Friday, March 30, 2007

UserHealth Official Homepage!

UserHealth Official Homepage!: "Do you spend several hours in front of the computer without breaks or pauses? Maybe you want a tool that can monitor how much time you actually spend in front of the computer? In that case this software can be perfect for you, and by the way did I mention that it is freeware!

The purpose of Userhealth is to be your silent health and sleep supervisor! What UserHealth actually will do is provide you with regular health, pause, and go to bed messages. The messages can be displayed like small popup windows in the right corner (Almost like a MSN login popup) or if you prefer a topmost window or just sound feedback. The messages will contain suggestions about pauses and small exercise that the user can do to stimulate the body and to avoid Repetitive Stress Injuries (RSI). However the main purpose is to draw attention to the user that he or she has been using the computer for a long time and maybe need to take a break."

How 2 Write Good

How 2 Write Good: "This is a guide to good legal writing. Good writing consists of avoiding common clunkers and using simpler replacements. The replacements aren't always perfect synonyms but 90% of the time they're better than the original. Warning: Some changes also require grammatical twiddling of other parts of the sentence. This is not a guide to proper high English usage. We don't give two hoots whether you dangle participles, split infinitives or end sentences with prepositions. We care that you can write clearly."

Excellently written - and should be read by everyone who writes - not just lawyers !

Thursday, March 29, 2007

Health information systems of tomorrow

Health information systems today suffer from a number of significant problems. Challenges which need to be met by the systems of tomorrow include:
    • Support for a life-long health record
    • True interoperability among all parties and systems used in patient care
    • Intelligent decision support
    • Domain size and rate of change
    • Systems obsolescence
    • Multi-contact healthcare system and mobile patients
    • Multiple medical cultures, including developing world, asian
    • Support for domain experts to have direct control over the information design and change management of their systems

This document discusses the challenges for health information systems of the (immediate) future, and offers some suggestions for how the work of both standards bodies and implementation efforts might be brought together in the form of global standards for health information systems, particularly EHR (electronic health record; note that in this document, the term EHR is used to mean all variants, e.g. CPR, EMR and so on).

Wednesday, March 21, 2007

HELP in the news !

HELP was featured in Hindustan Times, one of India's leading newspapers !

The Sun Online - News: The IVF tourists.. back for more

The Sun Online - News: The IVF tourists.. back for more: "The desperate couple, who had spent £8,000 on IVF treatment in the UK and endured seven miscarriages over 18 years, discovered the Malpani Infertility Clinic on the internet and flew to India. Not convinced that Wendy’s own eggs would develop, Dr Aniruddha Malpani, and his wife Anjali, both 45, implanted four donated Indian embryos, along with two of Wendy’s own. It was the adopted embryo which finally came to fruition and Freya came into the world on June 4, 2005.

Now Brian, 45, a lorry driver, and Wendy 41, have returned to Mumbai to introduce Freya to the doctors who helped create her and to undergo a second embryo adoption procedure. Wendy says: “It was an incredible moment introducing Freya to the Malpanis. One day we will tell her all about the story behind her birth.

“Freya’s conception happened because some wonderful couple had IVF treatment at the Malpanis’ clinic but allowed their leftover embryos to be kept in storage to help other childless couples."

I believe what sets us apart from most other IVF clinic is that we treat infertile couples as intelligent adults who are capable of making their own decisions for themselves. This is why we often treat couples who have been refused treatment by other doctors; and allow them to take an active part in formulating their treatment plan.

The McKinsey Quarterly: The retail revolution in health insurance

The McKinsey Quarterly: The retail revolution in health insurance: "Health insurers are entering a new world where individuals, not groups, are the decision makers. In essence, US health care is going retail, from the growing interest in health savings accounts (HSAs) to the proliferation of minute clinics and other convenient settings for delivering care. Yet many insurers are ignoring the transformation of their industry and the opportunities and challenges it presents."

Insurance companies need to invest in patient education and Information Therapy !

Friday, March 16, 2007

Extracting Knowledge from Science in Medicine

Extracting Knowledge from Science in Medicine " I talked about personalized medicine. I said that in twenty years we’re going to have what I call the “three-Ps medicines”: predictive, personalized, and preemptive. That’s my vision. And I really think that’s where science is going. A reporter then said, “Personalized—you mean that finally, in twenty years, I’ll have my own personal doctor?” No. That’s not what I meant: Tailored, individually tailored. But the key word is not personalized. The key work is preemptive. That’s different." National Institutes of Health (NIH) director Elias Zerhouni.

