Wednesday, October 31, 2007

Power to the Patient: Mount Sinai Puts Medical Records Snapshot on Smart Cards

Power to the Patient: Mount Sinai Puts Medical Records Snapshot on Smart Cards : "Today, Mount Sinai patients participating in the pilot test can choose to carry a 'personal health card.' This encrypted smart card with 64K of memory holds not only the patient's name, photo, and insurance information, but also a medical history snapshot, including notes on allergies, medications, recent treatment data, and even in some cases, a compressed EKG test result. The goal is to distribute 100,000 cards in the initial pilot project, Contino says. Mount Sinai's registration staffers can use the cards to check in patients quickly and accurately; emergency room triage nurses can use the cards for quick access to relevant patient data."

U.S. Needs to Push Harder for E-Health

U.S. Needs to Push Harder for E-Health: "The U.S. government needs to step up its push for electronic health records because they are not being adopted quickly enough, a group of health advocates said Friday. MORE ON CIO.COM Hurdles to an Electronic Medical Records System Big Hospital Puts Medical Records on Smart Cards Microsoft's HealthVault Health-care providers in the United States continue to make errors that hurt tens of thousands of patients each year, and e-health records could prevent many of those problems, said Dr. Alan Lotvin, senior vice president of oncology for Magellan Health Services. The U.S. health-care system is failing patients 'despite the fact we have the knowledge and the technology to really do a much, much better job.'"

Tuesday, October 30, 2007

Do your healthcare bills confuse you?

Do your healthcare bills confuse you? " Government and state laws require doctors, hospitals, ambulance services, therapists, and other caregivers to use different bill forms and sometimes-different terms for treatment. You may receive a lot of paper after a doctor or hospital visit, and may be confused by these bills and the words on them.
This booklet also includes a sample of a typical bill. Printed on the sample bill are notes explaining what different areas of the bill mean. We have also included some questions that patients often ask their doctors or hospitals about their bills, and answers to those questions. There is also a page that you can use to write notes or questions to ask your doctor or hospital about your bill."

Patient Friendly Billing

Patient Friendly Billing " The Patient Friendly Billing project is committed to helping the healthcare system create patient bills that are:
❍ Clear: All financial communications should be easy to understand and written in clear
language. Patients should be able to quickly determine what they need to do with the
❍ Correct: The bills or statements should not include estimates of liabilities, incomplete
information, or errors.
❍ Concise: The bills should contain just the right amount of detail necessary to communicate
the message.
❍ Patient Friendly: The needs of patients and family members should be paramount when
designing administrative processes and communications."

Hospitals can be very "creative" in the way they bill their patients - especially when it's a third party which is paying the bills. Here are some useful guidelines to follow.

Patient friendly billing

Patient friendly billing First, healthcare financial services will need to become more patient-centric in focus. This means coming up with new ways to identify and address patient needs, learning how to communicate with patients as partners, and incorporating such patient-friendly concepts as pricing transparency, point-of-service payment, and simplified charge structures. Providers will also need to provide meaningful information about quality of care.

Second, in order to be successful in the future, providers must be willing to make radical changes. Consumerism in health care poses a truly different way of doing business. Incremental change—nibbling around the edges—will not be enough to get us where we need to go.

Third, we cannot go it alone. The only way to make the system truly work for the consumer is to collaborate creatively with other providers, commercial and government insurers, employers, regulators, and— first and foremost—consumers themselves.

Innovative ideas in healthcare - how to generate them !

Innovative ideas in healthcare - how to generate them !

1. Patient Healthcare Advocate – “Health Buddy”.
Phone and on-site credentialed clinical advocacy services to patients and their family
members sold as a voluntary benefit through employers and to individuals. This helps
put patients more confidently in charge of their care because of access to an
educated advocate.

2. Global Research Network Use electronic medical records to identify potential subjects for clinical research. More rapid access to a broader and more diverse patient population by researchers should accelerate clinical trials, reduce costs, increase drug safety and medical practice innovation and population-wide surveillance.

3. Health Key Providers and other stewards of patient healthcare information use a secure “key” to identify an individual patient’s data. Making those “keyed” data available outside of firewalls gives patients web access to their records anywhere in the world when they need it.

HealthShopper : Vimo Newsletter

HealthShopper : Vimo Newsletter: "The 'Healthy Living' Credit Card Aetna and Bank of America have teamed up to develop the Aetna Healthy Living(TM) credit card for Aetna's medical, dental, pharmacy and behavioral health members. The innovative credit card, available later this year to qualifying Aetna members, is a rewards-based credit card that facilitates payment of out-of-pocket medical expenses as well as everyday purchases while promoting healthy living at the same time. The card offers a convenient way for consumers to manage their healthcare dollars. Members who apply for and are issued the Aetna Healthy Living credit card will have access to a base rewards program that offers one point for every qualifying retail dollar charged to the card and access to a wide variety of redemption options. Additionally, Aetna Healthy Living credit card members will be rewarded with the following unique features that provide incentives for healthy living. * Earn points for money spent on certain health-related purchases including hospital treatments, doctor and dentist charges, sporting goods stores, fitness and weight loss centers, vitamin stores and more. * Receive a discount on dozens of health-related items - gym equipment, spa set, bicycles, blood pressure monitors and more from the WorldPoints catalog."

This is a clever idea ! Now that insurance companies and banks are getting into the healthcare space, this is a logical extension of their offerings. - Medical ripoffs, overspending on overtreatment - Medical ripoffs, overspending on overtreatment: "Do more, make more . Paul DeLeeuw, M.D., whose whole-body CT scan led to many follow-up tests but no diagnosis of serious disease. Photo by Roark Johnson When it comes to health care, more is not necessarily better. But more is what patients tend to get. While America's health system has achieved important gains against major diseases, it has also encouraged the overuse of costly treatments. The system pays the vast majority of doctors and hospitals on a piecework basis called 'fee for service.' The more services they provide--a blood test, surgery, an MRI or CT scan--the more money they make. Experts estimate that the nation's $2 trillion annual health-care tab is one-third to one-half higher than need be, in part because of overuse of costly treatments and unnecessary care." - Medical ripoffs, 10 overused tests and treatments - Medical ripoffs, 10 overused tests and treatments: " 1 BACK SURGERY. Don't rush to surgery for a simple slipped disk. In 90 percent of cases, the pain goes away on its own within six weeks. In stubborn cases, surgery, which can cost $20,000 plus physician's fees, can relieve pain somewhat faster than physical therapy and medication, a recent study showed. But it also found that both groups of patients wound up with similar improvements after two years. 2 HEARTBURN SURGERY. Doctors surgically tighten a sphincter muscle that blocks stomach acid from backing up into the esophagus. But research shows the operation, which costs $14,600 or more, provides no better long-term relief than taking a proton-pump-inhibitor drug such as omeprazole (Prilosec OTC), which costs less than $1 a day. 3 PROSTATE TREATMENTS. Prostate cancer is often overtreated by surgery that costs $17,000, or by radiation therapy for $20,700 or more, plus physician's fees, without adequate discussion of the alternatives or the high risk of distressing side effects such as incontinence or impotence. Because prostate cancer can grow slowly, sometimes the best approach is 'watchful waiting.'

Check out the entire list !

JS Online: Do online reviews of doctors by patients hurt or help?

JS Online: Do online reviews of doctors by patients hurt or help?: "Hundreds of Wisconsin physicians are being rated on Internet sites such as, and From Rhinelander to Kenosha and Eau Claire to Appleton, patients are grading doctors from all specialties on their helpfulness, knowledge base, personal skills and punctuality. Advertisement Buy a link here According to a recent Forbes magazine article, this appears to be becoming a popular online activity, with some sites averaging 1,000 new reviews per day. Proponents of such sites argue that patients are customers who are paying for a service and should be able to openly express their level of satisfaction and that informed health consumers will make better choices about how to spend precious health care dollars. Critics complain the sites are defamatory and capricious. For example, customers are not qualified to judge a doctor's decision to order a particular test or procedure."

Sunday, October 28, 2007

MEDgle - search your symptoms

MEDgle - search your symptoms: "Search over 6000 symptoms and more than 2000 diagnoses. General Medicine Personalized medical search by doctors for everyone (for informational purposes only) All data have been entered by physicians. We are still in BETA and continuously updating the database."

This is a great tool - check this out. You'll have a pretty good idea of what your doctor will be considering once you check out this site !

Health Populi: The Future of Retail - Implications for Health

Health Populi: The Future of Retail - Implications for Health: "The new retail environment for consumer products has direct implications for consumers in health care. Control, co-creation, technology, globalization...these forces are, together, shaping some consumers' approach to health in the current market. By 2015, these forces will be part of the health landscape in which providers and marketers will compete, and where patients will behave more like...consumers."

