Tuesday, October 31, 2006

Why take charge of your own medical information?

Why take charge of your own medical information? "Every time you visit a new doctor or other health professional, a new medical record is created for you. The record only covers the current consultation and parts of your health history the healthcare provider thinks are relevant - and that you can remember! Each provider has their own record on you, and nobody shares.

Now things are different! You can quickly and easily create your own health record - a MyLife™ Health Record.

With MyLife™, your personal medical information belongs to you - instead of being regarded as the property of each different provider you visit. You decide exactly who can view it and who can update it. This might include your regular doctor, physiotherapist, pharmacist, hospital or even an overseas specialist if you're traveling. If required, new information can be added automatically from pathology services, hospital records and doctors’ computer systems.

Sharing your medical information in this way reduces the likelihood of errors in your treatment resulting from healthcare providers not being able to access important information about your previous illnesses. Did you know that one in twenty people who enter a hospital either die or are harmed by their treatment? Over half of these errors are caused by communication problems.

A MyLife™ Health Record is absolutely private and confidential. Your information is secured in the same way that banks use to keep their clients data (and money) safe."

Internet based repository of medical records that retains patient confidentiality . BMJ

Internet based repository of medical records that retains patient confidentiality . BMJ: " Using the internet to transmit medical information could allow providers access to medical information at the point of care, but it might violate patient confidentiality
Obstacles that have prevented such implementation include patient and provider identification, security requirements, content issues, format, and language
A patient controlled, 'granularly secured,' cross sectional medical record that is accessible via the world wide web may be simple enough to implement and practical enough to show benefit
Patient and doctor agree which clinical content is worth 'risking' for the benefit of making it available when needed
The patient determines the level of security for each data element".

Public standards and patients' control: how to keep electronic medical records accessible but private. BMJ

Public standards and patients' control: how to keep electronic medical records accessible but private. BMJ:
" Electronic medical record systems should be designed so that they can exchange all their stored data according to public standards.
Giving patients control over permissions to view their record---as well as creation, collation, annotation, modification, dissemination, use, and deletion of the record---is key to ensuring patients' access to their own medical information while protecting their privacy
Many existing electronic medical record systems fragment medical records by adopting incompatible means of acquiring, processing, storing, and communicating data
Record systems should be able to accept data (historical, radiological, laboratory, etc) from multiple sources including physician's offices, hospital computer systems, laboratories, and patients' personal computers
Consumers are managing bank accounts, investments, and purchases on line, and many turn to the web for gathering information about medical conditions; they will expect this level of control to be extended to online medical portfolios"

The need for a PHR

The need for a PHR : "Guardian Angel is a collaborative project, begun in 1994 to put power and responsibility for health care more into the hands of patients. The informal arguments for this are simple:
* Multidisciplinary and multi-institutional health care means that every patient will encounter many care providers over a lifetime.
* Providers and their institutions seem not to have incentives to share their data with others (e.g., they might fear competition), hence it is practically impossible for a patient to reconstruct a lifetime of health data.

Consider the following questions:
o Who cares most about your health?
o Who is always around to pay attention to your health on an ongoing basis, not just at scheduled office visits?
o Who constantly observes how you're feeling, how your body reacts to interventions?
o Who best knows how you would trade off different risks, pain, bother, costs?
o Who charges least for providing these services?

Of course, the answer to all of these is you ! "

This is one of the most eloquent arguments I have read for why we all need a PHR !

The MIT CDM Guardian Angel Project

The MIT CDM Guardian Angel Project: "Guardian Angel depends on having a comprehensive life-long record of the individual's health-related information. In our view, this records needs to have the following characteristics:

* owned, controlled by, and managed by the patient
* universally available (via the World Wide Web),
* but with access controlled by the patient, who can make data available to selected others, and can enable selected others to annotate or augment data
* able to capture, in some form, absolutely any kind of information relevant to the patient's health; this means inputs via structured, standardized protocols such as HL7 or DICOM, but also by fax, scanning paper or film, dictation, email, observation via video cameras, etc.
* secure and authenticated, to assure that only those reliably known to be allowed access can get at or augment the data
* based on public standards and protocols, to help support life-long persistence and utility".

What I find amazing is that this viewpoint was first articulated in 1994 ! The time to implement this is right now - we finally have the tools and technology to do so !

Personally Controlled Health Records: Are They the Next Big Thing?

Personally Controlled Health Records: Are They the Next Big Thing?: " In the mid-1990s, at the dawn of the internet revolution, a small band of researchers hatched a plan to put health care directly into the hands of patients. According to their vision, people would turn on their computers and have access to a virtual caretaker—a set of software programs that would collect and store all their health records in a central place. The system, aptly called Guardian Angel, would follow a patient from doctor to doctor, interpret medical symptoms and lab results, manage treatment, and even offer medical advice.

Patients may become the main drivers of the personally controlled health record movement. “Individuals are having to care for their own health and curate their own information in ways that they’ve never had to face before,” said Mandl. The burden may become especially great for people with ailing elderly parents. They may be the early adopters of such a system along with parents of young disease-prone children.

Once set in place, personally controlled health records could open the door to a flood of business enterprises, such as diagnostic and monitoring services. “Nobody expected the personal computer,” said Mitch Kapor, developer of the blockbuster business application Lotus 1-2-3, in his keynote speech. “It represented a fundamental shift of power from people inside the computing industry to entrepreneurial outsiders like myself who had no cache.” The rise of the internet was also an unexpected phenomenon, he said. Like the personal computer, it succeeded because it was built on democratic principles—openness, interoperability, and decentralization. “If you give patients control of their data, it will be very empowering to them as individuals and also to the aggregate,” he said. “Build it and they will come.”

The Value of Giving Consumers Personal Health Records

The Value of Giving Consumers Personal Health Records: "Right now adoption of EMRs ( electronic medical record) is moving slowly. Why worry about PHRs ( personal health record) ?

These are two different services meant for two different types of users. A PHR may have value even if your doctor does not use an EHR. A lot of your medical data is already available electronically and can be brought to your home computer – your medications, lab test results, diagnostic images, procedures and diagnoses. We shouldn't delay using PHRs until all health professionals are using interoperable, connected EMRs – we'll be waiting a long time."

Value Innovation to Win in Healthcare

Value Innovation to Win in Healthcare : "While a consumer-as-purchaser environment represents a threat to the status quo, value innovation represents unmatched opportunities for the forward thinking health system. As health leaders approach the subject of value innovation, they should do so with the following in mind:

* Healthcare is over-qualified. Highly skilled clinicians treat the simplest of problems.

* Healthcare is overly complicated and fraught with barriers. Complex processes and problems frustrate consumers and add costs.

* Healthcare protects the status quo. Healthcare is resistant to change and adverse to innovations that are valued by consumers; long-established organizations often are entrenched with a “we know what is best” attitude."

Hospitals, clinics and doctors who learn to treat patients as valuable customers will thrive in the future !

Doctors report low morale; many consider leaving medicine -- HealthLeadersMedia.com

Doctors report low morale; many consider leaving medicine : "
Doctors say they are burned out, according to new findings of the 2006 American College of Physician Executives’ Physician Morale Survey. This is a sampling of what the survey found:
* Nearly 60 percent of the 1,205 physicians who participated in the survey have considered leaving the practice of medicine because they're discouraged over the state of U.S. healthcare today."

Who's going to be left ?

Monday, October 30, 2006

MDCalc, The Clinical Calculator.

MDCalc, The Clinical Calculator.: "Quick access to medical calculations.
MDCalc is quick access to all those medical calculations that are too painful to memorize, and too useful to ignore. After wasting time hunting through Google results to find the equations I needed, I created this site as a respository. Start spending more time diagnosing, and less time dividing ! "

One of the reasons why the web is a godsend for busy doctors !

#1 of 8 from "If Disney Ran Your Hospital" (by Fred Lee): Perceptions is more important reality

If Disney Ran Your Hospital" (by Fred Lee): Perception is more important reality: " Patient perceptions of care are more important than the actual care they received.
A few years ago, while Andre Agassi was still in the peak of his career, Canon advertised their new 'rebel' camera with Andre, and the tagline: 'Image is everything.'This is true for healthcare too ! "

Patients assume their doctors are technically competent - and that all doctors are equally competent ( though this is not true !) All they can judge you by is your "bedside manner" - which is why creating the right perceptions is so important !

Sunday, October 29, 2006

Myths and Facts About Generic Drugs

Myths and Facts About Generic Drugs: " Unless you want to waste a large amount of money—often hundreds of dollars a year—by using brand-name instead of generic drugs, you should ask for the generic version, especially if you are starting on a drug for the first time."

Misprescribing and Overprescribing of Drugs

Misprescribing and Overprescribing of Drugs There is no dispute that for many people, prescriptions are beneficial, even lifesaving in many instances. But hundreds of millions of these prescriptions are wrong, either entirely unnecessary or unnecessarily dangerous. Inappropriate prescribing is an academically gentle euphemism for prescriptions for which the risks outweigh the benefits, thus conferring a negative health impact on the patient."

Excellent article, which covers:
* Seven all-too-often-deadly sins of prescribing
* Evidence of Misprescribing and Overprescribing
* The Causes of Misprescribing and Overprescribing

Ten Rules for Safer Drug Use

Ten Rules for Safer Drug Use: "Ten Rules for Safer Drug Use.

