Saturday, December 27, 2008

The Covert Rationing Blog » Blog Archive » The Two Flavors of Covert Rationing

The Covert Rationing Blog » Blog Archive » The Two Flavors of Covert Rationing: "closer look, however, reveals that these two schools of thought actually have very much in common; certainly enough to explain why Wonkonians and Gekkonians can often be seen forming alliances with one another in their efforts to “reform” the system.

First, both schools of thought are based firmly on the notion that the healthcare crisis is caused almost entirely by too much waste and fraud within the healthcare system. While one school tends to blame the waste and fraud on greed and the other on incompetence, the basic problem according to both schools is the inefficient use of resources. DrRich has described the fatal limitations of the “waste and fraud” hypothesis on his website - fundamentally this is the fiction that by increasing inefficiencies we can avoid the need to ration. It is a fatally flawed position. But still, it is attractive to suppose that enough waste exists in the system to make rationing unnecessary.

As a direct result of the “waste and fraud” hypothesis, both schools of thought are able to assert that the underlying problem is merely one of how the healthcare system is organized, that is, of who gets to call the shots and which philosophy gets to determine the “rules.”"

The Covert Rationing Blog » Blog Archive » The Two Flavors of Covert Rationing

The Covert Rationing Blog » Blog Archive » The Two Flavors of Covert Rationing: "The Wonkonians and Gekkonians have one more common feature that deserves prominent mention. In each, the primary solution to the healthcare crisis requires limiting the capacity of doctors to behave as independent agents. In one case this is to be done by regulatory means in order to stifle physician greed; in the other it is to be done by the marketplace in order to eliminate physician inefficiency. But either way the primary goal, the number one priority, is to control physicians’ behavior. To the extent that controlling physicians’ behavior prevents them from being greedy or inefficient, that’s good. But to the extent that controlling their behavior prevents them from fulfilling their defining role as advocates for their patients, that’s bad. Very bad. (We’ll explicitly discuss the importance of the classic doctor-patient relationship, and why we can’t have it anymore under covert rationing, in a future post.)"

I wish DrRich had coined better names instead of using the terms, Wonkonians and Gekkonians, to make viral marketing of his ideas much easier. Every doctor should read what he has to say - and worry about the
future !

The Evidence Gap - Health Care That Puts a Computer on the Team - Series - NYTimes.com

The Evidence Gap - Health Care That Puts a Computer on the Team - Series - NYTimes.com: "To visit the Marshfield Clinic, a longtime innovator in health information technology, is to glimpse medicine’s digital future. Across the national spectrum of health care politics there is broad agreement that moving patient records into the computer age, the way Marshfield and some other health systems have already done, is essential to improving care and curbing costs.

A paper record is a passive, historical document. An electronic health record can be a vibrant tool that reminds and advises doctors. It can hold information on a patient’s visits, treatments and conditions, going back years, even decades. It can be summoned with a mouse click, not hidden in a file drawer in a remote location and thus useless in medical emergencies.

Modern computerized systems have links to online information on best practices, treatment recommendations and harmful drug interactions. The potential benefits include fewer unnecessary tests, reduced medical errors and better care so patients are less likely to require costly treatment in hospitals."

Given the fact that the Indian IT industry is so well-developed and that we don't have the burden of old healthcare record storage systems, this is great opportunity for Indian healthcare to leap forward into the new year !

Tuesday, December 23, 2008

IVF - what everyone needs to know about IVF

Check out this SlideShare Presentation:

Wi-Fi Keeps Patients and Families Connected

Wi-Fi Keeps Patients and Families Connected: "The availability of such a wireless network comes at a time when people are increasingly connected 24/7, even in a hospital. Georgetown is one of 150 hospitals using CaringBridge, a nonprofit organization started in 1997 that offers a free Web service connecting 20 million families yearly. CaringBridge now has more than 150,000 personalized Web sites for people dealing with major health conditions. According to CaringBridge, the site is not accessible via search engines, and it's the first such free online service for people facing a serious health condition.

Kim said CaringBridge 'has been a nice service to have because the caregiver is very busy. They don't have time to answer phone calls all the time. They don't have to receive phone calls all the time.' Patients often post pictures and notes after they've left the hospital, she said. 'We can keep up with patients that have been discharged, are going home, and doing well.'GeorgetownPatient

Georgetown's Kim said the hospital’s childlife department loans out laptops when a family doesn’t have a computer handy. 'There's also one in the family room and one in the playroom,' she said. According to Kim, kids often stay busy playing Webkinz, the virtual online pet game, while parents are working.

Kim said the hospital also has Webcams available, allowing bedside videoconferencing as well . "

What a great idea !

Monday, December 22, 2008

Wired docs in India - Times of India reports


This is a sign of the changing times ! It's early days, but the web will soon become as indispensable to doctors as the telephone is today !

Patient Education | Four Patient Education Fallacies

Patient Education | Four Patient Education Fallacies: "Patient education is one of the critical elements of a successful practice, especially today, as more and more patients are having to finance their care out of their own pockets. What's incredible is that effective patient communications is such a small part (or totally absent) from the curricula of today's chiropractic colleges. This critical missing link will continue to sabotage more and more new doctors in today's increasingly competitive marketplace.

Best communicators have the best practices. Why not model those who depend upon optimum customer 'education' for their livelihood? Ask any advertising agency or marketing director how to help patients 'get it' and they will reveal two key approaches: impact or repetition, or a combination of both."

Sunday, December 21, 2008

Who Cares: Sources of Information About Health Care Products and Services

Who Cares: Sources of Information About Health Care Products and Services: "With so many sources of health information at your fingertips — many of them online — it can be tough to tell fact from fiction, or useful health products and services from those that don’t work or aren’t safe.

The FTC has created this website to help you find reliable sources of information on health topics important to you, whether you’re an older consumer or a family member, caregiver, or friend. You can:

* find links to agencies and organizations that care about topics like generic drugs, hormone therapy, caregiving, surgery to improve vision, alternative medicine, hearing aids, Medicare fraud, and medical ID theft;
* learn how to spot misleading and deceptive claims; and
* find out who you can contact to ask questions, enlist help, or speak up if you think a health product or service isn’t living up to its promises.

Just remember: Among the best sources of health information is someone you can meet face-to-face. Talk about all of your health-related decisions with your doctors and other trusted health care providers. "

This is a great website which help to protect you from health quackery and fraud !

Internet diagnoses: Trust them or toss them? | e-Patients.net

Internet diagnoses: Trust them or toss them? | e-Patients.net: "The Internet offers immediacy, an advantage at night or on the weekend. It offers anonymity, which is helpful when a symptom seems too embarrassing to discuss with your doctor. It also offers more detailed information than your doctor might have time to provide.

But the Internet also has erroneous information that can lead you to believe that pounds can literally melt away and cures exist for incurable diseases. A recent YouTube video that has been viewed thousands of times depicts a treatment that claims to reverse the effects of the Alzheimer’s disease, for which no cure currently exists. If miracle cures existed, everyone would know about them, including your doctor.

That is one of the reasons you shouldn’t use the Internet in a vacuum. Another is that looking symptoms up online can be confusing — and frightening — when you lack medical expertise, since there are seemingly endless possibilities to consider."

Like everything else, the net has pros and cons. Smart patients know how to use this sensibly - and smart doctors will teach their patients how to use the internet well !

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Helping Doctors and Patients Make Sense of Health Statistics This is one of the best articles I have seen, which can help patients make sense of their medical risks. Please read this - and make sure your doctor does too !

The Alternative Route: Hanging Out The Unmentionables For Better Decision Making In Health Information Technology -- Kibbe and McLaughlin 27 (5): w396 -- Health Affairs

The Alternative Route: Hanging Out The Unmentionables For Better Decision Making In Health Information Technology -- Kibbe and McLaughlin 27 (5): w396 -- Health Affairs: "Expert panels and policy analysts have often ignored potential contributions to health information technology (IT) from the Internet and Web-based applications. Perhaps they are among the 'unmentionables' of health IT. Ignoring those unmentionables and relying on established industry experts has left us with a standards process that is complex and burdened by diverse goals, easy for entrenched interests to dominate, and reluctant to deal with potentially disruptive technologies. We need a health IT planning process that is more dynamic in its technological forecasting and inclusive of IT experts from outside the industry."

A lot of what we do in delivering healthcare is going to be done online - and the sooner we realise this, the better !

Personal health records

Personal health records - Health Affairs Blog: " You may wonder where the huge numbers of “personal health record” (PHR) companies are in all this. Many of them are still around; some are gaining traction, especially those with a large provider, insurer or employer promoting their adoption. And Microsoft and Google are joining the fray. However, most consumers (other than expectant or new mothers) aren’t that interested in a health record per se. They are interested in dealing with medical bills, or a particular condition, or a particular threat. So much adoption, I believe, will be driven by the kinds of specific applications I mention above. Over time, the PHRs will be able to accept the specific data types generated by the applications, and new applications will generate data that they know the PHRs can handle."