Health Populi: Health 2.0 Conference -- Present at the Birth

Health Populi: Health 2.0 Conference -- Present at the Birth: "Paul Wallace, Medical Director of Kaiser Permanenete, offered that 'we talk about trust as a zero-sum game,' but that we should look at trust 'as an asset that you can grow.' Instead of thinking about the number of patients a doctor can see in a day in the office, Dr. Wallace thought it more relevant to think about 'how many patients you can touch in a day,' virtually, through e-consults, e-mail, and other technology-enabled tools. This could make each in-person visit richer, longer."

I already "talk" to more patients by email today than I do in real life !

Practice Fusion - Practice Fusion Officially Launches

Practice Fusion - Practice Fusion Officially Launches: "Practice Fusion, a leading force in healthcare IT, today announces the availability of its free, on-demand, no-risk Practice Management and EMR suite. With this launch, Practice Fusion is poised to change the dynamic in EMR adoption, significantly increasing independent practitioners’ ability to quickly select and begin using world class practice management and EMR. “Today marks the end of the era of big vendors taking advantage of independent physicians—we are empowering them to take control of their EMR decision,” enthuses Ryan Howard, CEO of Practice Fusion. “Our Practice Management and EMR Suite, which is free and on-demand, eliminates the risk of those traditional systems and expedites the purchase and implementation processes. Our EMR allows practitioners to stay competitive and thrive in a world of constant change and growing responsibilities and still increase their overall quality of care.”"

Tech Medicine

Tech Medicine: "Dr. Jay Parkinson (MD, MPH) runs an unusual type of medical practice in New York City. Like many 'concierge' physicians, he accepts no insurances -- the flat rate is $500 a year. He has no office -- he makes housecalls to your home or work. $500 gets you two visits and 'unlimited e-visits': email, phone calls, video chat, or instant messaging. In order for this system of primarily mobile medical care to work, Dr. Parkinson chooses his patients carefully. They must be accessible in Manhattan or Brooklyn, and they must be young (less than 40) and generally healthy. He runs his practice on a laptop, an electronic medical record system (Life Record), and an iPhone. Many of his patients don't have insurance and must pay 'out of pocket' for their medical care. To make his practice more appealing, Dr. Parkinson has contacted local laboratories, pharmacies, and radiologists to obtain the best prices on their services. Not only does he see patients, but he acts as their personal medical shopper for products. While there are many potential problems with this model of practice, the reality is that many younger people (who are generally healthy) don't have insurance, are very comfortable with instant messaging and electronic communication, and would prefer this type of online relationship with their doctors."

Enhanced Medical Decisions, Inc. - Announcing (Beta) -- A Powerful, First-Ever, Online Medical Search Technology That Empowers Users

Enhanced Medical Decisions, Inc. - Announcing (Beta) -- A Powerful, First-Ever, Online Medical Search Technology That Empowers Users To Quickly And Easily Find Accurate Information: "Enhanced Medical Decisions, Inc., a health information technology (IT) innovator dedicated to creating solutions for U.S. healthcare issues -- today announces ( Beta) -- a powerful, first-ever, online medical search technology that empowers users to quickly and easily find accessible, accurate information on drug interactions and side affects. Consumers and medical professionals will save vast amounts of time and eliminate irrelevant searches while using's groundbreaking 'natural language' search technology. This technology can determine whether any of the following may be causing adverse symptoms or reactions individually or together: prescription drugs, over-the-counter medications, vitamin supplements and herbal substances."

iGuard Drug Interactions, Risk Ratings and Safety Alerts

iGuard Drug Interactions, Risk Ratings and Safety Alerts: "iGuard is the fastest and easiest way to learn about the safety of your medicines. And, by keeping your iGuard profile up-to-date, you can help the FDA and other researchers identify problems faster than ever. iGuard is a powerful communication and research tool designed to: 1. Alert you and your doctor (if you choose) about important safety information for the drugs you are taking. 2. Distribute risk ratings that help you understand your risk today, and in the future as new safety information emerges. 3. Facilitate communication between you and your doctor about medication risks and monitoring. 4. Provide an easily accessible summary of your health to use in coordinating care across all your doctors. 5. Help researchers identify safety problems faster. 6. Support family members and caregivers who are responsible for monitoring the safety of others."

Pew Internet: E-patients With a Disability or Chronic Disease

Pew Internet: E-patients With a Disability or Chronic Disease: "About a fifth of American adults say that a disability, handicap, or chronic disease keeps them from participating fully in work, school, housework, or other activities. Half of those living with a disability or chronic disease go online, compared to 74% of those who report no chronic conditions. Fully 86% of internet users living with disability or chronic illness have looked online for information about at least one of 17 health topics, compared with 79% of internet users with no chronic conditions. Those with chronic conditions are more likely than other e-patients to report that their online searches affected treatment decisions, their interactions with their doctors, their ability to cope with their condition, and their dieting and fitness regimen."

Empowering the physician-patient relationship: The role of the librarian

Empowering the physician-patient relationship: The role of the librarian: "While searching the Internet is often personally empowering for patients, this sense of empowerment does not necessarily translate into self-efficacy in interactions with health care providers. Whether health information found on the Internet is empowering for patients in clinical consultations appears to depend on the power relations between patients and practitioners, how patients use the information they retrieve, as well as on physicians’ affective responses to these patients. Librarians have a role to play in educating health care consumers and mediating the exchange of information between practitioner and patient."

The librarian can play an important role as an infomediary in dispensing information therapy prescribed by the doctor !

Patient-Physician E-mail: An Opportunity to Transform Pediatric Health Care Delivery -- Rosen and Kwoh 120 (4): 701 -- Pediatrics

Patient-Physician E-mail: An Opportunity to Transform Pediatric Health Care Delivery -- Rosen and Kwoh 120 (4): 701 -- Pediatrics: "Patient-physician e-mail is a service that patients will use given the opportunity. The e-mail service enables physicians to answer medical questions with less time spent compared with telephone messaging. In our experience in an academic pediatric subspecialty practice, patients reported enhanced communication and access with the e-mail service."

The Partnership for Healthcare Excellence

The Partnership for Healthcare Excellence: "There are a lot of things you can do for your health. You can exercise and eat right — but one of the most powerful things you can do for your health is to be an active and engaged patient. That’s where The Partnership for Healthcare Excellence can help. The Partnership for Healthcare Excellence is dedicated to helping you — as a patient and as a consumer — get the high quality care you and your family deserve. Research shows that patients who are informed about their health, ask questions, and get involved in making decisions, actually get better care. That’s why we’re making it easier for you to get the information you need, by offering you tools, tips and resources that you can use to improve the quality of care that you and your family receive."

The second IVF cycle

For many patients, doing a second IVF cycle is much easier than their first one. There is much less apprehension and anxiety, because they have "been there, done that". They know exactly what is involved; and that there is no physical pain during the treatment. Their comfort levels are also much better, because they have developed a personal relationship with the clinic staff. However, for some patients, the second cycle is much harder. The first cycle is often done with the hope that " it has got to work !" The failure of the IVF cycle can be heart-wrenching and forces patients to confront the reality that there are no guarantees with IVF and that life is full of uncertainties. The fear of another failure can become a huge hurdle in some patient's minds - and many can never muster the courage to try another IVF attempt. This is especially true if their experience with the medical staff has been poor; and the clinic is seen to be impersonal and uncaring.

Fortunately, most patients have much more realistic expectations during their second IVF
cycle , which means that managing them is much easier. The index of a good IVF clinic in my mind is how many patients come back for their second attempt !

I especially enjoy treating patients who have failed an IVF cycle at another clinic. Not only are these patients more medically challenging;, it's much more fun to treat them, because we provide so much more personalised attention and care, which means they are more
appreciative . After all, unless patients have experienced poor quality care at another IVF clinic, how can they judge how much better we really are ?

Helping patients to make a decision

One of the most important roles a physician plays is helping patients to make the right decision. This is always very hard to do , because a good doctor should try to empower patients to make their own decision for themselves !

I see myself as being a Sounding Board, and I try to help my patients walk through their options. I do my best to not impose my answers or to tell them what to do , even though this can be hard . I often play the role of a Devil's Advocate, to make sure they have considered all the pros and cons before deciding. I will often give them a "cooling off" period, during which they have time to mull over their choices, so they can follow their heart.

I do have biases, and I share these with them, so they can factor these in when deciding. At the end of the day, they should have peace of mind they did their best !

