Friday, February 29, 2008

Test your own fertility - empowering women with medical information !

We treat infertile patients from all over the world, and many of them are very well-informed and understand their treatment options well. However, one of the problems they face is that it's often very difficult for them to get their medical tests done. Family doctors are often not very co-operative or well-informed - and there can be long waiting lists to see a specialist in many countries. Moreover, some of these tests can cost a bomb - not because the tests are expensive, but because of the doctor's consultation charges.

Finally, there is now a much better alternative for infertile couples. In collaboration with MyMedLab, we now offer infertile couples in the USA a chance to get their blood tested for the five key reproductive hormones - FSH,LH,PRL and TSH, and estradiol. This test, usually done on Day 3 of the cycle, gives us an excellent idea of their ovarian reserve, and helps them to formulate the right treatment plan.





We feel this is an innovative way to help patients to cut down on their medical costs and saves them time and money !

This type of service is also a great way of empowering women; and is also useful for 2 other groups of women.

1. Older women, who are worried about their biological clock, and need to check their ovarian reserve. The baseline FSH level is a good index of the number of eggs left in the ovaries. A high FSH correlates well with poor ovarian function.

2. Women with irregular periods. The reason their periods are irregular is because they do not ovulate. This is called anovulation and maybe because they have PCOD ( polycystic ovarian disease) or POF ( premature ovarian failure ) . This simple blood test can help them to make the correct diagnosis !

Not only can women order their tests themselves, they can also monitor their own fertility, if they so desire. Thus , many women with poor ovarian reserve will try alternative medicine, including yoga, acupuncture and herbal medicines to try to improve their ovarian reserve. Since most doctors do not believe in the efficacy of these interventions, they are not very helpful or supportive, so that most women have no idea whether the alternative medicine is really helping them, or just wasting their time ! They can now monitor their own FSH levels every few months, so they can track their own progress; and decide their next course of action.

What's really exciting about this is that women can now carry out their own clinical research ! Groups of women can collaborate; try various interventions ( such as yoga or acupuncture or DHEA) ; and track their own FSH levels and analyse these to see whether any patterns emerge. This is putting power back where it belongs – in the hands of the patient !

If they need help is making sense of their lab results , they can enter the lab values and clinical details in our Free Second Opinion form at www.drmalpani.com/malpaniform.htm and I’ll help them interpret the results !

PHRs in India


Wednesday, February 27, 2008

Medical tourist survey 2008: report and research

Medical tourist survey 2008: report and research: "Intuition has completed the first in depth survey of medical tourists, incorporating the experiences of 650 patients who have travelled for treatment. The highly encouraging data from this survey is the level of savings achieved and the level of satisfaction of those who travelled.

* 83% “wanted to save on the cost of treatment in the UK”.
* On the total cost of treatment, 11% of dental respondents spent £10,000 or more, and 9% of elective surgery respondents spent £10,000 or more.
* 17% said they saved more than £10,000 compared to UK cost.
* 9 out of 10 respondents very (74%) or quite satisfied (16%) with their experience of treatment abroad.
* 97% of the medical tourists stated that they would definitely or probably go for treatment abroad again.
* 96% of all respondents would definitely or probably go back to the same doctor/dentist/hospital/clinic.
* 96% of all respondents would recommend it"

Humor in Medicine.

Humor in Medicine.: "Humor has the potential to relieve stress in patients and medical professionals. Humor gives patients the opportunity to forget about their anxiety and pain, if only for a brief period of time. When doctors share humor with patients, they create lines of communication that encourage patients to discuss difficult issues. In effect, humor can put both parties at ease in a way that more formal types of communication cannot. 71 Medical professionals also use humor to deal with the tension that results from working in the modern medical environment. Doctors acquire their signature humor while in medical school. This behavior continues as students complete their training and begin working in the health care system. It is seen in the banter and jokes one witnesses on the wards and even in the humor doctors publish in the medical literature."

Tuesday, February 26, 2008

Healthcare provider's needs

Healthcare provider's needs: "Healthcare providers have seven basic needs: skills, equipment, information, structural support, medicines, incentives, and communication facilities (SEISMIC). A seismic shift is required to better understand and meet these needs."

Doctors in private practise also need patients :)

Monday, February 25, 2008

Bedside India

Bedside India: "In the future, Indian health care providers, such as Fortis, foresee medical tourism becoming a much-higher-volume business, in which patients’ insurance companies steer them to India because of the nation's reputation for low-cost, high-quality elective surgery. In this way, India hopes to capitalize on its pool of skilled, English- speaking doctors and nurses to better integrate its economy into the global market and to diversify its service exports."

How patients can heal a sick healthcare system

I feel the healthcare system today is sick because it is doctor-centric. Healthcare is fragmented and disorganized and there are too many specialists , most of whom have tunnel vision.

In order to reform the healthcare ecosystem , we need to put patients at the center ! We believe that patients are the largest untapped healthcare resource !

Patients ( or their relatives and friends) are : intelligent and capable; and because they have a lot at stake , they are motivated to get good health care and will be willing to invest time and energy if given the right tools to ensure a good outcome.