The PHR will provide the platform around which healthcare will be provided. Different players will use the data in the PHRs for their own purposes. Thus, patients ( consumers) will use it to get better medical care; doctors will use it to provide better medical care; pharma companies will use it to improve their drug marketing efforts; insurance companies will use it to improve the policies they provide; and governments will use this to improve healthcare in the community; while business people will use PHRs to make money by providing clever services which others want, and will pay for !

Current Health | Services | How It Works

Current Health | Services | How It Works: "You are at the center of our practice. See your doctor when you need to. We have as much time as you need.

* Schedule appointments or email your doctor anytime.
o Become a member today for preferred pricing and priority appointments.
* See your doctor anywhere. Come to our office or we’ll come to you. We’ll meet you at your home, office, or any other location within 30 miles of San Francisco.
* Pay at the time of your visit. Pay for the services you need. Don’t pay for what you don’t need. Current Health provides you with a simple, prefilled form to submit to your insurance company for reimbursement."

It's good to see doctors using technology cleverly to improve the services they provide to their patients. While this is "cutting edge" today, it will become routine in a few years !

Welcome to PharmaSURVEYOR - Beta

Welcome to PharmaSURVEYOR - Beta: "What is a PharmaSURVEYOR Regimen Survey?
When you enter your drugs, PharmaSURVEYOR immediately creates a personalized risk assessment for you which shows not only drug-drug interactions but the much more common and often dangerous adverse drug side effects.

Presented in a table that is easy to view, search, and sort, your Regimen Survey shows you the big picture including the additive toxicity and combined risks of all your drugs, not only those involved in interactions."

In this day and age of super- specialisation, your doctors may not know what drugs you are on; and your cardiologist may prescribe stuff your gastroenterologist is not aware of. PharmaSurveyor is a sophisticated version of the "brown-bag" approach - and since you are your own primary healthcare giver, you can use this clever tool to make your drugs don't make you sick ! This is especially important for older people, who are often on multiple medications ( many of which they don't really need !)

Wednesday, December 17, 2008

Transforming US hospitals - The McKinsey Quarterly - us hospitals compete - Health Care - Hospitals

Transforming US hospitals - The McKinsey Quarterly - us hospitals compete - Health Care - Hospitals: "US hospitals are under siege. Their operating model once was simple: amass—under one expensive roof—powerful technologies, skilled physicians working at arm’s length, and a volume of patients sufficient to leverage enormous fixed costs. Now, however, intense competition from more focused health care providers, as well as the increasing ability of payers and consumers to obtain information about a hospital’s quality, service, and pricing—in short, about the value it provides—threaten to change the equation."

Primary care doctors struggling to survive - Los Angeles Times

Primary care doctors struggling to survive - Los Angeles Times: "Small general practices afford doctors autonomy to practice medicine as they see fit and can produce strong doctor-patient bonds. But these physicians have little or no clout to leverage better payments with insurers; they have no economy of scale, which makes overhead more burdensome.

'It's very difficult, even in rich neighborhoods like Beverly Hills, to set up a solo practice,' said Richard Scheffler, an economist at UC Berkeley. 'The doctor has to pay rent, a nurse, have a bookkeeper, billing systems, computers. All of those fixed costs are very, very hard for a solo practitioner to have and survive.'"

Insurer Offers Option for Surgery in India - NYTimes.com

Insurer Offers Option for Surgery in India - NYTimes.com: "The health insurer Wellpoint is testing a new program that gives covered patients the option of going to India for elective surgery, with no out-of-pocket medical costs and free travel for both the patient and a companion.

The program is being tested at Serigraph, a printing company in Wisconsin whose managers have been looking for ways to curb rising health care costs, said Dr. Razia Hashmi, chief medical officer for national accounts for Anthem Blue Cross and Blue Shield, which is affiliated with Wellpoint."

This will force US doctors to become more cost effective !

Looking Under the Hood and Seeing an Incubator - NYTimes.com

Looking Under the Hood and Seeing an Incubator - NYTimes.com: "The heat source is a pair of headlights. A car door alarm signals emergencies. An auto air filter and fan provide climate control.

But this contraption has nothing to do with transportation. It is a sturdy, low-cost incubator, designed to keep vulnerable newborns warm during the first fragile days of life.

Unlike the notoriously high-maintenance incubators found in neonatal intensive care units in the United States, it is easily repaired, because all of its operational parts come from cars.

And while incubators can cost $40,000 or more, this one can be built for less than $1,000."

This is a great example of Appropriate Technology. There a lot of these great success stories in India - but they rarely get featured in the NY Times !

Prescription for Change - WSJ.com

Prescription for Change - WSJ.com: "But that is about to change. IT security will eventually meet the expectations of the health-care industry, just as has happened in other sectors, like banking. And when it does, powerful IT networks crisscrossing the globe will change the way much of health care is delivered: Outsourcing and offshoring of medical and nonmedical services will increase, providing more efficient health care at the most cost-effective rates; systems integrations will allow more medical records to be transferred swiftly and securely; efforts to monitor the safety of medicines will gain global access to data; and professionals and patients will find authoritative and up-to-date information on every specialty online."

The changes can come from top-down, being mandated by governments or health insurance companies; or they can come from bottom up, as individual doctors and patients can translate the power of IT into better medical care !

My Healthcare is Killing Me!

My Healthcare is Killing Me! : "Guess what? You're not alone! And you don't have to be an M.D. or a translator to understand healthcare and get your costs under control. The experts at change:healthcare share what they know about the system and how to survive it.

If you are looking to understand the system, save money, and become a smarter healthcare consumer then My Healthcare Is Killing Me is your guide!"

This is a free ebook - read it !

The Health Care Blog: Open source is a transparent Trojan horse

The Health Care Blog: Open source is a transparent Trojan horse: "McNealy wove all of these together to hone in on 7 ways that Open Source can help be a foundational element in solving the health care crisis. He gave a fascinating overview of how open source is perfect model for health care.

1. Lowers barriers to entry
2. Increases security
3. Faster procurement
4. Lower cost of ownership
5. Better quality products
6. Open standards
7. Lowers barriers to exit"

Thursday, December 11, 2008

Health Insurance in India - improving the healthcare industry

Health Insurance Summit India 2008: "Health Insurance is expected to play a critical role in ensuring healthcare access to people in India . The level of penetration of Health Insurance in India has been on a steady rise; however, it is clear that there is still a long way to go from single digit access figures to meeting global penetration levels.

While the Health Insurance industry has benefited from the recent changes in regulations, entry of new players, and improvements in systems and processes , it is important to sustain this growth trajectory. Thus it is critical that the key stakeholders in the health insurance value chain including Regulators, Insurance companies, Third Party Administrators, NGOs and technology companies work in synergy, paving the way for a brighter future ahead."

I attended an excellent seminar on 9 Dec organised by the CII on Health Insurance: The Road Ahead.

Mr Hari Narayan, Chairman, IRDA ( Insurance Regulatory and Development Authority, set up by the Government of India to regulate the Indian insurance industry) said “Requiring the third-party administrators (TPAs) to build their IT systems and infrastructure for speedier claim processes; and encouraging insurers to make their systems robust and embarking on wide consumer awareness programmes are the various measures undertaken by IRDA towards the growth of the health insurance in India.”

So far, the Indian healthcare sector has been run by doctors, and this has been a cottage industry. It's small, fragmented and disorganised. It is very interesting to see how the entry of the corporate world into this sector has changed the rules of the game.

I was impressed by the fact that health insurance companies have realised the importance of going digital - and appreciate the fact that the challenges they are dealing with are enormous. Because of India's huge population, the numbers of transactions are in the millions - but the value of each transaction is much less. Also, since the cost of medical care is low, the potential profit margins are much slimmer which means the operations have to be much more efficient.

The first need is to standardise medical records, and since there are no legacy issues, this is a huge opportunity to improve the quality of medical care. IT can be used to improve healthcare - and companies are insisting that doctors and hospitals use ICD-10 coding. While their primary motivation is to improve their claims processing , this will also help to improve the quality of medical care delivered, because it will be much easier to audit this . Electronic transactions are much more frictionless and reduce transaction costs, and it's possible to use the newest web-based technology to make them efficient.

One of the comments made was that doctors are very reluctant to participate in providing better data. I wonder why this is so ?