From retired caregivers, a spoonful of compassion - The Boston Globe

From retired caregivers, a spoonful of compassion - The Boston Globe: "A prominent Boston physician is organizing retired colleagues to provide the personal attention that is often missing in modern medicine. The volunteers with Bedside Advocates will not practice medicine. Instead, they aim to provide comfort and compassion while helping fragile and elderly patients navigate the increasingly complex medical system by accompanying them to the doctor's office, the hospital, and the nursing home. They hope to help patients get better care by empowering them to ask questions, follow their medication regimes, and get prompt attention to problems. And most of all, they plan to be there when no one else is, providing relief for tired caregivers and support for patients without families, according to Dr. Jonathan Fine, who is leading the effort."

This is such a great idea ! Retired doctors can be excellent patient advocates; and their skills are very poorly used at present. They have a lifetime of wisdom to share - why can't we tap this properly ?

Incidentally, retired doctors are a great resource when you want a second opinion; or when you want a referral to a specialist.

Communication now part of the cure -

Communication now part of the cure - "Retired Boston physician Jonathan Fine became a patient advocate in 2004 when he realized communication between doctor and patient is often the first casualty of a major illness. Miscommunication puts patients at greater risk of becoming victims of preventable medical errors, according to a report this year by the Joint Commission, a national hospital accreditation organization. And the Institute of Medicine reports that medical errors cause up to 98,000 deaths a year."

Two numbers every women should know !

Many women are now choosing to postpone childbearing because they want to pursue their career. However, sometimes it's hard to have your cake and eat it too, and some older women regret their decision when they find out that their eggs are too old for them to be able to have a baby .

So it is safe for you to do so ? At what age should you start worrying about your eggs ? 30 ? 35 ? What about all the celebs having kids at the age of 40 ? And can't IVF fix all problems ?

Unfortunately, there is no alarm on your biological clock, and every woman has a limited number of eggs which will run out as she grows older. So how do you know how old your eggs are and how much time you have left ? How can you assess what doctors call your "ovarian reserve" ?

There are 2 simple numbers which will help you to do so - your FSH level; and your antral follicle count. These are two basic numbers every woman who is more than 25 needs to know, so she can make well-informed decisions as to how long she can safely postpone childbearing.

Let's review some basic biology. Women are born with all of the eggs (oocytes) that they will ever have. A female fetus will have the greatest number of eggs around 16-20 weeks of pregnancy (5 million); at birth this number decreases to about 1 million; and by puberty it's down to about 300,000. This constant and dynamic process of decline continues until menopause and is not interrupted by birth control pills, pregnancy, or ovulation. From this reservoir of eggs, fewer than 500 eggs will ovulate during a woman’s reproductive life. Once a women runs out of eggs, she reaches her menopause. About 10 years prior to the menopause is a phase called the oopause, when the egg quality is good enough to produce hormones to generate a regular menstrual cycle ( and this sometimes lulls women into a false sense of security); but not enough to make a baby.

There is a continuous process occurring in the ovaries where eggs are constantly being prepared for the maturation process. It takes 3-6 months for eggs to develop and mature. As the eggs are developing, they transition from a primordial ( immature follicle) to a mature follicle, called an antral follicle. Antral follicles are visible by vaginal ultrasound. Antral follicles therefore represent the reserve of eggs in the ovaries ; and these are the follicles which can be stimulated by fertility stimulation medications (gonadotropins).

An antral follicle count ( AFC) is done during the 2nd-4th days of menstrual flow and is performed by doing a vaginal ultrasound scan. Studies show that the AFC is predictive of the expected ovarian response to gonadotropins. An AFC less than 6 total (between both ovaries), predicts a poor stimulation response. This means a low AFC can correlate with diminished ovarian reserve.

The other simple test for checking how young your ovaries are (the ovarian reserve) is by doing a blood test to measure the level of FSH ( follicle stimulating hormone) in the blood on Day 3 of your cycle . This is called the basal ( day 3) FSH level. Young women with lots of follicles produce a hormone called inhibin, which inhibits the production of FSH, which means they have low Day 3 FSH levels. A normal level is about 3-4 mIU/ml. A high level ( more than 8 mIU/ml) suggests poor ovarian reserve; and a very high level ( more than 20 mIU/ml) is diagnostic of ovarian failure.

These 2 basic tests should be a part of the annual checkup for all women. Unfortunately, most family physicians and gynecologists are clueless about the importance of this test. When a 28 year old asks them whether it's safe for her to postpone childbearing, most of them give her a reassuring pat on the head, and tell her not to worry !

While this advise may be fine for some women, it's a major disservice for others. I feel women need to take matters in their own hands, and ask their doctor to measure their FSH levels, so there is a sound scientific basis for their reassurance. If the FSH level is borderline high, which suggests poor ovarian reserve, further testing to check ovarian reserve is called for, including an ultrasound scan for antral follicle counts.

As Robert Ringer explains, remember that there is a price you pay for every decision you take in your life. There is a price you pay for pursuing a career; and there’s a price you pay for having a baby. No matter what you do in life, do it with your eyes wide open to the tradeoffs involved. And then deal with those tradeoffs with a mature confidence ... and don’t complain. If you find that you are not willing to live with the price of a decision you’ve made, cut your losses short and try to reverse the error as quickly as possible.

ConnectYourCare Consumer-Directed Healthcare Administration of HSA, HRA, and FSA plans

ConnectYourCare Consumer-Directed Healthcare Administration of HSA, HRA, and FSA plans: "ConnectYourCare's CDH Solution provides a complete Consumer-Directed Healthcare platform for employers and employees. Our unique CDH platform provides a pathway for employers to realize healthcare cost containment through CDH adoption. For employees, our solution puts the consumer at the center of the healthcare decision making process, with an enhanced user experience and state of the art tools. Products and Services * Healthcare Account Administration - ConnectYourCare administers all types of healthcare accounts, including HSAs, HRAs, and FSAs. We can administer any combination of accounts, giving employers ultimate flexibility. * Healthcare Payment (Debit) Card - Healthcare accounts can be easily accessed through the card to pay for healthcare expenses at the pharmacy and doctors’ office. * Online Account Access – Participants have online access to account balances, claims and reimbursement requests in real time. HSA participants can also access investment options online. * RapidRequest Claims Processing - State of the art claims process enables automated, paperless claims handling that reduces processing time for speedy turnaround of reimbursements. * Health Education Tools - ConnectYourCare provides a suite of online tools "

Medical Banking - Dr Stephen Parente

Medical Banking - Dr Stephen Parente " I’m very excited about the prospects of medical banking. What intrigues me most is the integration of medical banking and person health records (PHR). There are three elements of vision of medical banking:
- Personal health records (PHR) are a portable resource that patients and their families can use for the long term.
- Patients will use PHR technology as a critical resource for health improvement, prevention, and long term medical care affordability.
- PHR will give patients emergency access to critical information and allow the record to be customized to clearly define their preferences for treatment. For example, pregnant mothers can clearly identify their delivery preference. A delivering OB/GYN still can counter the patient’s preference for the safety of the mother, but there would be no ambiguity about the mother’s wishes. Likewise, patients who want their organs donated in the case of mortal injury could make their preferences known.

The technology platform that appears to be emerging for medical banking is the integrated health card solutions. Several insurers have been experimenting with this technology. Of the early adopters Exante Bank of United Health Groups appears to have made significant progress in developing a product as well as a client base for a early for of this platform know as an integrate health care (IHC) technology."

MedEncentive P4P EBM Ix P4Q

MedEncentive P4P EBM Ix P4Q: "The MedEncentive Program is designed to 'bolt-on' to existing health plans (such as Blue Cross, Medicare, commercial insurers, self-insured employers, etc.) to control healthcare costs by improving the standard of care and encouraging healthy behavior. MedEncentive accomplishes these objectives by financial rewarding both physicians and patients on a per-occurrence-of-care basis for incorporating evidence-based medicine (EBM) and information therapy (I x) through proprietary Internet Website applications, simple but profound checks and balances, and other innovative features. This method of financially rewarding accountability and empowerment falls into a national movement referred to as pay-for-performance or P4P."

