Saturday, June 30, 2007

Patient information is effective

Patient information is effective " Patient information is effective in improving patients’ knowledge and recall of medical facts. Combining verbal and written information is more effective than verbal information alone and personalised computer-based information is more effective than general information. Many patients prefer health information that is delivered using audio, visual or interactive media.

People in disadvantaged groups derive greater benefit from computer-based health
information systems than those with higher levels of health literacy. Computer-based systems
which combine information delivery with online discussion groups improve social support
among people with chronic conditions. Computer-based systems can also have a positive effect
on self-care. There is strong evidence for the effectiveness of patient decision aids, which
improve both patients’ knowledge and their realistic expectations of the benefits and harms of
treatment. They also improve patients’ involvement in decisions and the level of agreement
between patients’ values and treatments chosen, and in some cases they lead to reductions in
resource use."

Patient-focused quality enhancing interventions (QEI) overview

Patient-focused quality enhancing interventions (QEI) overview

Patient-focused interventions are those that recognise the role of patients as active
participants in the process of securing appropriate, effective, safe and responsive
healthcare. Patients/citizens can contribute to quality improvement at both an individual
and a collective level.

Patient-focused interventions are generally aimed at one or more of the following
seven quality improvement goals:
· improving health literacy
· improving clinical decision-making
· improving self-care
· improving patient safety
· improving access to health advice
· improving the care experience
· improving service development.

Patient Activation Measure

Patient Activation Measure Patient Activation Measure (PAM)
The questionnaire used in the Patient Engagement survey contains a 22 item scale that assesses the extent to which people feel confident and able to self-manage their own health and health conditions. The scale consists of a series of statements, with five possible responses:
• Strongly agree
• Agree
• Disagree
• Strongly disagree
• Not applicable.

Separate versions of the scale, with different wording, are intended for those who have chronic conditions and those who do not. Below is the scale for those reporting a chronic condition.

Believes active role is important

1. When all is said and done, I am the person who is responsible for managing my health condition.
2. Taking an active role in my own healthcare is the most important factor in determining my health and
ability to function.
Confidence and knowledge to take action
3. I know what each of my prescribed medications does.
4. I am confident I can tell my doctor concerns I have even when he or she does not ask.
5. I am confident that I can tell when I need to get medical care and when I can handle a health problem
6. I know the lifestyle changes like diet and exercise that are recommended for my health condition.
7. I am confident that I can follow through on medical treatments I need to do at home.
8. I am confident that I can take actions to prevent or minimize problems associated with my health
9. I am confident that I can find trustworthy sources of information about my health condition and treatment
10. I am confident that I can follow through on medical recommendations my doctor makes such as changing
my diet or doing regular exercise.
11. I understand the nature and causes of my health condition.
12. I know the different medical treatment options available for my health condition.
| 48 | How engaged are people in their healthcare? | The Health Foundation
Taking action
13. I have been able to maintain the lifestyle changes for my health that I have made.
14. I know how to prevent further problems with my health condition.
15. I know about the self-treatments for my health condition.
16. I have made the changes in my lifestyle like diet and exercise that are recommended for my health
17. I am confident I can come up with solutions when new problems arise with my health condition.
18. I am able to handle symptoms of my health condition on my own at home.
Staying the course under stress
19. I am confident that I can maintain lifestyle changes like diet and exercise even during times of stress.
20. I am able to handle problems of my health condition on my own at home.
21. I am confident I can keep my health problems from interfering with the things I want to do.
22. Maintaining the lifestyle changes that are recommended for my health condition is too hard to do on a
daily basis.

Wellness Programs Can Reduce Health Risks And Costs

" Wellness Programs Can Reduce Health Risks And CostsWellness programs that are properly implemented can achieve a reduction of up to 60 percent in health risks and major reductions in the cost of disease care for employees."

This paper shows that these programs provide an excellent return on investment !

