Sunday, September 30, 2007

Doctors, patients and money

Doctors are professionals who charge for their services and most patients are happy to pay these fees - after all, good medical care can be priceless. However, many doctors are often clueless about the cost of the treatments they provide- especially with regard to some of the new medicines; and even big ticket items such as surgery.

While they are aware of their professional fees, many are blissfully unaware of how much the hospital charges for its services - and how the hospital pads its bills. While many doctors fume about this in private, they usually put up with these evils as "the cost of doing business" - and since they are not united, they cannot fight the hospital management effectively. In the long run, it's their patients who suffer. It's quite funny to see the "sticker shock" which doctors get when they seek medical treatment for their family members in their own hospitals.

Why are doctors so poorly informed regarding the financial burden they levy on their patients as a result of their advise ? Many feel that money is a grubby topic which is below their dignity to consider. Others take the attitude that they need to prescribe the " best " - never mind the costs. This can be counterproductive - and many patients are driven to bankruptcy because of the high costs of medical treatment.

This is why offering all inclusive packages which cover all costs can be so helpful. This prevents last-minute financial surprises - and allows the patient to select the package which suits his budget.

In our clinic, we go one step further. IVF treatment can be very expensive - and since the outcome of a given cycle is always uncertain, the expense on IVF is potentially open-ended and limitless. This is why we offer our patients a money back option . Not only does this serve as a guarantee of our confidence in the high quality of medical care we provide; it also allows the patient to limit their financial exposure, thus putting a cap on their expenses. It also allows them to approach the IVF treatment with more realistic expectations,since they are mentally prepared that it may not be a single shot affair .

Lessons learnt after spending half a day at a hospital

I just spent some time in the hospital with a friend who was ill - and this was quite an eye-opening experience. As doctors, we are used to floating in and out of hospitals which are like second homes to us. However , as a patient, the view is quite different !

I found that while the medical care was fine ( after all my friend got VIP care since I was with him - some perks of being a doctor !); the customer service was extremely poor !

We spent a long time at billing counters and filling up forms - and everytime a new test was ordered, we had to go back to pay more money to get the test done. Finally, we spent more time with the billing department than we spent with the doctor !

It would be so easy to fix this problem ! Hospitals should have more counters to fulfill their administrative duties - and each department could have their own billing station, so patients would not have to run down to the central billing counter each time to pay bills !
Since all the billing is computerised, this would be very easy to do.

I also think hospitals should have escorts ( or concierges) to help patients make their way through the complex maze the hospital represents. I am sure it would be easy to recruit volunteers from the community to perform this task - a win-win situation in places like Bombay, where there is no shortage of people !

Why does customer service get such low priority in hospitals ?

Specialists can be harmful to your health !

I recently saw a patient who had conceived after IVF treatment. She had been infertile for 8 years, and had conceived in her very first IVF cycle, so she was on top of the world. At 10 weeks, we referred her to an obstetrician for managing her pregnancy. Her pregnancy was progressing uneventfully, but the ultrasonographer who did a detailed 20 week fetal anomaly scan ( to check the baby was normal) noted that the baby had " echogenic " fetal kidneys - just a fancy word to describe the fact that the sound waves reflected by the kidneys were a little denser than usual.

The rest of the scan was normal, but seeing this "abnormality" on the report, the obstetrician referred the patient to a fetal medicine specialist.

The trouble with specialists is that they see life through a specialised prism - a prism which is full of the problems in their field. If you have screwdriver in your hand, you tend to see only screws, and he then promptly advised an amniocentesis, to confirm that the baby was normal.
He even went so far as to suggest a termination, if she didn't want to take a risk !

It is true that life is full of risks - but these should be calculated risks ! While his advise was perfectly appropriate from a medical point of view, imagine the amount of emotional harm his words caused to the couple, who are now worried out of their wits. Rather than enjoying their long - awaited baby, each day is full of tension and suspense !

Tests are meant to reassure patients, but they often end up causing anxiety and worry - most of which is needless.

Tests are not always foolproof, and all medical tests have two major limitations.

1. False negatives , which refers to patients who have the disease, but the test fails to pick this up. Doctors worry like hell about these , because they can get sued for missing a diagnosis

However, far more common than there are the

2. False positives . These are the results which are reported as positive even though the person is healthy and does not have any disease. These results create more busy work for doctors , who then need to "run more tests" in order to clarify the situation , and rule out the "true positives" ( patients with the disease who have a positive test result ). However, these false positive results can create a lot of unnecessary anxiety in the patient's mind - as well as causing distress for family members. Unfortunately, none of anxiety is ever reported or considered by the specialist, who are blissfully unaware of the harm they have done.

WE ARE ALL SICK Chicago Sun-Times

WE ARE ALL SICK Chicago Sun-Times : "The idea that drug companies help to create new illnesses may sound strange to many of us, but it is all too familiar to industry insiders. A recent Reuters Business Insight report designed for drug company executives argued that the ability to 'create new disease markets' is bringing untold billions in soaring drug sales.' One of the chief selling strategies, said the report, is to change the way people think about their common ailments, to make 'natural processes' into medical conditions. People must be able to be 'convinced' that 'problems they may previously have accepted as, perhaps, merely an inconvenience' -- like baldness, wrinkles and sexual difficulties -- are now seen as 'worthy of medical intervention.' Celebrating the development of profitable new disease markets like 'Female Sexual Dysfunction,' the report was upbeat about the financial future for the drug industry. 'The coming years will bear greater witness to the corporate-sponsored creation of disease.'"

FIMDM Health News Review

FIMDM Health News Review: " is a website dedicated to: * improving the accuracy of news stories about medical treatments, tests and procedures * helping consumers evaluate the evidence for and against new ideas in health care

We support and encourage the ABCs of health journalism: Accuracy Balance Completeness

What news stories are reviewed? reviews news stories that make a therapeutic claim about: * specific treatments * procedures * investigational drugs or devices * vitamins or nutritional supplements * diagnostic and screening tests"

Foundation for Informed Medical Decision Making

Foundation for Informed Medical Decision Making: "The Foundation for Informed Medical Decision Making is a non-profit organization dedicated to assuring that people understand their choices and have the information they need to make sound decisions affecting their health and well being. Medical Evidence - Patient Values - Informed Decision Making The Foundation believes that no one medical answer is right for all people and the decision that will best serve a particular patient often depends critically on the patient's own preferences and values."

FIMDM Health News Review

FIMDM Health News Review: "# Grade health stories on the ABCs: Accuracy, Balance, Completeness
# Support excellence in health journalism
# Support consumers' informed decision-making"

This site will help you critically evaluate the medical stories you read in your local newspaper.

Poynter Online - Unhealthy Advocacy: Journalists and Health Screening Tests

Poynter Online - Unhealthy Advocacy: Journalists and Health Screening Tests: " Journalists and news organizations sometimes seem to abandon their usual healthy journalistic skepticism when it comes to coverage of certain health screening tests. While the journalistic intent here may be benign, the practice may produce more harm than good. I lead a team that monitors U.S. health news coverage each day for a Web project, Health News Review, that evaluates and grades health news stories. In the course of that work, I've seen surprisingly strong evidence of bias in favor of screening tests. Some stories, even by reputable journalists, ignore the recommendations of the U.S. Preventive Services Task Force, probably the most important, unbiased, balanced source on such questions. And the American College of Physicians' recently released guideline on mammography for women in their 40s doesn't seem to be getting the attention it deserves, either. What gets left out of these stories is the important concept that both benefits and harms can come from screening tests. You can screen many people and find a few problem cases. But in the process, there are always false-positive test results that suggest people have a problem when they really don't. That leads to anxiety, more testing (some of which carries its own risks) and more expense. Also, with today's more sensitive screening tests, some forms of "pseudo-disease" may be found -- early hints of possible problems without clear evidence about whether they will go on to create real trouble or not. That can mean many more people are inappropriately labeled with "disease" and treated. (An excellent source on these issues is the book "Should I Be Tested For Cancer? Maybe Not and Here's Why" by Dartmouth College's Dr. Gil Welch.)"

Taking patients for a ride

I am a big believer in Information Therapy and I am happy when infertile patients use the internet to get better informed about their problems and treatment options. In fact, one of my patients jokingly calls me the "Do Your Homework" Doctor - and I think this is a compliment !

However, I cringe when I see misinformation being peddled on the net - and unscrupulous people taking infertile couples for a ride. I have already blogged about how the net is being misused to sell ineffective "medicines" such as Ovulex, so I won't go into that right now.

What's worse is women who now sell "info-products" or "e-books" to "educate" couples about infertility. While educating couples is important and there's nothing wrong with making money by doing this either , what I object to is the misleading way the information is being sold.

Basically, they prey on an infertile couple's vulnerability and ignorance. They promise the earth and can do so safely, because they are not doctors, which means they are not accountable or answerable. They create attractive websites ( for example, the identical sites at and using sophisticated marketing techniques developed by clever internet entrepreneurs, and sell these using google adwords, thus pushing couples into buying their products. And since their products are priced very reasonably, most couples are happy to buy - even though the same information is available for free elsewhere !