McKinsey & Company - A Framework to Guide Health Care System Reform - January 2007

McKinsey & Company - A Framework to Guide Health Care System Reform - January 2007: "The main functions of health care systems – wherever they are in the world – is to promote health among the country's citizens. In designing and operating any system, health care leaders aim to satisfy three leading requirements: ensuring that all people have adequate access to the benefits of health care; making certain that the system delivers care of consistently high quality; and achieving all this at a sustainable level of cost. These three objectives raise a host of complex questions. What constitutes adequate access and quality care? What is sustainable cost? To what extent should market forces be allowed to play a role in managing health care costs, quality and service? Going back a step, shouldn't health care systems shift their current focus on caring for the sick to a more holistic effort to maintain citizen's health? The answers to all those questions vary widely, depending on the historical, political and social context of each national system. But sufficient commonality may exist to construct a universal analytical framework that can help leaders identify reform priorities then design and implement them effectively. By focusing on seven key principles that healthcare intermediaries can use to affect demand and supply of health care goods and services, MGI provides such"

Insurers refuse cover for infertility treatment-The Times of India

Insurers refuse cover for infertility treatment-The Times of India: " Early this year, Tata Consultancy Services, which has more than 90,000 employees, approached New India Assurance Company with a proposal. It wanted New India to devise an insurance package for its employees based out of India which would cover procedures like in vitro fertilisation and artificial insemination. The proposal was prompted by an internal survey's finding that about 15% of TCS employees, both men and women, had fertility problems. Sources say TCS wanted New India to cover each of its employees for Rs 1 lakh. This was meant to be over and above the regular health insurance benefits the company offered. On its part, the insurer examined the proposal and declined to prepare the package TCS wanted. New India argued that these procedures were expensive and did not require hospitalisation. More significantly, the argument went, infertility was not a disease as in such cases it could be a result of, among other things, stress. TCS is not the only company in India to approach insurers for customised packages to cover infertility treatment. Sources in the insurance business say companies such as outsourcing firm Evalueserve, Computer Sciences Corporation and GE have all approached insurers at some point in recent times to seek similar cover for their employees. And all of them have been turned away."

This is actually a big opportunity for a clever and innovative health insurance company in India ! Insurance has now become privatised in India, which means it is no longer just a seller's market. Huge IT companies such as TCS and Infosys employ a large number of young employees who are in the reproductive age group. Many of them get so caught up in the rat race that they tend to put off child-bearing in order to pursue a lucrative career - which means that by the time they are settled and want to start a family, many of them find that their biological clock has ticked on, leaving them infertile. Now these are smart young driven employees, who are used to being successful and getting their own way. They have become senior in the company and can exercise quite a bit of clout ! If they need IVF treatment ( which they feel is partly a result of the overtime and long hours they had to pay in order to advance in the company), they want the company to pay them back by covering for their fertility treatment. Companies are going to start feeling the heat - and they are going to pressurise insurance companies to provide this coverage !

The good news is that many studies done in the US have proven that providing this additional coverage does not increase the cost of insurance cover by a significant amount , so that this is a very cost-effective option insurance companies should be happy to provide. Not only will this be a valuable differentiator for them and a great USP, they can also project themselves as being pro-family and employee-friendly. It's my prediction that infertility coverage is an option insurance companies in India will soon provide to corporates, if they don't want to lose their business. Health insurance is a "hot area" in India right now - and infertile couples will benefit from this.

Of course, if the carrot approach does not work, I think infertile couples need to use the stick option. Many of them are smart and successful executives and entrepreneurs, and they can get together to lobby and advocate for making infertility coverage compulsory for all insurance companies. This is exactly what Resolve did in the US many years ago, as a result of which infertility coverage is compulsory in 13 states in the USA.

Hopefully a group of infertile couples or an infertility support group in India will file a PIL ( public interest litigation) in the High Court, based on the grounds that it's unfair for insurance companies to discriminate against infertile couples by refusing to cover their medical treatment. Infertility is a disease caused by medical problems ( such as blocked tubes); and modern treatment is very successful and cost-effective in providing a solution !

The right to have a baby is something most of us take for granted, and we often lose sight of the fact that 1 in 10 married couples will not be able to have the child they want. Infertility is a very common problem, and if you stop to think about it, you will realise that you know at least one person who is infertile amongst your own group of friends or relatives. However, it remains one of those taboo topics which no one wants to talk about, even though it interferes with one of the most fundamental and highly valued human activities – building a family.

Millions of infertile couples in Indian cities today face many obstacles in their attempts to build a much-wanted family, and one of the most frustrating is the lack of insurance coverage for medical treatment. What this means is that while infertility specialists in India can provide even the most advanced reproductive techniques to solve extremely complex infertility problems, at a level of sophistication which is comparable with that in the West (and at a fraction of the price), most couples cannot avail of these techniques because these are not covered by their insurance policy. So near – and yet so far, would sum up the situation for most couples!

The financial burden that some of the treatments may place on couples can be large, and adding this on to the emotional and physical consequences of experiencing infertility can literally be the last straw which breaks the camel’s back. The strong desire to build a family gives many the strength to face these obstacles, but infertile couples also need additional support from their employers and insurance companies.

While most diseases and medical conditions are covered by insurance, the disease of infertility is often singled out for exclusion, and such discrimination is unfair! Thus, to add further insult to injury, infertile couples not only face the emotional pain associated with not being able to have a child, but also face obstacles put in front of them by their health insurance and employers for reimbursement of the medical expenses they incur on their treatment.

Unfortunately, insurance companies in India still do not provide health insurance coverage for infertility. This is a very archaic attitude, but because the insurance industry in India is still a monopoly, this situation is unlikely to change, until the field gets privatised, or Indian companies fall in line with their Western counterparts.

Insurance companies have traditionally denied claims for infertility on one of the following flimsy pretexts.

  • Infertility is not an illness;
  • Treatment of infertility is not medically necessary;
  • Treatment of infertility is experimental.
  • Infertility treatment is too costly for a country like India to offer
However, it has now been well established that infertility is an illness, which is caused by various medical causes which result in the abnormal functioning of the reproductive systems (such as blocked fallopian tubes or a low sperm count); and that these can be successfully treated in most cases.

Medically necessary is usually defined by insurance policies as medically appropriate for treatment of an illness under professionally recognized standards of health care – and treatments such as IVF are now universally acknowledged to be standard medical treatments, which are no longer experimental.

While certain infertility treatments can be costly, most are quite inexpensive, and only about 5% of all infertile couples will need expensive treatments like IVF. Moreover, if expensive medical procedures like bypass surgery can be covered, then why should treatment for an abnormally functioning reproductive system be excluded?

Why this discrimination against infertile couples in India? Ironically, this is because of the high premium Indians have always placed on the family unit! The major role of the woman in Indian society was seen to be to have children to propagate the family name. Therefore, if a woman could not have children, she was singled out, ridiculed, ostracised and stigmatised.

In fact, given the value Indians have placed on having children, infertile couples should actually receive even more tender loving care from others – and be helped in their quest to complete their family!

However, because of centuries of misconceptions and myths regarding infertility (for example, "a barren woman has been cursed by God, and being punished for the sins of a prior life"), it will take a long time for social attitudes in India to change. Infertile couples are an easy and soft target for everyone –

Ranging from:

  • friends ("life is incomplete without a baby!");
  • in-laws ("when will I become a grandmother?");
  • relatives ("what do they want to earn money for – they do not have any children to leave it to!"),
  • neighbours ("they may have a lot of money, but what’s the use, they don’t have any children");
  • acquaintances (" no good news yet? Go see this doctor my sister-in-law’s cousin went to – he’s the best!") ;
  • co-workers ("you don’t have any kids, so can you stay on a little longer to finish this job – I need to go back to take care of my children!");
  • right to servants (" the reason she shouts so much is because she doesn’t have any children – serves her right!)
(Gentle reader, if you recognise yourself here, please suffer a pang of guilt, and promise to improve your behaviour the next time round!)

Many otherwise enlightened people take the attitude that infertility treatment is elective – and even compare it to cosmetic surgery. However, infertility is a serious medical condition – it is both a disease and a life crisis.

Others pontificate that these couples should just adopt a baby, rather than take treatment. While adoption is an excellent method of building a family for some couples, it is not acceptable to everyone– and forcing couples to do so when they don’t want to is very unfair.

A major problem is that infertile couples in India are too ashamed to stand up for their own rights – with the result that they often suffer in silence. However, infertility exacts a high toll! Not only do many marriages break up, many women are abused for being infertile as well. Also, infertile employees, because of the emotional stress they are under, are often not as productive in the workplace as they could have been if their problem was successfully resolved.

Fortunately, this discriminatory attitude is now being challenged by advocates for infertile couples – at least in the US. The pathbreaking Americans with Disabilities Act (ADA), provides protection against discrimination for Americans with a disability – a disability being defined as" a physical or mental impairment that substantially limits one or more major life activities."

The US Supreme Court has clearly ruled that reproduction is a major life activity. Since infertility is a physical impairment that substantially limits the ability to reproduce, this means that if an individual experiences discrimination because of his or her infertility, a claim can be made that this is illegal under the ADA. Thus, a police woman employed by the city of Chicago sued the city recently because it did not provide infertility insurance coverage. The Court ruled that infertility is a disability under the ADA, and today the city of Chicago covers the cost of infertility treatment incurred by all its employees.

Many employers in India are not still aware of the issues and concerns facing those with infertility. Employers need to be more understanding of the special needs of those of their employees who are infertile, and be willing to make workplace accommodations for those undergoing infertility treatments – for example, allowing the employee to change her work schedule or to take some time off. Employers, insurance companies, and legislators in India also need to take steps to recognize that reproduction is a major life activity – and that infertile couples need all the help we can give them.

