PatientOS 1.0 Roadmap

PatientOS 1.0 Roadmap: "PatientOS has two years of design and implementation of a solid flexible framework on top of which a clinical information system for physician offices, clinics, hospitals, or any other healthcare facility can be built. Our target for our 1.0 release is to be the most stable and fastest growing open source healthcare information system on any platform."

The open source healthcare space is getting hot :)

DocSite Registry™

DocSite Registry™: "A simple effective solution at an affordable price

For physicians by physicians. DocSite Registry™ demonstrably improves care with minimal disruption to office workflow for a modest price. DocSite Registry is a patient-centric, all conditions registry bringing evidence-based medicine to the point of care without stifling each physician's individualized excellence.
Success one patient at a time

Physicians use the registry to manage chronic, complex and preventive health needs for individual patients or entire patient populations. DocSite Registry graphically organizes relevant clinical information from the patient record to save time during office visits, and supports proactive management of clinical conditions across all patients in the practice showing care elements that are due or out of range.
Measure and report

DocSite Registry allows you to measure and track the care of one patient, as well as populations of patients in your practice. Participate in any clinical integration, health collaborative or quality-based initiative with confidence knowing you have been managing patients using nationally recognized evidenced-based medical guidelines aligned with outcomes measures."

Practice Fusion - Practice Fusion Officially Launches

Practice Fusion - Practice Fusion Officially Launches: "Practice Fusion addresses the complexities and critical needs of today's healthcare environments by proving a revolutionary application and delivery model for physicians and patients at no cost. Practice Fusion offers an integrated, on-demand healthcare platform delivered in a software-as-a-service model that eliminates the complexities associated with licensing, implementation, integration and support usually experienced with leading enterprise software solutions. Practice Fusion dramatically reduces the cost to the practice while enabling providers to deliver the highest level of care possible to their patients."

Finally - a commercially available free or low cost EMR !

Welcome to MedApps and Telemedicine 2.0

Welcome to MedApps and Telemedicine 2.0: "MedApps™ offers a complete system designed specifically to connect people with their healthcare providers by integrating:

• FDA Cleared Devices (internal and external)
• Cell Phone (acting as a “Hub”)
• Bluetooth® (“wireless”)
• Enterprise Level Interactive Voice Response
• Intelligent Call Routing
• Nurse/Agent Awareness

The result is a truly ubiquitous healthcare solution (“Healthcare Anywhere”).

MedApps “listens” around the “Body Area Network” monitoring a patients body, providing a more robust picture of the patient’s health, and bridging the gap between patient and healthcare provider.

MedApps encourages a more active lifestyle by integrating invisibly into a patient's daily activities. Accurate, timely readings help stabilize patient conditions, providing the ability for earlier intervention and enabling a patient to control their disease, instead of the disease controlling the patient."

Avvo.com - grading lawyers

Avvo.com - grading lawyers: " Avvo is a website that rates and profiles every lawyer, so you can choose the right lawyer. Avvo delivers the information and guidance you need to help you make this important decision, even if you’ve never worked with a lawyer before.

1. We profile hundreds of thousands of attorneys, using information from state courts and bar associations, websites, and lawyers themselves.

2. We calculate each lawyer’s Avvo Rating, to help you sort through the profiles.

3. You contribute your firsthand experiences by rating attorneys that you’ve worked with."

It's just a matter of time avvo will start doing this for doctors too !

Develop SOA solutions for healthcare organizations using business-driven development

Develop SOA solutions for healthcare organizations using business-driven development: "Business-driven development is the key methodology in delivering healthcare solutions based on a Service-Oriented Architecture. To ensure the information system to be developed meets the business requirements of the organization, BDD starts by capturing requirements and analyzing business process before investing in code development. In the ambulatory care case study, we conducted interviews with all the stakeholders and documented the expectations and challenges, identified issues and opportunities."

Check out the screenshots ! Delivering healthcare is a complex process - which is why automating it is a tough task. Otherwise, you'll end up as another horror story. " A hospital I talked to two years ago indicated that as the result of its major initiative of Health Information Systems (HIS), it already had a complete HIS in place that provided an integrated information system accessible by doctors, nurses, pharmacists, and administrators. One year later, when talking to an IT manager of this hospital, to my surprise, I was told that they were going to re-do the entire system because the system they put in place earlier did not support their business needs. Unfortunately, according a report by the Standish Group, if you have four IT projects going on, three of them will ultimately end up to a similar fate. Only 28 percent of software projects succeed where American companies spend annually upwards of $275 billion on about 200 thousand application software projects. Please see the Resources section for more information."

medIND: Indian Fulltext Bio-Medical Journals Indexed in IndMED

medIND: Indian Fulltext Bio-Medical Journals Indexed in IndMED: "One point resource of peer reviewed Indian biomedical literature covering full text of IndMED journals. It has been designed to provide quick and easy access through searching or browsing."

Great list of Indian medical journals available online, for people looking for peer-reviewed medical articles relating to Indian conditions !

Legal Process Outsourcing: Indian doctors reach US courts, virtually

Legal Process Outsourcing: Indian doctors reach US courts, virtually: " This is a new one for Indian talent helping US lawyers. And this time it is Indian doctors. Forget the $300/hour services being offshored, the outsourcing market is on a roll. How about seeking support from India for services that are typically between $500-$800 an hour?! St. Petersburg Times has this piece on the new use of India. Some snippets:

Sims, the Ocala lawyer, incorporates India into her law practice with a twist on the typical outsourcing model.
After a positive experience with doctors on a trip there, she started MD in a Box. For $90 an hour, the company links lawyers with Indian doctors who screen potential cases, analyze records and perform medical research. The same service with American experts costs between $500 and $800 an hour, Sims said.

The company's most powerful tool is also its most technologically advanced. Lawyers can hire an MD in a Box doctor to be present during depositions using Skype, a software program that allows the doctor to listen to the proceedings in real time. If the Indian doctors catch a defense expert making a medically suspicious claim, they quickly send literature or rebuttal questions to aid the cross-examination."

New roles for Indian doctors !

OpenSource Software - a Primer for Healthcare Leaders

OpenSource Software - a Primer for Healthcare Leaders This is an excellent guide on why open source software can help change the healthcare industry by making PHRs and EMRs affordable for everyone !

E-health: A matter of life and death

E-health: A matter of life and death: "I was standing in the security line at Dallas International airport some months ago when I was approached by a worried-looking gentleman who was carrying a large envelope with papers. He asked if I was travelling to Chennai (I was stopping over at London).