Picker Institute response to EC patient information

Picker Institute response to EC patient information " Picker Institute Europe welcomes the report’s recognition of the
increasingly active role of patients in seeking information in order to
make decisions about their health, care and treatment; and the report’s
support for a ‘partnership’ model of the relationship between patients
and health professionals
• However, Picker Institute Europe questions the report’s assumption that
the answer to patients’ information needs lies with industry, and its
conclusion that the pharmaceutical industry should be allowed a greater
role in the provision of information to patients
• The principles to be applied to patient information policy are that
patients need high quality, objective, reliable and evidence-based
information, including information about all the alternative treatments
available and their benefits and harms, in order to make decisions with
their health professionals
• Picker Institute Europe calls upon the directorates-general for enterprise
and industry and for health and consumer protection to take account of
all the existing evidence on patients’ information needs and, if
necessary, to commission a new review of that evidence, in order to
ascertain what kinds of information patients most need and want, paying
particular attention to issues of trust and reliability of information; what
are the barriers to availability and access; what are the appropriate
solutions to overcome those barriers; and what should be the priority
actions at European level"

Saturday, June 23, 2007

The doctor -patient relationship

The doctor -patient relationship: " Relationships based on openness, trust and good communication will enable you to work in partnership with your patients to address their individual needs.

To fulfil your role in the doctor-patient partnership you must:
1. be polite, considerate and honest
2. treat patients with dignity
3. treat each patient as an individual
4. respect patients’ privacy and right to confidentiality
5. support patients in caring for themselves to improve and maintain their health
6. encourage patients who have knowledge about their condition to use this when they are making decisions about their care."

I like the fact that they call this a doctor-patient partnership rather than a relationship !

Management for Doctors

Management for Doctors: "All practising doctors are responsible for the use of resources; many will also lead teams or be involved in the supervision of colleagues; 2 and most will work in managed systems, whether in the NHS or in the independent , military, prison or other sectors. Doctors have responsibilities to their patients, employers and those who contract their services. This means that doctors are both managers and are managed. This booklet will be particularly relevant if you have a management role, but should be helpful for all doctors.

2. For the purposes of this booklet, management is defined as:

Getting things done well through and with people, creating an environment in which people can perform as individuals and yet co-operate towards achieving group goals, and removing obstacles to such performance. 3

3. Doctors' management roles often involve responsibility for teams, people and the resources they use. If you manage resources other than people, or develop policies, set standards or audit others, you should follow the guidance in this booklet as far as it is relevant to your role."

GMP for Doctors

GMP for Doctors : " Good Medical Practice sets out the principles and values on which good practice is founded; these principles together describe medical professionalism in action. The guidance is addressed to doctors, but it is also intended to let the public know what they can expect from doctors."

These are a comprehensive set of guidelines which provide a useful framework.

Thursday, June 14, 2007

Crossing Borders For Fertility Treatments - More From News Story - KNTV | San Francisco

Crossing Borders For Fertility Treatments - More From News Story - KNTV | San Francisco: "In August of 2005, Shauna Anderson treated herself to a vacation of sorts: three weeks in Cape Town, South Africa, more than 10,000 miles from her home just outside Seattle, for a little respite, a safari - and a round of in vitro fertilization (IVF).

Not your typical vacation itinerary, but one that's becoming increasingly popular among American women struggling with infertility issues and overwhelmed by the cost of IVF in the United States. By traveling abroad for fertility procedures, women can pay thousands of dollars less than what they'd spend at home."

Perspectives on the Future of Personal Health Records -

Perspectives on the Future of Personal Health Records - "As a hub of information and information-management tools controlled by the patient, personal health records present a number of promises, perils, and challenges in the years ahead. In this report, six experts share their views on the future of PHRs, from the perspective of the technologist, informed patient, physician, employer, and public health professional.

The ideal PHR holds tremendous potential, according to these experts. It could receive and evaluate information from a patient's lab results or monitoring devices; store a patient's observations about physical and social environment; link with a clinician's electronic health record; and much more. On a grander scale, PHRs could also make health care more affordable by urging prevention and wellness, and by streamlining care delivery.

But some worry that PHRs might disrupt the doctor-patient relationship, saddle overburdened physicians with unreimbursed information-management duties, and overload consumers with data."

Excellent overview. To be truly useful a PHR has to be a part of an ecosystem - a system which revolves around the patient !

e-Patients - White Paper

e-Patients- White Paper
This is an excellent document on e-patients and what the future holds for healthcare !