Unfortunately, most infertile couples in India do not feel comfortable speaking publicly about this very private struggle, even though they represent all racial, religious, socio-economic and ethnic groups, as well as both sexes.

We all need to remember that infertile couples are our neighbors, co-workers, friends and relatives - and they just want to experience the joy of raising a family - an experience that so many of us take for granted!

A Tale of Two Doctors « Customers Rock!

A Tale of Two Doctors « Customers Rock!: "-WOM (Word of Mouth) referrals mean nothing if the customer experience is poor. The first doctor was a referral from my friend. I trusted that this would be a good doctor. However, the customer service we had (long wait for phone, surly phone agent, no appointment) discouraged us greatly. I found out that the person who answered the phone was a call center rep that answered calls for all the clinics in this particular physican’s network. A nurse from the office called me later in the day to chastise me for not taking the “new patient intake” appointment as they are apparently very difficult to come by. When I told her I wasn’t sure I wanted to have a doctor that was this busy, she told me all their doctors were very busy. I told her that was fine, and we would find another doctor! - You can hear a smile over the phone. Just by listening to the lady from the second doctor, I could actually hear her smile; she sounded glad to be talking to a potential new patient. I felt welcome! This is important for anyone representing your company by phone, including not just customer service but also sales and marketing.

McKinsey & Company - Synthesis - Accounting for the Cost of Health Care in the United States - January 2007

McKinsey & Company - Synthesis - Accounting for the Cost of Health Care in the United States - January 2007: "The United States spends more of its income on health care than other developed countries and that share is rising. It is an arresting statistic that the U.S. now spends more on health care than it does on food. In this new report MGI finds that the United States spends approximately $480 billion ($1,600 per capita) more on health care than other OECD countries and that additional spending is not explained by a higher disease burden; the research shows that the U.S. population is not significantly sicker than the other countries studied. Instead, MGI found that the overriding cause of high U.S. health care costs is the failure of the intermediation system — payors, employers, and government — to provide sufficient incentives to patients and consumers to be value–conscious in their demand decisions, and to regulate the necessary incentives to promote rational use by providers and suppliers. Given the less than optimal access for all U.S. citizens (relative to peer countries), MGI concludes that major opportunities for cost improvement —even if not the full $480 billion—are as possible as they are necessary although no single reform is likely to succeed in achieving the needed rebalancing. "

Consumer-focused healthcare

Consumer-focused healthcare: "# Consumers don't want to actually take control of healthcare, much as they didn't want control over their retirement funds-- but employer survival is forcing the transition # True consumerism likely to happen in ambulatory care setting: e.g., retail clinics, as that is where 80% of the people are. Current focus tends to be on 80% of the costs occurring with acutely ill people # Consumerism may look like 5% adoption in CDHP plans, but increasing consumer responsibility and cost-sharing is penetrating nearly all plans today # The coming revolution will be about lower cost combined with higher convenience. Likely, people will decide they don't need to go to see the physician (e.g., retail clinic is good enough)"

Scott Shreeve, MD: Athena Health: The History of the First Health 2.0 IPO

Scott Shreeve, MD: Athena Health: The History of the First Health 2.0 IPO: "I have previously written on several occasions about one of my all-time favorite companies - Athena Health. It is appropriate to once again put finger to key to congratulate Jonathon Bush, Todd Park, Nancy Brown, Ed Park, Jon Hallock, and the rest of the Athenista's for their recent IPO (September 20, 2007). It was the largest IPO of 2007 and bodes well for the ongoing wave of investment in healthcare information technology. I find the history, growth, and now the prosperity of Athena to be fascinating. Athena was founded by my fellow IT co-conspirators, Jonathon Bush and Todd Park, Athena has steadily advanced over the last decade birthing the 'software as a service' (SaaS) model within healthcare industry. I say 'birthing' because I have watched the labor pains of Athena fairly closely over the last 5 years since first meeting Todd Park in Waterbury, CT on my first ever presentation with Medsphere. We discussed then, and watched again and again, as Athena began to take a bigger and bigger swipe at the 'healthcare hairball'. The hairball (or at least the part I am referring to) is the traditional general practice outpatient clinic. As you may be aware, ~80% of all medical care is delivered in an ambulatory office setting. The office setting is completely disparate - ranging from huge conglomerate multi-specialty practices (50-250+ MD's), to medium-sized groups (10-49 MD's), to the single shingle proprietors in Nowhere, ND. After somehow convincing Todd to leave a schlickety consulting gig at BAH to run a "single shingle" woman's health clinic near San Diego (Dude, I am so interested to know what the pitch was), Jonathon and crew tried to figure out how to make money in modern medicine.

Gumption after gumption, piece by piece, they were able to develop a software system that could actually manage the insurers and all their crazy denial rules. Those late night Mountain Dew runs started to pay off as they began to AGGREGATE data from various insurers to increase their percentage of first time claims approval. Soon, an emergent rules engine was developing based on the power of their ANALYTIC engine. This then allowed them to automatically ADVISE practices of insurance rule variations before they were submitted for adjudication. They began to share this software engine with the other clinics they purchased and soon were selling their services to affiliate organizations. (These three elements - AGGREGATE, ANALYZE, and ADVISE - are three core ingredients to Health 2.0 companies)."

Scott Shreeve, MD: The Canonical Health 2.0 Representation

Scott Shreeve, MD: The Canonical Health 2.0 Representation: "# Begin by defining Health 2.0
# Realize that Health 2.0 is all about Patient Empowered (not the misnomer 'Consumer Directed') Healthcare whereby patients have the information they need to be able to make rational healthcare decisions (transparency of information) based on value (outcomes over price). In the Health 2.0 paradigm, everyone in the healthcare process is focused on increasing value for the patient.
# Realize that Health 2.0 is absolutely reliant on interoperability of health information. Everything from the Personal Health Record (PHR), to the Clinic Health Record (CHR), to the Enterprise Health Record (EHR), to the National Health Record (NHR) must be based on standards, be seamlessly transitioned between environments per standardized security and privacy protocols, and be accessible anytime from anywhere.
# Undergirding this foundation of information, the Four Cornerstones (Connectivity, Price, Quality, and Incentives) of the Value Driven Healthcare movement begin to create a virtuous cycle of innovation and reform. Transparency serves as a key catalyst in this process by creating positive sum competition that can deliver better outcomes at a lower cost.
# As more information becomes available as a result of increased transparency, there will be a wave of innovation at all points along the full cycle of care to appropriately determine value.
# An increased amount of personal health and outcomes information will create an ongoing role for infomediaries and related services providers to add value at each stage of the full cycle of care. These value added Health Advisory Services (more later) will offered by hundreds of companies, in thousands of forms, to millions of people who are can benefit from the remixing of medically related information. It is easy to see how the new Web 2.0 framework, with its inherent social networking and collaboration tools, will make this "long tail" of medicine a "value"able venture.


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."

SEC Info - Athenahealth Inc - S-1/A - On 8/31/07

SEC Info - Athenahealth Inc - S-1/A - On 8/31/07: "The dynamic and increasingly complex healthcare market requires an integrated solution to effectively manage the reimbursement and clinical landscape. We believe we are the first company to integrate internet-based software, a continually updated database of payer reimbursement process rules and back-office service operations into a single internet-based business service for physician practices.

We deliver these services at each critical step in the revenue and clinical cycle workflow through a combination of software, knowledge and work:

• Software. athenaNet, our proprietary internet-based practice management and EMR application, is a workflow management tool used in every work step that is required to properly handle billing, collections and medical record management-related functions. All users across our client-base simultaneously use the same version of our software application, which connects them to our continually updated database of payer rules and to our services team.

• Knowledge. athenaRules, our proprietary database of payer rules, enforces physician office workflow requirements, and is continually updated with payer-specific coding and documentation information. This knowledge continues to grow as a result of our years of experience managing back office service operations for hundreds of physician practices, including processing medical claims with tens of thousands of health benefit plans.

• Work. The athenahealth service operations, consisting of nearly 400 people in the United States, and more than 700 people at our off-shore service provider, interact with clients at all key steps of the revenue and clinical cycle workflow. These operations include setting up medical providers for billing, checking the eligibility of scheduled patients electronically, submitting electronic and paper-based claims to payers directly or through intermediaries, processing clinical orders, receiving and processing checks and remittance information from payers, documenting the result of payers’ responses and evaluating and resubmitting claims denials. "

Saturday, October 27, 2007


CureHunter: "The CureHunter Discovery Engine is the world's only fully unified and integrated numeric index of all known drugs, biologically active agents, diseases and empirical statements of all effective clinical outcomes published in the United States National Library of Medicine. The engine you are accessing online right now computes: 121,000 drug and biological agent data points X 11,600 diseases X 15,000,000 peer-reviewed research articles X several hundred thousand additional variables of Gene, Protein, Enzyme, Hormone, Growth Factor, Ligand, Kinase, Receptor, Inhibitor and other important small biologically active molecules. The CureHunter Engine essentially defines the Clinical Outcome in cross-comparable numerical weights for all successful agents and allows discovery clustering and pattern finding that illuminate both pathogeneses and cures."