It seems that a family member on holiday in India was undergoing emergency medical surgery and the medical records were needed faster than a courier could get them there. I was struck by the irony of the situation.

Consider this: you can travel anywhere on the planet or pay for your hotel or other purchases by the swipe of a credit card, where the payee authenticates your credit limit.

In essence, your financial information can and is transmitted to wherever it is required in the bat of an eyelid. And yet, the thing that matters most to us, our health and our health records, is pretty much stuck in the Stone Age.

Your medical information, history of medical treatment, surgeries, allergies and so on are recorded on paper and all this stays where it is recorded. If this information is not made available to doctors when and where it is needed, it is pretty useless and could mean the difference between life and death."

McHealthcare - Delivering Consumer-Driven Healthcare

McHealthcare - Delivering Consumer-Driven Healthcare: "McDonald’s consumer focus offers some important lessons for the healthcare providers to ponder as they are forced to transform into more consumer-driven organisations."

SMS - A new way to tap into health info

SMS - A new way to tap into health info: "Intelecare Compliance Solutions Inc., based in New Haven, Conn., sells a service -- which companies can then provide to their employees or customers -- that sends text, e-mail or voice-mail messages reminding users to take their pills, refill prescriptions, get to appointments or check vital signs. Drug companies, insurers and large employers hoping to improve efficiency and decrease absenteeism are Intelecare's main customers, says 35-year-old Kevin Aniskovich, chief executive.

Next year, Aniskovich says, the company will start a direct-to-consumer service that for $60 a year will offer e-mail, text or voice-mail reminders about prescriptions and appointments. He says that since 'txtspk' can be confusing, the service asks users to type in their own message reminders so they will be familiar with the message when it arrives.

A company called Smile Reminder in Lehi, Utah, lets businesses such as dentists and spas automatically send text and e-mail messages to remind customers of appointments. For dieters, a company called Sensei Inc. in Boca Raton, Fla., part-owned by insurer Humana Inc., will send weight-loss advice and information to Sprint and AT&T mobile-phone users for a weekly fee starting at $5.75. The information shows up in a multimedia format, rather than as a text message."

The Expert Patient - How I lost 40 kg in 6 months - without a doctor or a gym !

Here's a first person account of how Mr Rajat changed his life !

" Today, when I look back at 2007 especially January to July, I realize that “ simple determination and basic fundamentals can enable one to achieve almost anything “. Well that’s how I lost 44kgs in 6 months. No doctors, no dieticians, no gym. This is how my story goes …….

It was Nov.,06. I was in full bloom of my glory --- 110kgs and bulging from all sides. I used to hate my mammoth size and appearance but had learnt to live with it. Never thought it was possible to come back to normal size. But the incident in the flight from Mumbai to Surat brought about a resolve in me which I never thought would happen. I took a window seat and managed to squeeze myself in. And minutes later, guess who walked in ---- none other than Mr. Shashi Ruia, Chairman of the Essar Group, where I am employed. After a few minutes of discussion on business, he spent the next half an hour to Surat explaining to me how important it was for me, my family and general quality of life that I lose weight. It was like a father talking to a son, a guru teaching his disciple rather than an employer to an employee. Man, I thought to myself, how much he cares, how concerned he is. Not many people could have spoken with the intensity and feelings and the manner in which he urged me. Believe me, it was a beginning of a new “ME”.

From that day onwards my resolve started growing and finally from 15^th Jan.,07 I started my journey on weight reduction. I scanned through the net for an ideal diet and exercise regime but the message I largely got was

The calorie intake has to be lesser than calorie output.

Fruits, boiled vegetables are good enough to provide all the nutrients.

Walking/jogging are the best form of exercises.

Yoga is also very good coupled with aerobics.

Better to break exercise in two parts – morning and evening.

So I started with vigorous walks both morning and evening. Initially I would do about 8 kms and gradually stepped it up to 20 kms ( 10 in the morning and 10 evening). Twice a week to break the monotony I would swim about 2.5 to 3 kms. Simultaneously I started reducing my diet.

My normal diet was 2 eggs in the morning with 2 slices of bread and a glass of juice. Lunch comprised rice/noodles and soup. Dinner was always heavy post 3 to 4 drinks with mouthwatering snacks. Gradually, over a month, I came down to fruits in the morning – no lunch – fruits/ boiled vegetable at night with lots of hot water through the day.

Within 15 days I could see the results. On 1^st Feb. 100kgs. And I was extremely motivated. By Valentines day 96 Kgs…… mid March 88Kgs …… end April 75Kgs and 66Kgs by end July.

There was a lot of advice coming around from various sources. Do this….. don’t do this, are you feeling weak and so on. At one point of time I got very scared even though I was feeling at the top of the world. The family physician gave me one simple advice. Listen to your body. If there is something wrong your body will tell you. Do not ignore those signals such as spin in the head, giddiness, cramps etc. I felt none.

Today I am maintaining myself between 65 and 68Kgs and feel great. If you are keen on shedding Kgs build up a resolve and go for it. If a guy like me can do it anybody can, so go ahead and do it. At any point of time you feel like talking to me please feel free to write to me on my mail address ---- [email protected]

Best of luck,

RAJAT GUPTA

Since a picture is worth a thousand words, here's a before and after !

Compare medicine prices in India

Compare medicine prices in India : "It is impossible for a doctor to remember the prices of all competitive brands of a given medicine. He can recall only a few at the time of writing the prescription. Here you can find the price of the same medicine from different companies. If you find a cheaper brand please go back and ask your doctor whether you could take that. This will save you money on purchase of medicines and will not require your doctor to rely upon his memory to remember prices."

Making a Killing - HMOs and the Threat to Your Health

Making a Killing - HMOs and the Threat to Your Health: " One of the most powerful indictments of the managed care industry, this scathing exposé presents case histories of those who have lost their health or their lives because an HMO denied or delayed vital treatments, tests or surgery. ... This lively probe is must reading for anyone concerned with the health of the U.S. medical system."

You can read the full book here online. Excellent examples of what you can do to protect yourself and fight for your rights !

Patient Advocate Primer: Persuade, Plan, Passion, Pin.

Patient Advocate Primer: Persuade, Plan, Passion, Pin: " To be an effective advocate for yourself or someone else, there are a host of principles you can follow and many excellent books on the methods of advocacy. "

Here is a basic primer."