Doctors are service providers and are happy to do what needs to be done to provide better care for their patients . Most doctors understand that keeping better medical records and analysing their clinical data will help them to improve the medical care they provide. If it's so obvious, then why don't they cooperate ? The reality is that they have had their fingers burnt when dealing with insurance companies. Many doctors have had bad experiences - delayed pre-authorisation; delayed payments; and refusal to honour claims for the flimsiest clerical reasons ( a list of litanies all US doctors can empathise with , I am sure !) Doctors want to take care of patients - not to deal with paperwork and bureaucratic hassles. Unfortunately, all insurance companies seem to understand is paperwork - and hence the friction.

The problem is that patients, who are meant to be the beneficiaries, often end up suffering - and they take out their anger on doctors, who are the "customer face" of the industry, rather than the clueless clerk who is safely ensconced in the TPA's office. Patients expect instant cashless hospitalisation - and since they have an insurance policy, they cannot understand why the doctor refuses to accept this. Unfortunately, the burden of filling out the forms falls on the doctor - and many of whom don't have the staff to do so efficiently. In response to this pressure, doctors are now employing secretaries to fill in the forms - and the additional costs of this paperwork will be passed onto the patient.

An enlightened approach would be to provide doctors with practise management software, so that they can run their practises more efficiently; provide better medical care; and also provide the data the insurance company needs, thus creating a win-win situation. This is a huge opportunity for a clever company to provide open source web-based software as a ASP !

The elephant in the room which no one is willing to discuss is the fact that insurance companies have started using their financial clout to start squeezing doctors. They are cutting down on the amounts they are willing to pay for procedures - and doctors are being forced to toe the line, as they cannot afford to lose their patients to other doctors. This has already started to happen for cataract surgery in Bombay - where it's the insurance companies who are now deciding how much a doctor can charge. In a few years, the progressive corporatisation of medicine is going to force Indian doctors to deal with the same problems US doctors are facing today.

I must agree that it's doctors who are partly to blame for this. Some doctors are unethical and unscrupulous, and have taken insurance companies for a ride. They overcharge insured patients; fudge paperwork, and it's in order to protect themselves that insurance companies have introduced these safeguards. The trouble is that paperwork has a life of its own, and expands and grows, until it becomes unmanageable ! Also, in order to safeguard themselves from the 5% of doctors who are crooked, the companies end up penalising the other 95% of honest doctors. It's because doctors refuse to police themselves that corporates have been forced to do so.

In India, it's really not health insurance at all - it's actually all about illness insurance - about how to manage the financial risk when you need medical care. However, it's hard to sell when you are coercing people to buy policies based on appealing to their fear, because most of us think nothing bad will ever happen to us. We need to focus on wellness , not just illness insurance. The good news is that clever Indian companies are learning from the rest of the world, and are offering new initiatives, which promote wellness and help people to remain healthy.

Doctors were conspicuous by their absence in this seminar - and not a single practising doctor ( the ones who have to deal with patients daily ) was invited to be a speaker at the summit. It's a sad fact that most doctors are clueless about these policy decisions which are going to have such a huge impact on their future. Doctors have been sidelined and have become marginalised. Though they are very smart individually , as a group they have no unity, with the result that its very easy to manipulate the profession. The rules as to how healthcare will be delivered are changing - but doctors are not being given the opportunity to offer their insights.

What will the impact on patients be ? Most likely, it will be mixed. The good news is that insurance companies will invest in educating patients , who will then hopefully have a bigger say in their own care, because the process will become more transparent. However, the fear is that greedy insurance companies may force the industry to go down the US route , where patients and doctors get squeezed for the sake of profits.

Hopefully, companies will take an enlightened approach, and introduce good managerial business practises to ensure transparency and accountability ( both on their own part, and that of doctors). It's unfair for them to expect doctors to be transparent , when they refuse to share their business information, using the pretext that it is confidential . This will benefit doctors , patients as well as health insurance companies , because the entire industry will then grow in a healthy manner.

Wednesday, December 10, 2008

Obama adds health IT to economic stimulus package

Obama adds health IT to economic stimulus package: "President-elect Barack Obama on Saturday said health information technology will be included in an economic recovery plan that is now being worked out with members of Congress.

In his Dec. 6 radio address, Obama said modernizing U.S. hospitals would be part of a major effort to finance an upgrade of the broadband infrastructure of the U.S., which he said has fallen to 15th in the world in its rate of adoption.

Together with upgrading school and education networks, “we must ensure that our hospitals are connected to each other through the internet,” Obama said, an effort he said that “won’t just save jobs, it will save lives.”

“We will make sure that every doctor’s office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year,” Obama said."

Incentives and Communications « Patient Centric Healthcare

Incentives and Communications « Patient Centric Healthcare: "Everybody looking at the healthcare system understands that incentives and alignment of goals is a critical component for successful change.

* Providers need to be motivated to focus on wellness and prevention.
* Individuals need to be motivated to care about the cost of care and to act in a healthy manner.
* Pharmacists need to be motivated to take the extra action of moving patients to lower cost agents, resolving administrative edits, and counseling patients.
* Hospitals need to be motivated to focus on Six Sigma type process initiatives.
* Health Plans need to be motivated to invest in long-term care initiatives that prevent people from getting sick."

Carrots work better than sticks !

Myths about doctors

Patients still have a number of misconceptions about doctors.

These include the following.

1. All doctors are equally competent

2. All doctors have the same interests and expertise

3. You can judge a doctor's competence by his bedside manner

4. A doctor's reputation is a good benchmark of his medical skills.

Not only do patients have misconceptions about doctors, even doctors harbour misconceptions about themselves !

This list is from Dr. David Newman in his book Hippocrates’ Shadow: Secrets From The House Of Medicine).

  1. Physicians don’t know as much as you think they do.
  2. Doctors do know that many of the tests, drugs and procedures they order and prescribe either do not work or have not been proven to work.
  3. Doctors disagree about everything.
  4. Doctors like ordering tests better than they like listening to you.
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Haryana woman, 70, becomes world's oldest mom-India-The Times of India

Haryana woman, 70, becomes world's oldest mom-India-The Times of India: "Rajo Devi, 70, became perhaps the world's oldest mother when she delivered a girl child on November 28, 2008 with the help of in vitro fertilization (IVF) treatment at a Hisar fertility centre. Rajo had entered menopause 20 years ago."

Reading an article like this evokes mixed feelings. The good thing is that it highlights how modern IVF technology can help practically anyone to have a baby ! However, it does raise some concerns.

For one, no where in the article is it mentioned that donor eggs were used for treatment. I think this omission can mislead readers ; and lull older women into thinking that they can have a baby whenever they like !

Equally worrisome is the fact that after reading such an article, many people start believing that doctors are mad scientists who are now playing God; and that IVF specialists are irresponsible, and will do anything, in order to earn money , or some publicity. This craze to establish world records for " the oldest mother" is ridiculous - and one wonders where it will end ! 75 ? 80 ?

I am not happy about the publicity this particular case has attracted. Was this a publicity gimmick ? Is this really being done in the child's best interests ? My fear is that if IVF doctors continue behaving so irresponsibly, society will clamp down on their freedom, and start placing restrictions on what they can do - and what they cannot do.

While I am a big believer in patient autonomy and allowing couples to decide what they should do, I also feel that such freedom should be tempered with responsible decision making. Just because it's possible to do something does not mean this should be done !

Tuesday, December 09, 2008

Wal-Mart Launches E-Health Program - BusinessWeek

Wal-Mart Launches E-Health Program - BusinessWeek: "Starting early next year, Wal-Mart Stores (WMT) employees will spend less time filling out forms in the doctor's office. They'll be able to log on to the company's intranet to download and print any medical records their physicians require: allergy information, prescriptions, blood tests, entire health histories if necessary. After nearly a year of pilot tests, the Bentonville (Ark.) retailer made this option available to 1 million U.S. staffers who are eligible for insurance under its benefits enrollment program this fall. Thousands of employees have signed up, making this initiative one of the most ambitious thrusts into digital medical records, or 'e-health,' by any U.S. company.

Wal-Mart's program is part of a larger strategy embraced by incoming Chief Executive Michael Duke both to improve the company's image as an employer and to cut long-term costs. The retailer faces steadily rising health-care expenses, and it's not alone. A recent survey of nearly 3,000 U.S. companies by global consulting firm Mercer found that health-related costs are up 6%, on average, for the fourth straight year. Linda M. Dillman, Wal-Mart's executive vice-president for benefits and risk management, believes digital records will help by fostering 'healthier associates who are more productive.'
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Health 2.0: Patients as Partners - BusinessWeek

Health 2.0: Patients as Partners - BusinessWeek: "Medicine has always been a top-down affair. Doctors, drug companies, regulators, and researchers are the expert gate-keepers, telling patients what they need to know. Even their own medical records are locked away to protect their privacy. So what would happen if critically ill patients joined together, obtained their personal information, and made it public?