What's my objection ? Aren't they just fulfilling a need ? I strongly object to their bad-mouthing doctors on their sites. For example, one site which sells an e-book says,

So do not lose your chance to get the secret and the never been told methods that Doctors, Obstetricians & Gynecologist, may not be telling you just to protect dollars in their pockets and their entire line of businesses as well.

Doctors have their patients' best interests at heart. Why would we hide this information from our patients ? What sense does this make ? Even if you are cynical and think that all doctors are money-hungry grubbers, don't forget that every infertile couple an infertility doctor gets pregnant sends him ten more . And every gynecologist is happy to get their infertile patients pregnant, because they then become obstetric patients !

Please sell if you want to - but don't knock doctors in order to do so !

The Serenity Prayer for infertile couples

Counselling infertile couples after they have failed an IVF cycle can be very stressful. As a doctor, I am human too, and it's very depressing when they fail to conceive even after all the hard work and effort we have invested in the treatment. No matter how much you explain that the success rate is not 100% ; that it is often a matter of chance as to which patients' embryos which implant ; that Nature is not efficient at producing babies; and that our technology is not perfect as yet, and we cannot determine why embryos fail to implant, it still hurts when the HCG is negative. Sometimes I feel I have let the patient down by failing to get them pregnant - and this is especially true when patients are doing their "final IVF cycle" and we are the court of last resort.

At this time, the only thing I can give them is a shoulder to cry on - and a copy of the Serenity Prayer.

God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.

Living one day at a time;
Enjoying one moment at a time;
Accepting hardships as the pathway to peace;
Taking, as He did, this world
as it is, not as I would have it;
Trusting that He will make all things right
if I surrender to His Will;
That I may be reasonably happy in this life
and supremely happy with Him
Forever in the next.

--Reinhold Niebuhr

I try to explain the ABCs of Rational Emotive Therapy to them - that's it not the Action ( the negative HCG because of the failure of the embryos to implant) which causes the Consequence ( the depression and sadness); but rather their Belief about the event ( that they are "worthless " because they cannot produce a baby) which causes the problems. I need to remind them that they are far more than just "baby-makers".

It's always hard for humans to deal with failure. Many infertile couples are young and successful and used to having their life going the way they want it to. They are smart and hardworking - and they are used to topping in their exams; getting the jobs they desire; the spouse they pursue; and advancing rapidly up their career path. They earn more money; buy a new car; buy a new house - everything falls into place for them ! And when they find out they cannot have a baby, this is a rude shock. This is often the first time they are confronting failure - and the reason this is so scary is that it's often the first time in their lives they are being forced to come to terms with their own biological limitations - their own mortality ! This is not a comfortable feeling , and the fact that the outcome of what they do is not in their hands , and that they may never get what they so strongly desire, can be very difficult to accept for many of them.

Many make a bad situation worse by blaming themselves for the failure. They feel that God is now punishing them because they were " selfish " and pursued a career and postponed childbearing. Also, the social stresses add insult to injury when well-meaning fertile friends and relatives say hurtful things - without even realising the damage they cause !

Some patients become very bitter, angry and unhappy as a result of the failure. Others, who are more resilient, become kinder, nicer human beings - more empathetic and understanding, because they have been through the fire of adversity. This is one of the reasons I like treating entrepreneurs - because they are used to dealing with failure - and bouncing back ! They response is - " Fine, what did we learn from this ? And what do we do differently the next time ?"

The life lesson a failed IVF cycle often teaches is that it forces you to confront your own mortality - that life can be fickle and uncertain. This can be a major life changing event - and if you enjoy the learning , you will learn the truth behind the saying - What does not kill you, makes you stronger !

Is surrogacy being used to exploit infertile couples ?

Surrogacy hogs the limelight today and we get a phone call or email practically every day from either an "intended parent" or a journalist who wants to cover this "boom in reproductive outsourcing "!

Unfortunately, very few are willing to think through the " real-life problems" associated with surrogacy. Even a busy IVF clinic like ours which performs over 400 IVF cycles every year will only see 1-2 patients every month who actually need surrogacy.

Not only is surrogacy extremely expensive, it's also full of and emotional and ethical minefields which most doctors do not want to discuss. Infertile patients can be so desperate, that they are happy to try anything new - and clutching at the surrogacy straw seems to be a logical thing to do when you have failed 5 IVF cycles.

However , it's often not medically needed. Not only do these patients end up wasting a lot of time , money and energy - they also expose themselves to potential legal battles and emotional blackmail. Moreover, since they are operating in a legal grey zone, they leave themselves open to exploitation - both by the doctor ( who can charge a bomb for the treatment) ; the surrogate; and the agency which organises the surrogate.

The key question you should ask yourself is - do you really need it in the first place ? While there is no disputing that surrogacy is a valid treatment option for women without a uterus, the real tragedy is that it is being overused and misused to treat women with repeated IVF failures - an especially vulnerable group, which is extremely easy to exploit !

Most women who fail repeated IVF cycles for unexplained reasons usually do so because of a genetic abnormality in the embryo. This is Nature's defense mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetically abnormalities, because they have "aged" and have genetic defects, which cannot be screened for.

It's extremely rare that the reason for failed implantation is a damaged uterus. However, after failing repeated IVF cycles, these women have extremely poor self-esteem, nd it's easy for unscrupulous doctors to exploit them . Since the literature is so confusing ( and confused) about IVF failure ( because we really don't have the tools to pinpoint the causes in women), they come to the conclusion that their uterus is "defective"; or that they have "immunologic issues" which is causing them to "reject" their embryos.

Because many of them have reached the end of their emotional tether , they do not want to take any more medications or suffer from the crippling blow of another failed IVF cycle. They are more than happy to allow the surrogate to go through the IVF process, so they don't have to deal with the physical and emotional pain of another failure. And when there is a demand for this extremely lucrative option, it's hardly surprising that agencies and doctors will be more than happy to supply this option for well-heeled patients - even though they may not actually need this at all, and would be better served by considering alternatives such as donor eggs or donor embryos.

Does the IVF clinic matter ?

One of the toughest choices an infertile couple needs to make is - Where do I do my IVF
treatment ? IVF can be extremely expensive , and since there is so much riding on this decision, it is critically important that you make it correctly ! So, how do you decide ?

Most couples will not apply their mind and simply go to the local IVF clinic - or where their GP or gynecologist sends them. The vast majority of patients are very passive. They rarely do any homework, and are happy to follow their doctor's advise. While this may be a good idea for some patients ( since it's so easy to just do what the doctor says), this is often not the best option. Smarter patients will explore their options, so that they can select the clinic which is right for them. After all, not every sportcar driver is going to be as good as Schumacher - and it's a good idea to try to maximise your chances of success !

Many will ask friends or relatives as to which the "best IVF clinic" is - and then follow this recommendation. They shop around by soliciting opinions , and while this can be effective occasionally, it is not a very reliable technique . Bad doctors may get a good reputation for spurious reasons, so this is not a method I would recommend.

Others will use the internet to research their options. This is a good idea - but you need to be fairly sophisticated in order to separate the wheat from the chaff in order to be able to use this correctly. There are lots of bad clinic with very good websites out there !

The best way is to shortlist 3 IVF clinics - and then interview them. You can do this by visiting them ( if you stay in a large city, for example, there are likely to be many clinics in the city itself , so you maybe spoiled for choice !) and asking for a guided tour. The others you can explore by emailing them or phoning them. You become a better and more discerning patient each time you get a second opinion, so this is a valuable exercise - don't take shortcuts which you might regret later !

Making the final decision is always a very personal matter. Some patients prefer large clinics with an international reputation. Others prefer those with the best rankings on the success-rate league tables. Other want a smaller clinic which offers a personal touch and more individualised care. There are many intangibles, such as the chemistry between you and your doctor, so it's hard to generalise what's going to be right for you - you will need to explore to find out what works best for you. The good news is that there are now many choices. You are no longer forced to settle for the nearest clinic, so you should take off your blinkers and be willing to do your homework.

This is a crucially important decision, and if you approach it intelligently, and invest the time and energy needed to perform your "due diligence", you will have peace of mind you did your best !
What else can you ask for ?

Saturday, September 29, 2007

Patient education Libraries are a cost-effective option for providing better quality healthcare

In the past, housecalls were an integral part of the practice of medicine, and no nineteenth century doctor would even dream of practicing medicine without making housecealls. However, the fact that they are now practically unheard of means we should be taking a hard look at the present traditional ways of practicing medicine so e can come up with newer models of providing healthcare more efficiently and effectively.

The major bottleneck today in providing healthcare is the doctor. Doctors are expensive and scarce resources and the question we need to ask ourselves is simple – are we using this scarce commodity wisely ? The heart of modern medicine is based on the doctor-patient visit in the clinic – but is this really necessary ? Many problems are self-limited and could be better handled without involving a doctor. Many clinical transactions do not require a face-to-face discussion, and can be better done by email or through the web. Also, patients with chronic illnesses can be taught how to manage their own illness better. How can we create an alternative model, which offers a better option ?

