Saturday, December 27, 2008
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.”"
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
A paper record is a passive, historical document.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
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
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
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 !
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 !
The Alternative Route: Hanging Out The Unmentionables For Better Decision Making In Health Information Technology -- Kibbe and McLaughlin 27 (5): w396 -- Health Affairs
A lot of what we do in delivering healthcare is going to be done online - and the sooner we realise this, the better !
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 !
* 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 !
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
'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.'"
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 !
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 !
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 !
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 !
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"
Monday, December 15, 2008
Thursday, December 11, 2008
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
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."
* 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 !
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).
- Physicians don’t know as much as you think they do.
- 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.
- Doctors disagree about everything.
- Doctors like ordering tests better than they like listening to you.
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'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.'
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."
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
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."
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."
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
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 !
Saturday, December 06, 2008
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
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
“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."