We need to provide the tools directly to patients !

I feel there are 3 major influences which will help patients to regain control over their healthcare.

1. Patients will keep their own medical records using a PHR ( Personal Health Record)
2. Information Therapy can be precribed to them, tailored to their needs, based on their medical problems captured in the PHR
3. Web 2.0 technologies will allow them to form social communities to help and support each other.

In the pink of health

In the pink of health: "The Indian healthcare industry is expanding even as it is being transformed by the growing demand for quality healthcare from the increasingly affluent middleclass, the entry of large private groups, the use of advanced the technology and equipment and the availability of insurance."

The growth of health insurance in India

The growth of health insurance in India : " Health insurance is now sold by general insurers, life insurers and stand-alone health insurance companies in India. Whilst health insurance figures are not reported separately for life insurers, health insurance premiums written by the general and health insurance companies are reported and the figures make interesting reading Health insurance premiums exceeded Rs32 billion (US$800 million) in the financial year ending on 31 March 2007 (FY2006), an increase of 44 per cent on the previous year. For most of the private general insurance companies, health is one of the fastest growing lines of business. Growth in health insurance premium income in the last year ranged between 39 per cent and 686 per cent and many general insurers have made statements regarding the strategic importance of health insurance as a line of business for them.

The economic changes witnessed in India in the last few years are starting to have a major impact on both the provision of healthcare and the availability of health insurance. There is a unique opportunity to capture market share, whilst the market is relatively young and in a dynamic phase of development for early entrants. The insurance companies that offer innovative consumer-friendly products, whilst concentrating on building robust underwriting and claims ‘gate keeping’ protocols for their health insurance business, are likely to be the winners."

Infertility SUCKS!

Infertility SUCKS!: "We've finally made our decision-it's time for IVF#4.
I am, quite honestly, scared shitless. It would be different if it were our first cycle-full of the optimism that it will surely work and we'll end up with twins and everything will be picture perfect, blah blah blah. Three IVF cycles, numerous FET's, and a lot of heartache later, Sean and I both know that there's no guarantees in this. We're both a bit jaded about it all; in some ways, we're sort of going through the motions with this-perhaps it's because we're unsure of the outcome (ie. a baby) or maybe it's because we've been through this before and we're used to the drill....I'm not sure."

Infertility blogs written by infertile women ( the vast majority are by women !) are very helpful for other infertile couples, because they provide support, comfort, helpful tips and insight. It's helpful to belong to a community when you are in pan, because you know you are not alone. Such blogs are very helpful for infertility specialists as well - they help us to become more empathetic, so we learn to see things from the patients' point of view !

Operation Heads Up

Operation Heads Up: "Operation Heads Up is series of write ups about common procedures, medications, tests, and diagnoses associated with infertility. These entries were written by those who have been on the receiving end of the needle or catheter--they are not doctors, just fellow stirrup queens or sperm palace jesters like you. These write ups are meant to give you a heads up before your own experience and provide tips that have worked for other stirrup queens or sperm palace jesters before you. The information should never be used in lieu of medical advice from a doctor."

This is a great example of how to simplify complex medical topics ! What I really like about it is that it has been put together by patients, who are taking over control of their treatment - and helping others in the same boat.

I wish doctors could learn to write half as well !

Friday, February 22, 2008

The Google PHR

The Google PHR . "Many innovators in the healthcare industry have worked hard to make results of doctor visits, prescriptions, tests and procedures available digitally. By using the GData protocol already offered in many Google products, and supporting standards-based medical information formats like the Continuity of Care Record (CCR), our health efforts will help you access, store and communicate your health information. Above all, health data will remain yours -- private and confidential. Only you have control over when to share it with family members and health providers.

This week, we hit another important milestone. We launched a pilot with a medical institution committed to giving patients access to their own medical records: The Cleveland Clinic. A large academic medical center, Cleveland is one of the first partners to integrate on our platform. Because of their size and reach with patients who already have access to their medical records online, Cleveland has been a great partner for us to test out our data sharing model. Patients participating in the Cleveland pilot give authorization via our AuthSub interface to have their electronic medical records safely and securely imported into a Google account. It's great to see our product getting into the hands of end users. "

Tips for savvy medical Web surfing - CNN.com

Tips for savvy medical Web surfing - CNN.com: "When Mary Ryan's 4-year-old nephew, Nick, landed in the hospital with a serious infection, her brother called her in a panic. Ryan isn't a doctor. She's not a nurse. She's a librarian.

Finding accurate, reliable medical information on the Web can be a daunting task.

Nick had cat scratch fever, and for weeks it was impervious to antibiotics. Desperate, the doctor in Nick's small town wanted to use a more powerful antibiotic that might save him -- but also might make Nick deaf.

Ryan's brother hoped she could find something -- anything -- that would save his son without disabling him. Ryan asked one of her colleagues, a research specialist at the Texas Medical Center Library in Houston, to search the medical literature. She came up with an article about an antibiotic that worked against cat scratch fever but wasn't toxic."

Wednesday, February 20, 2008

World's first free fertility reminder service by mobile in India !