Rule 1: Have “Brown Bag Sessions” with Your Primary Doctor; Fill Out a Drug Worksheet.
It is impossible to overemphasize the importance of this first and most crucial step in preventing adverse drug reactions. Whenever you go to a doctor you have not previously seen or to one with whom you have never had a brown-bag session, gather all prescription and over-the-counter drugs and dietary supplements in your medicine cabinet or anywhere else and bring them to the doctor so that a list can be made and you can start to fill out a Drug Worksheet."

Check out all the 10 rules - they can save your life !

Saturday, October 28, 2006

Embryo Transfer video - teaching infertile couples

I am often distressed by how poorly informed infertile patients are about their medical problems and their treatment options. This is true even for couples who have been through IVF cycles ! This is why we have produced a series of animations to help educate infertile couples about infertility and their treatment options.

Tolven eCHR - The electronic Clinician Health Record

Tolven eCHR - The electronic Clinician Health Record: " As a companion to an electronic Personal Health Record, an electronic Clinician Health Record enables care providers authorized by the consumer to have access to their latest healthcare information. How often has a care provider asked you what medications another doctor has prescribed, or what over-the-counter medicines you are taking? All of this becomes a thing of the past as the consumer and other providers update information on-line.

The electronic Clinician Health Record enables authorized care professionals to capture information about their treatment plans and findings. Clinicians can securely share the information that they have collected about their patients with other care providers."

What I really like about this is the way it seamlessly integrates with the Tolven PHR ! The purpose of a medical record is to allow sharing of information between patients and doctors, and this is a clever way of doing so !

dbMotion - sharing medical information

dbMotion: "dbMotion is an innovative provider of medical informatics. The dbMotion™ Solution enables healthcare organizations to securely share medical information, creating a Virtual Patient Record by logically connecting a group of care providers and organizations without data centralization or replacement of existing information systems. Healthcare organizations and health information networks (such as RHIOs, LHINs and HIEs) use the dbMotion Solution to share medical information among themselves and with other healthcare organizations. By sharing medical information, clinical staff can make clear critical decisions therefore providing safer and more efficient care. dbMotion currently serves one of the world's largest HMOs as well as other hospitals and health information networks."

This works well in developed countries, but is a very hospital-centric approach. I feel getting patients to own and operate their own PHRs ( personal health records) which doctors and hospitals could tap into ( when they setup their EMRs) would be a better approach in countries like India.

HealthBlog : Medicine on the Net: If not now, when?

HealthBlog : Medicine on the Net: If not now, when?: "When you consider that somewhere between 25 and 40 percent of all primary care visits could be augmented or replaced with information and services provided on the Net, one might wonder why we don't see more of this? Lack of reimbursement is likely the primary barrier.

I hope very soon, the barriers will come down and providers who wish to provide e-health services to their patients can be rewarded for doing so. I hope government will conclude that the provision of health information and certain kinds of medical services via the Web is not only reimbursable, but absolutely a cornerstone of modern healthcare delivery. Only then will we see the rise of an Internet-enabled, global healthcare delivery system reaching its full potential. "

I agree that if doctors could charge for e-visits, many more of them would offer these ! I don't charge for emailing my patients - but I find it's so cost effective
( no time is wasted on telephone tag ; and since everything is documented, there is no confusion) that I would find it expensive to stop doing so !

Consumer Health World Blog >> Technology is an impetus for change in consumer healthcare behavior

Consumer Health World Blog >> Technology is an impetus for change in consumer healthcare behavior: " Congestive heart failure (CHF) is a terrible disease. It is also an ideal condition to illustrate how powerful technology can be as a tool to change health care consumer behavior, improving care and lowering health care costs at the same time.
These days, our standard approach to CHF patients involves caring for them in their home by supplying them with a technology set that includes a digital scale, blood pressure cuff, pulse oximeter and a series of questions about their activities of daily living. The patient is responsible for gathering this data set daily. There is some magic that occurs when one gives the patient responsibility for this aspect of their care and educates them about the meaning of their vital signs and their relevance. Patients begin to take charge of their health, adhere better to their care plan and, particularly, pay more attention to their dietary salt intake. As one of our patients says, “I can’t cheat anymore. They’d have a nurse out here in a minute.”

Friday, October 27, 2006

The Rights of Patients: The Basic ACLU Guide to Patient Rights - Questia Online Library

The Rights of Patients: The Basic ACLU Guide to Patient Rights - Questia Online Library: "The Patient Rights Advocate.
Recognition of patient rights in the form of a Patient Bill of
Rights is a necessary, but not sufficient, step in the protection
and promotion of patient rights. Rights are not self-actualizing.
We may look forward to the day when all physicians, nurses, and
allied health professionals will accord patients their basic human
rights as a matter of course, but this day has not yet come. Until
this goal is attained, mechanisms that can help to ensure that
patient rights are protected and honored will be absolute neces-
sities. Some of these mechanisms are discussed in this chapter.
I continue to favor the one Jay Healey and I proposed in 1974: the
patient rights advocate."


WHAT IS SELF-MEDICATION ?: " The use of medicines available without prescription is nowadays generally accepted as an important part of healthcare. It is in line with the growing desire of everybody to take more responsibility for their own health. When practised correctly, self-medication can also save expenses for the national healthcare systems.

Medical doctors agree that:

1. Self-medication is the use by patients of non-prescription medicines for symptoms and minor ailments.
2. The patient bears the full responsibility for his own treatment. Therefore it is important to read the leaflet/label carefully.
3. Medical doctors and community pharmacists have a very important role to play in providing assistance, advice and information to the patients about self-medication and the rational use of medicines. Medicines manufacturers are the basic information providers on medicinal products.
4. The period for which you can self-medicate will vary according to circumstances, but should not normally be longer than three to seven days. "

When medical reality doesn't match the spin - - MSNBC.com

When medical reality doesn't match the spin - - MSNBC.com: "The NCI has faced a huge problem since 1971 when President Richard Nixon ordered the 'war on cancer.” Deaths from cancer — not only total deaths — but the death rate adjusted for the age of the population — have been climbing. Only last year for the first time did the death rate drop by a mere 1 percent. To secure funding, NCI is always painting a rosy picture of progress. The optimism in the face of reality reached its apex in 2005 when Dr. Andrew von Eshenbach — appointed by President Bush to head the NCI — declared a goal to 'eliminate suffering and death due to cancer by 2015.' Many scientists derided the statement."

The desire for money makes even scientists do strange things !

Ignoring the failures of alternative medicine - Second Opinion - MSNBC.com

Ignoring the failures of alternative medicine - Second Opinion - MSNBC.com: "So-called “dietary supplements,” such as DHEA, saw palmetto and chondroitin, present the biggest problem. Marketers often sell them under the guise of a mom-and-pop alternative to big pharma. Yet the $29 billion-a-year dietary supplement industry wields such power that it got Congress to pass a law in 1994 that basically frees it to peddle almost anything that doesn’t kill people with claims of medical benefit that need not be proven.

No doubt some of the thousands of products sold as dietary supplements work well, but the industry that sells them has neither motivation nor desire to know which ones work and which don’t.

Neither do many of those who advocate their use, such as the guru of alternative medicine Dr. Andrew Weil."

This is exactly the problem with alternative medicines being promoted for promoting fertility, such as Ovulex ! They don't work - and no one cares ! The occasional patient who gets pregnant after taking Ovulex ( or inspite of taking it) will swear by it - while the thousands who wasted their money buying it will just forget about it altogether.

Thursday, October 26, 2006

ELINCS Specification - CHCF.org

ELINCS Specification - CHCF.org: "The EHR-Lab Interoperability and Connectivity Specification (ELINCS) project published ELINCS version 1.0 in July 2005. The specification is an HL7 v2.4-based message profile for the reporting of lab results from laboratory information systems to electronic health records (EHRs) in the outpatient setting. The goal of the ELINCS project is to provide precise and generally applicable lab-reporting specifications that can be adopted as an industry standard, thereby obviating the need for clinical laboratories and ambulatory EHR systems to define anew each interface that is implemented."

What this means is that doctors are getting their acts together, allowing everyone to use the same standards when sharing medical data across medical records.

Unnecessary Medical Tests

Unnecessary Medical Tests" Americans probably spend more money on unnecessary tests and procedures than they do on quackery.
The big problem in combating this problem is
that the tests and procedures may be offered by
highly respected and well-meaning physicians. Some
doctors claim that a full battery of expensive tests is
needed to protect themselves against later charges
of malpractice if something is overlooked. While
there is some validity to this defense, there are other
reasons why testing is overdone. One is the demand
of the public—people who are bombarded with TV
and news items about the marvels of new technology.
But a doctor’s job is to resist doing a procedure if it
is not going to help the patient.

Questions You Should Ask.