The California Patient's Guide: Introduction

The California Patient's Guide: Introduction: "How do I get copies of my medical records? What should I do if my health plan denies coverage for a particular treatment? How do I file a grievance against my health care plan? And, when can I sue my HMO? Can my health care plan exclude coverage for my pre-existing condition? If I don't have insurance, what are my rights to receive emergency medical treatment? What health care programs are available to me if I cannot afford private insurance?"

Excellent advise if you find yourself getting frustrated and upset. Full of useful tips and practical tools !

HealthCareCoach.com

HealthCareCoach.com: "Getting the health care you and your family needs isn't always easy in a system that's constantly changing. HealthCareCoach.com is packed with facts and do-it-yourself tips on everything from health insurance to patient care - to help you help yourself. For over three decades, our independent, non-profit group of health law specialists has given consumers the information they need to get the best out of the system."

VA National Center for Patient Safety - Cuture Change

VA National Center for Patient Safety - Cuture Change: "The goal of a Root Cause Analysis is to find out

* What happened
* Why did it happen
* What to do to prevent it from happening again.

Root Cause Analysis is a tool for identifying prevention strategies. It is a process that is part of the effort to build a culture of safety and move beyond the culture of blame.

In Root Cause Analysis, basic and contributing causes are discovered in a process similar to diagnosis of disease - with the goal always in mind of preventing recurrence."

Italian court rules against law restricting artificial reproduction

Italian court rules against law restricting artificial reproduction: " An Italian court has barred enforcement of a legal ban on genetic testing of the human embryos to be used in in vitro fertilization. The December 23 judgment by a court in Florence came in a case brought by a couple from Milan, challenging the law's effective ban on using the in vitro process to ensure a baby of the desired sex. The court's ruling was a strike against the law regulating artificial means of reproduction, which has been challenged as overly restrictive, but was upheld by a popular vote in 2005."

Does this mean that the law finally recognises that decisions involving their own bodies and reproductive rights are best made by patients - and not by bureaucrats ?

VA National Center for Patient Safety - Triage

VA National Center for Patient Safety - Triage: "This is a set of computer screens that will help you use the questions in a systematic way and lead your team to root causes for this case."

This is a great resource for analysing medical errors - and preventing them !

PATIENT SAFETY IMPROVEMENT HANDBOOK

PATIENT SAFETY IMPROVEMENT HANDBOOK This Veterans Health Administration (VHA) Handbook provides guidance for minimizing the chance of the occurrence of untoward outcomes consequent to medical care.
This is a new handbook that incorporates Root Cause Analysis, a widely understood methodology for dealing with patient safety-related issues allowing for clear and more rapid communication of information up and down the organization, thus speeding the process of safety improvement.

HealthBlog and Mobile solutions

HealthBlog and Mobile Solutions : "All of this has huge implications for the healthcare industry. I've written before about the power of Unified Communications and how commodity software will enable personalized tele-medicine and tele-health applications that would have been unimaginable just a decade ago. Here at the conference there are a number of old and new companies focusing on wireless applications and services for the healthcare industry. Examples include Intelliview, TELUS, Rogers Communications, InnoTraction, Capital Health, St. Jude Medical, and Dynastream Innovations. Not attending this conference, but a growing presence in this space is HealthPhone; a company offering highly mobile data capture solutions for healthcare providers who call on assisted living centers and nursing homes. HealthPhone also has a number of health and wellness services aimed at the consumer market.

Where is all this going? In the same way that young people increasingly experience the world through social networking channels (check out the new Zune by the way), service industries are reaching for technologies that will seamlessly connect them to new virtual markets. Healthcare is no exception. In fact, the opportunities here may be even greater than those of other industries considering the vast sums of money being spent by consumers, employers, and governments on healthcare delivery and wellness. "

HealthBlog- Medical Tourism. The World is Flat

HealthBlog. Medical Tourism. The World is Flat: "These hospitals in India and Thailand are no ordinary facilities even by US standards. Most American hospital administrators would be green with envy. The all-private-room facilities look more like 5-star hotels than hospitals and sport the very latest top-of-the-line imaging devices, therapeutic modalities, and information technologies. And unlike American Hospitals, when you check in for service here you know exactly how much you'll pay upon discharge.

In many ways this would be the story of American automobile manufacturing all over again were it not for the fact that not all patients can or will go overseas for treatment. But as the world grows flatter, in much the same way that the Japanese and Koreans have transformed the auto industry, global competition is making American healthcare a target for some revolutionary changes. And contemporary IT will play a significant role in all of this by making health information, healthcare quality, and pricing totally transparent and by facilitating communication and collaboration between care teams and patients across the seven seas."

FreeMD™ Your Virtual Doctor

FreeMD™ Your Virtual Doctor This is one of the cleverest consumer health websites I have ever seen ! It allows patients to find out what the possible reasons for their symptoms could be - and when they need to go and see their doctor. Just type in any symptom ( such as wheezing) to give it a spin. It's got a very attractive and simple user interface - and combines both video and text with an artificial intelligence engine to provide a very valuable service ! It's been developed by Dr Schueler, which means it's got a trusted and reliable pedigree. Full marks !

The Society for Innovative Practice Design

The Society for Innovative Practice Design: "The Society for Innovative Practice Design brings together physicians who understand and accept the challenge of bridging the gap between the theory and the practice of consumer driven medicine. The redesign of medical practice by our member physicians has as its core a clear understanding that the physician works on behalf of the patient, not the managed care plan, the employer or the government providing the insurance coverage. Many innovative practices even create a financial firewall between themselves and third-party payers because they have found the culture of third-party payment a distraction from their primary focus on patients.

The interest of physicians in redesigning medical practice focuses on dealing with opportunities and problems that embrace both patient care and practice economics:

Growing patient demand for prevention-focused primary care services

A need to improve practice efficiency by controlling the expenses of contracting with third-party payers

A need to develop innovative financing arrangements that are patient friendly rather than dictatorial.

The reengineering of practice operations to improve patient service and convenience"

Symbols for Use in Health Care

Symbols for Use in Health Care Hablamos Juntos, an initiative of The Robert Wood Johnson Foundation,
was launched to eliminate language barriers and improve the quality of health care for people with Limited English Proficiency (LEP). Symbols and universal and can be part of a viable and dynamic system that can assist all people, regardless of their reading skill level, to feel more comfortable and confident within a
health care facility.