Just such a real-world experiment is under way at a Web-based social network started by the company PatientsLikeMe. The two-year-old venture has already signed up 23,000 participants in five chronic-illness categories—amyotrophic lateral sclerosis (ALS), Parkinson's disease, HIV/AIDS, multiple sclerosis, and mood disorders."

Via E-Mail, Charity Links Sick People in Distant Areas to Specialists - washingtonpost.com

Via E-Mail, Charity Links Sick People in Distant Areas to Specialists - washingtonpost.com: "The Swinfens run the Swinfen Charitable Trust, a telemedicine charity that uses e-mail to link sick people in poor, remote or dangerous parts of the world with hundreds of medical specialists in some of the world's finest hospitals.

Doctors in about 140 hospitals and clinics in 39 nations use the organization to seek help for patients requiring specialized care beyond their capabilities. Through the trust, they can be put in e-mail contact -- often within hours -- with one or more of the 400 specialists who work without pay as part of the trust's network.

Doctors in distant areas, including Afghanistan, Antarctica and the Solomon Islands, e-mail photos (many taken with digital cameras supplied by the Swinfens), X-rays, test results and case notes. The information is reviewed by specialists, who respond by e-mail to help make diagnoses and recommend treatments."

Monday, December 08, 2008

BioMed Central | Full text | Integrated personal health records: Transformative tools for consumer-centric care

BioMed Central | Full text | Integrated personal health records: Transformative tools for consumer-centric care: "Integrated personal health records (PHRs) offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable."

Trend: Physician online consult volume growing - FierceHealthIT

Trend: Physician online consult volume growing - FierceHealthIT: " As we've reported for more than a year, online physician consults via the internet (sometimes known as 'e-visits') are growing more popular over time. While some physicians are leery of conducting patient check-ins online, as they're concerned they'll miss a critical detail, others believe that such visits are fine for patients with minor ailments. In any event, about one-third of e-consults end with the doctor asking the patient to come in for a face-to-face visit, according to e-visit technology vendor RelayHealth.

Insurers like Aetna and Cigna have come on board and begun reimbursing for such visits, making it more tempting for doctors to consider such an approach."

AHRQ on chronic care management: healthcare IT lowers costs, improves care

AHRQ on chronic care management: healthcare IT lowers costs, improves care: " Healthcare IT can improve the quality of care received by the chronically ill and lower costs, according to a report by the Agency for Healthcare Research and Quality.

The report, issued by AHRQ's National Resource Center for Health Information and based on information gathered from AHRQ-funded projects, found that use of healthcare IT in caring for the chronically ill improves patient outcomes."

DoD Launches Personal Health Record Pilot - FierceHealthcare

DoD Launches Personal Health Record Pilot - FierceHealthcare: "The Department of Defense (DoD) is pleased to announce the successful launch of MiCare, the Military Health System's prototype personal health record (PHR) at Madigan Army Medical Center (MAMC) in Tacoma, Wa. MiCare is designed to help members of the military and their families more easily and effectively manage their health and wellness, regardless of their location and as they seek care inside and beyond the Military Health System. MiCare developed as a pilot project in partnership with Microsoft Corp. and Google. The project which began in March 2008, focused on incorporating the services and features offered by commercial vendors as a way to expedite the development and expand the capabilities of the military's PHR."

Developing a Distributed Electronic Health-Record Store for India

Developing a Distributed Electronic Health-Record Store for India: " The DIGHT project is addressing the problem of building a scalable and highly available information store for the Electronic Health Records (EHRs) of the over one billion citizens of India.

There has been much recent interest in information services that offer to manage an individual's healthcare records in electronic form, with systems such as Microsoft HealthVault and Google Health receiving widespread media attention. These systems are, however, proprietary and fears have been expressed over how the information stored in them will be used. In relation to these developments, countries with nationalized healthcare systems are also investigating the construction of healthcare information systems that store Electronic Health Records (EHRs) for their citizens.

The DIGHT (Distributed Information store for Global Healthcare Technology) project is addressing the challenges of building a scalable and highly reliable information store for EHRs for the citizens of India. The project partners are SICS and the Indian Centre for Development of Advanced Computing (C-DAC)."

Sunday, December 07, 2008

Stopping the biological clock - Freezing eggs using vitrification at Malpani Infertility Clinic

IVF labs have been routinely freezing sperm and embryos for many years. However, freezing eggs has always been a challenge. This is because the egg is the largest cell in the body and contains a large quantity of water. Using conventional slow freezing techniques meant that this intracellular water would often form ice crystals while the egg was frozen, resulting in the egg being damaged.

However, using a new technique called vitrification ( vitros = glass) or flash freezing, we can now reliably freeze eggs as well.

How does vitrification work ? The principle is simple. This new method of cryopreservation allows ultra-rapid freezing. We put the eggs in very small droplets of vitrification solution in special straws, and plunge them directly in liquid nitrogen. This means the egg is cooled from 37 C to -196 C in a few seconds , so that the water does not get a chance to crystallize ! Vitrification uses a very high concentration of antifreeze solution (DMSO and ethylene glycol), allowing instant super-cooling into solid with no ice crystal formation at all.

Of course, it is not quite as simple as it might sound. Such high concentrations of antifreeze could be toxic to cells. This is why technical skill, experience and expertise is critically important !

Using this vitrification technique for freezing, we can reliably preserve eggs as well as embryos so that the pregnancy rate is as good as with fresh eggs.

This breakthrough will now allow us to offer the following additional services to our patients

- Formation of donor egg banksto facilitate and lessen the cost of oocyte donation. We can ship these frozen oocyte anywhere in the world. However, it is critically important that the receiving IVF lab have enough expertise in vitrification, to be able to thaw these properly

- Provision of egg cryostorage for women who wish to pursue their career and want to postpone childbearing.

Just like the introduction of birth control helped to revolutionise the way women led their lives by giving them control over when to have children and how many children to have, egg vitrification can allow the new generation of women to pursue their career without compromising their fertility, so that they can have their cake and eat it too ! This can be very empowering !


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Saturday, December 06, 2008

The Double Standard for Web-Based EMRs

The Double Standard for Web-Based EMRs: " Why are some physicians still fearful of web-based electronic medical records (EMRs) when most of them are comfortable using web banking and e-commerce sites?

Many physicians allow all of their personal financial information to be transmitted over the Internet - including actionable credit card data - but fear using the same methods for managing their patient records.

It’s not irrational to be worried about security breaches on the web. But what is the likelihood of compromising patient data through a web-based EMR? Is it a higher or lower risk than web banking or e-commerce? And who would try to hack that information anyways?"

Friday, December 05, 2008

Personal Health Records: Widespread adoption of PHRs could save $21 billion a year, according to study - - Medical Economics

Personal Health Records: Widespread adoption of PHRs could save $21 billion a year, according to study - - Medical Economics: "If 80 percent of the population maintained a personal health record – a web-based system that allows patients to view and manage their medical data – it would save the U.S. $21 billion a year on health-care costs, according to a study released earlier this month by a nonprofit research group."

Medical Tourism / International PPO | The Lungen Group

Medical Tourism / International PPO | The Lungen Group: " As healthcare in the United States has been changing rapidly over the past few decades, so has the manner in which healthcare has been provided, billed and paid. There is an increasing need to reach beyond our domestic borders to the international community for certain medical procedures, treatment and care at more affordable costs to consumers, benefit plan payers/administrators and re-insurers. The quest for premium quality medical care at lower costs with satisfactory outcomes beyond the United States is already underway and now classified as 'medical tourism.' As more Americans seek care in foreign countries, they also search for destinations that offer the high standards they have come to expect from their domestic healthcare system."

So far, most medical tourists travel of their own accord. They are usually self-funded and payout of their own pocket for their medical care. They are often affluential ; and find alternative solutions to their medical problems using the internet. This is why the number of medical tourists has just been a trickle so far.

However, once HMOs and insurance companies in the USA start realising the huge financial savings they can achieve by sending their members overseas for elective surgery, this trickle will soon become a flood !

Thursday, December 04, 2008

Doctor and Patient - Stories in the Service of Making a Better Doctor - NYTimes.com

Doctor and Patient - Stories in the Service of Making a Better Doctor - NYTimes.com: "While it has long been understood that clinical practice influenced the youthful writing of doctor-authors like Chekhov and William Carlos Williams, there is now emerging evidence that exposure to literature and writing during residency training can influence how young doctors approach their clinical work. By bringing short stories, poems and essays into hospital wards and medical schools, educators hope to encourage fresh thinking and help break down the wall between doctors and patients.