Before undergoing a test or procedure, always ask
the following questions:
l What is the purpose of this test? Is it being
done to screen for a possible asymptomatic
disorder, such as high blood pressure, or is it
needed to confirm a suspected diagnosis?
l Is it definitive or will additional tests be
l What will it cost? Is there a less expensive
l How accurate is it?
l Does it cause discomfort?
l Are there possible complications or hazards?
Does it require anesthesia or hospitalization?
l How will the information be used? Will it, for
example, alter the recommended treatment?
l What is likely to happen if the test or procedure
isn’t done?
Much of the time the answer will be that the test is
being used to provide baseline data or to
confirm something picked up on a physical
examination. This may not be a sufficient
reason to justify the procedure. For example,
the presence of a few extra or skipped beats in
a patient without symptoms of coronary heart
disease is not an indication for a 24-hour Helter
monitor; even in patients with heart disease it
may not be indicated. The presence of a heart
murmur is not, by itself, an indication for an
echocardiogram. Everyone who has a heart
attack does not have to be catheterized. It is
very difficult for a layperson to make a judgment
about the necessity for a medical test, but by
being informed, one can perhaps avoid at least
some unnecessary inconvenience and expense."

What a great way to teach ( and learn ) surgery !

What a great way to teach ( and learn ) surgery !: "The primary audience for the Vesalius website is the emerging generation of physicians, or more specifically, the medical students, resident physicians, and practicing MDs who are currently engaged in the somewhat overwhelming process of medical education. Within this community of physicians-in-training, Vesalius focuses primarily on those interested in surgery and surgical anatomy.
In a sense, today's medical students and residents represent the first of the 'Internet generation' of physicians, since most of them (and essentially all of their successors) will have undertaken their medical education during a period when the Internet has emerged as a ubiquitous and comprehensive information resource.

By providing detailed narratives on surgical procedures and anatomy, as well as access to over 11,000 medical images and videos, Vesalius attracts the generation of students and young physicians that turns to the Internet first for practically any information – whether it's the review of a new movie, the latest weather forecast, or an explanation of an emerging surgical technique.

The Clinical Folios are a collection of graphical educational narratives on surgical anatomy and procedures designed for online reference and study. Unless otherwise noted, all Vesalius narratives and discussions are written by medical professionals. Content in the Vesalius Clinical Folios is arranged by topic and presented under five headings: Narratives, Discussions, Thumbnails, Transparencies, and Exercises."

Medcyclopaedia - Medical Spell Checker

Medcyclopaedia - Medical Spell Checker: " Add all words from Medcyclopaedia to your Microsoft Office dictionary!
Finally a spellchecker that understands your vocabulary! If you are tired of working with a spell checker that is not up to the job - try this one. Medcyclopaedia Professional Edition Medical Spell Checker offer you more than 5000 unique words compared with what normally comes with Word Processing programs!"

Medcyclopaedia - Library

Medcyclopaedia - Library: "Medcyclopaedia.com is a text, media and feature rich web site addressing the information needs of medical professionals around the globe. Here, among other high quality pieces of content, you will find the complete on-line edition of the Encyclopaedia of Medical Imaging, the complete on-line edition of A Global Textbook of Radiology, as well as several hundred carefully chosen chapters from the ESNR CD-ROM series. For the registered medical professionals, all images come in higher resolution - i.e. diagnostic top quality - and all images can be magnified and brightness adjusted on-line and in real time as you view the images on your monitor. All together, right here at your fingertips, you have a medical multi media library that covers more than 18,000 firmly explained medical topics and that contains more than 10,000 images and media clips - resources that you are permitted to borrow for your own non-commercial use, for instance in lectures, articles, and publications - provided that you acknowledge to the source: www.medcyclopaedia.com by GE Healthcare."

Every once in a while, I come across a gem of a medical website - and this is one of those ! It's everything a radiologist needs to know - available at one place, free !

Medical practise management on the web

Medical practise management on the web: "Another area where practice management vendors are boosting functionality is the Internet. Web portals can help improve communication between patients and physician offices and cut down on all those phone calls staff handle on a daily basis. In April, The Family Doctors in Shreveport, La., enhanced its Web site with portal software from Misys Healthcare Systems, Raleigh, N.C. The 11-physician practice's previous site was rather basic, offering such static information as driving directions, physician bios and a list of insurance plans the group accepted. The new Web site, built on the vendor's PatientLink portal software, offers educational videos on demand as well as online appointment scheduling and registration. The portal also enables patients to print, complete and fax authorization forms for the release of their medical records, saving a trip to the office. Online payment is an additional function the practice expects to add this year, says Lisa Britt, practice administrator."

Docs Monitor Labor on Smart Phones

Docs Monitor Labor on Smart Phones : "Docs Monitor Labor on Smart Phones. Fourteen obstetricians at Fairview Hospital in Cleveland are using smart phones to remotely access patient data and images using the AirStrip OB application from GE Healthcare, Waukesha, Wis. The software, which can be used on smart phones and PDAs running the Windows Mobile operating system, enables data and images from the Centricity perinatal clinical information system--also from GE--to be encrypted and then transmitted over cellular networks. Obstetricians log into the application on their handheld device to have view-only access to the information. After 15 minutes of inactivity, all the patient information automatically is deleted.

Fairview obstetricians can use the software to view fetal heart tracings, maternal contraction patterns, vital signs, nursing notes and other patient data on their handhelds."

Wednesday, October 25, 2006

My Personal Health Record

My Personal Health Record: "Keep Track of Your Health Information Easily

* Do you sometimes forget the date of your last pneumonia vaccine or when your son had his last tetanus shot?
* Is it hard to remember all of the medications that your parents are taking?
* Would you like to have one place to keep track of health information for yourself and your loved ones?

On our secure, confidential site, My Personal Health Record, you can create, store and update health information for you and your family, free of charge.

And your information is confidential: Only you can access it, unless you choose to give permission to another person.

You can access it when you’re at

* Home or work,
* Your doctor’s office,
* An emergency room, or
* Anywhere with a computer and internet access."

I am very pleased to see that this hospital is offering a free PHR to everyone who visits their website. This is a clever idea - and is a value-added service patients will appreciate !

Medical Journal articles for Patient Research

Medical Journal articles for Patient Research : "Elsevier is the world's leading publisher of Medical Information. We are proud to make available our Patient Research option as a Beta program for patients, or friends/family of patients, who have a medical need for information regarding a medical situation for them or someone they know. This Beta program provides the article you request for free, with a small handling fee, $4.95. After ordering the article and confirmation of payment, we will e-mail the document to you typically within 2 hours, but no longer than 24 hours."

This is a great initiative - full marks to Elsevier ! A lot of high quality medical information is locked up in medical journals, and patients don't have easy access to this . This program will help to provide patients with this, so they can become as well - informed about their problem as their doctor is ( if they choose to do so !)

Tuesday, October 24, 2006

Producing patient education videos in India

I am very excited by how inexpensively we have been able to produce high quality patient education videos in India by combining the skills of medical experts computer graphics technology wizards. A 5 minute animation costs us about US $ 2000 - as compared to US $ 10000 in the US ! We hope to be able to leverage this expertise as the demand for patient education videos increases globally !

Monday, October 23, 2006

Consumer Reports Best Buy Drugs

Consumer Reports Best Buy Drugs: "Prescription drugs can be expensive, even if you have insurance coverage. But there are medicines that can effectively meet your medical needs and give you better value for your health care dollar. Consumer Reports Best Buy Drugs is a free public education service from the nonprofit Consumers Union, publisher of Consumer Reports. Millions of Americans trust Consumer Reports to provide expert, independent information about products and services, and to help them save money.

The information on this website can help you learn about more affordable drug treatment options to discuss with your physician. We work with respected doctors and pharmacists to compare drugs and point you to those that are proven to work based on current scientific evidence. In concise, easy-to-read reports, we tell you what you need to know about the effectiveness, safety and cost of many widely used prescription drugs."

Offshoring and Healthcare

Offshoring and Healthcare: "Both the tourism and the healthcare industries in a number of offshore locations are joining forces to create attractive destinations for patients from the US and Europe. The projections for growth are very promising. A joint study performed by the Confederation of Indian Industry and McKinsey & Company in 2004 estimated that the medical tourism business in India alone might generate revenues in excess of $2 billion by the year 2012."

This of course means a loss of $ 2 billion dollars for the hospitals and doctors of the countries where these patients come from !

A unique Indian experiment in online medical publishing

A unique Indian experiment in online medical publishing : "An innovative experiment in publishing by a doctor in Mumbai has sparked off a wide range of academic publications, giving authors hundreds of new readers and a genuine chance to create relevant new knowledge.

Mumbai-based Medknow is an open publishing firm that creates academic (mostly medical) journals, puts them online, and makes them accessible to all.

While sharing all this useful information without a fee, it makes a tidy profit for itself and also builds readership and credibility for both the journals and the authors.

Started by Dev Kumar Sahoo, a doctor, Medknow Publications Pvt Ltd promises to 'provide solutions for the scientific publishing community, helping in publication and dissemination of research and thus converting research to knowledge.'

'We now have 33 journals being published by us,' Sahoo told IANS. Journals published include the Journal of Postgraduate Medicine, Indian Journal of Medical Sciences, and a range of other technical and scholarly publications."

This is a treasure trove of quality peer-reviewed medical information - by Indians, from Indians, for Indians !

Sunday, October 22, 2006

IVFConnections.com List of All Boards

IVFConnections.com List of All Boards: " Infertile patients provide a lot of support to each other - and lots of it is now online !
These are some of the Forums/ Bulletin Boards which infertile patients use to reach out to each other, so there's no need for them to feel alone !