Many attempts have been made in the past – and all of these have revolved around using a substitute for the doctor – for example, a village health worker in India, or a “barefoot doctor” in China. The modern “ retail clinic” in the US which is located in a mall is a variant on this model, since they allow a nurse ( who is much less expensive) to offer care for simple medical problems. However , none of these are very effective solutions, because they still keep the patient dependent on an outsider.

How can we create a more patient-friendly model ? I think we can learn from the education sector. In the past, education meant that children were sent to schools, where the experts ( teachers ) “taught” the children what they needed to know to pass their examinations. Today, we understand that teaching is not just the passive transfer of knowledge from teachers to students. Good teaching involves the active participation of students so they learn to learn for themselves. In fact, this is the major reason why the US has been so much more successful than other countries in the past few decades. In most countries, students were taught using traditional rote learning methods, which means they made great clerks or professionals, but they never learnt to take risks or think for themselves . In sharp contrast, thanks to the national network of free public libraries set up by Carnegie in the US, students here were forced to go to public libraries to do their own research for themselves, so they learnt to ask questions and find their own answers.

I think the health-sector can learn from this model by setting up networks of Patient education libraries to help patients get better healthcare. I agree this is an unusual proposal, but it’s worth examining closely.

  1. This is quite inexpensive to do. For the cost of one new MRI scanner, one could setup over 100 libraries , each equipped with about 100 books and 10 PCs with internet terminals !
  2. Librarians are much less expensive than doctors. They are also far better teachers , because they are used to helping and guiding patrons so they can find the information they need
  3. Patients in a library are likely to be much more empowered . They will not feel scared or intimidated, as they do by their doctor. They will treat the librarian as a guide or peer , which means they are much more likely to craft their own answers and make their own decisions . They will formulate their own treatment plans and stick with these, ensuring a higher degree of compliance.
  4. This is a much more enlightened, participatory and democratic model, which puts patients at the center of the healthcare universe. This is where they belong, but in order to reclaim this place, they need to become well-informed, so they can be treated as equals by their doctors

Much more importantly, this model represents a completely different philosophy – one which respects patients, and teaches them to ask questions and find their own answers. This means patients will take much more responsibility for their own health , and this is especially important for patients with chronic illnesses , who can become “expert patients” and help guide others with the same illness !

How is this different from the traditional “patient education model” where the doctor educates the patient by giving them brochures or showing them videos ?

For one thing, the information is likely to be much more reliable ! Since the librarian has no vested interest in pushing surgery or promoting a particular drug, patients will get objective vetted information about cost effective, tried and tested treatments, rather than the newest , most fashionable ( and most
expensive !) drug which is being actively promoted by the drug companies.

Librarians are good at applying evidence-based medicine because they are information specialists. However, since they do not provide the actual care, they are objective and will act as guides or coaches. This allows a two-tier approach , so that armed with this information the patient goes to the doctor and discusses his options more intelligently . This makes better use of the doctor’s time as well – and helps to keep the doctor honest too !

I need to emphasise that my concept of a library is not just a collection of books in four walls. While it is important that each hospital have a patient education library to which patients can go and to which doctors can refer their patients, a lot of this will be done online as well . Information could be delivered through the web and the mobile and queries could be answered by email; or through a call-center. As clinical decision support software becomes more mature, this could also be used by librarians to help patients think through possible diagnostic alternatives.

Patient education libraries represent a great return on investment, as patients will no longer undergo unnecessary ( and expensive !) surgery; or be pressurized into popping the newest ( and costliest ) version of a drug . Since the information is being provided by someone other than the actual clinician, the information is likely to be much more objective and reliable ! These libraries could also form the nucleus of patient communities ; where patients could get together and support each other with a little help from a librarian.

Welcome to the world's largest patient education library !

How a Patient Education Library can help you get better medical care !

Thursday, September 27, 2007

"The Best Care Anywhere" by Phillip Longman

"The Best Care Anywhere" by Phillip Longman: "'The U.S. medical market as presently constituted simply does not provide a strong business case for quality.' Casalino writes from his own experience as a solo practitioner, and on the basis of over 800 interviews he has since conducted with health-care leaders and corporate health care purchasers. While practicing medicine on his own in Half Moon Bay, Calif, Casalino had an idealistic commitment to following emerging best practices in medicine. That meant spending lots of time teaching patients about their diseases, arranging for careful monitoring and follow-up care, and trying to keep track of what prescriptions and procedures various specialists might be ordering. Yet Casalino quickly found out that he couldn't sustain this commitment to quality, given the rules under which he was operating. Nobody paid him for the extra time he spent with his patients. He might have eased his burden by hiring a nurse to help with all the routine patient education and follow-up care that was keeping him at the office too late. Or he might have teamed up with other providers in the area to invest in computer technology that would allow them to offer the same coordinated care available in veterans hospitals and clinics today. Either step would have improved patient safety and added to the quality of care he was providing. But even had he managed to pull them off, he stood virtually no chance of seeing any financial return on his investment. As a private practice physician, he got paid for treating patients, not for keeping them well or helping them recover faster." Who Killed HealthCare?: America's $2 Trillion Medical Problem - and the Consumer-Driven Cure: Books: Regina Herzlinger Who Killed HealthCare?: America's $2 Trillion Medical Problem - and the Consumer-Driven Cure: Books: Regina Herzlinger: "'Four armies are battling to gain control [of health care]: the health insurers, hospitals, government, and doctors. Yet you and I, the people who use the health care system and who pay for all of it, are not even combatants. And the doctors, the group whose interests are most closely aligned with our welfare, are losing the war.'

What to do? Herzlinger's convincing, indeed compelling and eloquent response to that question is best revealed within her narrative. However, for present purposes, here are a few key recommendations:

1. Consumers must take back the money their employers and government now take from their salaries and taxes to buy health insurance on their behalf so they can make their own purchase decisions.
2. Physicians must be empowered to design better, cheaper health care.
3. The destitute must be subsidized by 'the rest of us' so that can purchase health insurance 'like everybody else.'
4. The federal government must help subsidize the destitute, provide transparency (a key factor for all consumers, actually), and prosecute fraud and abuse."

My Home Doctor - House Call Services South Florida

My Home Doctor - House Call Services South Florida: "Now seeing patients 24hrs/day! My Home Doctor gives you and your child a better option for medical attention. We send top, local physicians and pediatricians to your home - any time - day or night. We arrive in about one hour, conduct a comprehensive, unhurried exam, and diagnose your condition. You begin your treatment plan right away, in the comfort of your own home, office or hotel room. And our services are more affordable than you might think. Click here to view how our cost measures up against other clinical treatment centers. All My Home Doctor physicians and pediatricians are board-certified, licensed and practice exemplary medicine in South Florida."

Be MedWise Tennessee

Be MedWise Tennessee: "Did You Know That Taking Medications Is As Simple as PIE? If you know what the purpose of each medication is, understand instructions for use and dosage, and know the outcomes (effect) to expect, then taking your medication can be as simple as PIE.

* P–Purpose and name of the medication
* I– Instructions for use and dosage: o How many times a day? o Time of day? o With food or without food? o How long to take it? o What if I miss a dose? o Should I avoid alcohol, sunlight, certain foods, etc.?
* E–Effect of the drug, both positive and negative "

The ‘Poisonous Cocktail’ of Multiple Drugs - New York Times

The ‘Poisonous Cocktail’ of Multiple Drugs - New York Times: "This is what doctors call polypharmacy, otherwise known as a “poisonous cocktail” of many drugs that can interact in dangerous ways and cause side effects that can be far worse than the diseases they are treating. Elderly people are especially vulnerable because they often have several medical problems for which they see different doctors, each prescribing drugs, often without knowing what else the patient is taking."

Plain Language: A Promising Strategy for Clearly Communicating Health Information and Improving Health Literacy

Plain Language: A Promising Strategy for Clearly Communicating Health Information and Improving Health Literacy: "Conclusion: Plain language makes health information easier to understand Our nation faces an enormous challenge to ensure that people with low health literacy skills have the opportunity to receive and understand the health information they need to make sound decisions. Limited health literacy is a complex communication and information problem that requires multiple approaches and methods to realize improvement. This brief examines plain language and its contribution to improving health literacy. Research and experience demonstrate that plain language is an essential element of clear communication. Although more research is needed to determine the most effective techniques to communicate clearly with all consumers and patients, existing research shows that plain language is a promising strategy to address the challenge."

Retro Medicine: Doctors Making House Calls (for a Price) - New York Times

Retro Medicine: Doctors Making House Calls (for a Price) - New York Times: "Some doctors are doing things like taking only house-call appointments or operating “micropractices” in which they work without front-office staff and nurses and see their patients in a smaller one-room office, Dr. Kellerman said. When making house calls, “you get paid,” said Dr. Steven Meed, one of eight New York physicians working for Sickday Medical House Calls, which started last year and serves patients in Manhattan. “The paperwork overhead is kept at a minimum, the fee is fixed and it’s not going to be reduced.”"

