all types of carers and provider institutions tending to a patient, not just one speciality; in other words there are no important care events of any kind not in the EHR;
* prospective: not only are previous events recorded, so is decisional and prospective information such as plans, goals, orders and evaluations."
Monday, April 16, 2007
The following is a sample letter .
Dear Dr. Smith:
Paragraph I: Introduction and explanation of why you have chosen to write this particular doctor
I apologize for writing without the benefit of an introduction, but do so on behalf of my mother who has been diagnosed with lung cancer. I read of your (insert reason why you think they are a fit: research on the drug Iressa, expertise in new drug development, expertise in a new surgical procedure) and write with the hope that you might be willing to help.
Paragraph II: Summary of the medical situation
My mother, (insert name), was diagnosed with stage IIIA non-small cell lung cancer in June 2000. At that time, she underwent surgery to remove a portion of her right lung at ABC hospital in XYZ town. It was noted that the cancer had spread to the adjacent and even distant lymph nodes. As a result, my mother also underwent (specific details) eight weeks of radiation therapy and ten weeks of chemotherapy with the following drugs: (insert names of medications used if known). She then entered a remission.
Paragraph III: Current concern and how the doctor can help
Last week, we learned that my mother’s cancer has recurred in a single nodule in the remaining area of her right lung. My mother is eager to take all possible aggressive measures to combat this disease. I read of your recent work with a clinical trial (again, insert the reason you think they are a fit) and wondered if you would be willing to evaluate my mother as a candidate for participation in this trial.
We understand that this is one of many such requests that come across your desk and greatly appreciate any guidance that you can lend.
Thank you, in advance, for your help. I look forward to hearing from you at your earliest convenience. "
Doctors are often willing to help someone in need ! All you need to do is to learn how to ask nicely !
As a member, whenever you or your loved ones need help, HealthCare Advocates will be there for you. When you have medical questions, insurance disputes, questions about coverage, even if you've been denied access for a certain medical procedure, HealthCare Advocates can help. We've combined the strengths of our experts to offer members such valuable services as medical research, insurance dispute resolution, bills and forms consolidation services, health counse"
That is what The Health Resource will do for you. Many of our clients tell us that our service is exactly what they were looking for, but didn't know existed. Let us save you time and effort, freeing you to concentrate on yourself or your loved one."
Judge: web sites for health - consumer guidelines - how to search the Internet for health information
How to search
How to judge the quality of the information you unearth
How to manage the information ( and your doctor !)
Excellent coverage of:
* Information searching
* Gateways - searchable catalogues to good quality health Web sites
* Search engines
* Search tips
* Confidence building - learning how to search"
Reminders can be by:
- email – automated reminders are sent directly to your email address
- telephone call – automated reminders are sent directly to your phone’s voice messaging system
- text message (SMS) – automated reminders are sent to your cell phone
Whenever care is received, the prior records would be available (with consumer permission) from the health record bank, and the new information generated would be deposited in the consumer’s account. Each bank would have three standard transaction windows: withdrawal — for access to records, deposit — to accept new records, and search — to accept search requests from authorized medical researchers and public health authorities. There would be many competing health record banks, and each consumer would have an account at the bank of their choice."
This is a great idea ! Ideally, the virtual helper could be a tool which could be programmed in to the ubiquitous cell-phone everyone carries these days !
several have been proposed or are in formation. To help organizations and individuals that
are interested in using PHRs make the best choice among the proliferation of products,
CalRHIO developed a list of criteria for elements that should be included. The criteria provide
a minimal standard of completeness, usability, portability, and vendor stability. The criteria
provide a first-level screen. Consumers will need to apply their own situation and needs to
determine which product is the best fit. Proposed criteria and the rationale for each appear in the chart An evaluation score card also follows. These documents are available online at www.calrhio.org.
A reminder as to why "baby-lust" can be such a strong driving emotion - and why couples will move heaven and earth to have a baby !
Sunday, April 15, 2007
This is good advise - it will save both you and your doctor valuable time !
Saturday, April 14, 2007
HONEST MEDICINE: 9 Important Articles That Expose Some of Big Pharma's Highly Questionable Practices
This is well-worth reading . It will open your eyes ( and your doctor's too !) as to how pharmaceutical companies manipulate medical practise !
1. Get Organized
You will need some sort of binder or filing system to keep track of all the information you acquire. One way to keep your findings organized is to use the charts we've developed. Link here to download the chart.