Patients Beyond Borders › About the Book

Patients Beyond Borders › About the Book: "Did you know that 150,000 Americans now travel abroad every year for affordable, high-quality health care? From Thailand’s American-accredited Bumrungrad hospital to Eric Clapton’s Crossroads Clinic to Johns Hopkins International, health travelers now have a full array of the world’s safest, best choices in healthcare facilities and physicians.

Patients Beyond Borders is the first comprehensive, easy-to-understand guide to medical tourism. Impartial, extensively researched, and filled with authoritative and accessible advice—carefully culled from hundreds of resources here and abroad."

e-patients and medical tourism

e-patients and medical tourism: "Are e-Patients More Likely to Try Medical Tourism?

It's an interesting question, because as people become more informed about their conditions and treatment options, they also often learn more about the costs associated with treating their condition. When compared with many other developed nations, America's healthcare costs are extraordinary. Just today, we got hit with a prescription bill you wouldn't believe, as we recently changed healthcare providers (and may be changing much sooner than we had anticipated because of this surprise).

The rising cost of healthcare in America has spawned the emergence of a new type of travel. Medical tourism is now a phenomenon that has generated passengers in record numbers, especially those with no health insurance and limited access to insurance. In fact, Patients Beyond Borders reports that more than 150,000 Americans traveled abroad for healthcare last year, and that number is projected to double by 2008."

My answer would be - " Yes !" E-patients are much more likely to "think out of the box" and more assertive in exploring treatment options !

EHR - Who Pays for Efficiency? - New York Times

EHR - Who Pays for Efficiency? - New York Times: "“I can’t capture the economics of scale as a sole practitioner,” she said. “Electronic health records may well be a good thing, as a collective good, but why should I make the investment if I don’t get any of the gains?”

Physicians get only about 11 percent of the savings from electronic health records; the real benefit goes mainly to private and public insurers because, for one, they are paying for fewer unnecessary tests, and automated record-handling is a big cost saving for the payers, according to a study by the Center for Technology Leadership, a medical research group. “The doctors bear all the costs, and others reap most of the benefit,” said Dr. David J. Brailer, who was the national health information technology coordinator in the Bush administration from 2004 to 2006. “The incentives are totally awry."

This is a very short-sighted view. If patients prefer doctors who keep EMRs ( as many do, because they are much more confident that they will receive better medical care), then doctors who invest in EMRs will have more patients - and can recover their investment more quickly.

Thursday, June 07, 2007

Evaluating health information

The best health content in the world only helps if people can fi nd, understand, use, and act on the information. Otherwise, is the information really helping people to improve their health?
The new User Experience Team at Healthwise is just what its name implies—we’re all about how users experience our health care information. We go beyond “consumer-friendly.” We pair our evidence-based content with evidence-based delivery—the ultimate in helping people make better health decisions.

Wednesday, June 06, 2007


The MIVIA PHR: "The goal of MiVIA is to improve health outcomes of migrant and seasonal workers in California. Building on an existing pilot program, the next phase will include expanding the technical capabilities as well as planning and implementing a comprehensive multi-region and multi-state expansion of the program.

Even when workers are able to access health care, that care is sporadic and fragmented as the workers move from job to job; community to community; leaving their medical records, test results and care plans behind, resulting in unnecessary duplication in services. This lack of continuity in their health care contributes to poor health outcomes and increased costs to an already burdened health care system.

Each worker's PHR is password protected, using 128 encryption and is HIPAA compliant providing audit trails, secure messaging and provider entry portals. MiVIA allows patients, or any advocate whom they authorize, to download their information at any time or to have the information downloaded by a health care provider."

Overview: Personal Health Records – Current Landscape and Future Visions

Overview: Personal Health Records – Current Landscape and Future Visions: "Indeed, the power of a personal health record lies in its potential to be coupled with alerts, reminders and other decision-support tools that help people take action to improve their health or manage their conditions. From this perspective, the personal health record can be seen as part of a broader personal health record system. Health care and technology pioneers are beginning to develop solutions that harness the power of PHRs to create consumer-friendly tools people can use in their daily life to stay healthy and better manage illness."