Hormone-Replacement Therapy - New York Times

Hormone-Replacement Therapy - New York Times: "Many explanations have been offered to make sense of the here-today-gone-tomorrow nature of medical wisdom — what we are advised with confidence one year is reversed the next — but the simplest one is that it is the natural rhythm of science. An observation leads to a hypothesis. The hypothesis (last year’s advice) is tested, and it fails this year’s test, which is always the most likely outcome in any scientific endeavor. There are, after all, an infinite number of wrong hypotheses for every right one, and so the odds are always against any particular hypothesis being true, no matter how obvious or vitally important it might seem."

Using pictures to improve health communication.

Using pictures to improve health communication This presentation discusses the need for effective comunnication between health professionals and patients and the potentially important role that pictures can take in insuring accurate and effective communication.

The AGS Foundation for Health in Aging

The AGS Foundation for Health in Aging - : "2nd edition of Eldercare at Home as a resource for families and friends who are caring for older people at home. Written by experienced health professionals, the book is a tool for caregivers who are working in consultation with a health care professional in providing home care for an older person. Families are increasingly involved in caring for older adults who want to remain at home. Providing that care can be one of the most rewarding experiences of one’s life. It can be one of the most challenging experiences as well. Family caregivers frequently have to deal with new, unfamiliar problems and learn new skills. They must do this in the context of strong emotional relationships. They must also involve the older person as much as possible in his or her own care. At the same time, family members need to take care of themselves so that they are able to provide the long-term care that is required and maintain their own quality of life. To meet these challenges, advice and guidance from experienced professionals can be important and helpful. The 2nd edition of Eldercare at Home gives this guidance. The book gives clear, practical instructions for dealing with common caregiving problems and supports a problem-solving approach to managing care at home and working cooperatively with health professionals. "

Help Patients Remember Instructions With The “Teach Back” Method

Help Patients Remember Instructions With The “Teach Back” Method : "The “Teach Back” Method is simply asking patients to repeat back in their own words what they need to do when they leave the office. This method allows you to check your patient’s perception and understanding of your medical instructions.

* You do not want your patients to view the Teach Back task as a test, but rather of how well you explained the concept. You can place the responsibility on yourself by using this suggested language:

* “I want to be sure that I did a good job explaining your blood pressure medications, because this can be confusing. Can you tell me what changes we decided to make and how you will now take the medications?”

* If your patient is not able to repeat back the information accurately, you should try to re-phrase the information, rather than just repeat it. Then, ask the patient to repeat back the instructions again until you feel comfortable that the patient really understands the information."

Resolving conflict between patient and physicians - a model

Resolving conflict between patient and physicians - a model During the past 20 years, the number of people with End Stage Renal Disease (ESRD) on dialysis has increased to about 350,000. Many in the field sense that along with that has been a rise in tension between dialysis patients and providers. While difficult patients may be a small percentage of all patients with ESRD, they can command a disproportionate amount of the unit staff’s time, many in the field say. In addition, not only do patients exhibiting challenging behaviors place their own health at risk, they also endanger the health of other patients and potentially the providers. Yet, the question remains how to respond when faced with such a patient. For some, the answer is discharging or dismissing the patient, but not all in the field find that a satisfactory solution. Stories abound of units that discharge patients for infractions as minor as verbal abuse. Others strive to address the underlying factors that lead to the patients’ misbehavior in the first place. Given the wide variability in units’ standards for discharge, interviewees repeatedly endorsed the notion of a project to address this problem sooner rather than later. With the number of patients on dialysis projected to double by 2010,2 many feel the time is ripe to identify ways to reduce the potential for conflict and improve the work environment for professionals and the prognosis for patients.

Making a Bottom-Line Case for Health Literacy

Making a Bottom-Line Case for Health Literacy : "Putting health-literacy principles into place obviously takes time, training, persistence, and money. The clinic offsets these expenses by putting the most cost-effective people in positions where they can do the most good. This means that patients are not always seen by primary care physicians whose time is at a premium. Instead, returning patients may be seen by physician assistants, pharmacists, nurse practitioners, or dieticians. Patients also work with nonclinical “care assistants” who follow approved guidelines to assist with problem-solving and offer social support. They help in many ways, such as: * Checking patients’ records just prior to appointments and noting any situations that need extra attention. Even when patients come to the clinic for acute problems, care assistants flag important chronic concerns. * Taking a brief, targeted health history while patients wait in the examining room. The care assistant then shares this information and other significant concerns with the clinician just prior to seeing the patient, allowing more time for clinicians and patients to focus on healthcare interventions. * Following up with patients between appointments by calling them to gather information, consulting as needed with clinicians, and then calli"

In Other Words ... How to Help Patients Manage Their Action Planning - Health Literacy

In Other Words ... How to Help Patients Manage Their Action Planning - Health Literacy: "In Other Words ... How to Help Patients Manage Their Action Planning By Helen Osborne, M.Ed., OTR/L President of Health Literacy Consulting Patients, not providers, are ultimately responsible for the day-to-day management of their own chronic condition. But figuring out what to do and being consistent about doing it is hard for almost everyone. Hilary Seligman, MD, MAS, is an assistant professor in the department of medicine at San Francisco General Hospital in California. Many of the patients she sees in her internal-medicine practice have limited literacy or English-language skills, yet regardless of their skill level, Seligman makes it a point to help them develop effective action plans that let them take charge of their own care."

Beyond the Brochure

Beyond the Brochure Most of us obtain health information through many different sources,including printed media such as newspapers, magazines, books and brochures. But for at least 90 million Americans who demonstrate low levels of literacy (Educational Testing Service, 1993), or for individuals
who have learned to rely upon oral forms of communication, written information sources are of little or no use. For such audiences, health educators and communicators need alternative
approaches with appropriate visuals and activities that stimulate learning, are interesting and fun, and motivate the intended audience to experience new behaviors.
The AMC Cancer Research Center, with collaboration and support of the Centers for Disease Control and Prevention (CDC), Division of Cancer Prevention and Control, has developed Beyond the Brochure to assist health educators and health communicators in conceiving and producing educational materials and activities that do not rely solely on the printed word. The intent is to present innovative intervention ideas and strategies that can be used to reach audiences who are not benefitting from current health communication efforts.

In Other Words...Teaching with Pictures - Health Literacy

In Other Words...Teaching with Pictures - Health Literacy: "Pictographs Convey a Lot of Information Quickly Pictographs are a special type of graphics. They are simple drawings that represent ideas, and they can help a person grasp, understand, and remember medical information quickly. Pictographs have a long history, dating back to cave-wall paintings and renaissance stain glass windows. Today, road signs are a common example of pictographs. A sign with a simple picture of a school bus, for example, conveys the more complex message not only that a school bus is likely to go down the, but also that drivers should be alert to the possibility that children might walk across the road. “Pictographs can also be cues to help people remember spoken information,” says Peter Houts, PhD, professor emeritus at Pennsylvania State University, College of Medicine, and research associate at the Johns Hopkins Oncology Center. Houts is currently researching the use of pictographs to help cancer patients and AIDS patients who read below a fifth grade level remember medical instructions. Using simple drawings of patients, doctors, nurses, and family members, Houts has created a series of pictographs that show low literacy patients and family caregivers how to recognize a medical emergency as well as how to avoid medical emergencies. A sampling of these pictographs can be seen on the Johns Hopkins Oncol"

The Prepared Patient - Volume 1, Issue 2, May 2007

The Prepared Patient - Volume 1, Issue 2, May 2007: "The signs are everywhere - prescriptions doled out into weekly reminder boxes, blood glucose monitors in a desk drawer, maybe even an adrenaline injection pen stashed in a diaper bag for allergy emergencies. From high cholesterol to HIV, millions of Americans have a medical condition that they manage mostly on their own. But with so many of us acting as our own daily doctors, how do you know when it’s time to call in the professionals?"

Health Behavior News Service - The Prepared Patient, 2007

Health Behavior News Service - The Prepared Patient, 2007: "It is not happening widely now, but Kaplan thinks in the future insurance companies and other health payers will invest in effective patienthood training. “If prepared patients go and use health care services more efficiently and effectively, if they follow through on doctor’s recommendations more, why wouldn’t insurance companies pay to make patients more prepared? Otherwise services are wasted and payers are going to end up paying for more visits because patients have goofed up their health care regimens.”"

Great idea. Just like we have classes to teach people how to invest, we need to have classes to teach people how to take care of their health and how to talk to their doctor. A mini-med school for patients !