IVF Cycle Buddies ;
IVF Veterans ;
Pregnant after IVF;
Men discussing IVF
Same Gender IVF ;
Single Women ;
Stressful Situations
PG w. donor eggs/embryos/sperm
IVF by Age Groups
PG with twins or more
Marital Difficulties
Financing IVF
High Risk PG
IVF after pg loss
Bed Rest Buddies
Debating Donor Options
Egg Donors (for donors)
Parenting after IVF
Frozen Embryo Transfers (FET)
IVF in Asia
Parenting after Adoption
Lining Issues"

I found it very interesting to see how differently infertile couples organise their discussions - based on geography and personal issues. This is in sharp contrast to infertility specialists, whose discussions are based primarily on the diagnosis !

Online Patient Communications Appointment Reminder Services using Email

Online Patient Communications Appointment Reminder Services using Email "Preventing broken appointments has always been important to Dr. Wadler. He has used an automated telephone reminders system for Email appointment reminders...years, and he talks of the differences he sees between calling and emailing. 'With a phone call, we're never sure they got the message. Sometimes little brother takes the call and hangs up. Sometimes the messages don't record completely on answering machines, or the kids delete them. I feel that email appointment reminders reach patients more effectively than phone calls.' Dr. Wadler notes that confirming appointments two days in advance via email is an additional benefit, because patients have time to reshuffle their schedules if they've overbooked. 'Or they call and let us know they can't make the appointment so we have enough time to offer it to someone else.'"

Online Patient Communications Appointment Reminder Services using SMS

Online Patient Communications Appointment Reminder Services using SMS : "TEXT ME, DOCTOR! Sesame Communications has added text messages as an option for patients who wish to receive appointment confirmations from their dentists directly to their cell phones. Use of mobile phone text messaging, also called SMS, has been exploding in North America. It is particularly popular with teenagers, who make up the largest part of a typical orthodontic practice.

“We help our member practices tailor their approach to each patient according to that patient’s personal preferences,” says Frith Maier, CEO of Sesame Communications. “By giving the patient the tools to customize his experience, we build loyalty to the dental provider and increase patient referrals. It made sense for us to add text messages to the Sesame suite of services.”"

SMS is still a very underutilised tool in most medical practises, but it can help to improve patient compliance and minimise "no-shows" !

Putting Patients First

Putting Patients First: "There is little disagreement that our health and medical care system is in need of fundamental reform. But what should be the first step?
The National Health Council, an organization representing all segments of the health care community to improve the health of all people, believes meaningful reform must begin with patients and their families -- empowering people to play an active role in promoting health, preventing disease and managing their own health care decisions. Further, the Council believes adoption of, and widespread access to, personal health information technology (PHIT) is the logical starting point. Among other things, PHIT enables the documentation of an individual's complete, lifelong health and medical history into a private, secure and standardized format that he or she owns and controls, but yet is accessible to legitimate providers day or night from any location."

Makes sense ! We need to start with a PHR so patients are in control of their healthcare !

Saturday, October 21, 2006

HealthWISE - creating new markets by scanning for presymptomatic diseases

HealthWISE - creating new markets by scanning for presymptomatic diseases: "HealthWISE is more than just a screening facility. It is a doctor-referred wellness diagnostic center specializing in the detection of common, 'pre-symptomatic' diseases—cardiovascular and vascular disease, lung and colon cancers and osteoporosis. These diseases share numerous characteristics. They all have the potential to be treatable or preventable if diagnosed early and they share many risk factors, including diet, inactivity, smoking and family history, among others. Following diagnostic testing, a specific individualized wellness strategy (the HealthPATH) is provided to each patient and his or her doctor. What is the difference between screening and "pre-symptomatic" disease?
Screening is a generic term that has both good and bad implications. For instance, should all individuals be "screened" by age 30 for cholesterol? The answer is YES. However, should all individuals with high cholesterol before age 30 be given life-long drugs to lower cholesterol? The answer is NO. Individuals being evaluated for "pre-symptomatic" disease are those who, together with their doctor, determine that age, gender, medical history, environment, lifestyle, or heredity gives them a "better-than-even chance" for premature but preventable disease—such as heart/vascular disease, lung/colon cancer, and osteoporosis. Using the knowledge of the presence or absence of early disease, specific recommendations can be made to help maintain personal health and wellness."

This is a clever approach to increasing the market for the new scanners. All of us are "presymptomatic" patients after all ! The key question, which has never been answered as yet, is whether picking up these diseases early affects their natural history. It's tempting ( and logical ) to assume that the sooner we diagnose a disease the more effective our treatment will be, but no one knows if this is true or not !

Friday, October 20, 2006

California Pilot Offers Online Patient Info to Rural Docs - iHealthBeat - Daily News Digest on Health Care Information Technology

California Pilot Offers Online Patient Info to Rural Docs - : "A clinical message service pilot in Ukiah, Calif., aims to provide physicians with online access to patient test results and imaging scans.The project eventually could offer physicians many electronic health record system functions without the high cost, according to Carl Henning, president of Redwood MedNet and an Ukiah orthopedic surgeon. The clinical message service costs much less than an EHR system because software is placed on a secure Web site that physicians can access without having to purchase it individually. Hospitals and labs will enter their test results electronically on the secure Web site, which will sort the documents. Physicians then can enter their codes to access their patients' tests."

This is interesting ! A problem which often deters patients from signing up for a PHR ( personal health record ) is that their doctors will not buy in to the system. However, if patients can upload their scan images and lab reports to their own PHR, this will make it much easier for them to communicate intelligently with their doctors - even those who do not have a EMR ! And once their doctors see the benefits of having medical records online, they may be persuaded to adopt them for their own practises !

`Mother standard' guides cancer care | Chicago Tribune

`Mother standard' guides cancer care | Chicago Tribune: "To hear cancer hospital developer Richard Stephenson tell it, the U.S. health-care system is finally moving toward medical care that would be good enough for his mother. With a surge in consumer choice initiatives, U.S. care providers are increasingly putting patients first, converting hospitals to all private rooms and offering catered food and massage and nutrition therapies, which were once considered 'alternative' or part of a holistic approach. These are all ideas that have been part of Stephenson's 'Mother standard' for nearly 20 years, since he founded the Cancer Treatment Centers of America . He touts the large and small touches at his three existing hospitals, ranging from the latest $5 million imaging suite to physicians who return patient phone calls within the hour and the hospital's cafeteria servers decked out in cummerbunds and ties."
"At most organizations, the doctor is the center of the health-care system and that is not the case here," said Dr. Edgar Staren, a Chicago native who joined CTCA last year as chief medical officer and surgical oncologist after a stint as a professor and medical/surgical director at Medical College of Ohio Cancer Institute.

This makes a lot of sense as regards patient care ! If it makes business sense too and boosts the bottom-line which Americans worship, then lots more hospitals are going to adopt this "patient-friendly" approach !

Wednesday, October 18, 2006

PatientsLikeMe : Tutorial

PatientsLikeMe : Tutorial: " Use PatientsLikeMe to track your progress and make better decisions. We make it easy to get going.
* Simple data entry. Just answer some questions!
* No long forms.
* The more you share, the more you learn"
This is Web 2.0 as applied to healthcare. Clever websites are building up communities of patients who can help and support each other !

Mobile Phones Used To Track Diseases

Mobile Phones Used To Track Diseases: Mobile phone technology is being developed to manage the spread of communicable diseases, such as bird flu and HIV, in Rwanda and Indonesia, BBC News reports. The software used in the trials allows field workers to use handsets to send and receive patient and drug data, and information on disease outbreaks. The information can be transmitted through the 'general packet radio service' network, and, if the network is unavailable, data can be sent through an SMS data channel, which typically is used for text messaging. The software, which is programmed with interoperable Java language, allows physicians to send data to central databases and receive alerts, treatment guidelines or lab test results, BBC News reports."

Sunday, October 15, 2006

Why infertility is a much bigger problem in Africa and India

I received a very touching email today.

" I am a Zimbabwean woman who has lived with infertility. Recently, I joined a local support group for women living with infertility called Chipo Chedu.

Of late, childless women have made headlines in our local newspapers for stealing babies from their unwary mothers and we feel that it is important for the childless people to develop positive and better ways of dealing with their problem.
Infertility and childlessness are conditions that have always carried social stigma and a subject not for discussion. Affected families have had to endure the agony on their own with little or no support from the society around them.

Divorce Rate is high amongst people living with infertility

Many childless homes are breaking. Zimbabwe is a patriarchal society and many childless couples are finding it difficult to cope with their own (and their extended families’) - hopes, expectations and pressure to have children. The problem has been especially acute for women who culturally have borne the brunt of the stigma, ostracisation and blame for childlessness in a home. Women without children suffer social rejection and are made to feel personally inadequate. The general belief is that people, particularly women who fail to bear children, are cursed and must be shunned and ostracized.

Promiscuity in childless marriages

Men as well as community at large have not made the burden any easier on the childless woman. Husbands have used infertility as an excuse for promiscuity and in some cases divorce. They openly bring home other women to "bear" them children while at the same time subjecting their partners to unspeakable physical and emotional abuse. Women in such relationships have found it almost impossible to turn to their families for support as it is believed the man is justified in his search for an heir to his name. Indeed even in relationships such as these the woman is unable to insist on protection as she is trying for a child and thus exposing her to infections. The childless woman is therefore in an even greater risk of being infected with HIV/AIDS.