“We’re teaching the humanities to our residents, and it’s making them better doctors,” said Dr. Richard Panush, a rheumatologist and chairman of the department of medicine at Saint Barnabas.

The idea of combining literature and medicine — or narrative medicine as it is sometimes called — has played a part in medical education for over 40 years. Studies have repeatedly shown that such literary training can strengthen and support the compassionate instincts of doctors."

Friday, November 28, 2008

Preventing Post-Traumatic Stress Disorder after the Mumbai terror attacks

The recent terror attacks have devastated Mumbai. While Mumbaikars are resilient and the city will bounce back to normal soon , this is the sort of event which shakes everyone up because it reminds us of our own mortality. Many south Mumbai citizens visit hotels like the Taj and the Oberoi frequently . It could easily have been you or me ( or one of our family members or friends) trapped in the hotel. “ There, but for the grace of God, go I” is what many of us are likely to experience.

In the past, this sort of traumatic event would be experienced by a few hundred people and others would only learn about it second-hand, through the newspapers. Today, however, thanks to the electronic media, this sort of event affects all of us much more directly . All of us have been glued to our TV screens and have been watching scenes of the gore being replayed 24/7. This has a direct visceral impact and can cause fear, helplessness or horror . In some people, this emotional impact can result in a type of anxiety disorder, called PTSD or post-traumatic stress disorder.

Most people who witness such events have a brief period of difficulty adjusting and coping after which they bounce back to normal and life carries on as usual. In some cases, though, the symptoms can get worse or last for months or even years. This is called post-traumatic stress disorder.

It's normal to have a wide range of feelings after such an event, and these include fear and anxiety, a lack of focus, sadness, changes in sleeping or eating patterns, or bouts of crying that come easily. You may have recurrent nightmares or thoughts about the event. This doesn't mean you have post-traumatic stress disorder. But if you have these disturbing feelings for more than a month, if they're severe or if you feel you're having trouble getting your life back under control, consider talking to your doctor .

The diagnosis is based on a thorough psychological evaluation; and you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association . Treatment of post-traumatic stress disorder usually includes both medications and psychotherapy and will help you regain a sense of control over your life.

Getting support and help – either from friends, relatives , spiritual leaders or your doctor can help prevent normal stress reactions from getting worse and developing into post-traumatic stress disorder.

Self-management. Yoga and meditation can help you manage your feelings much better. These are useful skills to learn !
Take care of yourself. Get enough rest, eat a balanced diet, exercise and take time to relax. Avoid caffeine and nicotine, which can worsen anxiety.
Don't self-medicate. Turning to alcohol or drugs to numb your feelings isn't healthy, even though it may be a tempting way to cope. It can lead to more problems down the road and prevent real healing.
Break the cycle. When you feel anxious, take a brisk walk or find a hobby to immerse yourself in.
Talk to someone. Stay connected with supportive and caring family, friends, or your guru. Just sharing time with loved ones can offer healing and comfort.

If you’d like to learn more about PTSD and what you can do to help yourself, please do come to HELP ( Health Education Library for People, Excelsior Business Center, National Insurance Building, Ground Floor, Near Excelsior Cinema, 206, Dr.D.N Road, Mumbai 400001 Tel. No.:65952393/65952394, www.healthlibrary.com). We have lots of very useful information on PTSD and how to prevent this !

Thursday, November 27, 2008

The Mumbai terror attacks - How vulnerable we all are

The recent Mumbai terror attacks have shaken up the whole country, and we have received numerous messages and emails from concerned patients from all over world. Fortunately, the clinic, our staff and our patients are all safe and sound.

"Ask not for whom the bells toll - they toll for thee." Today it was Mumbai's turn - who knows where they will strike tomorrow ?

It's hard to make sense of such meaningless carnage. I think it just emphasises how vulnerable we all are - and that the only way we can fight this menace it to tackle it collectively.

May the souls of the innocent victims and the brave police officers rest in peace - and may God give their family members courage to deal with this trying time.

"There, but for the grace of God, go I" is what I feel. We eat out frequently at the Taj and the Oberoi - and it could easily have been us trapped in the hotel yesterday...

Some of our US patients are worried about how safe it is to come to India for treatment. In one sense, no place in the world can ever be safe ( a lesson we learned from the 9/11 blasts). However, after this incident, security is extremely tight in Bombay, which makes it a very safe place now !
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Monday, November 24, 2008

Healthcare I.T. News EU - Atos Origin picked to implement German electronic health card

Healthcare I.T. News EU - Atos Origin picked to implement German electronic health card: " Atos Worldline, an Atos Origin Company, has signed a five-year contract with leading German health Insurance Company, Gmünder ErsatzKasse (GEK), to implement and operate the issuing and management of the new German electronic health card (eHC).

In 2009, GEK plans to issue 30,000 cards per day to provide its 1.7 million members in Germany with the new card. One of the German public authorities' most important IT projects, the eHealth card is an important step in the modernisation of European health systems. It is designed to guarantee the simple and secure exchange of data between insured parties, doctors, pharmacists and health insurance companies.

The introduction of the new electronic health card helps to connect together people, pharmacists, doctors, hospitals as well as the private and statutory health insurance companies, and aims at simplifying and accelerating exchanges, thereby doing away with any paperwork."

SmartCards are all set to change the way medical paperwork is processed !

Friday, November 21, 2008

A Whole Lot of Infertility Blogging--Brought to You Sorted and Filed

A Whole Lot of Infertility Blogging--Brought to You Sorted and Filed: "This list brings together anyone in the infertility/pregnancy loss/assisted conception/adoption/pregnant or parenting after infertility or loss community. From those who were shocked by their diagnosis to those who are utilizing assisted conception because they are single parents by choice. Gay or straight, male or female, every race and religion--all are welcome here. From the newly diagnosed to the oldest vets to those who finished their family building via ART years ago."

Tuesday, November 18, 2008

Autopathography: the patient's tale

Autopathography: the patient's tale : " The case history was invented by Hippocrates. Since then medical practice has been straitjacketed by its artificiality, to the detriment of the patient's own narrative. But patients have found ways of expressing themselves other than by talking to their doctors. Over the past two years I have been collecting a bibliography of book length autobiographical medical narratives, each completely or largely devoted to the writer's personal experience of drug use or illness. My growing list currently runs to about 270 titles."

Monday, November 17, 2008

Medical imaging tool launched for Apple iPhone

Medical imaging tool launched for Apple iPhone: "A leading healthcare IT vendor has made its imaging technology available through Apple's iPhone App Store, in a move that looks to capitalize on the growing popularity of smartphones and the need for remote access to medical images.

Merge Healthcare's new Merge Mobile tool provides access to CT, MRI, X-ray and other images via the Apple iPhone and iPod Touch. The vendor is offering a free demo version of the product in the App Store.

iPhone and iPod applications built on Merge Mobile will allow radiologists to view emergency cases, consult with colleagues and securely forward care information to a patient's referring physician."

The Health Care Blog: Confessions of a Physician EMR Champion

The Health Care Blog: Confessions of a Physician EMR Champion: "The broad message is that, to be successful, the adoption of health IT by physicians, nurses, and staff must extend communication and health data exchange beyond the narrow confines inside the four walls of their practice. Health IT needs to empower all providers to act as effective members of a team which includes the patient, medical home, specialists, and ancillary service providers such as pharmacists and lab technicians."

Right now, the problem with healthcare is that it's all about doctors - who decide what to do and when to do it. It needs to be about the patient - and the clever use of IT in health can allow this to happen !

The Health Care Blog: The Technology Hype Cycle: Why bad things happen to good technologies

The Health Care Blog: The Technology Hype Cycle: Why bad things happen to good technologies:

"# Technology Trigger – The initial launch; a new technology reaches public or press attention.
# Peak of Inflated Expectations – A few successful applications of the technology (often by highly selected individuals or organizations) help catalyze unrealistic expectations, often aided and abetted by hype driven by word of mouth, the blogosphere, or vendor spin.
# Trough of Disillusionment – Virtually no technology can live up to its initial PR. As negative experience mounts, the balloon is pricked and air rushes out. The press moves on to cover another “hotter” technology, like a moth flitting to the light (see Phase II).Hypecycle_2
# Slope of Enlightenment – A few hardy individuals and organizations, seeing the technology’s true potential, begin experimenting with it unencumbered by inflated expectations. Assuming that the technology is worthwhile, they begin to see and demonstrate its value.
# Plateau of Productivity – As more organizations ascend the “Slope of Enlightenment,” the benefits of the technology (which by now has improved from its initial clunky phase) become widely demonstrated and accepted. The height of the plateau, of course, depends on the quality of the technology and the size of its market.