Health Literacy Solutions

Health Literacy Solutions: "Health Literacy - Not That Easy to Spot! Patients will tell you what hurts. They will tell you they need help and want medicine. They will not tell you if they cannot read. It's not easy to spot low literacy, but there are clues, if you are aware and if you ask the right questions. If your patients can't read, and you are giving them written discharge instructions, or booklets about their condition, or writing instructions to go on the medication label - a good outcome is not forthcoming. In fact, they cannot fully comply if they cannot read, understand and utilize health information, the definition of health literacy. Today, nearly one out of three in the US read at basic or below basic levels, not enough to be considered functional for today's society. And the elderly are also part of the poor health literacy picture, as their cognition, memory, hearing or sight problems may compromise reading levels. According to a recent NCES study, fewer than 1 in 8 (12% ) American adults are proficient in health literacy skills."

Imagine how much worse the situation is in India !

HELP is now working to develop original graphic-based solutions to educate low-literacy patients about their health problems.

Wal-Mart to expand $4 Rx program --

Wal-Mart to expand $4 Rx program -- "Wal-Mart Stores Inc., the nation's largest retailer, said Thursday it will expand its highly popular, year-old $4 prescription drug program, adding medications to cover such diseases as glaucoma, attention deficit disorder and hyperactivity. The Bentonville, Ark.-based company said it will add 24 new prescriptions. The company said it has also added $9 birth control prescriptions, which it said will save women as much as $250 a year. Wal-Mart said that the national average for birth control and fertility drugs ranged from $24 to $30 a month."

Clever appropriate technology

Clever appropriate technology : "In 2000, she helped diagnose an outbreak of dengue fever in Paraguay using the tools of molecular biology and working with the Ministry of Health. “In Paraguay they were like, ‘help!’” she recounted. “The CDC was busy, Brazil was busy, so they said, ‘Eva, can you come help us?’” Using molecular diagnostics, she and the Paraguayan team were able to determine that the dengue strains were coming in from Brazil via the border bus stations. The Ministry of Health was then able to target interventions to the specific locales where the epidemic was entering the country and, by acting quickly, was able to keep it from spreading. Discussing her work in Bolivia , she described the laboratory equipment improvised by her colleagues there. In order to make a centrifuge, they fused faucet widgets with a blender to create the “Blenderfuge.” They also took an old record player and transferred the circular motion to horizontal motion in order to make a lab shaker. These researchers were inspired by a concept that she used at the onset of her career. She wrote a manual about how to carry out polymerase chain reactions — the fundamental tool of molecular biology — in something akin to coffee cans. “What you do in this country is buy a $10,000 machine."

W e l c o m e t o J a n a n i

W e l c o m e t o J a n a n i: "Janani is a non-profit Indian Society that implements a large service delivery programme in three of the poorest states of India. The programme is modeled on the premise that the only option available to supplement the public sector in scale and impact of service delivery is the private sector. The NGO sector accounts for barely 0.7% health care in India and by itself is not a viable option. There are vast sections of the population in India, mostly poor and rural, who do not have access to good quality health and reproductive health products and services. About 16% of couples in reproductive union—25 million in total—want to either space or limit children but do not use a modern method of contraception, mainly due to lack of access. In poor states like Bihar, the unmet need is about 40%. Not addressing this need is a violation of some fundamental reproductive rights. Unwanted children also exact a huge price on the economy and the nation’s wellbeing. India has a vast public sector but during the five decades since the country’s independence from colonial rule, the public sector has not been able to address the needs of the poor fully. There are an estimated 450,000 private doctors, 1.25 rural providers and 12 million shops in India—leveraging such resources provides a huge opportunity to supplement the public sector in scale."

Clever marriage of private resources to accomplish public good ! We need more win-win partnerships like this.

Medicine Shoppe India – High-Quality Rural Health Centers

Medicine Shoppe India – High-Quality Rural Health Centers : "Medicine Shoppe India, the second largest pharmacy chain in India, is establishing health centers in rural India aimed at providing high quality yet affordable health services for poor and marginalized rural consumers. Medicine Shoppe India has considerable success serving India’s urban populations – with a strong emphasis on safety and quality – and with the help of Acumen Fund’s expertise will be able to expand into rural market. In addition, Medicine Shoppe India has innovated a new store format where health services would be offered at no cost, but medicine or other pharmacy products would be sold at affordable prices. To build awareness of their products and services at the village level, Medicine Shoppe India hopes to partner with one or more rural ICT network orchestrators."

BroadReach Healthcare

BroadReach Healthcare: " A consumer revolution in healthcare is underway in the United States and across the globe. It’s a revolution fueled by macro changes in population demographics and income growth. It’s fueled by Baby Boomers, now entering their prime healthcare consumer years, who are seeking to proactively manage their own health and wellness – just as they proactively manage their own financial portfolios. It’s fueled by young professionals, who’ve grown accustomed to high levels of service from their coffee shops and from their health clubs – and now naturally expect those same service standards from their healthcare providers. It’s fueled by a generation of consumers with the highest levels of disposable income in history, who seek to use those resources to trade up to higher levels of quality and service in all areas of their lives. It’s a revolution also fueled by important legislative and regulatory changes that have disruptive market implications. New insurance and health financing instruments, such as Health Savings Accounts (HSAs) and other consumer driven health plans, are rapidly shifting the leverage and control in the healthcare system back to where it belongs – into the hands of the patients and consumers themselves. Sadly, today’s $2 Trillion dollar US healthcare system is poorly designed to respond to"

Wednesday, September 26, 2007

Designing better PHRs

Designing better PHRs
1. Using PHRs for medical record keeping is only the tip of the iceberg.
As the Project HealthDesign teams design and test their prototypes, they are learning that using PHRs to record observations of daily living – such as sleep, diet, mood, medications taken, etc. — may provide helpful clues to patients and doctors about how to better manage their care.
2. The need to make day-to-day observations about mood, pain, etc. is consistent across all patient groups and lends itself to common approaches to record, store and analyze this data
As PHRs are further developed, technology designers could create personal health applications that respond to trends in daily information to empower patients to make minor lifestyle and health adjustments, thereby improving how they feel.
3. Successful PHRs and their applications need to mesh with the tools that consumers rely on in their everyday routines. For example, patients aren’t likely to use a separate calendar that highlights timing for breast cancer treatments; they want information about their breast cancer treatments to sync with the electronic calendar they already use to organize the rest of their lives.

Specialization and Global Reach Characterize the IT Services Landscape — Digital Healthcare and Productivity

Specialization and Global Reach Characterize the IT Services Landscape — Digital Healthcare and Productivity: "Specialization and Global Reach Characterize the IT Services Landscape By Wendy Wolfson April 10, 2007 | While the low hanging fruit was harvested in the first wave of healthcare-IT outsourcing, both national and global companies now report that the biggest opportunities lurk in niches. Moreover, traditionally entrenched players like EDS and Oracle are ceding ground to new global companies, say observers. Even modest IT services companies that deal mainly with community hospitals are tapping employees located outside U.S. borders. Stir into this frothy market the steady growth of software provided via an application service provider (ASP) model, the growing desire by healthcare providers to outsource billing, and the ongoing need for systems integration and suddenly the outsourcing landscape looks more nuanced and complicated. 'The healthcare domain is becoming more specialized and competitive,' says Anubhav Saxena, associate vice president of HCL Technologies, in Sunnyvale, Calif., a division of a $3.8 billion company of 41,000 employees, operating in 17 countries. Healthcare-IT comprises around 5 to 8 percent of HCL's revenues.

Yos Technologies eyes top slot in ‘health management’ -

Yos Technologies eyes top slot in ‘health management’ - "The healthcare ecosystem has a large number of players, including hospitals, doctors, diagnostic centres, insurance companies, third-party administrators, and pharmacists. These players have traditionally operated independently, with goals and objectives that are specific to their own interests. There is little synergy between them to exploit common information and provide a consolidated information view to the consumers. Our product YosCare™ is an e-Health Gateway that seamlessly inter-connects consumers and providers through a secure consumer-owned personal health record (PHR) system and 'continuous care' applications. Our solution uses the consumer's health records as the core, while enabling anytime, anywhere access of the records for both consumers and providers through use of Internet and mobile technologies."

Integrated EHR

Integrated EHR: "Pulse Patient Relationship Management (Pulse PRM) is designed to efficiently streamline all the functionality needed for front office, clinical or middle office, and back office operations. It is a Microsoft Windows based product and is designed using the latest and most powerful software development tools and methods. Pulse PRM includes all the functionality of Practice Management Systems, Electronic Health Records (EHR) and Document Management Systems. It is also enhanced with full PDA handheld solutions for physicians and nurses, ANSI standard Electronic Data Interchange (EDI) and a long list of third part product interfaces. Most importantly, the Pulse PRM is backed by experienced implementation and support teams that are second to none in the industry."