I like their philosophy of empowering patients with access to this information.

As they put it ---

" I am not technically trained, should I be using CureHunter at all? And can I understand it?

Don't underrate yourself. As a general rule we believe it is fundamentally good for patients to become knowledgeable about the diseases life may throw at them and the medicines they are advised to take. Often by reading extensively, participating in their patient associations, and talking to others with their condition, patients can support the efforts of their doctors to help them get well. You may, for example, become aware of signs and symptoms that help your physician refine your diagnosis. You may note particular side effects--sometimes very subtle--of medications you are taking that would cause your physician to change your prescription. And with serious study, you may even develop insights to new cures. Only you really know the patterns of your daily life, the stresses put on you by work or school or family or play; the daily
choices of food and medicines you consume. You are your own best instrument and always monitoring your good health as well as your illnesses and the aches, pains, and dysfunction they bring with them. The more aware you are of your own body and behaviors, the more likely it is you can bring good information to your physician and team up with him or her. The fact that you have ordered a CureHunter Patient Summary Report means that you are already a "patient activist" for your own best health. To use this report well, however, you must have a general understanding of the science and methods that produced the data contained here. That said, CureHunter is very different from most "consumer health information" resources you might find on the Internet or at your public library. Because CureHunter does not rewrite (or water down) the technical medical articles for "consumer consumption," in many cases the actual "key statements of outcome" shown in your Summary Report will be very difficult to understand because they are
directly extracted from the peer-reviewed scientific literature and are quoted without modification. This "control on original sources" is critical so that similar findings can be counted, and most importantly repeated patterns in many thousands of clinical observations can be analyzed for how those patterns shed light on both the causes and cures for human diseases. In the final analysis, even if you are technically trained in one area of science, this is pretty complicated work. And that is why we recommend you take printed versions of your CureHunter Patient Summary Report to your physician. Talk about the data
together and see what your doctor thinks. You may wish to discuss your report with your pharmacist, too. Or if you have friends or associates in the biological sciences or in your patient association, ask them for their opinions. Getting well is a team effort. No one, "knows it all" with over 200,000 new research articles published each year."

Friday, October 26, 2007

Medicine on demand -

Medicine on demand : "'Video has always been an incredible educational tool, but the Web in the past didn't support it,' says Nan Forte, executive vice president for consumer services at WebMD, a popular medical site. Now, health-information consumers are demanding online video and getting it.

•General medical sites from WebMD to are expanding their video libraries. At the Mayo site, you can see how to do a biceps curl, inject insulin and check your blood pressure. At WebMD, a mix of expert interviews, patient stories and news pieces grows by the day.
•Sites devoted to specific disorders are adding video, too. The American Cancer Society ( features videos on its campaign to increase access to cancer care. Autism Speaks ( offers a set of videos that show the early signs of autism. Videos on seizures and their treatment can be found at
•A revamped eMedTV site, coming soon, will be built around 1,200 short videos that explain procedures, disorders and medications. Many of the videos have been used in major hospitals to inform patients before they consent to treatment, says the site's developer, physician Art Schoenstadt.
•Video bloggers ('vloggers') are sharing their own health stories "

And you can see our library of healthcare videos at !

Thursday, October 25, 2007

Majority Use Online Health Sites Before and After Visit to the Doctor

Majority Use Online Health Sites Before and After Visit to the Doctor : "We knew the number of people going online for health research is constantly growing, but these recent stats are pretty astounding: more than three-quarters of Internet users in the United States go online for health information, according to Burst Media. It looks like people in the droves are turning to online resources to learn more about conditions, procedures and medications. Is it a flawed healthcare system that drives people online? Speaking from personal experience and that of friends around me, we’ve often found hospital doctors too busy to explain illnesses and conditions that unwell family and friends are being treated for in hospital. Niche health sites, such as Healthline, Quality Health and WebMD have helped me decipher the “mumbo jumbo” of medical terms thrown at me, so I’ve been able to go back to the doctors with meaningful questions. And it seems my experience is one that many have. Of the BurstMedia respondents that go online for health research, more than one-third researched health topics online before visiting a medical professional. After a medical appointment, 43.5% of respondents went online to learn more."

About - Comparison Shopping for Health Products

About - Comparison Shopping for Health Products: "HealthPricer Interactive Limited is leading the way in comparison shopping for consumer healthcare products. is a top destination site for finding and buying healthcare products from a comprehensive list of trusted merchants across the web. Focusing solely on consumer healthcare products, HealthPricer offers shoppers great benefits such as simplified product search, accurate merchant ratings and reviews, detailed product information and discount prices - an unparalleled time & money saving experience for online shoppers. is a one-stop comparison engine where consumers can find, compare and buy the best health products such as prescription drugs, contact lenses, non-prescription medicine and supplies, vitamin and nutritional supplements, and beauty and personal care products online at the best discount prices available. We take responsibility for the products we refer consumers to and ensure that all of the online retailers we provide access to are legitimate, quality companies."

What Consumer Guided Health Insurance Means

What Consumer Guided Health Insurance Means: "Consumer Guided Health Insurance is designed to help fix the traditional health insurance system, in which costs have been spiraling out of control for decades. The idea is to let consumers apply their own common sense about cost and value to health care, then make smart buying decisions — just like they would for any other purchase. Simply put: when customers can see real value, they can choose real value and minimize out-of-pocket costs. To make Consumer Guided plans work, HealthMarkets is using new insurance ideas and technologies that make it much easier for our customers to be smart consumers of their own health care. For instance, our plans are the first to show relative cost information for different doctors and hospitals nationwide — with information for over 400,000 doctors and 45,000 facilities for more than 20,000 procedures readily available to customers, to help them choose the best value. Consumer Guided Health Insurance rewards consumers who become involved in the process of knowing their plan and making decisions related to their health care. These rewards are many — including the ability to attain lower costs for competitive benefits, giving our customers greater freedom to choose a doctor or provider based on their own priorities. That puts the ability to control costs and benefits back in consumers' hands, where it needs to be ."

Interactive Health Communication

Interactive Health Communication: "The rapid proliferation of information and communication technologies that have emerged during the last several years has both hopeful and alarming implications for the future. These technologies have already produced profound changes in the US economy and continue to exert increasing influence on many aspects of daily life, including personal health decisions and behaviors, health care delivery and financing, and public health systems. Evidence of this phenomenon is the growth of interactive health communication (IHC): the interaction of an individual—consumer, patient, caregiver, or professional—with or through an electronic device or communication technology to access or transmit health information, or to receive or provide guidance and support on a health-related issue. IHC applications include health information and support Web sites and other technology-mediated applications that relay information, enable informed decisionmaking, promote healthy behaviors, promote information exchange and support, promote self-care, or manage demand for health services."

Health Information Translations

Health Information Translations : "Health Information Translations is a collaborative initiative to improve health education for limited English proficiency patients. This site is intended to be a valuable resource for helping health care professionals teach health education to those patients with limited English skills. By leveraging the combined skills and experience of 3 of Central Ohio's largest health care organizations, this project will produce some of the most valuable resources for health care education in diverse communities."

Even though India is a leading IT power and exports medical skills and people to the West, it's a tragedy that there is such little good quality information for patient education written in Indian languages on the Web. Ironically, it's easier to find Hindi materials for patient education on a US website than on an Indian
website !

Healthy Roads Media

Healthy Roads Media: "Health information access is a basic healthcare need. Literacy, health-literacy, illness, aging, disability and language are all issues that can pose barriers to obtaining basic health information. This site contains free health education materials in a number of languages and a variety of formats. They are being developed to study the value of these formats in providing health information for diverse populations in a variety of settings. We need your feedback! Our Materials There are many contributors to Healthy Roads Media. Our text is always from reliable sources and the information is reviewed regularly. Sometimes our partners provide both English and non-English text. We only accept translated materials that have been created through a quality controlled process. If Healthy Roads Media does the translation, then the work is carried out by certified translators, again through a quality controlled process. We work to make sure that the translations are done in a way to make them easy-to-read and as accessible as possible to people with literacy challenges. High quality translation is a complex and difficult process, especially when trying to accurately communicate health information. We welcome any suggestions."

This is an extremely valuable resource - we need to grow this !