If you live in a modern metropolis, you may find that you may not be able to have a baby simply because you cannot schedule sex during your fertile time ! One of the reasons for the increasing incidence of involuntary childlessness is the fact that many couples are not able to have sex during their "fertile days".

There are many reasons for this.

1. Many couples simply do not know the basics about their body or their menstrual cycle ! While most husbands are happily clueless about ovulation, it's unfortunate that many women do not know that ovulation occurs 14 days before the next menstrual period is due; and that fertility peaks on the day of ovulation, and for 4 days prior to this.

2. Because they do not know enough to be able time sex during their fertile days, they often end up having sex on a haphazard basis, and often miss the fertile period altogether ! This is especially true when both partners are working in high-profile jobs which involve a lot of travelling.

3. They are too stressed to have sex - the price we pay for " modern civilisation " !

We can help !

With the Infertility PHR, we can send you a SMS on your mobile, to remind you of your upcoming fertile days; so that you can arrange your schedule and that of your husband, to ensure that you are together during your fertile days. ( Seducing him is your responsibility - our PHR still cannot do this !)

At present, this service is only available if you live in India.

How a PHR can help you get a second opinion !

A common problem we have encountered in our practise is that many infertile patients are reluctant to change doctors, even when they are very unhappy with their present doctor. Often this is because they prefer being passive and refuse to take matters in their own hands - "better the known devil than the unknown one". Some feel that their present doctor knows all their medical details, even though he may not be very competent, and they do not want to take the time and trouble to explain their problem all over again to a new doctor. They often don't even have copies of their medical tests and treatments, because many doctors refuse to give these to patients ( so that they can "hold on" to their patients.) Unfortunately, this passive attitude means that you are depriving yourself of getting the best medical care, and reducing your chances of conceiving.

The Infertility PHR can help you empower yourself !

Get a second opinion - this can never hurt and is always helpful. If you find two experts saying the same thing then you know you are on the right track.

The Infertility PHR can help you with getting a second opinion because you can print out and email a summary of your medical records to the specialist, so that it becomes much easier for the consultant to review your tests and treatment. Well-organised medical records help the doctor to review what you've done in the past, so he can formulate an effective treatment plan and help you move forward !

Helping infertile patients to get better organised

Infertility treatment can be stressful ! You may be overwhelmed by a hectic schedule of medical checkups and infertility tests and treatments. Gathering and keeping track of all of the information generated can be a challenging task ! Not only do you have to decipher all that medical jargon ( sometimes it feels like you are studying for a PhD !), you have to make sure that your family doctor and andrologist and IVF specialist are on the same page and talking to each other, because it often feels like the left hand does not know what the right hand is doing.

When you are going through the worry and stress of infertility problems, the last additional burden you need is to have to remember the results of every test and procedure that you've had for the last 6 months!

You know that Knowledge is Power - but how do you apply this to your own treatment ?

We can help ! For the first time in the world, we are pleased to be able to offer you an online Personal Health Record, customised to help iyou gain control over their treatment.

The Infertility PHR is designed to help you manage your infertility treatment from beginning to end. The PHR provides you a centralized place to organise , store, and protect your infertility information, testing and records so that you :

* Never have to look for test results from your doctor, or wonder what test you had performed
* Make it easy for a spouse/relative or friend to find your medical records in an emergency
* Easily document and track the infertility medications you are taking
* Never have to worry about trying to explain the details of your healthcare to someone else (such as another doctor or infertility specialist)
* Track and document all of the critical aspects of infertility including, your body temperature, fertility charts, doctor recommendations and treatment plan, lab tests, and any questions you may have when trying to become pregnant
* Make it easier for you to get a second opinion
* Never have to beg your doctor for a copy of your own medical records!
* Share what you choose with trusted friends and guides, so they can provide you with information tailored to your needs
* With the Dr Malpani Infertility PHR, you now have all of your treatment records at your finger tips.

PHRs can help to revolutionise healthcare - by putting you in control of the treatment your receive !

As a smart patient, you understand the importance of tracking and organizing your infertility treatment medical records . We can help you ! You can store and access all your medical records online at http://infertilityphr.yoscare.in - free of charge. This Personal Health Record ( PHR) is available 24/7; can be updated any time; can be shared with all doctors; and can be downloaded on a flash drive.

We also provide exciting value-added services such as sending you an SMS during your fertile time , so you can improve your chances of getting pregnant naturally !

Your medical records are too important to be left upto your doctor or clinic. These are your responsibility - you need to guard them jealously. A well-organised medical record can spell the difference between failure and success !

Wal-Mart Mandates E-Health Tools For Patient Care -- E-Health -- InformationWeek

Wal-Mart Mandates E-Health Tools For Patient Care -- E-Health -- InformationWeek: "Are a patient's symptoms more likely to get digitally documented into an electronic medical record at the convenience clinic inside Wal-Mart than at his or her own doctor's office? Possibly. The emergence in the last few years of convenience health clinics operated in the stores of retailers such as CVS, Walgreen's, and now Wal-Mart has brought with it an unexpected twist.