New York Doctor Forms Online Practice for Healthy Uninsured - iHealthBeat

New York Doctor Forms Online Practice for Healthy Uninsured - iHealthBeat: "New York Doctor Forms Online Practice for Healthy Uninsured Minnesota Public Radio's 'Future Tense' on Monday included a discussion with Jay Parkinson, a general practitioner in Brooklyn, N.Y., who founded a solo practice that treats young, healthy uninsured patients over e-mail, instant message or video chat. Parkinson said he set up the site a few days ago and has received many positive comments from physicians. He said he has received some criticism from authors of blogs who raised privacy concerns. Parkinson compares treating patients online to banking online and said patients' personal information will be protected"

Patient-Doctor E-mail - iHealthBeat

Patient-Doctor E-mail - iHealthBeat: "Patients who consult with their physicians via e-mail are less likely to visit their physician and less likely to call their doctor's office, according to data from the Kaiser Permanente Center for Health Research, the Portland Business Journal reports. Kaiser found a decline of between 7% and 10% in primary care office visits for patients who e-mail their physicians and a 14% decrease in patient phone calls to doctors' offices. The reduced number of office visits could help save money for employers and insurers, although it also could be financially harmful for medical practices that rely on patient visits for income from insurance reimbursements, the Journal reports. Kaiser Northwest several years ago began using e-mail as part of a pilot project, and currently, 113,000 Kaiser members in Oregon and Washington state use the Internet and e-mail services as part of their health plan. Patients are becoming increasingly interested in secure e-mail services, and they might pressure clinics to invest in the systems or develop a new business model to pay for the systems, according to the Journal."

Tuesday, September 25, 2007

The business case for why insurance companies should invest in patient education

wired.MD patient education videos, consumer health information videos, health videos.

wired.MD patient education videos, consumer health information videos, health videos.: "wired.MD® has effective solutions for payers and health insurance providers seeking more engaging and effective patient and consumer health education for their members. These solutions are ones that help better answer the questions of how can an organization differentiate benefits and offerings to our members? How can an organization increase the educational value of an application, website or portal to members? How can an organization better manage members health to help lower costs and improve health outcomes? Payers and health insurance providers have interest in implementing patient and consumer health education content that allows them to educate more of their members, to provide preventive education, to increase member compliance and satisfaction, to better manage members' health and to increase member patronage. wired.MD's mission is to help payers and health insurance providers to meet any or all of these initiatives with the wired.MD content library. wired.MD has a content library that payers and health insurance providers can integrate into applications, websites and/or health portals. Initiatives and needs for payers can change and can be very specific so wired.MD works to be open to developing the best possible solution for the specific initiatives being implemented."

Why aren't Indian health insurance companies investing in patient education ?

Today, health insurance in India is focussed purely on collecting the premium; and paying the medical fees when the patient falls ill. Unfortunately, there is little being done to help customers remain well . Aborad, insurance companies realise the high cost they have to bear as a result of chronic diseases ( such as diabetes , obesity and hypertension) which are primarily life-style disorders; and are taking proactive steps to ensure their customers remain healthy. Corporates are also investing in employee wellness programs, because this directly affects their
bottom-line !

As the cost of medical care goes up, medical insurance coverage is going to become increasingly important for India’s huge middle class population. This challenge actually presents a significant opportunity for the health insurance industry which can change the face of the healthcare industry by making it more patient-centric ! Indian patients are becoming increasingly articulate , and they want more information about their medical problems. Unfortunately, their doctors do not have the time to provide them with this. Patient education has been a neglected area in India so far, and this lacuna represents a major opportunity for the insurance company which has the vision to realize the importance of owning this area . This is a significant value addition to your customers – and even ends up saving you money on their policies , as they are less likely to fall ill !

In the USA, a growing number of health insurance companies are providing their customers access to patient education in order to reduce the cost of their disease expenses. An excellent example is the CIGNA HealthCare Web site at “ Information is the best prescription”, and Information therapy ( the right information to the right person at the right time) can be very powerful medicine !

Many studies have proven that a dollar spent on patient education ends up saving the insurance companies over 10 dollars ( for example, by preventing unnecessary surgery).

Patient education is a powerful tool to promote health, manage chronic disease, prevent medical mistakes, achieve patient-centered care, improve health care system efficiencies, and improve the overall quality and experience of patient care.

Can't the Health Insurance companies see the forest for the trees ?


PeerClip: "What is PeerClip? PeerClip combines the two preferred ways physicians gain knowledge—reading medical literature and interacting with peers—into a powerful online tool. Who can use PeerClip? PeerClip is exclusively for physicians, physician assistants and nurse practitioners. PeerClip is free to qualified users. Why should I use PeerClip? PeerClip is the first-of-its-kind service that offers physicians an efficient way to store important medical information coming from a variety of online resources. With PeerClip, physicians are able to quickly capture key information in a central location while gaining insight from the collective intelligence of their peers."

Monday, September 24, 2007

Lavasa Corp, Apollo to develop healthcare centre - Healthcare - Healthcare / Biotech - News By Industry - News - The Economic Times

Lavasa Corp, Apollo to develop healthcare centre : "Healthcare major, Apollo Hospitals group and Lavasa Corporation on Friday signed an agreement to set up an integrated healthcare and wellness destination at the Lavasa Hill town near Pune. Lavasa is a modern hill town being developed by Hindustan Construction Company group and is spread across 12,500-acres of land, about 65 kms from Pune. Initially, the plan is to establish a multi-specialty hospital with a capacity of 50 beds which would be ready by 2009, a company statement issued here said. Eventually, services shall extend to wellness activities, long-term care and research and development, amongst others."

Bluewater plans healthcare foray; to invest Rs 500 cr - Healthcare - Healthcare / Biotech - News By Industry - News - The Economic Times

Bluewater plans healthcare foray; to invest Rs 500 cr - Healthcare - Healthcare / Biotech -: " UK-based private equity firm Bluewater International Investment Ltd plans to invest Rs 500 crore in India to tap the lucrative healthcare sector by setting up a multi-speciality hospital with a medical training centre. The company, which has already lined up multi-million dollar investments in India's real estate space, is also contemplating tie-ups with various foreign and domestic varsities for accreditation of its proposed medical training centre. 'Indian healthcare sector has seen an exponential growth in the past couple of years and a lot of PE funds are eyeing the sector for their investments. Instead of investing in a running firm, we are planning to foray into the sector on our own with a planned expenditure of Rs 500 crore,' Bluewater Investments Chairman and Managing Director Ved Goswami said."

Medical tourism is a major growth area - and custom built hospitals are a clever way of attracting international patients.

Helios & Matheson eyes $100-m buy in Europe - Healthcare - Healthcare / Biotech - News By Industry - News - The Economic Times

Helios & Matheson eyes $100-m buy in Europe - Healthcare - Healthcare / Biotech - News By Industry - News - The Economic Times: "The Indian company is looking at a pureplay European IT company which operates in the healthcare sector. Globally, the healthcare outsourcing market is around $80 billion. Indian healthcare IT service providers have so far tapped about 2-3% of this market. But as the healthcare expenses mount in the US and European countries, Indian healthcare IT service providers are upbeat about their growth. In India, companies such as Perot Systems and EDS also provide healthcare IT services in the US and European companies."

The healthcare BPO and RCM sector is booming - and India is going to get a large slice of the pie !

Sunday, September 23, 2007

The NHS - IT plan for EMR

The NHS - IT plan for EMR Accurate information is crucial if patients are to have choice and receive the right care at the right time. A key aim of the National Programme for Information
Technology in the NHS is to give healthcare professionals access to patient information safely,
securely and easily, whenever and wherever it is needed. The National Programme for IT is an essential element in delivering The NHS Plan. It is creating a multi-billion pound infrastructure, which will improve patient care by enabling clinicians and other NHS staff to increase their efficiency and effectiveness.

Family Medicine Meets the Blogosphere - May 2007 - Family Practice Management

Family Medicine Meets the Blogosphere - May 2007 - Family Practice Management: "While blogs have a lot to offer family physicians and their patients now, their impact could be greater in the future, as imagination and motivation advance their use. Just 10 years ago, replacing some office visits with e-mail communication seemed inconceivable to most, but it's happening. Blogs won't replace face-to-face interactions either, but they may enhance doctor-patient communication. For example, blogs have the capability to revolutionize group visits. A physician can give patients with diabetes an Internet address for a blog site that the physician has created. The physician can post his or her thoughts about lifestyle modifications or other relevant topics. Patients can then comment on the physician's original posting, share solutions or problems they encounter, and offer support to one another. Physicians can respond to patients' posts and introduce new subjects. I am working on launching blogs for diabetes group visits and well-child care. The diabetes blog will include posts on diet, exercise, medications and routine testing. The well-child blog will focus on growth and development, immunizations and other guidance for parents. Check out this rapidly growing piece of the Internet. You may find interesting patients, fascinating stories and worthwhile information. It is easy to get started, and once you do, the blogosphere can t"

Patient Relationship Management: When Patients are in Charge !

Patient Relationship Management: When Patients are in Charge !: "Patricia Seybold expressed these principals well in The Customer Revolution – How to Thrive When Customers are in Control.