Disruptive Innovation: Can Health Care Learn From Other Industries? A Conversation With Clayton M. Christensen -- Smith, 10.1377/hlthaff.26.3.w288 --

Disruptive Innovation: Can Health Care Learn From Other Industries?: "Both Toyota and Southwest Airlines had similar roots as these hospitals in Thailand or India or Tijuana, in that at the beginning their cost advantage was really rooted in lower-cost resources, primarily labor. But labor is a very transitory economic advantage. And if they're going to survive, they have to transform what is a labor cost advantage into process-based advantages. And so Wal-Mart did that, and Southwest Airlines did that, and Toyota did that. I would bet that the hospital in Tijuana doesn't follow fundamentally different processes than one in America. Maybe they do. But the very fact that they're there--I would expect that competition over time forces them to create and improve processes, which then will come back to the United States, just as Toyota's processes have come back to the United States in the plants that Toyota builds in the United States. So I guess I would say that 'medical tourism' is the first step. A 'self-pay' scenario makes people much more sensitive to cost differentials and encourages them to look for a market for lower-cost solutions, and we see Americans seeking out these medical and surgical services abroad, so you really would have to call this a disruptive innovation."

Medical tourism is going to shake-up the US healthcare industry and force doctors to become more patient-friendly and competitive !

Why do patients come to us for IVF treatment from all over the world ?

I just did an interview for BBC, and one of the first questions I was asked is - "Why do patients come to your clinic from all over the world ?"

In the beginning, I think the major reason was the fact that our prices were much more competitive than what clinics in the USA and UK charge. However, our major USP is no longer our labour arbitrage . I think what sets us apart is the fact that we are a "focussed factory" ( a concept described by Michael Porter and Regina Herzlinger). We run a lean and mean unit , which does IVF and only IVF ! Because we do so many cycles, we are very good at it; and because we do nothing else, we have to be very good at it in order to survive !

Thursday, March 08, 2007

Shanti Avedna Sadan Cancer Hospice India

Shanti Avedna Sadan Cancer Hospice India: "The Shanti Avedna Sadan is India’s first Hospice, an institution that takes care of the advanced terminally ill Cancer patients. It is neither a hospital nor a home, but is in fact both, offering the specialized care of a hospital together with the love of a home"

Scans don't save lives, study says | Chicago Tribune

Scans don't save lives, study says | Chicago Tribune: "Screening current or former smokers with annual CT scans does not appear to prevent deaths from lung cancer, a new study concludes.

The study, in Wednesday's edition of the Journal of the American Medical Association, reported that CT screening found three times more cancers than expected and resulted in nearly 10 times as many cancer surgeries. But there was no reduction in deaths from lung cancer."

The sad truth seems to be that there is little we can do to influence the natural history of the disease ! The "War Against Cancer" seems to have failed.

Monday, March 05, 2007

Ahead for 2007: Open-source software for RHIOs?

Ahead for 2007: Open-source software for RHIOs?: "But he said a survey Forrester undertook for the foundation suggested that if open-source systems were available, 60 percent of the country might have access to a RHIO by 2014, compared with 48 percent without open-source software.

President Bush set 2014 as a target for all Americans to have e-health records. Health care providers could share those records via RHIOs."

The Next Round Of Microsoft Vs. Linux: Health Care - Technology News by InformationWeek

The Next Round Of Microsoft Vs. Linux: Health Care - Technology News by InformationWeek: "An industry that has long resisted IT automation got a double dose of medicine last week. Both Microsoft and backers of key open source initiatives laid out plans to push IT further into health care--plans that also put the Windows and Linux camps on another collision course.

Red Hat, the largest business Linux distributor, is teaming up with the health care sector's largest company, McKesson, an $88 billion-a-year pharmaceutical and IT supplier. Red Hat will provide a core of Linux and JBoss software geared to run McKesson's clinical applications."

Open Source for HealthIT

Open Source for HealthIT: "Suggesting that a private healthcare provider switch from proprietary software to open source-based applications is one thing. But when an official affiliated with as august a body as the United Nations suggests that all member countries adopt open source for their healthcare applications, that's a much bigger deal. " - Growth of international fertility treatment 'tourism' - Growth of international fertility treatment 'tourism': "An AP/Washington Times report has revealed that the market for fertility treatment tourism is booming as a solution to egg donor shortages, high private clinic costs and restrictive donor anonymity laws. More permissive nations are taking a cottage industry approach to promote fertility services that are attracting a growing international clientele. US women travel abroad for cheaper treatment, while women in other nations with stricter donor laws seek access to the US or nations where market-priced competitive donor recruitment is more easily available and donor selection is possible. "

Saturday, March 03, 2007

How many embryos to transfer - and who should decide ?