Rape and Child Abuse in Childless marriages

Some couples resort to bringing in a young female relative, mainly the woman’s brother’s daughter (a niece). Culturally, a niece is considered as the husband’s wife (muramu in shona). These children are then raped by the husband in a bid to have children, with the blessings of the aunt as she is afraid of losing her marriage. The results of such an act are far reaching and until something is done to stop this practice, our culture is prefers to turn a blind eye.

Our Culture

Our culture must move with the times. There is need for pressure to bear on the man of Zimbabwe to acknowledge and take responsibility for Infertility as a condition that can affect them as well. There is need for the man of Zimbabwe to get involved in the search for answers as well as seeking coping strategies for living with and dealing with the issue of infertility in a home. For many years, male infertility has been regarded as a taboo subject, to be concealed at all costs. However, research has since revealed that

10-15% of couples world wide are unable to conceive a child.
94% of couples who are affected by infertility problems never seek medical help or do not have access to it
Among couples affected by infertility, 40% of cases are related to male issues, while female issues also make up 40% of cases.
20% are either combined male and female or cannot be explained.

Educate communities

Society as whole needs to be made to understand the pressures that arise from stigma and ostracism that the childless woman is exposed to. People affected by infertility experience a range of negative emotions such as depression, bitterness, resentment, anger, guilt and feelings of inadequacy, which have seen some women stealing babies from other women in order save their marriages and themselves from the shame of childlessness. Generally, ignorance, denial and discrimination are symptoms of lack of information. It is therefore our desire that our women and men of this country have access to high quality information that will assist them to make healthy choices and positive life decisions for themselves and their families

Elderly Care

The childless woman has no one to look after them in their years of infirmity. In our society for instance, it is the adult children who are a crucial source of care for the frail and old, especially for widowed and divorced people who cannot turn to spouses for help. Adult children are indeed the main source of income for the parents when they get old Because the government is unable to pay for social security or other support for the old, the children automatically become a retirement savings plan. It’s an obligation which the majority of children assume without question or complain. Who then looks after the childless woman or man? To make matters worse, upon the death of a spouse, the childless woman is sent away from the matrimonial home with nothing. Some end up as destitutes while others move back with their parents – if they are still alive. Government and its partners can help support our desire to set up centres where childless couples can live together with orphaned children in mutual support. "

I feel this will be an eye-opener to many infertile couples who live in more privileged societies. Not only is infertility a major personal crisis in India and Africa ( just as it is for any infertile woman anywhere in the world); it also has unique social overtones, as this letter points out so eloquently !

Egg donors looking for prospective couples

I received an interesting email today.
" Dear Doctor,I have come to know about your clinic through related websites on these
topics. I would like to become an egg donor or a surrogate mother (either
Traditional or Gestational) or both as you and / or your patient may find my
suitability.I am fully aware of the medical procedures, its implications, expectations from me, etc. I am looking for a reasonably affluent intending couple who can provide me above average compensation (for example something similar to
a level which between what Indians normally offer and what western countries
such as USA offer) so that the same can be utilized by me to provide a
better future for my twin kids. I am also aware that, normally clinics or doctors do not involve into the aspect of providing the egg donors and surrogate mothers and the patients themselves are expected to arrange this service provider directly. In the
absence of a proper intermediary agency, this is a difficult task where the
couples do not know how to locate people like me and people like me do not
know how to locate a prospective Intending couple. Hence, your assistance is very essential and will be highly regarded by me."

I think this is a clever use of the internet, which allows donors and recipients to get in touch with each other directly, without the use of an intermediary !

Take your doctor with you !

Take your doctor with you ! : "PlanetHospital, which helped Mr. Hulmes with his trip, caters to nervous patients with a service called “the best of both worlds,” in which American doctors travel with patients overseas to perform surgeries and then handle follow-up care back home. PlanetHospital’s price for a heart valve replacement in India with an American doctor is $11,000. That includes the doctor’s malpractice insurance as well as airfare and hotel for both physician and patient. The surgery typically costs about $55,000 in the United States. PlanetHospital now offers it to insurers, which can offer it to employees. The first patient has signed up for the service, and PlanetHospital’s owner, Rudy Rupak, expects more to do so soon. “I can give you a familiar doctor and suddenly it makes it affordable,” Mr. Rupak said. “Your geography changes but everything else stays the same.”"
And your doctor gets a free holiday in the bargain !

Basking on the Beach, or Maybe on the Operating Table - New York Times

Basking on the Beach, or Maybe on the Operating Table - New York Times: "A coronary artery bypass, it said, could cost $75,536 in the United States but $11,438 in India; a $36,664 knee replacement here might be $17,824 in Singapore. Such savings have caught the attention of large and small companies, too. United Group Programs, an insurer in Boca Raton, Fla., offers medical travel in its health plans to 4,300 corporate clients. About 40 employers now offer those plans to employees.The West Virginia legislature is studying a proposal that would encourage state employees to travel abroad for some procedures, giving them cash bonuses equivalent to 20 percent of the net cost savings. The balance of the savings would go into a fund to reduce the amount employees pay for health care premiums. State Delegate Ray Canterbury, a Republican who proposed the bill, said he thinks such a shift could add to pressure to make domestic health care more affordable."

Thursday, October 12, 2006

The Conversation - washingtonpost.com

The Conversation - washingtonpost.com: "It is an honor and a privilege to help a parent die."

Doctors Slow to Adopt E-Records for Patients - washingtonpost.com

Doctors Slow to Adopt E-Records for Patients - washingtonpost.com: "'The big problem is that the vast majority of electronic medical-record systems do not give patients the right to decide who has access to the records,' said Deborah C. Peel, a psychiatrist and founder of Patient Privacy Rights, an Austin-based nonprofit that wants greater safeguards. 'They do not give patients the right to segment sensitive portions. . . . The electronic medical records in use now have been designed primarily for the convenience of physicians.'"
This is one of the reasons PHR make much more sense than EMRs ! They are owned by the patient, who can share them with whomsoever they choose.

Open Source Conversations: Adam Bosworth

Open Source Conversations: Adam Bosworth: "He speculates that the ability of a community to interact within an application may eventually outweigh the content provided by the application itself. Bosworth then calls special attention to the health care industry. As the population ages and health care costs continue to soar, Bosworth sees tremendous opportunity for developers to embrace the health care community and to build useful tools which cater to clusters of patients and doctors. 'Health is the new enterprise,' Bosworth claims, and there's a growing need for tools that allow members to add value to their community by sharing information and experiences related to their health; tools that can lead to better predictors of health conditions, earlier diagnosis, and more successful treatments."

Amid The Intensity Of Neonatal ICU, Havens For Privacy Begin To Emerge

Amid The Intensity Of Neonatal ICU, Havens For Privacy Begin To Emerge: "The room will allow private good-byes, and it will also provide a place for discussions about babies who may face surgery or a lifetime of challenges, says Dr. Victor Herson, the medical director of the NICU at CCMC. 'For every one death, we have 10 serious conversations, maybe about a baby with a poor long-term prognosis.'
The cozy room with subdued dark-blue walls is set up like a living room. On one wall are plugs that allow parents to wheel in the bassinette and spend quiet time with a baby without removing life-sustaining equipment. Doyens says anybody who has had a premature baby knows the time in the neonatal intensive care unit can be a harrowing roller coaster ride.'Caroline's Room makes that ride a little less bumpy,' he says."
What a great way of keeping the memory of their baby alive for ever !

Wednesday, October 11, 2006

High-Speed Internet Connects Physicians in U.S., India

High-Speed Internet Connects Physicians in U.S., India - iHealthBeat : "Physicians at Johns Hopkins University this week used Internet2 - an advanced Internet connection - to interact with physicians in India during an online, interactive HIV/AIDS clinic, the Baltimore Daily Record reports. The Internet2 network, which is about 1,000 times faster than the average home broadband connection, connected physicians at eight U.S. facilities and three Indian facilities. The online clinic also utilized video conferencing, high-resolution digital microscopy, three-dimensional MRIs and an interactive model of HIV drug resistance. Dr. Robert Bollinger, director of the John Hopkins University Center for Clinical Global Health Education, said the Internet2 program will expand on the university's work to provide care and education to areas of the world with limited resources. He added that utilizing the Internet2 network is a long-term, cost-effective alternative to physicians traveling across the world, the Daily Record reports."

Health standards for India

As medical tourism becomes increasingly important for the Indian healthcare industry, patients who come from overseas are going to demand assurance that the quality of the medical care they receive in Indian hospitals and clinics is of a high standard. Unfortunately, Indian healthcare facilities are of very uneven quality - it is nearly impossible for a patient travelling from the US or the UK to India to determine how good ( or bad) the doctor he is going to seek medical treatment from is. Today, most patients go by word of mouth reputation; or select a "corporate hospital" with a brand name.
One simple way to help patients find high quality medical care services in India is to ensure that hospitals adopt internationally recognised standards. However, it is not practical to adopt US standards such as the JCAHO standards, because if we do so, then medical costs would be nearly as high as they are in the USA - and most of it is wasteful expenditure on clerical documentation. It's important for Indian hospitals to create their own standards - and this can be difficult to do, as doctors are very reluctant to "toe the line". The best way is to identify high quality Indian hospitals ( such as Narayan Hrudalay or Sankar Netralaya) and adapt their standards. This would be much more practical and cost-effective. Instead of blindly aping the West, we can create our own standards, as adapted to our needs !