The key 'customer-centered' principles she identifies have been adapted and paraphrased below for healthcare and patients specifically:

1. Create a compelling 'brand personality.'
2. Deliver a seamless experience to patients across channels and touch points
3. Care about patients and their goals
4. Measure what matters most – to patients
5. Value patients’ time
6. Place patient “DNA” [information] at the core of the system
7. Refine operational excellence
8. Design any new system or process with the expectation that it will need to evolve
9. Provide self-service access to services if possible, when and where the patient wishes"

Patient Relationship Management: Streamlined Approaches for Defragmenting Healthcare — NHS Connecting for Health

Patient Relationship Management: Streamlined Approaches for Defragmenting Healthcare — NHS Connecting for Health: "Patient relationship management (PRM) is an overarching strategy (not just a technology) for identifying and anticipating diverse patient and clinician needs and preferences in order to tailor communications and programs accordingly. The currency for these transactions is patient data. The resulting benefits typically include improved customer service, reduced medical errors, better productivity, cost savings, and improved health outcomes, to name a few. This report first outlines the impetus for PRM stemming from the pervasive fragmentation of healthcare delivery and supporting data, then summarizes the ‘nuts and bolts’ of PRM, and finally highlights how several PRM initiatives are providing valuable benefits to both patients and providers." for doctors - for doctors - "Patient-Centered Medicine, where you concentrate more on how the patient feels about things.

The PCM acronym I like is : FIFE.

F = FEELINGS related to the illness, especially fears What are you most concerned about? Do you have any specific fears or worries right now? I imagine you have had many different feelings as you have coped with this illness. Sometimes people have fears that they keep to themselves and don't tell their doctor.

I = IDEAS and explanations of the cause What do you think might be going on? What do you think this pain means? Do you have ideas about what might have caused this illness?

F = FUNCTIONING, the illness' impact on daily life How has your illness affected you day to day? What have you had to give up because of your illness? What goals do you have now in your life? How has your illness affected your goals? How does this illness affect important people in your life?

E = EXPECTATIONS of the doctor & the illness What do you expect or hope I can do for you today? Do you have expectations about how doctors can help? What do"

Use birthdays for preventive services reminders

Use birthdays for preventive services reminders : "Use birthdays for preventive services reminders It is especially challenging to provide preventive services for two groups of patients: those who don't visit our clinic often and those who have multiple medical problems that must be addressed at problem-focused visits. To manage this problem, we started sending patients a letter on their birthday wishing them well and listing the age-appropriate preventive services they have received and those that are still needed. The letter encourages them to schedule an appointment for the needed services. The response has been positive, and many patients are now up-to-date on their preventive services."

Saturday, September 22, 2007

The Patient Portal

The Patient Portal : "The new Web-based Patient Portal lets patients and doctors communicate easily, safely, and securely over the Internet. Patients are given secure passwords that allow them to log into their physician’s system to see their own private set of documents including labs, diagnostics, statements, and messages. Doctors can automatically remind patients for their health maintenance reminders, procedure due dates and also send them patient statements and lab results electronically. Thus minimizing the need for the patients to call the office."

Friday, September 21, 2007

Intel, Wal-Mart EHR Systems Let Employees Track Health at Home - iHealthBeat

Intel, Wal-Mart EHR Systems Let Employees Track Health at Home - iHealthBeat: "Intel, Wal-Mart EHR Systems Let Employees Track Health at Home American Public Media's 'Marketplace Morning Report' on Wednesday reported on electronic health records for employees of Intel and Wal-Mart. 'Creating a one-stop shop on the Web is a monumental task,' APM's Helen Palmer reports. 'We've had the difficulties that you always have when you're trying to innovate/do something you haven't done before,' Anne Chapman of Intel said. The online EHRs are accessible from employees' home computers and encrypted for privacy protection."

Health Trackers --

Health Trackers -- "Trackers can be a useful tool in managing and tracking your health. Revolution's trackers allow you to enter your information when it's convenient to you, put in your information from past dates, and identify trends over time. Tracking your health in areas important to you is one of the best ways to keep current with your health."

Family-Centered Care

Family-Centered Care : "After years of confining outreach efforts to the occasional focus group on decor or food service, hospitals are striking far-reaching new partnerships with patients and their families, creating advisory councils whose members help plan new facilities, set hiring standards and interview job candidates. Patient groups are participating in the design of clinical trials, evaluating hospital equipment, reviewing medication safety measures and helping train medical residents. The new councils are giving patients an increasingly powerful voice at a time when hospitals are scrambling to increase customer satisfaction, better respond to complaints and avoid costly malpractice litigation. Hospitals also have a strong financial incentive to bring patients and families into the equation: Starting later this year, Medicare will require hospitals to publish customer-satisfaction data on the Medicare Web site to receive full reimbursement for their services. Patient advisers from hospitals around the country worked with survey firm Press Ganey Inc., on five questions to measure concern for patient and family issues. The nonprofit Institute for Family-Centered Care, which developed the core principles behind the patient- and family-centered care movement, is working with hundreds of hospitals in the U.S. and Europe to create patient and family advisory councils. Last"

AAAS - AAAS Science and Human Rights Program

AAAS - AAAS Science and Human Rights Program: "The Right to Health: A Resource Manual for NGOs"

Thursday, September 20, 2007

Health Data Management | I.T. Can Help Tip Health Care (September 18, 2007)

Health Data Management | I.T. Can Help Tip Health Care (September 18, 2007): "LATEST NEWS September 19, 2007 I.T. Can Help Tip Health Care (September 18, 2007) Health care has become more expensive because it's been more successful at keeping people alive, said Brandon Savage, M.D, chief medical officer and general manager global marketing at GE Healthcare, Milwaukee. 'A lot of the health care dollars are spent on keeping people alive that have chronic diseases--and we're having success in that area,' said Savage, who gave a keynote speech at Health Data Management's Clinical Automation Summit, Sept. 17-18 in Chicago. But to get health care over the tipping point--where it can help save lives and money--I.T.must be the driver, he said. For example, the health care industry must increasingly focus on early health rather than late disease to start this paradigm shift, he said, and use I.T. to help diagnose and monitor a patient's condition ahead of the disease curve to prevent further complications, he added. Hospitals then can use I.T. to transform information into insight, Savage said, by building order sets, decision support and other outcomes measurement tools into clinical applications such as EHRs. 'Electronic records can connect your overall understanding to get to one strategy, one view of the data,' he said. Patients also must use"

Wednesday, September 19, 2007

Want those workers to lose weight? Well pay them!

Want those workers to lose weight? Well pay them!: "Want those workers to lose weight? Well pay them! Medical Studies/Trials Published: Wednesday, 12-Sep-2007 Print - Want those workers to lose weight? Well pay them! Printer Friendly Email - Want those workers to lose weight? Well pay them! Email to a Friend American researchers have found that employers who want their workers to lose weight should pay them to do so! It seems giving money to overweight workers is the best incentive to make them lose weight and is in the long term a cost-effective exercise. Dr. Eric Finkelstein of the non-profit research organization RTI International in North Carolina and a team of researchers found people paid to slim down lost more weight than employees who had not been given a financial boost to get fit. For the study the researchers divided 207 people, who had an average weight of 200 pounds (91 kilograms), into three groups to compare their weight loss. One group were not offered any financial incentive to slim down; the second group received $7 for every percentage point of their body weight they lost, while the third group were offered $14. Dr. Finkelstein says after three months people in the $14 group lost an average 4.7 pounds, compared to three pounds in the $7 group while those who had not been paid lost about two"

Five must-do's when a loved one is ill -

Five must-do's when a loved one is ill - "Rule No. 5: Scope out the nurses Suzanne Atryzek said it's crucial to befriend the smartest, most helpful nurses early on. 'Nurses will guide you,' she said. 'Nurses are where it's at.' Atryzek said late one night, a doctor came into her daughter's room and reported that recent blood test results could mean Molly's cancer was getting worse. Atryzek said she broke down in tears. 'But then I went and found a wonderful, smart, smart nurse and got her to explain it to me,' she said. The nurse reassured her and the next morning, the doctor confirmed that the tests were not bad news. Of course, with all this advocating, it's possible to get on the wrong side of the hospital staff. Atryzek said she periodically checks in with the nurses -- and so far, so good. 'They said, 'They're not talking about you in the lunchroom yet, and believe me, they talk about parents in the lunchroom.' ' advertisement Another tactic:gifts. 'It doesn't hurt to take candy to the nurses,' Garrett said. 'Call it a bribe if you want to, but they're human beings. If you bring them candy, it may help them do something extra for your loved one.'"