This still remains one of the most contentious issues in IVF treatment today. If the technology was perfect , we would all transfer 1 embryo ( or 2 for patients who want an "instant family") for all our patients, so they would all get pregnant at their first shot. However, the sad fact is that the technology is not perfect, which means that most embryos do not become babies ! One way of improving success rates is by transferring more embryos - but there is a price to be paid for this decision too ( as is true for most things in life !); and this is the increased risk of a high-order multiple pregnancy ( with an increased risk of complications during pregnancy , the biggest risk being that of prematurity).

In order to get around this problem, many countries have passed a law which allows doctors to transfer only 2 embryos. While this dramatically reduces the risk of high order multiple births ( which is good for the government which would have to pay the bills for caring for the premature babies), this sort of "one-size-fits-all" policy can be harmful for patients who have a poor chance of getting pregnant with IVF - for example, the older woman; the one with poor quality embryos; or the one who has failed multiple IVF cycles in the past. Logically, they should be allowed to transfer more embryos, as their chance of getting pregnant ( even with a singleton) is pretty low in the first place, which means their chances of having a high order birth is extremely poor. Unfortunately, bureaucracy cannot formulate flexible policies, and this sort of rigidity is very patient-unfriendly !

It is my personal belief that patients should be allowed to decide how many embryos they want transferred - after all, they are the ones who are going the pay the price for whatever decision they take, so why shouldn't they be allowed to take this ? I feel it is very patronising and unfair to tell intelligent, well-informed couples what they are allowed and not allowed to do. They are adults who are capable of weighing the pros and cons, and making their own decision for themselves !

Their are 3 possible outcomes to any IVF cycle:

1. A pregnancy with a singleton or twins. This is a "good outcome", and is what all of us are aiming for ! Whether we achieve this outcome by transferring 1 or 2 or 3 or 4 embryos does not matter - it's not the number we transfer - it's how many finally implant, which is what matters. If the outcome is good, everyone is happy, so there's no need to discuss this any further !

2. No pregnancy. Unfortunately, this is still the commonest outcome for most IVF cycles. Treatment is financially and emotionally expensive , and for most patients, it ends in failure. This is a major personal disaster - but the only one who gets hurt in the process is the couple. The government does not really care - because this is a personal and private loss.

3. High order multiple pregnancy ( triplets or more). This is a major problem - for both the couple and the government ( who has to pay the neonatal intensive care unit bills for the premature babies). This is why the government does its best to prevent this particular outcome, and does not allow the transfer of more than 2 embryos. However, from an infertile couple's individual point of view, a triplet pregnancy may be better than no pregnancy at all - and they have a safety net, as they can still salvage the pregnancy by performing a selective fetal reduction.

Let's look at the individual case of a 38 year old woman who is doing her 5th IVF cycle after 4 IVF failures, and has 4 embryos in the incubator. The law will allow her to transfer only 2 - and she is forced to discard the other 2 ( which are not good enough to freeze). Imagine the heartburn and pain this must cause her if she fails to get pregnant ( once again). She will always be left with the dreaded nagging feeling that she might have had a baby if she had been allowed to transfer all the four embryos !

Is it ethical to force her to discard these embryos ? Shouldn't she be empowered to decide for herself ? If she is willing to take on the risk of a high-order multiple birth, shouldn't she be allowed this right ?

The body which has the longest track record for regulating IVF is the HFEA ( Human Fertilisation Embryology and Authority) in the UK. When it was set up, IVF was a very new enterprise and it was established with the best of intentions - to ensure that the human embryo was respected. However, IVF has now been around for over 25 years and has become a part of mainstream medicine. Patients - and their doctors - should be allowed to make their own decisions for themselves , just like they do in other complex areas such as the treatment of cancer. In factm the Department of Science and Technology even recommended the dismantling of the HFEA 2 years ago, because it felt that it has outlived its utility . However, no action was taken on this recommendation . After all, given the nature of the best, every bureaucracy will ensure that it will perpetuate itself for ever !

The biggest tragedy is that instead of learning from these mistakes, India seems hell-bent on repeating them all over again, and is in the process of passing a law to regulate IVF and IVF clinics. Who will this really help ?