Besides providing quick tests for strep throat and prescriptions for antibiotics by nurse practitioners working in small spaces set up somewhere between the cosmetics and pet food aisles, these retailers are deploying technology tools in their clinics that most doctors still lack in their offices -- e-health records and decision-support systems."

Once patients start seeing how much better EMRs are, they'll start pushing their doctors to adopt them too !

Saturday, February 16, 2008

The sad state of drug information for consumers in India

The sad state of drug information for consumers in India.: "This paper examines the nature of information currently being disseminated to consumers. It identifies which actors are involved in dispensing such information and the type of information that each provides. It also identifies models and guidelines on what kind of information should ideally be provided, how it should be done, and how this can further the cause of helping consumers make informed choices. Finally, it examines the law and policy regimes applicable to drug information disseminated to consumers.

The main findings of the paper include:

* The availability of consumer drug information in India is extremely low in terms of quantity. Information is not provided in a user-friendly manner in most cases, and rarely includes traditional medicines.
* There is a particular lack of information relating to drug prices, and there is no single dedicated actor concentrating only on consumer drug information.
* There is no coordination between the various actors providing consumer drug information, and no consistency of information being supplied. Information directed at consumers is largely aimed at creating awareness about preventive strategies; it does not provide technical medical details pertaining to drugs, nor does it provide practical information regarding usage and consumption of the drug."

Friday, February 15, 2008

How a PHR can help infertile couples to help their doctor !

Being infertile is bad enough. Often going to the doctor ends up making you even sicker !

The healthcare system today is sick , and one of the reasons for this is because it is doctor-centric. Medical care is fragmented and disorganized - and this is especially true for infertility treatment. After going to your family physician ( GP), you have to wait until he decides to refer you to a gynecologist. This can take 2-3 months in certain countries. While gynecologists are good at tackling simple problems, if, God forbid, you have a complex problem, then you get referred on to an infertility specialist. Since there aren't too many of these, you may have to wait upto 6 months to get an appointment - and if your husband has a problem, then he will have to see another specialist, called an andrologist. To make matters worse, these doctors rarely bother to communicate with each other ( forget about talking to you !), with the result that you get piecemeal attention, often on an ad hoc basis. This can be very frustrating; can waste time; and is often expensive, because tests may have to be repeated and no one ( least of all you !) seems to have a clue as to what the next step is.

In order to improve this broken system, we need to put patients at the center of it all – after all, “ patients are the largest untapped healthcare resource “ ! Patients ( and their relatives and friends) are : intelligent and capable; and because they have a lot at stake , they are motivated to get medical care and will be willing to invest time and energy if given the right tools to ensure a good outcome. We need to provide the tools directly to patients !

The key to patient-centered health care is the Patient Health Record ( PHR). The health record is the patient’s story – from the patient’s point of view . Unfortunately, for most of us, our financial records are in better shape than our health records . There are many reasons for this - and the bigget problem is ignorance. Because we cannot make sense of medical records, we often give up and do not bother to store or analyse them.

The Dr Malpani PHR helps to correct this problem ! Not only does it help you organise and store your records safely, it also educates you about infertility and helps you make sense of your problem and your treatment options.

How an online Infertility Record Manager can help you get better medical care

  • Have you ever been in a situation where the doctor cannot locate your old ultrasound scans ? the lab has misplaced your blood test results ? the nurse has mis-filed your consultation sheet ?
  • Have you ever felt that your doctor does not have a clue as to what he plans to do with you during this visit, because he has not documented his thoughts or treatment plan ?
  • Is your doctor so disorganised, that he does not keep your medical records at all ?
  • Do you find yourself repeating your entire history over and over again to your doctor, because he cannot remember what you discussed in your last visit ?
  • Have you been forced by your doctor to get a blood test repeated because you could not find your old reports ?
  • Has your doctor ever got upset with you because you forgot to bring your old reports with you to the consultation ?
  • Have you found yourself in the embarrassing position of going to the doctor without your lab results - as a result of which you wasted your time and your doctor's and had to go back again for another visit ?
  • Have you felt like an idiot because you could not remember the dates of your last menstrual cycle when your doctor asked you for this information ?

The Dr Malpani Infertility PHR can help prevent all these problems ! They are available safely and securely - 24/7 - and can be accessed through any PC - and even though your mobile ! If you are willing to take the time and trouble to maintain them and update them, this can go a long way in ensuring your records help you get the best medical care.

Wednesday, February 13, 2008

The world's first free PHR for infertile couples !

Infertility is a very common medical problem which affects 15% of all married couples. In fact, it is the commonest medical problem amongst young couples in the reproductive age group
( 20-40). While there is an increasing demand for infertility treatment, both from couples in India and those coming as medical tourists from the US and UK, many of these patients are not aware of the best treatment options which are available today.

In order to remedy this, we are now offering infertile couples from all over the world an opportunity to store and access their medical records online at

http://infertilityphr.yoscare.in
- free of charge !

This Personal Health Record ( PHR) is available 24/7; can be updated any time; can be shared with all doctors , consultants and specialists; and can be downloaded on a flash drive. We also provide exciting value-added services such as sending patient reminder SMSes during their “fertile time” so they can improve their chances of getting pregnant naturally !