Making PHRs personal !

“The focus of PHR development so far has been on what is contained in the medical system: claims, lab results, clinical data, diagnosis,” says Patricia Flatley Brennan, RN, PhD, professor of Nursing and Industrial Engineering at the University of Wisconsin-Madison and director of Project HealthDesign’s National Program Office. “That’s a good start, but we believe that information about how you live and how you feel on a day-to-day basis is important, and can be incorporated into PHRs to empower patients to make better health care decisions on a daily basis.”

Global Competition Seeks Disruptive Innovations in Health and Health Care

Global Competition Seeks Disruptive Innovations in Health and Health Care

A global competition has launched to find disruptive innovations that could dramatically reshape the health and health care marketplace. The online competition, “Disruptive Innovations in Health and Health Care—Solutions People Want,” is hosted by Changemakers in partnership with the Pioneer Portfolio of the Robert Wood Johnson Foundation (RWJF). It uses Changemakers’s unique open sourcing social solutions™ competition model.

The “Disruptive Innovations” competition, which runs through July 18, expects to attract global entrepreneurs whose ideas lead to new services, tools, and choices that consumers want. Examples of disruptive innovations that are already transforming health care are home glucose monitors that give diabetics the ability and convenience to get blood glucose readings in seconds in the convenience and comfort of their own homes; and walk-in health clinics in retail stores that enable patients to quickly see skilled nurse practitioners and physician assistants, who diagnose and treat common conditions at lower costs than typical doctor visits.

Approximately twelve competition finalists will be selected by a distinguished panel of judges, including: RWJF Senior Program Officer Nancy Barrand; Margaret Laws, director of the California HealthCare Foundation’s Innovations for the Underserved program; Dr. Jason Hwang, Harvard Business School Fellow, Innosight; and Sonal Shah, Global Economic Development, All finalists will attend a Change Summit to stimulate future collaborations and insights from thought leaders in the field.

Changemakers’s global network of social entrepreneurs will then vote for three winners from anywhere in the world—each of whom will receive a $5,000 cash prize from Changemakers. In addition, RWJF’s Pioneer Portfolio will review competition entries and may award up to $5 million to support projects (restricted to U.S. organizations) that show potential to go to scale.

“We are challenging enterprising thinkers to consider how shifts or changes in the marketplace can help consumers manage their health and health care how they want to, where they want to, when they want to,” said Barrand. “Changemakers’s open-source competition model provides RWJF with a transparent, interactive way to engage a vast network of entrepreneurs in finding solutions that make sense to consumers and respond to what they value.”

This is the second in a series of idea competitions co-sponsored by Changemakers and RWJF. The unique competition model attracts solutions from social entrepreneurs from around the globe. Innovators submit their ideas online and the Changemakers community provides feedback on the problem and proposed solutions throughout the competition. This interactive process is designed not only to catalyze action on important issues but also to connect participants’ solutions with key decision-makers, investors, and health and social service providers.

“Changemakers is about connecting the global change community and providing innovators the collaborative power and velocity to deal with problems in real time," according to Charlie Brown, Changemakers’s executive director. "Our collaborative series of competitions with RWJF promises to forge wider, stronger communities of practice that will take solutions to scale at unprecedented rates."

“Disruptive innovation,” a term coined by Harvard Business Professor Clayton Christensen, describes a technology, process, or business model that enables more consumers in the market to afford and/or have the ability to use a product or service. The change caused by such an innovation is so big that it eventually replaces, or disrupts, the established approach to providing that product or service.

In the health and health care arena, services historically have been designed and delivered with providers’ needs in mind. They also tend to be procedure-oriented, treating patients more as passive recipients than engaged participants in the care process. Recasting patients as consumers puts them in an active role and challenges the system to meet consumers’ interests in managing their health and health care in ways that are more affordable, more accessible, simpler, and more convenient.

The Disruptive Innovations competition is the second in a series of three competitions Changemakers is hosting in partnership with RWJF’s Pioneer Portfolio. All three are designed to source cutting-edge solutions to some of the most pressing health and health care challenges around the world. The first competition on ending domestic violence attracted nearly 250 submissions. The third competition begins in June and looks to stimulate innovations in how computer and video gaming can improve health and health care.