6 A’s to Health Promotion

“6 A’s to Health Promotion”. This is from and is useful for all health professionals !

1. Assess: Use a short, well-directed interview. Remember that selfreported
behaviors are usually underestimated.
2. Approach: A warm, empathetic, and non-judgmental approach is
better received by the patient.
3. Advise: Personalize the risks and benefits to the patient, while
emphasizing “quality of life”.
4. Agree: The patient will be much more willing to implement change if
there is a mutual agreement based on compromise. Ask “How
important is this change to you? and how confident are you that you
can make the change?”.
5. Assist: Self-management skills and resources are important. What
are her sources of additional assistance?
6. Arrange: Follow-up and resources. Patients are 30% more likely to
comply with treatment if they know there will be follow-up.

Thursday, March 01, 2007

Personal health records pull patient's data to one file | - Houston Chronicle

Personal health records pull patient's data to one file : "The PHR is the latest addition to the alphabet soup that is health care, and it may actually do a body good.

EHRs — electronic health records — were the focus in the health information-technology industry when President Bush began pushing for standards to facilitate the sharing of health records across the nation.

But that was two years ago. Now, personal health records are the order of the day.

'The PHR movement is beginning to take solid root,' said Donald Mon, a vice president at the American Health Information Management Association.

A personal health record helps solve a big problem: Even if medical facilities create electronic health records, 'a consumer's health information is still going to be distributed across many health records,' Mon said. 'The PHR is the one place where you can accumulate all your health information in a consistent way to reflect your lifetime of care.'"

Study: Patients Favor Electronic Records | - Houston Chronicle

Study: Patients Favor Electronic Records | - Houston Chronicle: "Doctors looking to attract new patients may want to buy an electronic medical record system because a new survey slated to be released Monday found that a majority of consumers said the technology plays a role in their selection of a physician.

The good news for doctors is that patients may offset the cost of such a purchase: Fifty-one percent of consumers said they would be willing to pay for the service if the price was reasonable."

The McKinsey Quarterly: A consumer view of boutique health care

The McKinsey Quarterly: A consumer view of boutique health care: "For US nonprofit hospitals, a new study suggests, the disparity between supply and demand and the attendant decline in service levels have boosted the number of consumers willing to pay more for better service.

Hospitals now have an opportunity to supply target customers with differentiated, 'boutique' services that would offer easier access to and greater integration of health care2 and enhanced comfort and convenience during hospital stays. Some nonprofit hospitals have already begun to promote these services, but others are holding back, principally for two reasons—one philosophical, the other economic. The philosophical concern is that catering to affluent patients will diminish the quality of care for those unable to pay more.3 In reality, the extra revenues are likely to mean better service for all patients. "

The McKinsey Quarterly: Health savings accounts: Making patients better consumers

The McKinsey Quarterly: Health savings accounts: Making patients better consumers: "After several consecutive years of double-digit premium increases, employer-sponsored health insurance is again coming under intense scrutiny in the United States. But a remedy might be emerging in the form of consumer-driven health plans. This new type of insurance combines a high-deductible policy1 with a tax-exempt health savings account (HSA) and gives consumers more responsibility for managing their spending on health care.2 Early results suggest that these plans could slow the rise in costs by lowering demand and prompt hospitals and other medical professionals to improve the quality of care."

The McKinsey Quarterly: IT remedies for US health care: An interview with WellPoint's Leonard Schaeffer

The McKinsey Quarterly: IT remedies for US health care: An interview with WellPoint's Leonard Schaeffer: "I believe that smart third parties from outside the industry will take away a lot of the IT stuff from health insurers, hospitals, and doctors—and will do a better job of it. Some clever people will pull the pieces together and have it all make sense. You know, Amazon's business model isn't brilliant, but its service is exceptional. My wife likes Amazon because it's easy and it speaks to her. It tells her about new books and greets her by name. Why isn't there a medical system that says, 'Hello, Mr. Schaeffer'? We need the opposite of 'You've got high blood pressure; lose 30 pounds.' That just isn't very friendly or persuasive. There must be some way to say,'We understand your problem. We want to help you. How can we do so?' The models will change; there will be new opportunities in wellness and preventive care for us and the other players. The challenge for current health care providers is to get there before an outside third party does.

It's the same for all of the administrative stuff: someone smart will come in with better processes. For example, 'one-write' systems—take the patient's name once and never ask for it again. Every time I go to the doctor, I have to write down everything all over again and again."

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