This is an extremely valuable service, which will help to revolutionise the way care is provided to infertile couples, because it will empower them with information, so they are in control of their lives and their treatment.

The Infertilty PHR is the first specialized product targetted at a highly motivated group of patients. We plan to roll out a series of such PHRs for specific segments; such as pregnant women; children; and chronic diseases such as arthritis, diabetes and heart disease.

Patients are the largest untapped healthcare resource; and by providing them with the tools they need, we can help them to promote their health , and prevent and treat medical problems in the family in partnership with their doctor.

I am an angel investor in Yos Technologies , which provides a comprehensive "Personal Healthcare System" which includes PHRs, Healthcare tools and applications for Preventive and Continuous Care ( www.yostechnologies.com). It is a startup located in Bangalore which aims to empower patients with information, so that they can get the best medical care, by providing them with a free Personal Health Record. The CEO is Vijaya Verma; and the other angel investor is Rajesh Jain.

Tuesday, February 12, 2008

Mouse calls

Mouse calls: "'Over the past decade, Americans have learned to rely on the Internet to become their own travel agents, stockbrokers and retirement planners,' said Donald W. Kemper, founder and CEO of Healthwise, a nonprofit that helps patients make better health decisions. 'Americans are ready to take more control over their health through the resources available on the Internet today,' he said.

More than 160 million Americans look for a doctor via the Internet and search for health information online, according to a current Harris Poll.

But a search using Google, for example, would turn up millions of hits on a subject as broad as cancer or diabetes. So smart consumers start their searches on health Web sites where information has already passed the test for being credible, reliable and current.

When you surf on your own, beware. The Consumer and Patient Health Information Section of the Medical Library Association evaluates Web sites. They recommend you rely only on sites sponsored by a well-known organization (.org) or medical center (.edu) or government (.gov) agency. Always check the bottom of the page to confirm that the information has been updated within the last year or two."

Monday, February 11, 2008

Why PHRs are better than EMRs !

Why PHRs are better than EMRs !: "Many participants observed that they have moved frequently during their life times. Consequently, they have received medical care from various providers over time. Each provider keeps his or her records detailing visits and treatments. The same is true for hospitals, clinics, laboratories, pharmacies, and so on. One participant noted, “Like most people, I’ve moved around quite a bit. Over time, it’s easy to forget when you were treated, by whom and even for what!”

Respondents noted such problems as the wide variation among providers in the amount of time they retained records, paper records were misfiled or even destroyed, electronic records were lost, stolen, damaged or vulnerable to unauthorized access, and physicians sold their practices. Stated a respondent, “I was made to feel intimated in asking one of my doctors for a copy of my medical records. He acted like my medical record was his property and his only.”"

Empower Patients

Empower Patients: "To end with an answer to the question, ultimately IMHO, the source of the medication error in the case study is the failure to communicate among doctors (specialists) in failing to coordinate their efforts in the care of the patient."

Sunday, February 10, 2008

HealthTrain - the Open Healthcare Manifesto

HealthTrain - the Open Healthcare Manifesto This Manifesto proposes principles under which open media could become a force of positive change in public health and the healthcare system. It steers clear of issues that may favor any stakeholder group over another, aside from promoting greater empowerment of individual healthcare consumers and professionals. The goal of this effort is not to offer specific prescriptions for a healthcare reform, as different people and groups have very different ideas. The objective is to propose general principles under which open expression and discussion can force system change for the better. This is work in progress that will benefit from constructive criticism.

How Access to Information, Science and Relationships can Improve Healthcare

How Access to Information, Science and Relationships can Improve Healthcare Please read this thoughtful essay - it's not only extremely well-written, it will change the way you think about how the healthcare system should work !

Consumer Access Practices for Networked Health Information

Consumer Access Practices for Networked Health Information: "Consumers/patients want service and value based on the content of their own data. They're not looking for technological experiences with their computers or websites. They're looking for ways to save money, get better information about care providers, and have a better experience with the health care system. Consumers don't want online banking: they want what online banking makes it easier, faster, or more enjoyable to do. Similarly, patients don't want online medicine: they want what online medicine enables them to do with their health and wellness data, which in turn will improve health and wellness. This includes being able to converse with their doctors."

Clever application built around their PHR will allow them to do this !

Enhanced Medical Decisions

Enhanced Medical Decisions: "DoubleCheckMD.com -- developed by Enhanced Medical Decisions, Inc. -- is a powerful, first-ever, online medical solution that uses 'natural language' search technology, empowering users to quickly and easily find accurate information on drug interactions and reactions. DoubleCheckMD.com covers all over-the-counter and many herbal remedies as well as prescription drugs."

Welcome to Health Hero Network

Welcome to Health Hero Network: " Health Hero Network develops and markets the Health Buddy® system for health improvement. The Health Buddy system serves as the interface between patients at home and care providers, facilitating patient education and monitoring of chronic conditions. The system includes monitoring technologies, clinical information databases, Internet-enabled decision support tools, health management programs and content development tools. Through increased communication, behavior modification, and prevention, the Health Buddy system improves quality of care."