Tuesday, October 10, 2006

USATODAY.com - Mental health treatment by video growing

USATODAY.com - Mental health treatment by video growing: "Psychiatrists, often in need and hard to find in rural areas, are increasingly turning to video to treat their far-flung patients, illustrating one of the latest growth areas of telemedicine. Once the telemedicine session starts, it's no different than a face-to-face,' said Dr. Umar Latif of the Dallas VA Medical Center, which has been offering psychiatric sessions over video for more than a year. Video medical treatment increasingly is filling the gap in regions of the country where specialists are in short supply. And mental health appointments work especially well over video, enabling therapists to reach many patients who otherwise might not get help, experts say."
And it's as easy to provide this from India - at half the cost ! Medical outsourcing is going to become increasingly popular.

Monday, October 09, 2006

How to H.E.A.L. disappointment

" The word H.E.A.L. can remind you how to successfully communicate with patients and families and how to help them heal from disappointment:

  • H is for Hear. Hear what the patients and their families are trying to say.
  • E is for Emotions. Address patients' and families' emotions.
  • A is for Ask and Answers. Ask the patients and families to tell you what they already know, and answer what they want to know.
  • L is for Loyalty. Foster and rebuild loyalty.

This nugget was adapted from Communication Strategies to Help Patients H.E.A.L., an HCPro, Inc. publication."

Clever acronyms can help when you are stressed out and not sure what to do next !

Sunday, October 08, 2006

Busting myths about mental illness in India

Busting myths about mental illness in India: " NAMI's mission is: To help in the eradication and treatment of mental illness in India by integrating and involving consumers, mentally challenged people, doctors, healthcare workers, Government and other sections of society.
1. To eradicate the stigma associated with mental illness in our society.
2. To make available treatment and medication to all sections of society.
3. To be a nodal agency to support the rights of persons who are or have been treated for mental illness.
4. To help in the reintegration of people with mental illness in our society."
The great thing about running HELP , the world's largest patient education library, is that I meet so many interesting people. One who has especially impressed me is Akila Maheshwari, who runs NAMI, which aims to dispel the myths about mental illness in India. What is really unusual about her is that she has schizophrenia - and is proud of it. Life has served her lemons - from which she has made lemonade, which she shares with the rest of the world !

Lotsa Helping Hands

Lotsa Helping Hands : " Lotsa Helping Hands is a simple, immediate way for friends, family, colleagues, and neighbors to assist loved ones in need. It's an easy-to-use, private group calendar, specifically designed for organizing helpers, where everyone can pitch in with meals delivery, rides, and other tasks necessary for life to run smoothly during a crisis."
If you ( or a loved one ) have an illness, and if anyone asks, "What Can I do to help ?", this is a great way of allowing them to help you in a constructive fashion ! This site allows you to create your own support group of volunteers !

Saturday, October 07, 2006

Ask the Doctor Your Medical Question Online at MyPhysicians.com

Ask the Doctor Your Medical Question Online at MyPhysicians.com: "Unsure if you got the correct medical advice? Too embarrassed to ask your physician what's really bothering you? Having to wait weeks or even months before your next doctor's appointment? Eliminate your worries right now and let our team of US board-certified medical specialists with a combined 200 years of clinical experience answer your health concerns."

Unnecessary angiograms

Heart disease is one of the "big killers" - and angiograms are one of medicine's most profitable procedures. Unfortunately, they are overused and misused. Here's a chillingly true story I read in Dr Levine's book, What Your Doctor Won't ( Or Can't) Tell You. " At a recent meeting of cardiologists, members were asked three questions . They were asked to raise their hands if they thought some of their colleagues performed unnecessary angiograms on patients . Almost all those present raised their hands . They were then asked if they knew someone in that room who performed unindicated angiograms and again almost everyone raised his hand . Finally , they were asked if they ever performed nonindicated cardiac catheterizations. This time , not surprisingly , no one raised his hand ! " This would be funny if it weren't so true ! The message is simple - let the patient beware . The book is a goldmine of useful information - and is a very enjoyable read as well - buy it !

Friday, October 06, 2006

NEJM -- Videos in Clinical Medicine -- A New Journal Feature

NEJM -- Videos in Clinical Medicine -- A New Journal Feature: "This week, the Journal's table of contents includes a new type of article, Videos in Clinical Medicine. Innovative technology affords us the opportunity to offer peer-reviewed educational videos that capitalize on the ability of moving images to teach procedures requiring skilled techniques and specialized physical examination. This first series of teaching videos is intended to help students, trainees, and younger physicians to learn procedural techniques from experienced colleagues. Our ultimate goal is to provide effective clinical instruction and improved patient care."
Medical journals are re-inventing themselves and using new technology to educate their readers.

Wal-Mart speeds low-cost drug plan - The Boston Globe

Wal-Mart speeds low-cost drug plan - The Boston Globe: "Wal-Mart Stores Inc. expects to offer $4 prescriptions for some generic drugs in most states this year after expanding the program from a test market to all of Florida ahead of schedule, the world's largest retailer said yesterday.Wal-Mart also raised the number of generic prescription drugs offered under the $4-for-a-month's-supply plan to 314 from 291. The new number comprises 143 drugs in a variety of dosages and solid or liquid forms that together make up the total, up from about 125 drugs when the program started, Wal-Mart said."
This is going to set the cat amongst the pigeons as consumers are going to start demanding more reasonable costs for the drugs they take !

Wednesday, October 04, 2006

How modern medicine is corrupting alternative medicine

Alternative medicine in the form of natural herbs is making a big come back. Chinese medicine and ayurveda are becoming increasingly popular as people are looking for "natural" alternatives to western medicines which are potent - and have equally powerful side-effects ! I heartily approve of this - and believe patients should be encouraged to take whatever works for them, no matter what "system" of medicine discovered that particular therapeutic agent. After all, in onse sense, these are all artificial distinctions and barriers which doctors have constructed, primarily to protect their own turf ! However, what worries me is that alternative medicine is being corrupted.

In today's worls, everyone wants a quick fix - a pill for every ill ! And there are enough businessmen who are ready to pander to this demand. Herbs are now being packaged in pouches and capsules - but I feel that the very process of this packaging is not causing them to lose their efficacy. For example, studies have shown that processed herbs no longer provide the same antioxidant efficicay the "natural " product does.

Even more importantly, I feel we are debasing and corrupting the basic underlying philosophy of these traditional systems of medicine in our search for a quick cure. Traditional systems were a "system of life and health" - and formed a philosophy of life and living. They provided a holistic system of living which provided guidelines for all areas of life - how to eat; when to eat; what to eat; exercise; prayer; personal relations, and so on. I am sure the very process of actually hunting for the required herbs ensured that patients would get exercise in the open air - and this would also help them get better.

Homeopathy is an excellent example of a system which has been completely bastardised. Originally, it was based on providing a remedy which was tailor-made for each person, based on their constitution and complaints. Today, these are packaged as pills for practically any disorder you care to name. I am sure Hahnemann must be turning in his grave !

What we are trying to do is to "distill" the essence of these therapeutic systems into chemicals and then packaging them in order to sell them to millions. Can this possible work ? Or are we fooling ourselves ?

2020: The View from 2006 -- HealthLeadersMedia.com

2020: The View from 2006 -- HealthLeadersMedia.com: " Healthcare consumers are Healthcare Kings and Queens. They control their health destinies, choose and afford the best, and rely on themselves, rather than payors and providers. They completely control their sensitive personal health information. Control of that information dictates with whom consumers do business and determines whether electronic and personal health record systems succeed or fail. Health consumers are true gatekeepers of their personal and private information."
What a great vision for the future ! Will doctors allow this to happen ? Most are very reluctant to give up control and power !

Social Impact Games :: Entertaining Games with Non-Entertainment Goals

Social Impact Games :: Entertaining Games with Non-Entertainment Goals: "Health and Wellness Games are among the most researched Social Impact Games as to their effectiveness. They are also a hot topic for proposals right now at the NIH. "
One of my perennial areas of interest is combining learning with fun ! Health games are a great tool for edutainment !

Tuesday, October 03, 2006

Going Lean in HealthCare

Going Lean in HealthCare So what is meant by “lean thinking”? Simply put, lean means using less to do more.
Lean thinking is not typically associated with health care, where waste — of time, money, supplies,
and good will — is a common problem. But the principles of lean management can, in fact, work
in health care in much the same way they do in other industries. This paper presents a brief
overview of lean management principles, and provides examples of two health care organizations
that are successfully using lean thinking to streamline processes, reduce cost, and improve quality
and timely delivery of products and services.The core idea of lean involves determining the value of any given process by distinguishing valueadded
steps from non-value-added steps, and eliminating waste (or muda in Japanese) so that
ultimately every step adds value to the process.
To maximize value and eliminate waste, leaders in health care, as in other organizations, must
evaluate processes by accurately specifying the value desired by the user; identifying every step
in the process (or “value stream,” in the language of lean) and eliminating non-value-added steps;
and making value flow from beginning to end based on the pull — the expressed needs — of the
US hospitals can learn a lot from Indian doctors working in government hospitals , who are used to working on lean budgets ! In India, necessity is the mother of invention !