Five must-do's when a loved one is ill -

Five must-do's when a loved one is ill - "Rule No. 5: Scope out the nurses Suzanne Atryzek said it's crucial to befriend the smartest, most helpful nurses early on. 'Nurses will guide you,' she said. 'Nurses are where it's at.' Atryzek said late one night, a doctor came into her daughter's room and reported that recent blood test results could mean Molly's cancer was getting worse. Atryzek said she broke down in tears. 'But then I went and found a wonderful, smart, smart nurse and got her to explain it to me,' she said. The nurse reassured her and the next morning, the doctor confirmed that the tests were not bad news. Of course, with all this advocating, it's possible to get on the wrong side of the hospital staff. Atryzek said she periodically checks in with the nurses -- and so far, so good. 'They said, 'They're not talking about you in the lunchroom yet, and believe me, they talk about parents in the lunchroom.' ' advertisement Another tactic:gifts. 'It doesn't hurt to take candy to the nurses,' Garrett said. 'Call it a bribe if you want to, but they're human beings. If you bring them candy, it may help them do something extra for your loved one.'"

Value-Based Health Benefits Pay Off for P&G

Value-Based Health Benefits Pay Off for P&G:

"P&G's 'Healthy Living brand' is built on the following principles:

* Partnership--working with employees and their families to maintain or improve their health and wellness
* Quality--supporting initiatives that promote health care quality and help to identify the best health care providers for employees
* Prevention--decreasing barriers to preventive health care in order to reduce the burdens and costs of illness

To help implement the brand, in 2006 alone, P&G began to offer the following preventive benefits and incentives:

* A $40 incentive for employees who complete an online health risk appraisal
* An $80 incentive for completion of weight loss and smoking cessation programs
* A $160 incentive for completion of a one-to-one personalized condition management program (for conditions such as diabetes, congestive heart failure, coronary heart disease, and depression)

Some of the early program successes that P&G can report now include:
* 40 percent of eligible employees have completed wellness assessments
* 78 percent of those eligible for condition management have enrolled in a program
* More employees have become compliant with taking prescriptions for their conditions (such as diabetes) while overall medical costs have dropped."

The Key to Medical Cost Reduction: Partnering with Employees

The Key to Medical Cost Reduction: Partnering with Employees: "Then, the company made a strategic move which Kopanis told the audience was one she could not recommend highly enough. The Dynamic Dies workforce was primarily male, but the primary caregivers of employees' children were their spouses, who were incurring much of the medical costs, and most of the employees weren't passing the information Dynamic Dies was providing along to their spouses. So Dynamic Dies contacted employee's spouses directly by sending information/letters to their homes. The company also upped the ante in terms of motivation by letting employees know it would offer a 1 month free premium if there was a zero percent insurance increase the following year. In 2004-05, Dynamic Dies had a 15.8 percent decrease-- premium increases were passed along to employees for the second year in a row and employees were rewarded with the 1 month free premium, paid back to employees at the end of the year (November--just in time for holiday shopping Kopanis notes,--which created even more buy-in from spouses for the coming years). Dynamic Dies also offers free risk assessments for employees and its spouses, has continued to conduct informational/training meetings, has implemented the education process into new employee orientation, and more. Kopanis stresses that the attention you devote to communicating with and motivating employees--and their spouses--regarding
health care costs and the impact that their actions have on these costs must be unrelenting and ongoing. "I partnered with them and they partnered right back," she explains."


A Shocking Expose of the 12 Biggest Scams,
Cover-ups, Lies, Myths and Deceptions In The Diet and Weight Loss Industries!

This is a well-written e-book - and very honest and factual !

What Is Consumer-Directed Health Care?

What Is Consumer-Directed Health Care?
Comparing patient power with other decision mechanisms.
by John C. Goodman

ABSTRACT: To control health care costs, someone must choose between health care and
other uses of money. The value of most health care is experienced subjectively, as is the
value of other goods and services. No one is in a better position to make these subjective
trade-offs than patients themselves. The current system not only systematically denies patients
the opportunity to make such choices, it distorts the incentives of providers in the
process. Chronic patients in particular would be much better off if they could manage more
of their own health care dollars and if providers were free to compete to meet their needs.

This surgery school operates on the cheap

This surgery school operates on the cheap: " The voice crackles out of the computer speaker, filling the small office in Toronto Western Hospital where Allan Okrainec, a 31-year-old general surgeon, bends over his laptop. 'I'm here, Alemayehu,' Dr. Okrainec says loudly into a small headset. 'Can you hear me?' This has been Dr. Okrainec's Tuesday routine for the past six weeks: First, establish a reliable Internet connection between two doctors' offices in Toronto and Botswana. Dr. Allan Okrainec simulates minimally invasive surgery in Toronto while a doctor in Botswana, shown on the projection screen, learns the technique. Enlarge Image Dr. Allan Okrainec simulates minimally invasive surgery in Toronto while a doctor in Botswana, shown on the projection screen, learns the technique. (Tibor Kolley/The Globe and Mail) The Globe and Mail Then, teach a small group of eager Botswana-based surgeons the basics of a minimally invasive surgical technique that is increasingly common in Western nations due to its health benefits - but rarely used in Africa."

This is a great idea ! It's such a simple tool, which can be used to help doctors across the world.

Government Health IT News - Hacking into e-health records is too easy, group says

Government Health IT News - Hacking into e-health records is too easy, group says: "Hackers can access many e-health records and modify them unbeknownst to the software’s legitimate users, according to a new study by an organization concerned about EHR vulnerabilities. The E-Health Vulnerability Reporting Program (EHVRP), a nonprofit organization formed in 2006, issued a summary of its findings after a 15-month study assessing the security risks associated with EHR systems. It found that a low level of hacking skills would suffice to get into a system, retrieve data and make changes, such as altering medication dosages or deleting records. The good news: The “risk of vulnerability exploitation can be dramatically reduced when vulnerabilities are known and appropriate security controls are in place,” the report’s executive summary states. For the most part, EHR systems are no more vulnerable to hackers than"

Who Killed Health Care ?

Who Killed Health Care ? : "Harvard Business School Professor Regina Herzlinger has written a must-read book, 'Who Killed Health Care?'. It is written in the style of a murder mystery. The puzzle to be solved: Who killed Jack Morgan, (a patient who dies while awaiting a kidney transplant)? Like Murder on the Orient Express, there is not one killer here but many: health insurance companies, hospitals, employers, the federal government and even academics. Jack Morgan is a composite figure, based on the experience of 112 people who needlessly died while waiting for a kidney transplant. They were all insured by California-based Kaiser Permante. Of those who died while waiting, 25 had a perfect match. So the mystery begins, appropriately enough, by asking; what's wrong with Kaiser? 'The original idea behind Kaiser was not all bad,' writes Herzlinger. The company was formed by caring doctors who wanted to practice high quality medicine. Things went wrong when managed care became commercialized and insurers started telling doctors what to do so they could save a buck. Herzlinger is not against managed care in principle, but she argues health insurers are the last people who should be doing it. Geico may be a great auto insurance company, but who would go to Geico for auto repairs? The same principle applies to health care."

Consumerism in Health Care

Consumerism in Health Care: "

* Consumerism in health care is based on the idea that individuals should have greater control over decisions affecting their health care.
* A number of innovative products and plans are advancing the consumerism trend. Health Savings Accounts (HSAs) and Health Reimbursement Arrangements (HRAs) are savings vehicles generally paired with High-Deductible Health Plans (HDHPs).
* Consumer-directed health care is a common-sense approach for addressing two of the most vexing challenges in our health care system: controlling costs and improving access to affordable, high-quality care."


WikiHealthCare: "WikiHealthCare is a Joint Commission-sponsored wiki application. Unlike Wikipedia (which is an encyclopedia), the purpose of WikiHealthCare is to foster collaboration among tens of thousands and in due course of time millions of health care professionals. While this has been a dream of many health care quality pioneers, it has only recently become technically possible."

It's good to see that official bodies and the government have started using Web 2.0 technology to help doctors to talk to each other !

PACE - How to Talk to your Doctor

PACE - How to Talk to your Doctor: "People often complain about doctors' poor communication. While many doctors could stand to improve their communication, there are good reasons why patients also should be effective communicators: * Doctors' appointments are usually limited to about 15 minutes, so it's important for patients to be prepared and organized. * The doctor's ability to determine what is wrong and how to treat it depends almost entirely on the communication between the doctor and patient. * Science has provided many wonderful medications and tests, but the doctor's decision to order a test or prescribe a medication most often depends on what information is provided by the patient.

In general, effective patient communication involves:
Presenting detailed information about how you are feeling.
Asking questions if desired information is not provided.
Checking your understanding of information that is given to you.
Expressing any concerns about the recommended treatment.

These four communication skills make up the PACE system for communicating with you doctor. You can get the most out of this web site if you take notes as you work through the pages. There will be points where you will want to write down information to tell"

Handbook for Mortals : Talking With Your Doctor

Handbook for Mortals : Talking With Your Doctor: " It isn't easy to talk about disease and dying. And talking specifically about your own dying is both harder and more important to do. Sometimes talking about it is hard because you don't know which words to use. That isn't your failure: Our society doesn't have the words and shared stories that would make it natural to talk of death and dying. Sometimes it is hard to talk about your own dying because you are afraid to learn what might happen next. You might fear that if you talk about something bad, you will cause it to happen. Even if you know this 'magical thinking' is illogical, it can still keep you from talking and asking important questions."

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