The pregnancy ultrasound overtesting scam

As an infertility specialist, I refer our patients to obstetricians for their antenatal care once they get pregnant. What's very alarming is the large proportion of our patients who are being subjected to unnecessary caesarean sections for their childbirth. Many of these women are healthy young women who are perfectly capable of giving birth normally. However, many doctors these days seem to prefer doing elective caesarean sections for them - a practise which is remunerative for the doctor, but harmful for the patient.

So how do they convince the patient to sign the dotted line and give "informed consent" for the surgery ? Doctors are cleverly misusing ultrasound testing to do so. While there is no doubt that ultrasound scanning is extremely helpful during pregnancy to confirm the well-being of the baby, the commonest racket is to get the ultrasonographer to over-report minor variations as abnormalities, and then scare the patient that the baby's welfare is at stake.

The number of "abnormalities" which are reported are mind-boggling for their creativity ! I have seen patients being subjected to caesarean sections for a huge range of normal findings , including:
1. nuchal cord . This is a condition in which the umbilical cord is near the neck. This is perfectly normal and safe, but they scare the patient by saying that this cord can tighten during delivery and strangle the baby, which is why a caesarean is much safer !
2. reduced amniotic fluid. It's common for the amniotic fluid volume to decline as the pregnancy progresses. Here, the scans are repeated frequently, and the sonographer "documents" a declining trend in the amount of fluid. This is "creatively interpreted" as suggesting "fetal distress" which requires a caesarean section !
3. oblique lie. Often the baby's head does not settle down into the pelvis until quite late during pregnancy. If it does not do so by 36 weeks, patients are told that this suggests that head is "too big" or the "pelvis is too small" and that a caesarean section is needed to prevent birth trauma !

The beauty of these "reported abnormalities" is that they are "soft findings" which are dynamic and therefore cannot be conclusively documented. Since a baby is a "high-investment" product, no patient wants to take chances, and they are happy to do what their doctor suggests.

What's even worse is that if they get a second opinion from another obstetrician, the new doctor will also most probably agree with the first one, since it's much more profitable for a doctor to do surgery, than to allow for a normal vaginal birth !

Interestingly, ultrasound over-reporting seems to be widely prevalent in gynecology as well. Patients who are infertile are "documented" to have small subserous fibroids ( of no clinical importance) and then advised to undergo laparoscopic surgery ( which is projected as being "minor surgery") to remove these. The other common "finding" is a small ovarian cyst ( which is extremely common) for which they are advised to undergo laparoscopy to "rule out and treat" endometriosis.

Similarly, older women with heavy menstrual bleeding are diagnosed as having fibroids or endometrial hyperplasia ( a fancy term for a "thick endometrium " ) and told that they need a hysterectomy !

It's becoming increasingly difficult for patients to protect themselves from this sort of overtesting and overdiagnosing which lead to unnecessary overtreatment ! The best bet is to find an ethical doctor who will guide you properly !

Patient Education to help Health Insurance Company's Marketing and Sales efforts

Patient Education to help Health Insurance Company's Marketing and Sales efforts : " Consumer-centered health plans will lead employer and consumer markets. Just as stock brokerages, banks, and travel agencies made an innovative shift to empower their customers with information, so too will traditional insurance plans. Health plans that differentiate based on consumer decision support will have a huge advantage with both their employer and consumer customers.

* Demonstrate significant value with employers
* Improve employee health care decisions
* Add value to member services
* Attract the young and wired market
* Increase Web services success
* Build marketable benefit designs"

Consumer Medical Information for Physicians & Clinics

Consumer Medical Information for Physicians & Clinics: "Ask physicians to name the most important thing they do for their patients, and they'll probably say 'provide information.' If you ask patients what they most value from their physicians, they'll likely say 'information.'"

This is exactly why patient education libraries are so important. They are a very cost effective way of providing reliable information to patients; and can save the doctor and hospital valuable time and energy !

Why health insurance plans should educate their customers

Why health insurance plans should educate their customers : "Consumer-directed health insurance policies will succeed only if they integrate a way to help members make good decisions. Without evidence-based information to guide their decisions, your members may under use effective prevention and treatments. They may overuse commercially promoted treatments that may in fact be of little value to them.

Healthwise Supports Consumer-Directed Health Plan Goals
* Help members make health-improving choices
* Help members make cost-effective choices
* Add differentiating value for employers
* Build satisfaction"

Wednesday, October 24, 2007

Massachusetts Patients First

Massachusetts Patients First: "A bill now pending before the Massachusetts legislature would codify many of the elements contained in the voluntary Patients First initiative and, therefore, hospitals are strongly supporting its passage. The Patient Safety Act is truly a groundbreaking initiative that both addresses the nursing shortage and injects transparency and accountability into the health care system.

Specifically, Senator Moore's bill:

* dedicates needed resources for nursing scholarships, loan repayments, mentoring programs and faculty development to increase the number of nurses.
* requires all hospitals to file their staffing plans for each unit with the Department of Public Health, and to publicly post the plans.
* requires hospitals to use and publicly report on “nurse-sensitive” measures to track how patient care is affected by the nursing care hospitals provide."

A Healthwise “Gray” Paper:How the Baby Boomers Can Save Healthcare

A Healthwise “Gray” Paper:How the Baby Boomers Can Save Healthcare " In the context of a complex system, it sometimes takes a
few simple rules and tools to break out of the old patterns. The Ix Solution rules and tools can create the disruptive innovation needed to reinvent health care in a more positive and cost effective way.

3 Rules
#1 The Self-Care Rule. Help Boomers do as much for themselves as they can.
#2 The Guidelines Rule. Help Boomers ask for the health care that they need.
#3 The Veto Rule. Help Boomers say “No” to care they don't need.

3 Tools for Health Care Transformation

Self-Service Tools: 24-7 access to health information, symptom checkers, and decision aids in self-care guides and on Web sites.
Information Prescription Tools: Short information prescriptions “prescribed” to patients by their doctors or health plans at every “moment in care.”
Long-Term Engagement Tools: Ongoing, interactive programs that are personalized and targeted to meet each individual’s self-management needs over time."

A great way to convert problems into opportunities !

FIVE QUESTIONS FOR .... Maureen Regan and Julie Vargo / Two authors bring infertility out of the closet

FIVE QUESTIONS FOR .... Maureen Regan and Julie Vargo / Two authors bring infertility out of the closet: "In metropolitan areas, there's a delay in having children because women go to these areas to have careers. The older you get, the more precious time you lose to have a child. Women here are beautiful -- 50 is the new 30. It's a very healthy city to live in, San Francisco. You're looking at yourself in the mirror and you look great. But it's not connecting -- the idea that just because you look good on the outside, that your eggs look good on the inside. Vargo: Women only have 12 times a year to get pregnant, and that's only if the egg is released, if the cilia, or hairs, in the Fallopian tubes, push the egg from the ovary and if you have sex at the right time, along with a lot of other factors. Q: How can women balance their quest for fertility -- and all the anxiety it produces -- with the rest of their lives? Regan: Our culture is about 'I want this, I want this now.' You have to keep your mind open rather than say, 'I can only have children this way.' That puts limits on how you will find your family. Vargo: You get baby lust, baby stress. "

WellPoint doctors to get Zagat ratings

WellPoint doctors to get Zagat ratings: " One of the nation's largest health insurers, WellPoint, has teamed with Zagat Survey to let patients rate their doctors, just as diners rate restaurants in Zagat's burgundy-colored guides. Instead of Zagat's four categories for restaurants — food, d├ęcor, service and cost — the ratings guide will consider trust, communication, availability and office environment. In addition to giving doctors a numerical score based on a 30-point scale, the site will include comments from patients. The WellPoint program will be available online to more than a million members by the end of March. It plans to roll it out to all of its 35 million members but would not give a schedule. The move by the insurer comes as consumers increasingly turn to the Internet to learn about products and services — and see customer reviews."

Great idea. Of course, initially they will measure only what they can - and not the most important stuff ( clinical competence). But at least it's a start. Getting doctors ( and nurses !) to rate doctors would also be a useful metric which is worth tracking !

Monday, October 22, 2007

"Just relax !"

This is the commonest advise doctors give patients - for example, when doing an embryo transfer. But how does one relax when lying on a cold examination table, with a mind which is full of worries and fears ?

Interestingly, it's not possible for you to relax your body - after all, you can only contract your muscles - you cannot relax them ! So what's the secret ? Here's a simple tip. What you need to do is to actively contract the opposing muscles. So if you want to relax your biceps, you need to contract your triceps !

What this means is that during the embryo transfer, you need to actively push your buttocks down to the bed; and keep your knees wide apart. This will force the inner thigh muscles ( the adductors) to relax, allowing your vaginal muscles to relax, thus making the doctor's life ( and yours !) much easier.