Kaizen and Lean Healthcare

Kaizen and Lean Healthcare : "One of the key ideas in Lean is to increase velocity, or the amount of profit generated over a period of time. Velocity is increased by examining the revenue generating sequence of activities called Value Streams. When waste such as delays, errors, transportation, motion, and so forth are eliminated from these operations what remains is the ability to provide the same value in less time. Flow is the key to increasing velocity.
What is the impact of better patient flow for hospitals? As waiting time is reduced, the healthcare experience for the patient improves, reducing waiting time and speeding recovery. As patients flow from process to process (from sickness to health) beds turn faster, and more patients can be served. More patients served equals to more revenue for the hospitals. "
Happier patients - and happier hospitals ( and doctors) !

Physician as chief executive officer is a trend

Physician as chief executive officer is a trend : "When a search committee began its hunt in January for a new chief executive officer of Aurora Health Care, members quickly learned through market research that a doctor might be the best choice. Executive search consultants from Spencer Stuart, Chicago, conducted lengthy interviews with Aurora employees and community leaders outside the Milwaukee-based health care system. Almost universally, interviewees expressed the desire for a leader whose top priorities were not simply business acumen but patient care, innovation and quality in medical settings."
Makes sense. It's much easier for a physician to learn business skills than for a CEO to learn medical skills !

Web Site Seeks Patient Input on Statin Side Effects

Web Site Seeks Patient Input on Statin Side Effects : "University of California-San Diego researchers last month launched the Statin Effects Survey Web site to collect feedback from patients on potential side effects of statin drugs, the Wall Street Journal reports. Reliable side effect data on statins, a class of cholesterol-lowering drugs, are incomplete because studies that aim to evaluate the potential benefits of a drug often are designed differently than studies that aim to evaluate the harm a drug might cause, according to Dr. Beatrice Golomb, the UCSD assistant professor who created the Web site. "
When a large number of patients put their experiences and wisdom together , they will have enough clout to be able to improve the healthcare ecosystem !

IT Tools for Chronic Disease Management: How Do They Measure Up ?

IT Tools for Chronic Disease Management: How Do They Measure Up? : "Chronic disease management systems (CDMS) focus specifically on managing chronic disease and preventive care, while the more comprehensive electronic medical record (EMR) documents the entire patient encounter and provides real-time patient information. Few, if any, studies, have compared the merits of these two tools, which show potential to reduce costs and improve outcomes for patients with chronic illnesses. IT Tools for Chronic Disease Management: How Do They Measure Up? assesses them side by side."

IVF bloggers

cyclesista: "...who are the lucky bloggers this month?..."
I learn a lot from my patients - and I have found that I can learn a lot from the infertile patients ( the vast majority are women) who keep their own blogs. These are brave women, who share their innermost feelings, deepest desires and darkest moments with the rest of the world. This is a courageous thing to do - and by helping others , they help themselves ! I learn a lot about what infertile couples go through by reading these blogs !

High Quality Patient Education Animations from India

We are now producing and selling high quality video animations for patient education. Since they are made in India, they are much less expensive than comparable products made in USA. We hope this product range will help to make high quality patient educational materials more widely available !

Monday, October 02, 2006

The gift that keeps on giving !

The great thing about being an IVF specialist is that you can see the fruits of your efforts grow and evolve ! Abhishek is now more than a year old - and is a barrel of fun ! I am sure he's going to be smarter than his Dad !

Health pro laments coming healthcare

Health pro laments coming healthcare "chaos": "A consultant for rural hospitals says the industrial revolution of health care is underway, and medicine in America will be undergoing huge changes soon.HomeTown Health Owner Jimmy Lewis says that Wal-Mart fired the first shot in the entrepreneurial take over of health care last week, when they announced their new, cheaper generic drug program. Lewis says the nation's top retailer has plans to provide primary health care to it's customers in it's stores, and he predicts five years of health care 'chaos.'"
Any change is going to cause some discomfort - especially for the "established" players who would like to protect their turf !

Hope, at $4,200 a Dose - New York Times

Hope, at $4,200 a Dose - New York Times: "Drug industry experts say Abraxane’s price reflects the fact that makers of cancer drugs can charge high prices for new medicines even if they are only marginally better than their older counterparts. That pricing dynamic is enabled by insurance, which shields patients from the full price of drugs. Without pressure from their insurers, patients have little reason to choose older treatments over expensive new therapies. Doctors, who ultimately decide what drugs to prescribe, also do not have to worry about paying for the treatments they choose. Charging $4,200 a dose for a new version of an old cancer drug has helped make Dr. Patrick Soon-Shiong a billionaire. The drug, Abraxane, does not help patients live longer than the older treatment, though it does shrink tumors in more patients, according to clinical trials. And the old and new medicines have similar side effects. An independent review of Abraxane published in December in a cancer research journal concluded that the drug was “old wine in a new bottle.”
It's easy to fool patients ! What's the point of "shrinking" a tumour if this does not allow you to love longer - or better ?

Union blocks foreign healthcare plan - Yahoo! News

Union blocks foreign healthcare plan - Yahoo! News: "Carl Garrett, an Appalachian paper mill worker, had hoped to go to India this month for medical care - but it didn't work out that way. The planned journey to New Delhi by Mr. Garrett, a Leicester, N.C., resident wasn't just about fixing his aching left shoulder. His employer, Blue Ridge Paper Products of Canton, N.C., wanted to send a message to American hospitals: Control costs or we'll give our insured workers the option of going overseas for quality, but low-cost care. Garrett, who belongs to the United Steelworkers, would have been the first union member to go overseas for medical care. But after his pioneering trip became public, the union stepped in and threatened to file an injunction to stop it. In response, Blue Ridge Paper withdrew the proposal to send its employee to India for surgery. So two days before Garrett was to leave, he had to unpack his bags."
I thought the US was the "land of the free " ! Protectionism and artificial barriers will never work - and patients will find the best deal for themselves !

Music Therapy

Music Therapy : "Even cows and hens increase their yield when exposed to soothing music. But humans, assaulted day-long by hooting horns and other civilisational cacophony (including crappy music), have yet to wake-up to the impact of music on health. Alfred Tomatis, M.D. and pioneer in music therapy, has stacked up evidence to suggest that listening to classical music was better `than two cups of coffee’. Another doctor likened 30 minutes of music to ten milligrams of valium. But music provides more than a high. Research proves music can lower heart, breath rate, blood pressure, affect brain waves positively, is a muscle relaxant and effective pain-killer, improve post-surgical healing rate, distract from the pain of migraines, release feel-good neuro-chemicals called endorphins, control stress hormones and spastic muscle spasms, shorten labor and improve well-being of new-borns."

Is your iPod a possible tax deduction?

Is your iPod a possible tax deduction? : "Did you know that when your iPod is attached to your computer, the iPod can also act as an external hard disc, providing you with extra storage and also giving you the ability to back up massive amounts of data, such as the contents of your laptop computer? Microphone attachments can be used to turn the iPod into a recording device, easily capable of capturing all of the talks at all of the meetings you attend in a year."
This is why every doctor needs an iPod !

Incentivising and enticing patients to take better care of themselves !

Incentivising and enticing patients to take better care of themselves !: "How MedEncentive Works – The MedEncentive process is initiated in two fashions, 1) when a doctor accesses MedEncentive’s fast and easy to use Website during a patient encounter (“Point-of-Service Initiation” version or “POSI™”) or 2) by a doctor’s normal insurance claim filing process (“Claim Initiation” version). With the POSI™ version, the doctor enters the patient’s diagnosis(es) and MedEncentive supplies an EBM decision-tree treatment guideline (Figures 2). With the Claim Initiated Version, MedEncentive captures affected physician services from a submitted claim and sends an e-mail notification back to the doctor that contains the guideline. The doctor responds by answering three simple questions: “Are you following this guideline in the treatment of this patient?”, “Do you wish to prescribe information therapy to this patient?” and “How do rate this patient’s compliance to recommended care for this diagnosis?” The doctor’s appropriate responses to these questions affect an automatic increase in reimbursement and send an information therapy prescription to the patient through MedEncentive (Figure 3).
The patient receives their doctor-initiated information therapy prescription by mail (Figure 3) or e-mail from MedEncentive or from their doctor in his/her office in the case of the POSI™ version. This letter or e-mail directs them to MedEncentive’s patient Website (Figure 4). There the patient is asked to read evidence-based medical content (Figure 5) and answer a series of questions (Figure 6). These questions are designed to accomplish four objectives, 1) test the patient’s understanding of their condition, 2) determine and/or have the patient declare their adherence to recommended treatment, 3) seek their impression of their doctor’s care relative to recommended care, and 4) allow the patient to authorize the release of the physician’s rating of their compliance (which, in effect, causes the patient to contemplate whether their physician’s rating of their compliance will coincide with their own compliance declaration). As the patient answers these questions, they score points toward a financial reward or rebate of their out-of-pocket medical expenses (Figure 7). The patient’s score is automatically forwarded to their health plan who affects the rebate. The patient’s actual responses are forwarded to their doctor to support subsequent care and to create another check and balance. "
This is a clever win-win situation !

Patient education makes good business sense !