Pharmacist-Provided Disease Management Programs: Evidence of Success

Pharmacist-Provided Disease Management Programs: Evidence of Success Implementing a team approach to care improves diabetes management. Increasingly, pharmacists are members of these teams,
providing such services as education, screening, and medication monitoring as they work collaboratively with physician colleagues to help patients meet their goals.

The Role for Pharmacists

Pharmacists can get involved in the care of patients who have or are at risk for developing diabetes; some activities include:
Identifying patients at risk for Type II diabetes due to known risk factors
Conducting blood glucose screening of patients with risk factors
Offering point-of-dispensing services including reminders for proper preventive care and glucose testing
Disease state management
Providing patient education

Strategies to Improve Communication Between Pharmacy Staff and Patients: Training Program for Pharmacy Staff

Strategies to Improve Communication Between Pharmacy Staff and Patients: Training Program for Pharmacy Staff: " This training program is designed to introduce pharmacists to the problem of low health literacy in patient populations and to identify the implications of this problem for the delivery of health care services. The program also explains techniques that pharmacy staff members can use to improve communication with patients who may have limited health literacy skills."

IVF Ethics Questionnaire

IVF Ethics Questionnaire: " The objective of this questionnaire is to examine views regarding assisted reproductive technology and ongoing advances in the field of in vitro fertilization (IVF). We are interested in the opinions of scientists and physicians, previous and current patients, and anyone else who is interested in IVF. We intend to present the collected data at major fertility conferences around the world and online at IVF.net."

Very thought-provoking questions !

6 Tips for Making Your Patient Education Pieces Easier to Understand

6 Tips for Making Your Patient Education Pieces Easier to Understand : "

1. What do you want the patient to do as a result of your document? Make sure that everything in the document supports that goal.
2. Use short simple statements that are jargon-free. If you must use jargon, include a dictionary of those terms at the end of the document.
3. If you are using a question and answer format, phrase the questions exactly as your patients do.
4. Prune your text. Take out unnecessary words, even paragraphs. Does everything in the text support the goal of the document?
5. Browse through Dr. Spock's Baby and Child Care for a wonderful illustration of writing that stood the test of time for clarity.
6. Ask some patients to proofread a draft for you and indicate where they got stuck in the document. Where did they have to stop and re-read? What questions did they have as they went along, and were those questions answered? What do the patients think they were supposed to do as a result of reading the document?"

Susan Keane Baker: Presenter and Speaker on Service Quality for Health Care Organizations

ReminderMed - Home

ReminderMed - Home: "Surveys show 75% of people don't take their prescriptions as directed. When asked, half said they forgot to take their medication. Non-compliance results in 125,000 deaths each year in the US. Don't be one of them. Life being what it is, there are lots of reasons why people forget to take their medications. So having someone around that'll remind you when it's time to take that pill is a good thing. And if you have a mobile phone, then ReminderMed™ is that good thing. In fact it could save your life."

Stress, sex and infertility

We are now seeing many "infertile" couples who are having difficulty conceiving because they are too stressed or too busy to have sex ! This is the price couples often pay for living in a huge metropolis like Bombay !

Having a sexual problem is bad enough - and the added stress of the involunatary " infertility " makes it even worse. This often becomes a negative vicious cycle, which is hard to break.

The traditional response was to go to a sexologist or psychiatrist for counselling - with expectedly poor results, because talking does not make the problem go away !
The next step was to forget about the sex altogether and just focus on having a baby by going to a gynecologist for an artificial insemination. Often, this can be very hard on the ego - and it's not easy to make time to go to a doctor's clinic for these super-busy couples. The result is often that the baby-making gets postponed year after year - often until it's too late !

We are very pleased to sell a Comprehensive DIY Fertility Treatment Kit online . The kit costs only Rs 4400 ( about US $ 100 only) and includes the following:

1. An Ovulation Prediction Test Kit, to help you determine your "fertile time"

2. Self-Insemination Kit, to help you insert the sperm in the vagina

3. A Penile Vibratory Stimulator, to help you ejaculate

4. Non-Toxic Condoms, to collect the semen

We feel this simple kit will help many more Urban Stressed Infertile Couples to have their own babies ! It's much easier than going to a doctor - and much less expensive and more fun !

Treating India's ailing healthcare system by championing patient education

Most of us would agree that though Indian doctors are amongst the best in the world, the Indian healthcare system is sick. Private healthcare can be world-class; but this is expensive and unaffordable for the vast majority. While the government does provide free healthcare, a lot of it is of very poor quality. Both doctors and patients are unhappy, as evidenced by the increasing violence against doctors and patients.

One reason for this sad state of affairs is that the entire medical system is built around the doctor. This is crazy! Healthcare is a service industry, and should be designed around the patient. The best way of doing this would be empowering patients with information, so they know how to get the best medical care, in partnership with their doctor.

Unfortunately, patient education seems to be no one's baby, as a result of which it is a relatively neglected area. This is a shame, because the potential cost-benefit ratio is huge! For the investment of a small amount of money, it's possible to improve the healthcare millions of patients receive. Patients represent healthcare's largest resource - and they have been untapped so far. If we can make intelligent use of patients, and help them to make use of their intelligence, everyone will benefit!

An investment in patient education is one of the most cost-effective ways of improving healthcare in India. Well-informed patients will take much better care of themselves, and information therapy will help to make medical care much more patient-centric.

This can be a major opportunity for pharmacists. So far, chemists in India have been treated as "baniyas", who only sell medicines. This is partly because most of them have only focused on making money, by selling products. They do not provide any value addition. However, the traditional small chemist shop is now under threat, as the large retail healthcare chains enter India. Just like the small "mom and pop" grocery stores are closing down because Indians prefer to shop in large malls, the large pharmacy chains will wipe out the small chemist, because of their financial muscle and ability to provide better service. The only way the small chemist can counter this threat is by providing better service to his patients. Patients are thirsty for information, but their doctors are often too busy to talk to them. If pharmacists (who are also professionals and expert in their field) can take the time and trouble to educate their patients, their customers will remain faithful to them!

The good news is that there is a lot of patient educational material which is now freely available. It's easy to adapt this – and to translate this into local languages. This investment in patient education will actually help pharmacists to increase their business!

Healthwise Handbook - now in India !

What can you do to manage your back ache at home ?
Is there a safe and simple home remedy for your nagging cough ?
Is your child's fever serious ? When should you take him to your doctor ?