You can chart the course of virtually any health information technology on the Hype Cycle curve."
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The Health Care Blog: A patient's perspective

The Health Care Blog: A patient's perspective: "As a customer relations expert and a concerned healthcare observer, I must comment on doctor's turning a deaf ear to patient input.

Two things to remember:

-You don't have to read an entire stack of articles that a 'patient customer' brings you. To minimize how often this happens, give them more *undivided attention when you see them, more empathy, and much more clear updates on their condition. If they are bringing you a stack of articles, it is one sign that you have not earned their trust yet. Else they would more likely just ask you if you were familiar with xyz info.

-Turning a deaf ear to patient customer is disrespectful and breeds long term mistrust of the entire medical community. Mistrustful customers are tougher to deal with next time. Many doctors (not all) like to be in control. They frequently present options as must haves. Answer our questions doctors, present options, and make your recommendations -- without the attitude that you have something better to do. The sooner you do it, the sooner you will be free to move on to what is next in your schedule and your life. It takes less time when you give patient customers your focus and your respect -- not more. Listen to the questions and answer them clearly. Then your patient customer will relax."

If doctors remember that both doctor and patient are on the same side ( the patient's !) , life becomes much easier. It's only when we start thinking of patients in an adversarial role; or resent them for taking upo so much of our time, that we start running into trouble.

Reframing your perspective, by thinking of your patients as "research assistants" who will educate you about their problem, can help a lot !
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Saturday, November 15, 2008

Compassionate honesty for infertile couples

Compassionate honesty for infertile couples : "We have found that when ovarian reserve is low, the best course of action for the physician is compassionate honesty. After all, time is precious by the time a couple reaches infertility specialists, so little can be gained by creating false hope or continuing down a fruitless path. Instead, physicians can provide invaluable assistance by helping the couple re-evaluate their parenting needs and determine what, if any, other options they might pursue. In the world of infertility, some doors shut while others open. The door may not reveal what the couple thought they wanted, but for many, it might reveal something that is even better."

Friday, November 14, 2008

The Doctor Is In, but He’s Almost Always Late - Poked & Prodded - Health.com

The Doctor Is In, but He’s Almost Always Late - Poked & Prodded - Health.com: "Most of the time, I’m just happy if I see a doctor within an hour of my scheduled appointment. Over the years of visiting so many waiting rooms, I’ve learned a few tricks:

• Scout out the waiting room. The bigger the waiting room, the more inefficient or overbooked the doctor (for practices, divide the number of chairs by the number of doctors). Make sure there’s only one room.
• Book the earliest morning appointment possible. It usually takes doctors a few appointments to get behind schedule.
• Ask the scheduler to book you on the lightest day of the week.
• Avoid school holidays if your doctor or dentists sees kids.
• Bring your own magazine."

21 Primary Care Time Wasters « Pookiemd’s Weblog

21 Primary Care Time Wasters « Pookiemd’s Weblog: " In my travels as the ExtraMD, I have seen many different practices, different styles and hundreds of ways practices waste time and annoy patients. In my quest to help primary care physicians stay afloat, I will list my observations of time wasters that suck the joy out of medicine. I will also include my incredibly astute suggestions for positive change. Beware, you may even see your practice here."

All doctors can use this information to improve their efficiency !

Good to Great Patients | Medical Practice Business Blog

Good to Great Patients | Medical Practice Business Blog: "These are the commonest complaints from both patients and doctors. Physicians can take steps to address many of the patient’s issues, as well as their own, which will lead to more satisfied physicians and patients, better care and better outcomes. Let’s look at these complaints and how to address them."

The 7 "Cs" of Meaningful Work for Physicians-Nov08 - The Entrepreneurial MD

The 7 "Cs" of Meaningful Work for Physicians-Nov08 - The Entrepreneurial MD: " I often ponder about what makes one's work meaningful. It's a rumination that pops up regularly when I am enjoying navel-gazing time.

Having gone from showing up at work and getting the required job done to passionately engaging in both aspects of my work - coaching clients, and building a business - I now know the difference.

Work that serves a purpose has most if not all of these seven 'C' attribute.

Thursday, November 13, 2008

Pew Internet: Finding Answers Online in Sickness and in Health

Pew Internet: Finding Answers Online in Sickness and in Health: " Recent research from the Pew Internet & American Life Project shows that, as more Americans come online, more rely on the internet for important health information. Many Americans are deepening their connections to the internet, whether for entertainment or to help a loved one through a crisis. And though the audience for the latest DVD may be larger than the audience for clinical trial information, the impact on someone’s life in the latter case may be dramatically different in scale. Fully 58% of those who found the internet to be crucial or important during a loved one’s recent health crisis say the single most important source of information was something they found online."

Pew Internet: The Engaged E-patient Population

Pew Internet: The Engaged E-patient Population: " This latest Pew Internet Project survey confirms that information gathering has become a habit for many Americans, particularly those in the 55% of households with broadband connections. Home broadband has now joined educational attainment, household income and age as the strongest predictors of internet activity. For example, 78% of home broadband users look online for health information, compared with 70% of home dial-up users. Home broadband users are twice as likely as home dial-up users to do health research on a typical day -- 12% vs. 6%.

High-speed, always-on connections enable frequent and in-depth information searches, which is particularly attractive if something important is at stake."

Pew Internet: Recruit doctors. Let e-patients lead. Go mobile.

Pew Internet: Recruit doctors. Let e-patients lead. Go mobile.: "E-patients are at the center of the health care revolution, marching forward with or without the help of industry leaders. They are the worried well using search engines to look up basic advice. They are the chronically ill using discussion forums to trade in-depth knowledge. Or as one e-patient wrote in one of our online surveys, 'we are lab rats tapping out messages on the bars of our cages.' But how will Health 2.0 attract and serve the majority, not just the elite?"

PRE-VISIT PREPARATION PACKETS

PRE-VISIT PREPARATION PACKETS: " Patients who are better prepared for an appointment with their doctor will make better use of their one-on-one time with the doctor. The Stoeckle Center is developing novel approaches to reach out to patients and their families prior to their appointment. Newly designed pre-visit packets will contain basic information specific to each patient’s upcoming appointment, ensuring:

* a better prepared and better educated patient who becomes an active participant in his or her own treatment and prevention plans;
* the patient and physician identify clear objectives for the appointment;
* the groundwork is laid for true shared decision-makingthat patients understand their medications;
* better use of the time that patients and physicians spend together to make informed decisions and plans for care."

What a great idea ! Every physician should give one of these packets to patients prior to their consultation.

Participatory Medicine: Text of Susannah Fox's Keynote Presentation at the Connected Health symposium | e-Patients.net

Participatory Medicine: Text of Susannah Fox's Keynote Presentation at the Connected Health symposium | e-Patients.net: "Going back to the Seven-Word Wisdom contest, the Cancer article might have given us a new set of rules for the Information Age:

Go online. Use common sense. Be skeptical.

That might resonate with people who say we should trust users to find the good stuff and ignore the bad stuff. Indeed, Pew Internet Project surveys show that this ad hoc system has worked pretty well. About one-third of e-patients say they or someone they know has been significantly helped by following medical advice or health information found on the internet. Just 3% of e-patients say they or someone they know has been seriously harmed by following the advice or information they found online. Reviews of the medical literature have also turned up very few cases of bad outcomes related to the internet.

Participatory medicine is a cooperative model of medical care that encourages and expects active participation by all involved parties as an integral part of the full continuum of care.

WellPoint, X Prize launch $10M health care contest - Yahoo! News

WellPoint, X Prize launch $10M health care contest - Yahoo! News: "The companies have announced an open competition to devise solutions that improve health care cost and quality, and they're dangling a prize of at least $10 million for the winner.

'Reinventing and rebooting the U.S. health care system is not to be taken lightly,' said X-Prize Chief Executive Dr. Peter Diamandis. 'Its an audacious task but, we think, very achievable.'"

Wednesday, November 05, 2008

U.S. Hospitals Lag in Patient Satisfaction - Forbes.com

U.S. Hospitals Lag in Patient Satisfaction - Forbes.com: " In the first national survey of patients' experiences, many hospitals were found wanting in key areas such as pain management and discharge instructions. In fact, almost one-third of patients gave low ratings to pain management, and one-fifth gave low ratings to communication at discharge.Patients in many U.S. hospitals are not satisfied with their care, Harvard researchers report.

Jha also puts part of the onus on patients to improve care. 'Patients need to be proactive -- ask questions,' he said. 'The more engaged patients are, the better the care they will receive and the better the care all of us will receive, because they will drive the change for better systems of health care.'"