Getting paid for online and phone consultations !

Getting paid for online and phone consultations: "What is CPT code 0074T? In 2004, the American Medical Association published a new CPT code 0074T that allows US health plans to reimburse physicians for online consultations. Code 0074T is defined as: 'Online evaluation & management service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient's request.'

How are physicians paid?

Physicians are compensated for American Well consultations in the same way as an office visit. This includes the consumer's co-pay and the health plan portion (depending on the member's benefit). American Well claims are often processed more quickly, because the claim is automatically submitted during the consultation, and the member's co-pay is charged to a credit card before the consultation begins."

Iconic Health - Data Visualization to Reduce Medication Errors

Iconic Health- Data Visualization to Reduce Medication Errors: " At least 1.5 million Americans are harmed each year by avoidable medication errors. The extra medical costs of treating medication-related injuries occurring in hospitals alone is estimated to be $3.5 billion a year.

Traditional medication lists in Electronic Medical Records and ePrescribing systems are text based and include no more than 5 pieces of information about each of the patient’s medications. Medication IconoGraphs are designed for use wherever a patient’s medication list is displayed to prescribers, dispensers or patients. A set of IconoGraphs create an enriched medication list designed for rapid
assimilation. In a small screen space, IconoGraphs intuitively display at least 14 pieces of clinically relevant information per drug. "

Clever use of graphics to provide a lot of valuable information at one glance !

The expert e-patient

The expert e-patient: "Some e-patients develop significant expertise in their conditions. Kate Lorig and her colleagues at the Stanford Patient Education Research Center were the first to identify and study the expert patient. They found that, compared with other patients, expert patients did a much better job of managing their diseases-improving their health status, coping more effectively with fatigue, remaining less dependent on professional care, and managing the many other challenges of their chronic condition. The next step involved the development of a system by which professionals could support expert patients.

In Lorig's expert patient model, experienced patients are recruited and trained to help fellow patients with arthritis and other chronic diseases develop the necessary skills to manage their own conditions. Such patients can serve as facilitators, educators, and supporters of self-managed care. They also encourage their fellow patients to help other patients-and teach them."

How e-Patients can help us heal health care !

How e-Patients can help us heal health care !

Just like war is too important to leave up to the Generals, health is too important to leave up to Doctors. Patients - you and me - we all need to get involved, if we want to improve the health care we receive. If we don't do this, who will ?

Saturday, February 09, 2008

7 Steps to Safety - DrugDigest

7 Steps to Safety - DrugDigest: "Unfortunately, medication errors are more common than we think. These medication errors can occur in hospitals, pharmacies, or even in your own home. However, being an informed consumer can help you to prevent errors. Follow our Seven Steps to Safety to help ensure your safety."

Wal-Mart Will Expand In-Store Medical Clinics - New York Times

Wal-Mart Will Expand In-Store Medical Clinics - New York Times: "Moving to upgrade its walk-in medical clinic business, Wal-Mart is set to announce on Thursday plans for several hundred new clinics at its stores, using a standardized format and jointly branded with hospitals and medical groups.

The design of the Wal-Mart medical clinic is intended to look like a doctor’s office, complete with the usual medical hardware.

The first of the new Clinic at Wal-Mart walk-in centers, as they will be called, is to open in Little Rock, Ark., in April and be run by nurse practitioners employed by the St. Vincent Health System, a three-hospital group in central Arkansas."

It's All About The Mobile Internet

It's All About The Mobile Internet: "The British Medical Journal (BMJ) recently published a story about a British test of a mobile reminder and support service: 'Max the virtual friend for teens with asthma'. GP Ron Neville reported they found in their trial that the young people developed a rapport with Max, often texting him back. Max sends messages to remind teens to use their inhaler. In the BMJ examples are given: 'Yo dude, it's Max reminding you to take your inhaler.'

Neville reckoned: 'Text messages that are a reminder about treatment and useful tips on education may be a medium to allow people with chronic health problems to make the disease comply with their lifestyle and not the other way around.'"

Friday, February 08, 2008

myMedLab.com

myMedLab.com: "MyMedLab represents the future of private and affordable health care for today’s consumers. We combine the expertise of our doctors with upfront pricing, convenient service and quality testing to create a simple way to learn about your health. We have built our service around the revolutionary
tool of a Personal Health Record (PHR). Get involved in your care today, your health and your family are depending on it. "

Thursday, February 07, 2008

Health Insight - Taking Charge of Health Information

Health Insight - Taking Charge of Health Information: " Most people are on their own as they evaluate health information, put it into context, and make important health care decisions for themselves and their families. This requires an understanding of the concept of risk. Risk is important because it implies that there is some chance that something bad might happen. The uncertainty can be frustrating and frightening, but it also means that your attitude and choices can play a major role in your future health. The best advice you might get when it comes to making sense of health information is ASK QUESTIONS! Check out a list of 10 questions designed to help you turn health information into clues and to get you started on becoming your own health risk detective."