Your husband has chest pain. Should you panic ? Is this heartburn ? Or a heart-attack ?
Solutions to the daily health problems we all encounter every day can start with this comprehensive self-care guide from Healthwise.

While health care crises of cost, quality, and staffing continue to make headlines, Healthwise has been helping people transform their role from passive recipients of health care to active, engaged partners.

Since 1975, people continue to use and trust the family of Healthwise Handbook to help them:
Do more for themselves.
Ask for the care they need.
Say “no” to the care they don’t need.
Used by employers, hospitals, and health plans, the family of Healthwise self-care handbooks are proven to help improve self-care, reduce unnecessary doctor and emergency department visits, and increase consumer loyalty. They are the "aspirin" in the information formulary, because they offer solutions to many common health problems for very little cost. They help a family make basic decisions about:
Prevention, home treatment, and when to call a health professional.
How to make wise decisions about tests, medications, and surgeries.
How to make lifestyle choices to improve health.

People turn to the Handbook about seven times a year. One client reported saving an estimated $34.5 million in unnecessary doctor and ER visits in just 30 months with the Healthwise Handbook . Over 30 million copes of the Healthwise Handbook have been sold worldwide !

The unique feature of this new edition is Go-to-Web icons which direct you to the online Healthwise Knowledgebase for more in-depth information, combining the convenience of print with the depth and currency of the Internet.

Covers more than 200 common health problems.
Provides help with topics ranging from ear infections to diabetes with clear, easy-to-understand information and full-color illustrations.
Go-to-Web icons connect to the online Healthwise Knowledgebase.

You can order this invaluable book online now ! This is the authorised low-cost high-quality Indian reprint of the latest US edition. We will ship to Indian addresses only . It's only Rs 395 ( including the cost of couriering to your address in India). It's a great gift to give to your family members and employees too !



We ship to Indian addresses only !

Photonovels for patient education

Photonovels for patient education : "Photonovels (or fotonovelas) are like comic books, but they are compiled using photographs and captions and they are a highly visual and creative form of getting a message across to wide ranging audiences. Based on the revolutionary Brazilian educator Paulo Friere’s concepts of participatory education, the process of creating the photonovel allows learners to define the content and outcome of their own learning by creating a story line about an important topic or theme and then acting it out; using photography as a means to express a story and message.
Essentially, the genre of the photonovel challenges a more traditional educational approach because it has the learner as the main subject in the pedagogical process."

These are a great way of teaching patients , since they combine story telling with pictures - and they are so easy to produce with today's technology !

Health insurance companies - healthcare goes retail

" The average American now spends more than $6,600 a year on healthcare and, for the most part, has only vague ideas as to where that money goes, how to manage it or how to navigate the healthcare system. As a rule, the information provided by health plans is sparse, confusing and usually out of date.
Although health plans are increasingly embracing consumer-oriented product designs and strategies, many have left the consumer in the dark.
“It is hard to believe that an industry that plays such an important role in the lives of consumers
doesn’t provide regular statements that answer basic questions about benefits, funds and care,” says Dan Spirek, senior vice president and chief solutions officer of The TriZetto Group, Inc.
As healthcare costs continue rising to record levels,1 consumers are taking on greater responsibility for both costs and decision-making, and they need information with which to manage these responsibilities effectively, Spirek says.
“Here’s an opportunity for our industry to step up and deliver a solution to a fundamental consumer problem.”
Healthcare payers are ideally positioned to deliver the information and guidance that consumers
need, but few have taken steps to meet these needs. If payers hope to play a central role in the
changing healthcare market, they can’t afford to ignore their constituents’ needs for transparent
information. Payers that don’t take steps to deliver critical information to key constituents—members, providers, employers and brokers—will lose market share to those that do."
Making health and benefit information transparent through personalized consumer statements—the topic of this paper—is one innovative way that payers can advance their transparency strategies and further engage members.

The consumer statement also can direct members to appropriate health and wellness programs, provide discount coupons for fitness-center membership, explain incentive programs, deliver information about upcoming educational seminars, and more. The consumer health and benefit statement is more than just a snapshot in time; it is also a way for payers to drive greater usage of their web sites and further engage members to help them make sound financial and health decisions.

TriZetto® is releasing a series of papers that explore transparency and its implications for payers. This paper, the second in the series, focuses on transparent health and benefit information and how personalized consumer statements help meet member needs for information and guidance regarding benefits, funds and care.
To request a copy of the first paper, Healthcare Goes Retail: Consumer and Provider Cost
Transparency for the Emerging Consumer Retail Healthcare Market, please visit www.trizetto.com. Upcoming papers will cover key areas such as how integrated technology solutions can help payers make the evaluation and selection of healthcare benefits and services more enjoyable for consumers; and why payers should focus on care coordination and integrating health incentives across members and providers, instead of settling for narrowly defined pay-for-performance programs for providers.

Transparency: The Key to Unlocking Consumer-Directed Care

Transparency: The Key to Unlocking Consumer-Directed Care: "Forward-thinking health plans ( insurance companies) are using technology to harness these existing links and combine data to create personal health records (PHR) for their members. With the member’s permission, this comprehensive and secure look at a patient’s health status can be made available to the provider at the point of care, via the Internet, resulting in more efficient and higher-quality care. The creation of a PHR hosted by payors has a multitude of possibilities. Before providing care, a physician or hospital can first check the patient’s eligibility and review her allergies, current medications, recent diagnoses, etc. The benefits of this type of transparency – in which information is shared among the payor, provider and member – can include decreased misdiagnosis and drug interaction, reduced duplicate testing, improved patient care and satisfaction, higher enrollment in appropriate disease prevention programs, and more efficient use of the provider’s time.

SAS | On-Demand Webcast - Intuitive Health Plan Reporting

SAS | On-Demand Webcast - Intuitive Health Plan Reporting: "The call for more and more information is permeating our everyday life. Certainly, health insurers and their customers are no exception.

Today’s insurance benefit plans are evolving from more traditional products to those reliant upon medical case management, incentives for improved outcomes, member lifestyle change and increased member health accountability. Thus, the demand for information is great – as is the need for insightful data and analysis."

Good Personal Health Records: Documentation Can Mean Life Or Death

Good Personal Health Records: Documentation Can Mean Life Or Death: "Keeping comprehensive health records consolidates important information in one place and makes it quick and easy to access. 'You are the only person who has your whole health picture,' Hayman said. 'It's out there in pieces all over the place.'"