The Doctor's Office - WSJ.com

The Doctor's Office - WSJ.com: "Did you feel healed the last time you went to the doctor? My bet is no. If you were lucky, maybe you got 10 minutes with the doctor. In not much more time than you might have spent in a fast food drive-thru, the doctor wrote a prescription, ordered a battery of lab tests and sent you off for a thousand dollars worth of imaging studies.

Somewhere along the line too many doctors stopped being healers and became prescribers and technicians.

We became business people and started thinking in terms of relative value units -- the coin of the medical finance realm -- as much as how to make patients better. We took seminars in medical coding, so we could talk the same lingo as the government and the insurance companies.

The changes in medicine are at odds with many of the values that defined the profession I joined."

Doctors, like all humans, respond to incentives. Given the perverse system of incentives which exist today in healthcare , it's hardly surprising that most doctors behave as rational human beings, and focus on maximising their benefits. Rather than preaching, it makes more sense to change the incentive structure, so that doctors are rewarded for being healers, rather than for being technicians. Patients will ultimately get what they pay for !

Tuesday, November 04, 2008

Indian clinics woo "fertility" tourists | Send to NEWS home | News.com.au

Indian clinics woo "fertility" tourists : "'Nearly half of our patients come from overseas. Of them, nearly half are of Indian origin,'' said Aniruddha Malpani, whose IVF clinic in Mumbai is considered among the country's best.

A full IVF cycle at the Malpani clinic costs $US4500 ($6771), including medicines. In the United States, the average cost is $US12,400, according to the American Society for Reproductive Medicine. "

Thursday, October 30, 2008

Optimizing Healthcare Delivery in INDIA: A Patient Centric Approach'

Optimizing Healthcare Delivery in INDIA: A Patient Centric Approach': " The Indian Healthcare sector is undergoing a radical transformation, with the initial steps taken forward more than a decade back. Healthcare, which is a US$ 40 billion industry, is growing at 15% every year. We stand at the threshold of an exciting opportunity to design and engineer sustainable delivery systems, develop numerous commercially viable & customizable delivery formats for the growing, demanding and health conscious Indian populace.

The 5th India Health Summit will focus on 'Optimizing Healthcare Delivery in INDIA: A Patient Centric Approach'.

SmartCards for Digital HealthCare

SmartCards for Digital HealthCare: "The Medical Group Management Association (MGMA) will push the health insurance industry to standardize patient identification cards with magnetic stripes, bar codes, or embedded chips and has commissioned a study to quantify the potential savings for payers and providers alike.

MGMA wants to go after the perceived low-hanging fruit of administrative waste, specifically in standardizing physician credentialing and patient eligibility and benefits verification. The organization will study the cost to medical practices of making copies of patient insurance cards, manual entry of data—and related transcription errors—telephone calls to check benefits, and delayed collection of co-payments from not having accurate information at the time of service."

This makes so much sense ! We all carry over 2-10 types of credit cards already, to manage our money ! Why not a card to manage our health ?

HealthVault, Aetna Offer New Service - WSJ.com

HealthVault, Aetna Offer New Service - WSJ.com: "In another step toward making patients' health records portable, a new partnership between Aetna Inc. and Microsoft Corp. will allow patients covered by the national insurer to transfer medical records to Microsoft's year-old health-record Web site, HealthVault. Starting next month, many enrollees in the insurer's plans will be able to move information from their Aetna 'personal health record' -- an online repository of data that includes claims, diagnoses, test results and prescriptions -- to HealthVault. Patients can pick and choose what they would like to transfer between Aetna's and Microsoft's sites.

The program will be available to people who have access to Aetna's personal health record, which the insurer has so far rolled out to some six million people. It will be available next year to many more Aetna customers. Aetna has a total of 17 million members.

A variety of technology companies, insurers and health providers are pushing to give patients the ability to access all of their health information in one place and to transfer it easily to doctors or hospitals, among others. Sites such as HealthVault and Google Inc.'s Google Health, which launched earlier this year, are trying to become central points where patients' data are available to them, for instance, when they switch from one insurer to another."

Will this be an inflection point in the way consumers manage their health on the web ?

Wednesday, October 29, 2008

Criminal checks for IVF women?

Criminal checks for IVF women?: "Women seeking IVF treatment could be forced to undergo a police check if new laws are passed. The Victorian legislation would mean more than 14,000 women who sought out fertility treatment each year were forced to undergo the test.

News Limited newspapers reports the legislation is before the Victorian Parliament. Under the laws, a patient would need to undergo a checks for history of sexual convictions, violent offences or any child protection orders taken out against them. The laws would mean some potential patients were unable to receive treatment."

Another great example of the way infertile women are discriminated against ! If you are fertile and a drug addict , no one stops you from having as many babies as you want. However, if you are infertile, and are willing to put yourself through an IVF cycle in order to have a deeply loved baby, then you need to undergo a security check ! Talk about unfair double standards...

Monday, October 27, 2008

Consumers Key to Health Care Reform Efforts

Consumers Key to Health Care Reform Efforts: " There is a growing consensus that activating and engaging consumers is an essential component to health care reform in the United States. The health care choices of individual consumers and daily management of their own health can profoundly affect health care utilization, costs and outcomes. While there are sharp differences between advocates of a strong government role in health care reform and those who believe reform should be achieved primarily through the private sector, most health care reformers at least acknowledge that improvements in quality, cost containment and reductions in low-value care will not occur without more informed and engaged consumers and patients. Payment reform and structural changes to care delivery only address one side of the equation. The other side is consumers and patients becoming more informed decision-makers and managers of their health."

Friday, October 24, 2008

Asking questions - a guide for patients

We expect our doctors to provide us with the information we need about our medical problems, so that we can get the right medical care. The only way we learn about our options is by asking questions , but unortunately, most patients are not very good at asking questions - and if you don't ask the right questions, you'll never get the right answers !

1. What to ask ?

Which questions to ask is the first skill you need to master. In general, it's quite easy to find answers to medical FAQs easily online - and if you can find the answers to your questions on the web or from books, then it's not usually a good idea to ask your doctor these questions, unless you need confirmation or validation.

Since doctors have a limited time, the best questions to ask are those which will have an impact on your treatment options. Make a list of all your questions - and try answering those you can by doing your own homework yourself. With the remaining questions, try prioritising them, and start by asking the important ones first; leaving the unimportant ones to the end, so you can skip them if you run out of time

2. Whom to ask ?

The doctor is not always the best person. If it's questions about billing or costs, often the clinic staff will be much better informed - and much more helpful too !

3. When to ask ?

This is an art you need to learn. Unfortunately, many patients only seem to remember all their important questions right at the end of the consultation - at which time the doctor is trying to wind up and move on to the next patient. Not only is he unlikely to provide good answers , he will also resent your questions.

4. How to ask ?

This is an important skill to master. You don't need to be aggressive - but you do need to learn to be assertive. There's a fine balance between the two and you can hone your abilities so you know how to do this. You can learn from your children - when they want something, they know exactly which questions to ask , and how to ask them, so you are much more likely to say yes, rather than no !

Also, remember that not all questions need to be asked face to face. Email is a great way to ask questions and receive answers - and many doctors prefer this option.

What US doctors can learn from Indian doctors

With the looming global economic recession, doctors and hospitals are going to have to learn to provide medical care more efficiently. This is not something most doctors in the US are good at, unfortunately. Since they live in the lap of luxury, they are often very wasteful about using scarce resources - and often overuse tests and treatments, even though they are not useful or effective. While HMOs and evidence based medicine guidelines have tried to curtail this , they have not been very successful so far.

I think rather than try to restrain doctors and not allow them to do what they want to do ( an approach most doctors resent, because they feel this encroaches on their autonomy) , if we can show them how other doctors manage to provide great medical results under the same resource constraints, then they can learn from these positive role models, and stop their wasteful practises. We need to use a carrot approach, rather than a stick approach !

Doctors have always been happy to learn from centers of excellence. In the 1920s, US doctors would do to Europe to learn from European doctors. In the 1980s, many doctors from all over the world would travel to the US to learn from US doctors. While US doctors and hospitals are still great at treating zebras, they don't do a very good job at managing basic medical problems cost effectively or efficiently.

I think they can learn a lot from Indian doctors and hospitals, who have mastered this art. Indian doctors are used to working frugally with limited resources, and still achieve great clinical results. We can be world leaders in teaching other doctors how to do this !

A.D.A.M., Inc. | Mobile Applications for the iPhone

A.D.A.M., Inc. | Mobile Applications for the iPhone: " A vast knowledgebase of health symptoms at your fingertips! The A.D.A.M. Symptom Navigator for the iPhone will let you quickly and easily identify
what to do about any health symptoms, right at your fingertips, all within just a couple of taps!