2. Doctors and Medical Professionals
Your physician and other professionals should be your primary source of information, but not your only source of information. Find one who will be willing to partner with you in your search for information. Learn more about working with professionals here.
3. Second Opinions
When your primary doctor suggests that surgery, difficult drugs, or any other difficult treatment is the best option for you, then it's time to get a second opinion. Learn more about second opinions here.
4. Your Medical Records
You have the legal right to acquire all medical records produced on your behalf. Laws vary state-to-state, but in general, you must obtain these records through your primary physician (the person directing your tests and treatment.) Contact your primary physician and ask for copies of all your records: notes, test results, pathology, others.
5. Non-Medical Professionals
There is a large group of other professionals, some health-related, who may be able to help you.
6. The Internet
You'll find a wealth of information on the internet. Not all the information is credible, however, and all your findings should be confirmed with your physician(s). One of the biggest benefits of the internet is that new information can be found everyday. Further, you will find access to others who share your diagnosis, and a way to get updated news every day. Sometimes the internet will lead you to articles available only to subscribers, often doctors only, and the articles will be very expensive to purchase. Check with your primary physician to see if s/he has a subscription and will be willing to provide you with a copy of the article. Or check with your local library by taking all the publication information you have (title, pub, author, dates, etc.) They may be able to find a branch in their system that can obtain the article you seek at little or no cost.
7. Media, Books and Articles
Your local library, bookstores, newspapers, health channels on TV, and other media may help you find information. News can be emailed to you on a daily basis through Google, Yahoo, MSN and others.
Other people can be a very important source of information. Ask everyone you know if they know others who have the same condition or disease. Ask to be referred, even to people you don't know, if you think they have information that can be beneficial to you. You never know who knows exactly the right person who can help you.
9. Participate in Support Groups
Support groups comprised of other patients who share your diagnosis, and their friends and loved ones, can be a lifeline. Check your phone book, online, local newspapers, and your library to find groups that can help you.
10. Help Others
Nothing reinforces learning like teaching someone else. So it is true with health and knowledge empowerment. By helping others, you will learn to deal better with your own situation. You can start by providing feedback to diagKNOWsis. Your feedback will help others who find this website."
Or perhaps you understand the diagnosis, but the treatment just doesn't seem to have a positive effect. Your symptoms may not improve, or perhaps new ones appear. People are giving you advice: doctors, family, friends. But some advice conflicts with other advice. It's difficult to know what to do.
diagKNOWsis.org was started to help you sort out the questions, answers, and advice. It is provided by patients, from a patient's point of view. It was begun by someone who has been right where you are.
It will help you take responsibility for your own health and medical decisions. It teaches you to become a better health and medical care consumer."
The next time you read a health-related newspaper story, remember this article !
Here's a thought-provoking blog entry by the CEO of a leading US hospital. By comparison, do doctors get paid too little ?
Thursday, April 12, 2007
So why do they fly half way around the world to get a baby ? There are many reasons for this ! Initially, patients would come to us because our charges were a fraction of the cost of what a
Our clinic has a very high pregnancy rate and one of the reasons we are very good at what we do is because we specialize in providing IVF treatment ( we only see infertile couples and do not treat any other gynecological problems). We do not have a waiting list. We do not employ assistants, and provide highly personalized care, so we can tailor our treatment to suit our patient’s needs. We treat couples as intelligent individuals, and invite their input in the decision making process, so they have peace of mind they did their best. We are a patient-friendly boutique clinic, and we take pride in pampering our patients !
Our website at www.drmalpani.com allows couples to read our 300 page book, How to Have a Baby, which is designed to empower infertile couples with information. They can view 20 IVF videos online; and also get a second opinion from me, free of cost. This allows overseas patients to develop confidence in our professional expertise and abilities. I reply to all my emails myself within 48 hours, and this allows them to build a relationship with me well before they come to the clinic.
Medical tourists can be demanding patients ! They have often lost faith in their own medical system; and many of them are doctors and nurses who make their own medical decisions. They are challenging to treat and I enjoy doing so, because they are well-informed and capable of thinking out of the box – it does take guts to travel to
Many of our patients come to us because of word of mouth. We have been interviewed by many international newspapers, magazines and TV channels, and this has given us global recognition. Infertile couples can be highly vocal – and once they get pregnant, they are very happy to refer other patients to us. Because they have high expectations of us, all our staff has to be on their toes to ensure they provide high quality treatment – and this helps us to improve the level of the service we provide to our Indian patients as well .