Personal Health Records

Personal Health Records President Bush and Secretary Leavitt have put forward a vision that, in the Secretary’s words, “would create a personal health record that patients, doctors and other health care providers could securely access through the Internet no matter where a patient is seeking medical care.” The National Health Information Infrastructure Workgroup of the National Committee on Vital and Health Statistics (NCVHS) held six hearings on personal health records (PHRs) and PHR systems in 2002-2005. On the basis of those hearings, the Workgroup developed a letter report with twenty recommendations that it sent to the Secretary in September 2005. Citing the role PHR systems could play in improving health and healthcare and furthering the broad health information technology agenda, the letter report urges the Secretary to exercise leadership and give priority to developing PHRs and PHR systems, consistent with the Committee’s recommendations.

Medicine as a service business

Medicine as a service business : "The best way to answer that question is to recognize that hematology/oncology and medicine in general is a business. Once you understand the basic principles of business, you realize that whether you are in the retail clothing business, the hardware store business, the retail pharmacy business, or sales in general, the central focus is service. All successful businesses provide a needed service to their customers. And in this case, the customer is the patient. Those who provide the best service in the best environment with the best personnel will be successful.

Consolidating all care services into one center makes receiving those services much easier for the patient. And referring doctors like it too, because they know their patients are getting the best care. A centralized cancer center also offers several benefits in a business sense. For instance, it offers easy accessibility for referrals for outpatient radiology and laboratory services.

Because of these and other benefits, the concept of a consolidated center is becoming more prevalent. Several oncologists are trying to copy our concept by offering patient-centered care in an all-in-one facility."

How to get your insurance company to pay for new treatments

How to get your insurance company to pay for new treatments: "Total disc replacement is a new treatment that insurance companies (third party payors) are just beginning to recognize. Many insurance companies do not have a standard policy for covering total disc replacement procedures, so physicians and patients may be required to petition these companies to cover the procedure. Instructions for requesting coverage for total disc replacement surgery and sample letter templates that can be modified and sent to insurance companies to request coverage are provided below."

You can adapt these excellent instructions and model letters anytime you need to ask your insurance company to cover a new ( and possibly experimental) medical treatment.

Reimbursement guide - how to fight your HMO !

Reimbursement guide - how to fight your HMO ! This is an excellent guide which will help you to get reimbursement from your insurance company in case they deny your claim! It tells you what you and your doctor need to do to get pre-authorisation; and how to document the appeal process in case the claim is denied !

Patients More Satisfied With Automated Test Results, Survey Finds - iHealthBeat

Patients More Satisfied With Automated Test Results, Survey Finds - iHealthBeat: "Patients who received test results from physicians who use automated management systems were more satisfied than patients with physicians who did not use the systems, according to researchers at Brigham and Women's Hospital in Boston, Healthcare IT News reports.

The study, published in the current issue of the Archives of Internal Medicine, found that the systems significantly increased patient satisfaction with test results communication. Patients also were more satisfied with the information they received for treatments and conditions associated with their results, Healthcare IT News reports.

Researchers surveyed 570 patients who visited 26 ambulatory clinics that adopted Results Manager, an automated test results system embedded in an electronic health record system. Patients were surveyed before and after the system was adopted, as well as at clinics that did not adopt the system."

Improving Medicine: The Checklist:The New Yorker

Improving Medicine: The Checklist - The New Yorker: "But, with the checklist, what we have is Peter Pronovost trying to see if maybe, in the next year or two, hospitals in Rhode Island and New Jersey will give his idea a try. Pronovost remains, in a way, an odd bird in medical research. He does not have the multimillion-dollar grants that his colleagues in bench science have. He has no swarm of doctoral students and lab animals. He’s focussed on work that is not normally considered a significant contribution in academic medicine. As a result, few other researchers are venturing to extend his achievements. Yet his work has already saved more lives than that of any laboratory scientist in the past decade. I called Pronovost recently at Johns Hopkins, where he was on duty in an I.C.U. I asked him how long it would be before the average doctor or nurse is as apt to have a checklist in hand as a stethoscope (which, unlike checklists, has never been proved to make a difference to patient care). “At the current rate, it will never happen,” he said, as monitors beeped in the background. “The fundamental problem with the quality of American medicine is that we’ve failed to view delivery of health care as a science. The tasks of medical science fall into three buckets. One is understanding disease biology. One is finding effective therapies. And one is insuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia. It’s viewed as the art of medicine. That’s a mistake, a huge mistake. And from a taxpayer’s perspective it’s outrageous.”

What a simple idea ! Make you wonder why everyone doesn't do it. And if checklists are so important for doctors, they are even more important for patients !

My Sugar Level - Online diabetes tracking & charting software for all diabetics

My Sugar Level - Online diabetes tracking & charting software for all diabetics: "The Visual Management Tool for Diabetics Do you have diabetes? Do you take your blood sugar levels frequently? Do you find it difficult to visualize how well you are doing? My Sugar Level will help you organize all your important diabetes related readings and levels. You can try My Sugar Level free for one month - Sign up now! My Sugar Level enables you to see how well you are doing on easy to read graphs. You will be able to build a record of your progress through a series of graphs which you can share with your healthcare professionals or personal mentors. My Sugar Level lets you see your results on real-time animated graphs allowing you to interact with each entry to see more information and to easily edit your records."

Reassessing Health Care Consumers Online - iHealthBeat

Reassessing Health Care Consumers Online - iHealthBeat: "He believes that smart agents will help improve the personalization and relevance of online health information. He notes, 'There are some useful trends relating to information agents that could apply wonderfully to health care.' For instance, the travel industry is now going beyond booking and best-price finding, and some sites allow consumers to enter their preferences and then build an itinerary based on what other customers have done. Morrow said, 'These are the kinds of trends that I look outside of health care for -- to see what might or should happen that could be slick for health care.'"

Health Care Unplugged: The Evolving Role of Wireless Technology - CHCF.org

Health Care Unplugged: The Evolving Role of Wireless Technology - CHCF.org: "Wireless technology enables clinicians to monitor patients remotely and give them timely health information, reminders, and support—potentially extending the reach of health care by making it available anywhere, anytime. This report is based on interviews with more than two dozen researchers, clinicians, and application developers, along with a review of a broad range of published papers and articles, Web resources, and other materials. It includes an overview of who is using wireless technology and how it is evolving, as well as the wide variety of wireless health care applications that are already available or under development. The impact these advances could have on providers, patients, and payers is also explored, as are the difficult issues that must still be resolved. The author concludes that the health care industry's appetite for wireless applications will likely depend more on systemic changes in the way medical services are delivered and reimbursed than the capabilities of the technology itself."