Changemakers is an initiative of Ashoka: Innovators for the Public. Changemakers focuses on the rapidly growing world of social innovation. It provides solutions and resources needed to help everyone become a changemaker and presents compelling stories that explore the fundamental principles of successful social innovation around the world. Changemakers is building the world's first global online "open source" community that competes to surface the best social solutions, and then collaborates to refine, enrich, and implement those solutions. Changemakers begins by providing an overarching intellectual framework for collaborative competitions that bring together individual social change initiatives into a more powerful whole. For details on the competition, visit

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing the United States. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change.

The Foundation’s Pioneer Portfolio supports innovative ideas and projects that may trigger important breakthroughs in health and health care. Projects in the Pioneer Portfolio are typically future-oriented and look beyond conventional thinking to explore solutions at the cutting edge of health and health care.

Tuesday, June 05, 2007

Is Health Care Making You Better—or Dead?

Is Health Care Making You Better—or Dead? " You devote 5 chapters to 5 health care players that you actually call "killers." They are the hospitals, health insurers, employers, U.S. Congress, and academics. How do they all interact to make this such a bad or unresponsive or inefficient system?

A: I think there is a big 3 here, an iron triangle, and those are the hospitals, the insurers, and the government. They want power. It's very understandable. Everybody wants to be powerful, and the way they will be powerful is to institutionalize their role in the system."

I am glad people are realising that it's high time we start looking for options more aggressively !

Google Health - discovery, action and community

Bosworth went on to focus on three core principles to unlock this information for consumers: discovery, action and community. He argued that consumers should be able to easily find the health information they need, have immediate access to health care services and learn from those in similar situations.

"… Scared cancer patients could find out how others were tolerating the same medications they were on for the same conditions and how the doctor was. People really care about how they are treated by the doctors. Are they listened to? Is the doctor actually treating them as an adult and understanding their needs? All this could surface," said Bosworth.

Bosworth didn't take long to get into Google's vision for authenticated data, which he insists is necessary for trustworthy shared standardized online computable health data.

Consumers looking for information on a reviews site would be redirected to a CMS (content management system) that would require them to authenticate themselves to access their PHR (personal health records) before returning them to the reviews site. He assures that being logged into their PHR would not compromise the user's anonymity on the reviews site.

Sunday, June 03, 2007

HELP is looking for sponsors !

HELP the Health Education Library for People, India’s first Consumer Health Education Resource Center, and one of the world’s largest consumer health libraries (as determined by the Medical Library Association, USA) was established in 1997 to empower people by providing them information needed to promote their health, and prevent and treat medical problems in the family in partnership with their doctor. We are a charitable trust and a non-profit organization.

We are a public library – everyone is welcome ! *Entry to HELP is free!*

We have access to information on every health and medical topic under the sun – explained in terms which the layperson can understand. We have an Internet connection and access to subscribed medical websites so that we can provide information on the latest medical research from all over the world.


1. To create and provide access to a reliable and upto-date collection of consumer health materials, so people can become better informed about their own health. We believe the best prescription is knowledge.
2. To encourage a health doctor-patient relationship, since the best patient is a well-informed one!
3. To provide resources which doctors can adapt to their own practise, to use for educating their patients.
4. To be a useful resource for writers and journalists, and thus improve the quality and accuracy of reporting for medical topics in the lay press.
5. To act as a stimulus for patients with a particular disease to get together and form self-help support groups, to help one another cope with their disease.
6. To prevent health fraud and quackery by educating the consumer about health and illness.
7. Finally, we hope that well informed patients will demand the best treatment available internationally – and that this will act as an incentive for doctors to update their skills, and for hospitals to improve their facilities.



We have a comprehensive collection of over 10,000 books covering all medical topics. Over 600 videos which can be viewed in our audio-visual room, pamphlets which help in easy understanding of the subject and kits covering various topics to help medical health-givers.


Anyone can come to the library for free. A membership is also available after paying a refundable deposit of Rs.2,000/-. A reading charge of 10% of the cost of the book (maximum charge being Rs.50/-) is charged from the members. Members can borrow 2 books for one week at a time.