Tuesday, February 05, 2008

Online house calls click with doctors - Los Angeles Times

Online house calls click with doctors - Los Angeles Times: "Consulting your family physician is finally moving into the 21st century and out of the doctor's office.

Since the dawn of e-mail, patients have been pleading for more doctors to offer medical advice online. No traffic jams, no long waits, no germ-infested offices with outdated magazines and bad elevator music.

There was always one major roadblock: Most health insurers wouldn't pay for it.

Until now.

In recent weeks, Aetna Inc., the nation's largest insurer, and Cigna Corp. have agreed to reimburse doctors for online visits. Other large insurers are expected to follow, experts say.

These new online services, which typically cost the same as a regular office visit, are aimed primarily at those who already have a doctor.

The virtual visits are considered best for follow-up consultations and treatment for minor ailments such as colds and sore throats."

Website may spark change in medical economics

Website may spark change in medical economics: "Plymouth-based Carol.com, which debuted this month, is the first attempt in the country to put together an online medical marketplace. Its creators want to do for health care what Travelocity did for airline tickets. In doing that, Carol's creators are riding the leading edge of a wave of change headed toward consumers just as questions about how to cure the nation's chronic health care crisis are resounding from the corner cafe to the presidential campaign trail. Some think putting more choices in consumers' hands will drive down spiraling health care costs. Others fear those choices may be too complex for the average person to make."

Let’s ban surrogacy !

I recently participated in an NDTV program on Surrogacy. In a covert operation using a hidden camera, an NDTV reporter filmed the operations of an IVF clinic in Anand which offers surrogacy. This was an extremely negative story, which was slanted to show that poor women were being exploited by foreigners and doctors and were being used as “wombs on hire”. They called it the “baby outsourcing industry “ and claimed that the surrogacy industry was worth $ 20 billion dollars ! They stated that hundreds of women were lining up to be surrogates and were being exploited by greedy doctors.

I wonder where they get their “facts” from ! The figures are ridiculous and a simple “back of the envelope “ calculation will show how inflated they are ! In the entire country, about 300 IVF clinics perform a total of about 30000 IVF cycles every year. As a rule of thumb ( which can be corroborated by looking at the US figures from the ASRM), only about 1% of IVF cycles need surrogacy. (Surrogacy is an expensive and complex treatment option, which is best reserved for women without a uterus. This comes to a grand total of about 300 surrogacy cycles every year in India ! This is worth about US $ 3000000 – does this make it an industry ? Unfortunately, no one wants to listen to reason. In order to get their 15 minutes of fame, activists deliberately fabricate figures and play on emotions , thus creating a storm in a teacup !

What is it about surrogacy which attracts so much media attention ? Why does everyone want to meddle and interfere in women’s reproductive rights under the garb of trying to “protect” them ?

If you approve of altruistic surrogacy, where a sister or family member agrees to be a surrogate out of love, then what’s wrong with commercial surrogacy ? Just because it is a commercial transaction does not make it wrong !

Is it unethical ? No ! There are 3 pillars on which medical ethics stands – Autonomy ( allowing people to decide for themselves) ; Beneficence ( do good); and Non-maleficence ( do no harm) ! Surrogacy allows us to respect all these, when done properly !

Does it make sense for activists to take the moral high ground ? If we cannot feed the poor women who volunteer to be surrogates to feed their starving children, is it ethical on the part of activists to ask for it to be banned ? Is it ethical to let the children of these poor women starve ?

The presenter asked – “ How does the poor woman feel about having to give up her baby after 9
months ? “ The answer is simple - Just like an unmarried woman feels when she has to give up her baby for adoption ! Most surrogates do not have an emotional attachment to the baby . They are doing it to help her own children who are already born and are hungry and need to be fed. They understand it’s not her child – she’s just carrying it for 9 months to help someone who cannot have a baby !

The other popular tack is to compare surrogacy to prostitution , because women are “selling their wombs” just like prostitutes “sell their bodies” ! This is unfair and ridiculous ! The goal seems to be to get quotable sound bites - not to get a dispassionate viewpoint or start an informed debate. Indian journalism seems to be following US industry standards and going downhill very quickly !

Unfortunately, doctors are no longer regarded as respected professionals. They are painted to be unethical money-hungry monsters, who are out to make a quick buck. I think doctors are to blame for this. Our profession has done a bad job with protecting its image, and has allowed it to be tarnished beyond repair. We have abdicated our responsibility towards our colleagues and our patients. Many doctors are so jealous of the successful ones, that they are happy to pull each other down, causing serious harm to the profession’s image.

Bureaucrats and lawyers sit in their ivory towers . They have never seen the pain which an infertile woman who cannot have a baby because she does not have a uterus goes through; or experienced the heart break a mother endures when her child cries because of hunger pangs . Magnificently blissful of ground reality, they are happy to interfere in women’s personal lives and pass laws which hurt the rights of the individual to decide for themselves. They are heartless and have no empathy.