Research Data Show Variations in E-Health Behaviors - iHealthBeat

Research Data Show Variations in E-Health Behaviors - iHealthBeat: "'Research' and 'Locate': The Two Top Verbs in E-Health The top four online health activities conducted by U.S. residents all involve the activity of researching: prescriptions (38% of people), treatment options (37%), medical procedures (37%) and disease/wellness information (31%). After that, people are mostly using online health sources for locating: finding directions to a hospital or facility (28% of people) and looking for doctors by searching online directories (26%)."

Hewitt Launches New Tool to Help Companies Quantify Cost Impact of Value-Based Health Care Designs

Hewitt Launches New Tool to Help Companies Quantify Cost Impact of Value-Based Health Care Designs : "'Value-based design is a viable and compelling approach that — when integrated with other employer initiatives such as focused employee communication, disease management, coaching and wellness programs — can better support and influence the interactions between patients and providers and enable positive patient behaviors while improving health outcomes,' said Jennifer Boehm, a principal at Hewitt Associates who is leading Hewitt's efforts in this area. 'But while these designs are appealing in concept, most companies have struggled with an effective way to quantify the cost implications associated with them. 'We've worked closely with Dr. Fendrick and Professor Chernew to create a comprehensive and interactive tool that enables companies to model, in a fiscally responsible yet clinically sensitive way, 'what if' scenarios that help them understand the cost impact of prescription drug plan changes necessary to implement the most effective value-based design for their employee population.'"

Hewitt Associates : A Holistic Approach to Improving Health and Health Care

Hewitt Associates: A Holistic Approach to Improving Health and Health Care : "In a quest to make a difference in the health and health care of their employees, employers are starting to think about how they are influencing the behavior and accountability of both their employee population and their health care plan providers. Employers can support positive behavior of employees — acting as a 'consumer' or 'patient' — by providing information and education, targeted incentives, and clinically sensitive plan designs. Successful employers will deliver measurable results that yield improved health outcomes, more present and productive workers, and lower costs."

The Cancer Survival Toolbox

The Cancer Survival Toolbox: "The Cancer Survival Toolbox is a free, self-learning audio program that has been developed by leading cancer organizations to help people develop important skills to better meet and understand the challenges of their illness. On this site, you can read or listen to the Toolbox in English and Spanish, or download the files to read or listen later. Chinese transcripts are also available. The goal of the Toolbox is to help you develop practical tools in your daily life as you deal with your cancer diagnosis and treatment. Family members and caregivers can also use the Toolbox on behalf of a child or anyone else with cancer."

Overview of Misdiagnosis - WrongDiagnosis.com

Overview of Misdiagnosis - WrongDiagnosis.com: "One of the first issues for a newly diagnosed patient is to consider whether the diagnosis is correct. It is important to validate a diagnosis and be certain of its accuracy. On the other hand, hoping for a misdiagnosis should not be used as a way to vaccilate and avoid treatment for a serious medical problem. Nevertheless, it is prudent to attempt to confirm a diagnosis via methods such as seeking second opinions, consulting specialists, getting further medical tests, and researching information about the medical condition."

Differential Diagnosis: Confirming Your Diagnosis

Differential Diagnosis: Confirming Your Diagnosis: "How does your doctor figure out your diagnosis? His thought process should work like that of a detective. Using clues drawn from your descriptions of symptoms, your medical tests, his knowledge of medicine, and additional input, your doctor will make a list of all the possible diagnoses that could explain what is medically wrong with you. Then, one by one, using those same clues, he will begin to narrow down the list by finding clues that don't fit. That process of elimination is called 'differential diagnosis.' Ultimately he will be left with one diagnosis, and that's the one he gives you. What Happens Next? Most patients think the next step is to ask about options for treatment. After all, they want to know how to fix or cure whatever their health problem is. But you, the empowered patient, know better. Or at least you will, once you've learned what to do next. Ask your doctor, 'What else can it be?' These five words can make a major difference in your care."

Effective Patient - Doctor Communications

Effective Patient - Doctor Communications: "There are more challenges than ever in today's healthcare environment. Limited appointment time, the ability of patients to do their own research which then needs to be discussed with practitioners, and the numbers of patients who are undiagnosed or misdiagnosed; these challenges and others make effective communications between patients and their practitioners more important than ever. Good communications really boils down to two things: respect for each other, and the ability to manage expectations. The following will help you understand how to be a good communicator yourself, and what to expect from a practitioner who is a good communicator."

Your Role as a Partner on Your Healthcare Team

Your Role as a Partner on Your Healthcare Team: "Perhaps the most important trait that separates an empowered patient from one who is not empowered is the role of 'active participant.' Active participants are those patients who realize that when they begin to experience symptoms, or at the point where they recognize that something in their body isn't functioning correctly, it's time for them to actively seek answers and solutions in collaboration with other members of their healthcare team. To be an empowered patient, you must recognize yourself as the hub of the healthcare wheel. Each other participant is positioned at the end of a spoke, allowing them to work directly with you, and in concert with the other team members found at the other spokes."

When the Patient Is a Googler - TIME

When the Patient Is a Googler - TIME: "Susan got me thinking about patients. Nurses are my favorites — they know our language and they're used to putting their trust in doctors. And they laugh at my jokes. But engineers, as a class, are possibly the best patients. They're logical and they're accustomed to the concept of consultation — they're interested in how the doctor thinks about their problem. They know how to use experts. If your orthopedist thinks about arthritis, for instance, in terms of friction between roughened joint surfaces, you should try to think about it, generally, in the same way. There is little use coming to him or her for help if you insist your arthritis is due to an imbalance between yin and yang, an interruption of some imaginary force field or a dietary deficiency of molybdenum. There's so much information (as well as misinformation) in medicine — and, yes, a lot of it can be Googled — that one major responsibility of an expert is to know what to ignore."

My favourite patients are entrepreneurs. They are good at making decisions - and for taking responsibility for themselves !

OutofPocket Weblog

OutofPocket Weblog: "I have become a cost-conscious consumer of health care services, and I shop around for the best value, just like I would shop around for a car or electronics. The only problem is there are no Consumer Reports for health care where I can easily find the best value for health care services. I have no meaningful tools to help me make informed choices about where to find the best value for routine health care services like MRIs, X-rays, vaccinations, mammograms, and office visits. How do I avoid the overpriced providers with poor performance ratings? Now that I pay out of pocket for these services (up to $5000), how do shop for value? How do I find out what other patients think of a physician that is listed in my plans network?"