We organize daily free ‘HELP TALKS’ and seminars to keep the general public aware of what is happening in the healthcare industry and how it will directly affect their lives. Doctors and experts in their respective fields are invited to talk to them e.g. talks on HIV awareness in association with public hospitals, BMC etc., Regular talks on coping with Mental Illness, Stress Management, Music Therapy etc. NGOs are invited to make the general public become aware of their activities. We also conduct free Yoga Sessions for the general public.

These talks take place at our lecture hall and can accommodate 70 persons. No rent is charged from the speakers. Our website: carries a list of lectures scheduled at the library. A list of schedule is also sent out to our readers currently comprising around 3000 readers.


We help our readers to get the latest information from our subscribed medical websites by conducting assisted internet searches. Our librarians are trained to pick out appropriate information from these websites.

We also provide free internet training course for doctors to help them to
learn to use the internet. We feel the internet will change the way medical
care is provided in the future, and our free training courses help doctors
to learn this new tool to help them improve the care they provide to their
patients. We also offer doctors in India access to the world's largest
online medical library, at We also arrange to obtain the
full-text of any article from any medical journal in the world, to help them
remain upto date.


Readers’ health queries (postal and email) are answered within a stipulated time period – completely free of charge. This enables us to provide health related information to queries on diseases and specific health problems. We also provide a list of Doctors /Hospitals/Chemists in the readers’ city to enable them to easily access medical care. Information on complementary therapies is also provided.



HELP plans to set up libraries in other cities across India. A satellite library has already been opened in Ahmedabad, in collaboration with the Future Group (Pantaloon.).

We plan to set up mini libraries in large corporates for the benefit of their employees and customers. This will help in reaching out a larger number of readers.

Several international retail chains have shown interest in providing space to house mini HELP libraries.


We plan to meet up personally with Doctors/Chemists to create awareness about our library. We offer internship to college students looking at making a career in Marketing and Sales.

At HELP, we monitor our activities by rolling out a monthly MIS, feedback from speakers, readers, and suggestions pouring into our suggestion box.


1. Office space for mini HELP library at corporate offices/branches for employees and customers – it requires very little space but will go a long way in promoting our goals.

2. Marketing ideas to create awareness about the Library. These could be supported by help from corporates to implement the same.

3. Volunteers for our HELP OUTREACH programmes.

4. Corporates offering HELP membership to employees in their group companies. Corporate specific details can be worked out.

5. Creating awareness for HELP Talks: This could be done by inserting a monthly schedule of talks to each employee alongwith salary slips, Company websites, Press etc. We welcome any other idea that Corporates may think suitable. Talks are given by eminent Doctors and specialists in their respective fields. For a complete list please log on to

6. Sponsorship for Seminars - A joint seminar addressing healthcare issues can be organized at the premises of HELP Library, CST, Mumbai.

7. Media publicity of our HELP Talks.

8. Sponsorship for yoga sessions at HELP for employees/customers.

9. Printing of brochures and other promotional material.

10. To use HELP Library as a venue for health ‘melas’, ‘medical camps’ ‘health awareness camps being conducted by your company as a part of your CSR / Employee benefit programmes – including handling of media publicity.

11. To use HELP Library premises to hold special health talks/screening of health awareness films for employees’/customer benefits.

12. An e-health-newsletter prepared by HELP and circulated to your employees/customers.

13. Health Awareness camps organized by HELP for children of your employees/ customers.

14. You could donate a photocopier/electronic equipment upgraded PCs/ LCD screens/Projector for use at the Library. A sign will be put up indicating your sponsorship.

We invite you to visit our Library, which is very conveniently located. It will help you to discuss a range of activities in which we could work together.

Dr.Aniruddha Malpani, MD
Medical Director
Health Education Library for People
Excelsior Business Center,
National Insurance Building,
Ground Floor, Near Excelsior Cinema,
206, Dr.D.N.Road, Mumbai – 400 001
Email: [email protected] , [email protected]

World's largest free health library!
We help patients to talk to their doctors
PS: Read over 20 books on health online at
Read my blog about improving the doctor-patient relationship at

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