Medical tourism represents a huge opportunity for doctors and hospitals who are willing to tap this market. Firstly, they need to identify niche areas where the demand is the highest. These include: elective surgical procedures which are not covered by insurance, such as : cosmetic surgery and dentistry; expensive surgical procedures which cost an arm and a leg in the US, such as bypass surgery and joint replacement; and alternative medicine , such as health spas for stress management.
Secondly, they have to go out of their way to build a world-class reputation by being transparent, accountable, responsive and patient-centric.
Finally, they should be willing to provide a “point-to-point” service, which takes care of all the needs a medical tourist will have – including: visas; local hospitality ( airport pickup and hotel stay) and sightseeing.
The need for medical tourism is going to grow as the
Unfortunately, the lack of support which the government provides has been a great disappointment, and I feel doctors and hospitals are given step-motherly treatment. The foreign exchange which IT companies earn is tax-free, so why shouldn’t the same consideration be provided to medical services too ? The government should be proud to export medical services, and since Indian doctors have such a good reputation globally, they can leverage this to earn foreign exchange and reverse the brain drain. We do hope the government will put its money where its mouth is, and formally recognize the superb value Indian doctors and hospitals provide to overseas patients, so that medical tourism can be encouraged and supported.
Wednesday, April 11, 2007
With the Best of Both Worlds program you will be able to meet your doctor in advance and receive follow up care with them, plus you get to visit a beautiful country.
PlanetHospital is perfect for employers and insurers who want to take advantage of the cost advantages offered by overseas hospitals without compromising the quality and continuity of care. It also allows a company to provide its employees access to some of the top surgeons in their city affordably.
PlanetHospital's Best Of Both Worlds Plan™ will allow top US surgeons to provide pre and post op care to a patient in the US while helping the patient and their employers save a significant amount on their surgeries by agreeing to let the surgeon perform the surgery in a foreign hospital. "
This is a clever idea ! I think we are going to see a lot of bright innovations in this burgeoning area, which will help medical care to become more affordable for US patients. US doctors will soon have to start becoming more competitive and cost-conscious !
Medical Tourism India - at a glance
* Low cost medical treatment
* High quality medical care
* Low wait time for critical treatments
* Fluent English speaking staff
A combination of many factors has lead to the recent increase in popularity of medical tourism. Exorbitant cost of healthcare and medical facilities in advanced countries, ease and affordability of international travel, favorable currency exchange rates in the global economy, rapidly improving technology and high standards of medical care in the developing countries has all contributed their share to this rapid development of medical tourism.
Wednesday, April 04, 2007
We’ve used web technologies such as Ajax in order to make data input as easy as possible. What does this mean? This means SugarStats works more like a regular desktop application than an actual website."
This is a clever use of web technology to help patients with diabetes better manage their disease. A similar model could easily be used for most chronic illnesses !
In a short time, Diabetes PHD will determine a personalized Results Overview for you, showing your current risk for diabetes, heart attack, stroke, kidney failure, as well as foot and eye complications. By changing certain variables in your profile, like stopping smoking, losing weight, taking ACE inhibitors, getting a regular foot exam etc., you will be able to see how making these changes would affect your future health."
Monday, April 02, 2007
The latest generation of collaborative Web-based tools, namely wikis, blogs/photoblogs, blikis and podcasts/vodcasts, offer many unique and powerful information sharing and collaboration features. In this paper we have explored how these Web 2.0 applications would prove useful on the long run for virtual collaborative clinical practice and learning, based on the currently available initial online medical/health-related examples and literature about these tools. Careful thinking and research are still needed in order to find the best ways to leverage these emerging tools to boost our teaching and learning productivity, foster better 'communities of practice', and support continuing medical education/professional development (CME/CPD) and patient education.
Speaking, I think, both for those of us at Google and most of you, given our specific condition or conditions and medicines, just knowing what the guidelines and generally accepted standard of care is for us specifically would be hugely helpful in knowing what to discuss with our doctors and what to research further. Today, even if we can figure out which sites upon which to rely, it is hard to find this out. We don’t know where to start. Our treatment scares us, or our drugs have worrying side effects, or we’re just frightened that we’re not getting the treatment we should be getting.
Honestly, this information can even help our doctors sometimes. They are over-worked and often pressed for time and it cannot ever hurt to double check. Sometimes they didn’t get accurate or complete information from us. While most drug-to-drug and drug-to-condition interactions are known to our doctors, they do change and the doctor might miss a new one or not know about all your drugs because we forgot to tell your doctor about one.