Chemists( pharmacists) in India are very busy, but they are a very under-utilised resource. Most of them are small mom-and-pop shops which spring up around hospitals, and are designed primarily to serve the needs of the patients in these hospitals. However, as retailing becomes more organised in India, and the big retail giants enter the country, drug retailing is going to undergo a sea change in the next few years. How can chemists differentiate themselves in order to remain competitive ?
I feel an important innovation they will need to provide will be a patient education service for their customers. All patients who take drugs have questions about the medicines they are taking - especially their side effects. Most doctors are just too busy to explain these properly. This is a major lacuna, which clever chemists can exploit, so that by providing this value-added service, they can beat the competition !

Patient education resource centers in hospitals

This is a photograph of a general hospital in India. Indian hospitals are very busy places; and doctors here are not renowned for their communication skills. In all fairness, they are so busy taking care of their patients, that they just don't have the time to even eat their meals on time - leave alone talk to patients. However , these patients have millions of questions, and are often frustrated by the lack of answers. Doctors are super-busy people - and really don't have the time or energy to answer these questions. This is often why family and friends find hospitals are intimidating places; and doctors are unapproachable. A simple solution would be to have patient education resource centers in each hospital or clinic. Doctors could "refer" their patients ( and their relatives) to these centers, where a helpful librarian could help them find the information they need.

IVF consultation

Deciding to go in for IVF can be an intimidating and scary decision. Not only can the treatment be expensive ( and it's potentially an open-ended expense); the outcome is always uncertain, so there is always considerable emotional and financial risk involved in starting an IVF cycle. Also, because IVF is the "treatment of final resort", there's a lot of hope riding on the treatment - and a failed IVF cycle represents the death of lovingly nurtured dreams and hopes.
Having a friendly doctor with whom you can communicate openly can help considerably in making this journey a positive one, so you have peace of mind you did your best !

Sunday, October 01, 2006

Where’s the time to make babies ? Times of India article

Infertility has a new face today, thanks to a stressful lifestyle coupled with unhealthy habits. Sudeshna Chatterjee reports

" Wannabe parents do it. Celebs do it. Even J-Lo is doing it! No it’s not what you’re thinking. We’re talking about Assisted Reproduction Technologies (ART), which helps people make babies the scientific way. Infertility expert Dr Anjali Malpani has stopped counting the number of couples visiting her clinic in Colaba, Mumbai for ART. They come from all over , especially many from the IT hubs of Bangalore and Pune. “Thanks to their ambitious career drive, they work long hours, eat junk food, deal with a lot of stress and when they come home, have little time or energy to indulge in sex. This lifestyle pattern, mostly seen in India’s A and B cities, is resulting in couples suffering from infertility,” she observes. Dr Firuza Parikh, director, department of assisted reproduction and genetics, Jaslok Hospital, Mumbai, concurs. “For the last 10 years, couples seem to meet more in the boardroom than the bedroom. Even when they are in bed, they have sex very sporadically, which does not ensure pregnancy. This is what I call voluntary infertility. Today, three out of 10 couples, who come for infertility treatment, belong to this category,” says Dr Parikh. In fact, beside obesity, the other lifestyle disease, diabetes, affects the sperm count and motility of the sperms. A woman who gets pregnant by a diabetic man is more prone to miscarrying. Some jobs also carry an added risk. “I have seen that men exposed to radiation (such as orthopaedic surgeons,
radiation specialists, interventional cardiologists, etc.) tend to have more abnormal sperms. Similarly, stress hormones affect ovulation in females. I have particularly seen this with flight attendants. In fact, lifestyle is a menace that alone can generate infertility in an otherwise perfectly healthy couple. Men from a rural environment have a more robust sperm count. We urbanites have deleted the word ‘leisure’ from our dictionary, it seems,” says Dr Parikh.
Another fall-out of this hectic lifestyle that affects fertility is when people are obsessed with fitness and embark on excessive diet and exercise programmes or are so absorbed in their career plan that they follow irregular food habits, which results in obesity. In either case, it promotes infertility, says Dr Malpani. There is an equal number of male and female infertility cases. Lifestyle affects women in ovulation and men in their sperm counts, motility of the sperms as well as production of abnormal sperms.
How infertility can strike you…
YOU’VE WAITED TOO LONG : This is the most important reason why several couples, especially women, are facing infertility problems. These days, couples are postponing their conception, says Dr Malpani. By the time a woman turns 40, the pool reserve of her eggs gets depleted. So the biological clock for producing children practically stops, observes Dr Parikh. Unlike a man, who can produce sperms till he dies, a woman is born with half a million eggs that deplete as she ages. Till about the age of 35, a woman’s chances of conception are very high (about 55 per cent). The 36-40 age-group is the grey zone, where the chances of conception drop to about 20-25 per cent. As a woman ages the success rate of assisted reproduction technologies procedure also drops proportionately.
YOU SMOKE OR DRINK : Dr Parikh observes that an ongoing study on the effects of smoking on sperm count at Jaslok Hospital shows a marked increase in abnormal-looking sperm, which also affects men’s fertility potential. International studies reveal regular smoking actually brings down the sperm count by 15 per cent. The good news is that the effects are reversible. According to Dr Malpani, when a chain smoker has stopped smoking for a year, his sperm count increases between 50 and 800 per cent! These days, women too smoke a lot, which results in fewer chances of conception, higher incidences of miscarriage and premature births (which, in medical parlance, is known as secondary infertility).
Alcohol without which parties, it seems, fail to sparkle, can affect the male libido and therefore indirectly promotes infertility, says Dr Parikh.
YOU’RE ON MEDICATION : More people are suffering from diseases like asthma and hypertension, thanks to unhealthy living habits. But they need to be careful while popping their regular pills, says Dr Parikh. For example, a study reveals that up to 95 per cent of men taking some anti-hypertensives (used to treat hypertension) are reversibly infertile. It is believed that these drugs may elevate the cholesterol level in sperm, leading to the decreased ability of the sperm to bind the eggs. With women too, some anti-hypertensives block fertility.
YOUR ENVIRONMENT IS POLLUTED: Plastic (never mind the number of microns, all of it emits xenoestrogen), exhaust fumes like lead, pesticides like DDT, dioxine (industrial chemical) and such other pollutants, contribute to falling of sperm count, says Dr Malpani. In fact, we are surrounded by toxins everywhere. We breathe paints, we breathe, eat and drink pesticides... In the long run, all this can suppress spermatogenesis. Toxins also affect the quality of eggs, says Dr Parikh.

Infertile, yet want a baby? Dr Indira Hinduja offers some options...
The most common type of ART is IVF. Here, eggs and sperm are mixed in a laboratory dish to fertilise and then, once the embryo is formed, it is transferred to the woman’s uterus.
In Gamete Intrafallopian Transfer (GIFT), eggs are collected from the ovaries, then placed into a thin flexible tube with the sperm. This is then injected into the woman’s fallopian tubes, where fertilisation takes place. GIFT is more invasive than IVF and the success rate is about the same.
Intracytoplasmic Sperm Injection (ICSI) is the injection of a single sperm into an egg. Following fertilisation, the embryo is then placed in the woman’s uterus. Often used in conjunction with IVF, ICSI is often a successful treatment for men with impaired sperm.
There are two surgical procedures (PESA and TESA) to retrieve sperms from the epididymis or testes when it is not available in the semen. Then the ICSI procedure is used.
Zygote Intrafallopian Transfer (ZIFT) combines IVF and GIFT. Eggs and sperm are mixed outside the body and fertilised. The embryo is implanted surgically to the fallopian tubes.
Apart from the above procedures, egg donation, embryo donation and surrogate motherhood are also part of ART, where a third party is involved.
When there is a history of genetic abnormality or repeated failure of other procedures of ART, Pre-implantation Genetic Diagnosis (PGD) is used. Here, the sperm and the egg are brought together in the laboratory and genetic evaluation of the embryo is done to ensure a higher success rate of pregnancy and to prevent birth defects.

Health Declarations, Resolutions, Charters, Programmes, Platforms, UN - Healthy Documents

Health Declarations, Resolutions, Charters, Programmes, Platforms, UN - Healthy Documents: "We therefore presented a draft compilation, Healthy Documents: a sourcebook of important documents and instruments that impact on peoples’ health, at the international People’s Health Assembly at Savar, and sought the views of some key participants - health activists, health professionals and practitioners, teachers, policy makers, UN officials and also officials from the government health departments and ministries. Their response has been overwhelming and we have tried to incorporate appropriate suggestions and comments before finalising this publication.
The finalised Healthy Documents contains resolutions, declarations and charters on health made at international meetings and also related UN instruments, such as international covenants, programmes and platforms of action which support these declarations. The declarations and UN instruments are arranged in seven categories: 1) Medical Ethics, 2) Health Rights, 3) Public health, 4) Health and Social Development, 5) Nutrition, 6) Children’s Health, and 7) Women’s Health."
This is an interesting collection. Of course, most of it is still words, but there is always hope for the future !

Mobile phone text messaging can help young people manage asthma

Mobile phone text messaging can help young people manage asthma: "We set up a mobile phone text message service consisting of daily reminders to use an inhaler, health education tips, and safety messages. We streamed these into a supply of lifestyle related text messages about sport, celebrity gossip, and horoscopes; they were all written in contemporary text jargon and sent by a “virtual friend with asthma” called Max".Text messages that are reminders about treatment and useful tips on education may be a medium to allow people with chronic health problems to make their disease comply with their lifestyle and not the other way around."

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