You never know when or where a symptom will occur. Whether you’re on a business trip, on vacation with family, or at the baseball park, you have access to important health information from your iPhone, allowing you to make informed health decisions even when you are away from your home computer.
From chest pain to fever, sprain, and upset stomach, you can access up-to-date, expert-reviewed
medical content. The tool will help you determine what your symptoms mean, whether to self-treat,
and when to seek professional medical attention."

The Health Care Blog: Liveblog Health 2.0: Health-Management Tools for Consumers

The Health Care Blog: Liveblog Health 2.0: Health-Management Tools for Consumers: "What sort of digital tools are available to health consumers to help them manage the healthinfosphere–and [not to put too fine a point on it]–their health?"

Breaking bad news - how much to tell ?

Breaking bad news is one of the most difficult tasks a doctor has to perform. It's also one of the most difficult ones to do well - and many doctors never manage to do a good job with this. There are many reasons for this and the most important is that every patient is different - and every patient's needs as regards being told unpalatable news are different . Some would rather hear all the gory details, so they can arm themselves with the information they need, and then find the right solution. Others would rather shield themselves from hard reality - and let the doctor make all the decisions. For most of us, we'd prefer a balanced mix between these two extremes - Gautam Buddha's middle path !

The trouble is that the doctor has no way of divining which our preferred coping style is. This is why most develop their own preferred style, depending upon their own personality. Many take a paternalistic approach, where "the doctor knows best" and routinely censor all information, because they do not want the "shock" of the "bad news" to unduly distress the patient. Others, who believe that "honesty is the best policy", spill all the beans dispassionately and heartlessly, which is why many patients now believe that doctors are uncaring and unfeeling.

Many doctors tell the unvarnished truth to a relative of the patient, who acts as the patient's advocate. This person can then present the truth to the patient in a style which the patient is comfortable with. While this is a great model in theory, in real life it often fails miserably, especially in Indian society, where we take great pains to not use words like cancer in the deluded belief that hearing the truth will cause the patient to hasten her way to an early death.

Sometimes , hiding the truth from the patient is the unkindest cut of all - even though it is done with the kindest of intentions !

Tuesday, October 21, 2008

Communicating With Patients

Communicating With Patients: "THE RESPECT MODEL

Rapport

* Connect on a social level.
* See the patient’s point of view.
* Consciously suspend judgment.
* Recognize and avoid making assumptions.

Empathy

* Remember that the patient has come to you for help.
* Seek out and understand the patient’s rational for his/her behaviors or illness.
* Verbally acknowledge and legitimize the patient’s feelings.

Support

* Ask about and understand the barriers to care and compliance.
* Help the patient overcome barriers.
* Involve family members if appropriate.
* Reassure the patient you are and will be available to help.

Partnership

* Be flexible with regard to control issues.
* Negotiate roles when necessary.
* Stress that you are working together to address health problems.

Explanations

* Check often for understanding.
* Use verbal clarification techniques.

Cultural competence

* Respect the patient’s cultural beliefs.
* Understand that the patient’s view of you may be defined by ethnic or cultural stereotypes.
* Be aware of your own cultural biases and preconceptions.
* Know your limits"

The Ideal Doctor Revealed - Greater Case Acceptance and Referrals in the Voice of the Customer

The Ideal Doctor Revealed - Greater Case Acceptance and Referrals in the Voice of the Customer: "Interestingly, the Mayo 'traits of the ideal doctor' study that's been widely seen in the past few years, involved 192 patents—a smaller number of patients perhaps than your office sees in a few days. According to the Mayo survey, the seven things that patents most appreciate (with patient descriptions) in doctors are:

* Confident: 'The doctor's confidence gives me confidence.'
* Empathetic: 'The doctor tries to understand what I am feeling & experiencing, physically and emotionally, and communicates that understanding to me.'
* Humane: 'The doctor is caring, compassionate, and kind.'
* Personal: 'The doctor is interested in me more than just as a patient; he/she interacts with me, and remembers me as an individual.'
* Forthright: 'The doctor tells me what I need to know in plain language.'
* Respectful: 'The doctor takes my input seriously and works with me.'
* Thorough: 'The doctor is conscientious and persistent.'"

Monday, October 13, 2008

How the global financial crisis is going to be good for Indian doctors

Everyone is hurting from the global financial crisis. I think this is actually a great opportunity for Indian healthcare. US companies and US health insurance players are going to need to tighten their purse strings - and they are now going to be forced to look for more cost effective healthcare services. Since these are not available in the US, they will start looking for options overseas - and India will be high on their list.

Uptil now, most medical tourists came to India of their own accord - either because they were not happy with their own healthcare system; or they could not afford US medical care, and needed to save money. They were paying from their own pockets for their medical care.

Now, as the entire country needs to save money, lots of corporates and health insurance players are going to be forced to look for inexpensive alternatives. While many US doctors and hospitals will have to shape up and provide more cost effective services, they will find it hard to compete with Indian healthcare providers.

Money talks - and it's going to talk very loudly in the next few months. Uptil now, doctors and hospitals i the US only had to compete with each other, which means they could set their own rates ( which were often exorbitant, and about 10 times as much as Indian doctors charged , for no very good reason, other than - " This is the US market rate". This is going to change very quickly, as payers are going to demand efficiency and cost savings . Just like remuneration rates for cataract surgery dropped dramatically in the US when Medicare cracked the whip, we are going to see a similar impact across the entire medical ecosystem.

We live in interesting times !

Sunday, October 12, 2008

For Some Doctors, Empathy Is in Short Supply - US News and World Report

For Some Doctors, Empathy Is in Short Supply - US News and World Report: "'It would be helpful for physicians to think about having a response ready,' Morse added. 'The bulk of patients' concerns are existential and physicians don't necessarily have to do something to fix it. Just acknowledging it, in and of itself, can be very helpful and it doesn't take a lot of time.'

Added Frankel: 'The most important job of a physician is also the most important job for a minister or for a lawyer or anyone else: To try and help people cope with the uncertainties of life.'"

This is the challenge - and the opportunity. Patients don't expect doctors to work miracles - but a kind word can be very healing !

An Overview of Empathy

An Overview of Empathy: "Empathy is a powerful communication skill that is often misunderstood and underused. Initially, empathy was referred to as 'bedside manner'; now, however, authors and educators consider empathetic communication a teachable, learnable skill that has tangible benefits for both clinician and patient: Effective empathetic communication enhances the therapeutic effectiveness of the clinician-patient relationship. Appropriate use of empathy as a communication tool facilitates the clinical interview, increases the efficiency of gathering information, and honors the patient."

Empathetic doctors have patients who often become "raving fans" ! It's also important for patients to be empathetic, so they can get the best care from their doctor. Smart patients can sense when doctors have time to sit and chat - and when they don't !

Doctors as learned infomediaries - a better option ?

Doctors are medical knowledge experts, and patients go to doctors so that they can use their specialised knowledge to get the correct diagnosis and the right treatment. The trouble with this traditional model is that there are too few doctors, with the result that doctors often act as bottlenecks. It takes time to get an appointment - and waiting lists can extend for months. Also, doctors tend to guard their specialised knowledge and often refuse to share it. Finally, while good doctors will provide good care, often bad doctors will overtreat for financial reasons. This means that patients are often unhappy with the medial care they receive from their doctors.

Is there a better alternative ?

I think the trick is to use learned infomediaries to provide medical triage, so that simple problems can be handled with self-care; and doctors only need to see patients with complex problems, who require more advanced expertise.

This has many advantages. Access to medical information will be much faster; less expensive; and doctors will not get bored handling mundane "routine " problems.

This is not a new idea, and has been tried before in different avatars. For example, computer scientists have tried to use artificial intelligence to develop expert systems which allow computers to make a diagnosis; and countries have used "primary health care" village workers to reach out to many more people, to provide them with basic healthcare.

The good news is that the internet allows us to reach many more people much more efficiently. Most people will now routinely use the net to research their medical problem - both before going to the doctor; and after wards, to check on his recommendations.

The trouble is that many people are not sophisticated enough to be able to use the net efficiently. They often get lost - or even worse, misled by unreliable websites.

Can we provide a better model ? I think the missing element we need to add is a human being, who will help the patient find the right information. This person could be a nurse; a physician assistant; a medical student; an expert patient; or a retired doctor - all of whom are much less expensive than a doctor !

This expert can help the patient find the correct information - and help them to make sense of it. It also adds an element of humanism to the net, something which can be vitally important when you are ill !

This sort of blending click and mortar model will allow us to provide patients with the best of both worlds - online and offline !

We can use a stepped care approach, in which simple problems can be resolved with the help of these learned infomediaries; and more complex problems can be referred to the doctor.

This approach can help to save time , money and energy. Call centers and medical helplines staffed by nurses already provide such a service in many cities - can't we do a better job and scale this up ?

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