Learning how to do pranayama ( a type of breathing which yoga teaches) and meditation also help !

Sunday, October 21, 2007

10 Patient Safety Tips for Hospitals

10 Patient Safety Tips for Hospitals: "10 Patient Safety Tips for Hospitals Medical errors (or adverse events) can occur at many points in the health care system, particularly in hospitals. These tips for hospitals are from studies by the Agency for Healthcare Research and Quality (AHRQ), which has funded more than 100 patient safety projects since 2001. Many findings from AHRQ research can be put into practice in hospitals by following 10 practical tips."

Choosing your words carefully: how physicians would disclose harmful medical errors to patients.

"Choosing your words carefully: how physicians would disclose harmful medical errors to patients." This study surveyed 2637 medical specialists and surgeons regarding how they would disclose harmful medical errors to patients. Prior research revealed that patients wanted the physicians to apologize for the error, explain how it occurred, and discuss how such errors could be prevented in the future. Whereas most respondents in this study supported error disclosure in general, only a minority of medical specialists and surgeons would explicitly inform the patient, especially for less clinically significant errors. Approximately half of respondents declined to explain how the error occurred or discuss specific plans to prevent such errors in the future. Most respondents would explicitly apologize to patients, although surgeons were significantly less likely to do so than medical specialists. A companion study explored factors influencing physician's support for full disclosure of medical errors."

Electronic Health Records: Just around the Corner? Or over the Cliff?

Electronic Health Records: Just around the Corner? Or over the Cliff?
" We recently implemented a full-featured electronic health record
in our independent, 4-internist, community-based practice of general
internal medicine. We encountered various challenges, some
unexpected, in moving from paper to computer. This article describes
the effects that use of electronic health records has had on
our finances, work flow, and office environment. Its financial
impact is not clearly positive; work flows were substantially disrupted;
and the quality of the office environment initially deteriorated
greatly for staff, physicians, and patients. That said, none
of us would go back to paper health records, and all of us find
that the technology helps us to better meet patient expectations,
expedites many tedious work processes (such as prescription writing
and creation of chart notes), and creates new ways in which
we can improve the health of our patients. Five broad issues must
be addressed to promote successful implementation of electronic
health records in a small office: financing; interoperability, standardization,
and connectivity of clinical information systems; help
with redesign of work flow; technical support and training; and
help with change management. We hope that sharing our experience
can better prepare others who plan to implement electronic
health records and inform policymakers on the strategies needed
for success in the small practice environment.
Ann Intern Med. 2005;143:222–226."

Long Term Conditions Management | Solutions | Clinical Solutions, Bringing Decisions to Life

Long Term Conditions Management | Solutions | Clinical Solutions, Bringing Decisions to Life: "“A patient outreach solution based on our world class medical technology.” The long term conditions management (LTCM) solution combines clinical expertise with telephone communications and tailored software. It gives patients autonomy over their care by educating and supporting them through a tailored programme designed to help them manage their specific condition. With the expert input of the clinician, patients help to structure their own care plan, increasing their chances of success. Clinicians provide reassurance and reinforcement through regular telephone contact. By linking with telehealth or telecare monitors, the clinician can receive accurate feedback and monitor progress alongside the patient."

Do you think it's acceptable for doctors to lie under special circumstances ?

Medicine is a complex art and there are lots of grey zone areas.

When is it allright for a doctor to lie ? Is it safe to allow the doctor to decide ? Even if it's much easier to just insist that the doctor tell the truth all the time, regardless of the circumstances, is such an "all-or-none" approach the right one for all patients at all time ? Isn't this taking a legalistic approach and oversimplifying a complex problem ? Shouldn't doctors be allowed to be flexible and can't they be trusted to use their own judgment when making these decisions ? Or has society become so distrustful of the medical profession that this would be considered anathema, and that we should insist that doctors should tell the truth every time, even if it harms their patient ?

I'd like to hear from you !

Fill in the survey at

Saturday, October 20, 2007

Should doctors lie ?

The simple answer would be No, but few things in life are as simple as they appear to be, and I think a more thoughtful reply would be - Yes, sometimes.

In fact, the distinguishing mark of a senior doctor is that he knows how to lie - and when to do so. This is not something which can be taught or written down, which is why it is a sixth sense which is acquired by experience. I am sure all senior doctors will agree that they have lied for their patients' good during their career - and anyone who does not agree with this is telling a much bigger lie.

Is it ethical to lie ? This is a hard call. It's much easier to just tell the truth all the time - but there are times when hiding the truth and lying is in the patient's best interests. Good doctors know this - and will use a lie as a valuable therapeutic tool, when they feel that the truth would harm their patients.

Am I suggesting that we return to the "good old days" when the "doctor knew best" and cancer was a word which was never discussed openly. Of course not ! I am a big believer in patient autonomy and the patient's right to know . However, in clinical practise, there are situations when the patient does not want to know the truth ; and times when the truth can actually be harmful. Some patients what their doctor to shield them from the truth, and good doctors can sense this . They know when to hide the truth; and from whom.

This is not an easy skill to acquire, and requires reflective contemplation and practise. It's a privilege which can easily be abused by a bad doctor, but a good doctor can use a lie ethically , if he does so in order to help his patients .

CNN - Study says doctors will lie to get best patient care

CNN - Study says doctors will lie to get best patient care : "Would doctors, frustrated by managed health-care programs with strict coverage limits, lie to deliver the best-quality care for patients? A new study indicates many would. 'When it comes down to something like a nose job or a rhinoplasty, only 3 percent said they would do it. But for very significant things like whether or not they thought a bypass was indicated, and it was being withheld, over 50 percent were willing to endorse fudging the data,' said Dr. Daniel Sulmasy, one of the study's researchers. According to the report, published in this week's Archives of Internal Medicine, many also would lie to obtain what they consider important diagnostic tests -- like mammographies for patients who need them. "We asked whether the physician would be willing to write on the sheet 'suspicious breast lump,' and more than a third of physicians were willing to do that," said Sulmasy, who works in the Department of Ethics at St. Vincents Hospital and Medical Center in New York.

Why don't hospitals invest in patient education libraries ?

" Although apparently it may seem antagonistic to profit making for hospitals, the model of putting health education units in hospitals actually makes great business sense where hospitals can make real good money by properly distributing materials, tailored patient care settings, and educating patients. A prominent example of the success of your type of business model is Nicotrol CQ the nicotine substitution with controlled quitting for smokers. It took the pharmaceutical companies years to realize the worth of patient education, but once they got the hang of it, it changed the way medicines were brought to people. Think of insulin and Novartis campaigns to educate patients.

Unfortunately, you cannot change the "perceptions" of hospital administrators, but you can hope to change practices. Medicine is information science, and those in the medical profession who take it as business than a profession, play the following game, that's characteristic of any business transaction --

a) you should have an information advantage over your client (or patient), and

b) you should scare your client/patient/patient-party and then you let them decide what's best for them.

QED, system-wise, in areas and times when the practice is slow, the number and frequency of surgeries/cesarian sections/expensive intervention goes up. Hospital administrators too take advantage of this asymmetry of information and therefore create imposing structures in the names of hospitals, as if hospitals are factories where the "sick" are made better.

Your concept is aimed at tipping the scale at the other end, empowering the patient. If I were you, I'd not bother messing with the hospital administrators, they are not our audience. I'd focus on the patient (or people at risk) and then go for tailoring messages to the segment of population that matter. Information presentation is the crucial key here. In presenting the information, revert the two points we alluded to above:

c) the patient should now have an information advantage (one, he or she already has, his or her personal physical problem, that he or she knows better than the doctor to start with. The physician, on the other hand, is an expert with the technical knowledge as to what works). Educate the patient so well that she knows what's the problem and the physician then will be able to fine tune the diagnosis and the treatment process. That means creating evidence based literature and translating that in the language of a class Eight pass idiot. Can we the doctors, do it? With similes, stories, comparisons, parables, comics, graphic novels, games, etc?

d) Information, if properly tailored, should minimize irrational fear in the mind of the patient.

Some of the best doctors with whom I got trained, without exception, I found all these "best"/great doctors were extremely polite and teacherlike with their patients, even in their most busy schedules. It's purely my personal opinion and therefore it's of little worth, but I must share this with you -- I found that the technically most incompetent doctors also tend to be very rough and ruthless with their patients. Sorry for this long post, and I will sign off with these two aphorisms by Don Berwick

e) from the perspective of patients, the aphorism is -- "Nothing about me without me": in other words, patients should be clearly explained why some diagnostic procedures or treatments were offered
f) from the perspective of the doctors -- "Every patient is the only patient" -- self explanatory. "

Dr. Arin Basu MD MPH
Allan Smith's Research Group
1950 Addison Street
Berkeley, CA 94704
United States

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