I agree the present situation in India needs to be rectified. Surrogacy is overused and misused – and often done for women who do not need it by doctors who are out to make a quick buck. At present, there is no legal protection for surrogacy in India, which means there is no secure mechanism by which patients can take their baby after birth. I have written more about this at www.drmalpani.com/surrogacy-in-india.html

At present we are operating in a legal vacuum . While doing the treatment is not illegal, there is no safe mechanism by which the infertile couple can claim the baby after birth. This means that at present the birth certificate is forged or fabricated ( by putting the infertile couple’s name on the certificate, rather than the birth mother’s). While doctors may do this with good intentions, the fact still remains that this is blatantly illegal. It also means that good doctors often refuse to offer surrogacy treatment ( because of the uncertainty in which it is shrouded), as a result of which quacks have a field day. This means that the good doctors ( who would protect the patient as well as the surrogate) are being elbowed out by unethical doctors , leading to corruption and malpractice , and giving the entire treatment an undeserved bad reputation.

In fact, we could easily use the adoption model to help regulate surrogacy. Social workers would be responsible for counseling the surrogates – and only surrogates who have been certified by these agencies would be eligible to act as surrogates !

We can learn from Iran which legalized kidney donation – or from California, which has an elaborate legal mechanism to protect all parties concerned – thus creating a win-win situation which benefits everyone !

Monday, February 04, 2008

Richard Branson's Virgin to run GP surgeries - Telegraph

Richard Branson's Virgin to run GP surgeries . Virgin is opening a string of doctors surgeries across the country which would also house dentists and complementary therapists. The first clinic - believed to be in Nottingham - will be launched this year, with more planned for 2009. The move by Sir Richard Branson's new business, Virgin Healthcare, would see patients treated on the NHS by health service staff but also offer extra paid-for services such as dentists, conventional and complementary therapies.
The idea is to create a one-stop shop which would be tailored around the needs of residents.
Virgin say it would be working with the NHS to create a better health service."

This is the new avatar of the Public-Private Partnerships !

Sunday, February 03, 2008

Legalise kidney sales

Legalise kidney sales: "India's law against the sale of body parts hurts kidney-sellers who are poor.

Laws don’t work against the economics of a marketplace. India’s illegal kidney transplants are proof of that. They take place because our law against the sale-purchase of body parts outlaws a money value being attached to a kidney. But a kidney’s priceless for a person with renal failure who needs it. And his need transforms a poor, healthy man’s kidneys into a liquid asset. Selling one fetches him say, Rs 1 lakh, bank interest on which can help to keep his family afloat. Meanwhile, his one kidney begins to do the work of two. Contrary to common belief, parting with a kidney is so safe that healthy donors in western nations aren’t even charged higher premiums by life insurance companies.

India’s kidney trade thrives because the transaction benefits both the kidney-buyer and the kidney-seller."

This is why I think economists are smarter than doctors , lawyers, politicians and activists !

We could apply the same model to surrogacy as well !

Saturday, February 02, 2008

BBC - Health - Talking to your doctor - GPs' bad days

BBC - Health - Talking to your doctor - GPs' bad days: "It's easy to forget that GP ( General Practitioner or Family Physician) s have personal lives: their children may have kept them up all night, they could have older relatives to look after, or have relationship problems. In this respect, they're no different to anyone else.

Patients react differently when they find this out at first hand, when their GP seems bored, tired, fed-up, uninterested or even angry. If you've known your GP for a while you may recognise when they're having a bad day and probably won't think any more about it.

If your GP appears to be having a bad day, instead of getting angry or frustrated, acknowledge that they seem to be having a rough time. Often this acknowledgement will help your GP get back on track and you'll get the care and attention you need."

BBC - Health - Talking to your doctor - Doctor-patient communication

BBC - Health - Talking to your doctor - Doctor-patient communication: "Around 80 per cent of the information your doctor needs to make a correct diagnosis comes from what you say. The remaining pieces of the puzzle are found when you're examined and from tests.

This verbal information - known as your 'history' - is important and is often obtained in two ways:

* your answers to their questions
* what you say without being prompted


Often it's a little piece of information that you feel is irrelevant that cracks the diagnosis

Never be afraid to give your doctor information as very little of it will be unhelpful. Often it's a little piece of information that you feel is irrelevant that cracks the diagnosis.

Give your doctor as much information as you can. If there's anything you think they need to know - that you're taking supplements or over-the-counter medication, for example - then say so. Doctors are human too and may forget to ask certain things."

BBC - Health - Talking to your doctor - Inpatient checklist

BBC - Health - Talking to your doctor - Inpatient checklist: "The better prepared you are for your hospital stay, the less worrying it will be. We've provided a list of useful questions that you can print off and take with you. The list will launch in a new window. To print it, just right click on your mouse and select Print from the menu."

ConsumerReports.org - Choosing the right doctor 02/07: Getting better care

ConsumerReports.org - Choosing the right doctor 02/07: Getting better care: "# Almost one-third of the doctors failed to discuss side effects of prescribed drugs, and two-thirds never brought up costs of treatments and tests, patients said.
# Patients stuck with uncommunicative doctors got much better results when they took active steps such as taking a friend or relative along on the visit or asking doctors directly about their experience treating similar cases."
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