NPR : India's Middle Class Gets Brand-Name Health Care

NPR : India's Middle Class Gets Brand-Name Health Care: "Down the street looms the new, granite-clad facade of the Wockhardt Hospital — part of a fast-growing chain of for-profit hospitals. Underneath the Wockhardt name, in letters just as big, it says 'Harvard Medical International.' Vishal Bali, CEO of the Wockhardt Hospitals Group, says his company — far from the largest Indian hospital chain, but with big ambitions — formed an alliance with Harvard because 'we felt what we needed was a partner who would hand-hold us into getting the best practices from the American heath care system.'"

The Benefits, and Potential Side Effects, of Sharing Medical Records Online - Knowledge@Wharton

The Benefits, and Potential Side Effects, of Sharing Medical Records Online - Knowledge@Wharton: "Hsu expects concerns about the electronic transfer of personal medical information to fade over time. While medical information is guarded more closely than financial data, there are similarities. Initially, financial data was largely paper-based and consumers were reluctant to share information electronically. Today, web-based banking and financial transactions are commonplace. Personal health records may follow the same path, says Hsu. 'Electronic banking faced initial resistance too,' he notes. 'Remember, it is still quite early in the Internet age. So there will have to be education about electronic medical records, a clear value proposition and a lot of selling before people are prepared to make the transition.'"

Who will pay for a PHR?

Who will pay for a PHR?
" Lots of possibilities

- Logical: Payer, Provider, Risk-holder
- Mind boggling: Citibank, NRA
- Established players: Harvard Medical School, Microsoft
- New players: Hdox, American Well

Do we know how this will play out?
No, NO-ONE YET KNOWS!
Don’t let anyone kid you otherwise."

Richard Dale lists 26 possible business models !

PHRs: Barriers and Enablers

PHRs: Barriers and Enablers

Barriers
- Immature standards (for portability of data)
- Difficulty reaping economic benefits where funding for PHR originates
- Perverse incentives of the healthcare system

Enablers
- Desire to improve healthcare
- Increasing cost of poor health in direct and indirect costs to business
- Business opportunities driven by PHR infrastructure

Benefits of Electronic Health Records Seen as Outweighing Privacy Risks - WSJ.com

Benefits of Electronic Health Records Seen as Outweighing Privacy Risks - WSJ.com: "A sizable majority of Americans believe electronic medical records have the potential to improve U.S. health care and that the benefits outweigh privacy risks, according to a new Wall Street Journal Online/Harris Interactive poll. The survey of 2,153 U.S. adults, conducted Nov. 12-14, shows three-quarters of respondents agree that patients could receive better care if doctors and researchers were able to share information more easily via electronic systems and 63% agree sharing of such records could decrease medical errors. Fifty-five percent agree this could reduce health-care costs, compared with 15% who disagree. However, about one-quarter of adults remain unsure whether electronic medical records can provide these benefits. About one-fourth of respondents say they currently use some form of electronic medical record; most say the record is kept by their physician, while only 2% say they have created and maintain their own record and another 17% said they aren't sure whether they have such a record. Still, 91% of those polled say patients should have access to their own electronic records maintained by their physician."

Welcome to myexpertdoctor

Welcome to myexpertdoctor: "People usually get what they ask for from their doctors. Myexpertdoctor helps patients ask the right questions, personalized to their particular condition and situation. Developed with grants from the National Institutes of Health, myexpertdoctor is backed by a team of medical experts. Our experts incorporate the latest research and medical guidelines, created by professional medical organizations, into our Medical Condition Tools. Myexpertdoctor covers preventive health care and a wide variety of health conditions, including asthma, headaches, arthritis, high blood pressure and heart disease, with more conditions being added each month. More about myexpertdoctor How it works: 1. Patients answer 10 - 20 questions online before they visit their doctor. 2. They receive immediate personalized feedback and information, including a list of questions to ask their doctor. 3. Patients ask the suggested questions and get better health care."

A Website to Improve Asthma Care by Suggesting Patient Questions for Physicians: Qualitative Analysis of User Experiences | Hartmann | Journal of Medi

A Website to Improve Asthma Care by Suggesting Patient Questions for Physicians: Qualitative Analysis of User Experiences | Hartmann | Journal of Medical Internet Research: "To test the impact of patients asking their health care providers about tests and treatments they could receive, we developed an interactive website (myexpertdoctor.com) to inform patients about asthma and to provide tailored feedback. The website is designed to be used before a physician visit to help patients know what questions to ask during the visit, which in turn may increase the chance that they receive tests and treatments suggested by evidence-based guidelines"

Women's Health Matters - Web Toolkit

Women's Health Matters - Web Toolkit: "More and more Canadian women rely on the Internet as a source of health information for themselves and their families. Are you one of these women? Whether you are a beginner or an experienced Internet user, the sheer volume of information can be daunting for all of us at times. The womenshealthmatters.ca team created this toolkit to assist the many women who have asked us for help in navigating the often confusing maze of health information on the Web."

Natural Way to Healthy Living !

HELP educates patients in partnership with Tulsi - the Pantaloon Pharmacy chain !

Pantaloon Pharmacy customers can log onto www.pantaloon.com/tulsi.htm and get all their health queries answered. This is a great win-win partnership; and allows us to offer a value-add services to Pantaloon customers; and reach out to many more people !

Clever way to enhance patient understanding !

Demand Management: The Patient Education Connection

Demand Management: The Patient Education Connection : "Does the pairing of demand management and patient education surprise you? It shouldn't. After all, demand management is largely a process of educating patients about how to make appropriate use of health care services. Every time you tell a patient not to worry about a temperature of 101°F, you're managing demand -- as you are every time you try to get a patient to understand that antibiotics aren't effective against cold viruses and every time you say, 'and if it doesn't get better in a week, call the office.' While the purposes of patient education are usually thought of as increasing adherence to therapy and reducing health risks, demand management is and always has been an integral part of it. The concept of patient education is central to all efforts to manage demand, from computerized or telephonic decision-support systems for self-help and triage to the poster about the risks of high cholesterol that hangs on your waiting room wall. Are these demand management tools that provide patient education or patient education tools that manage demand? Your answer probably depends on whether you're a managed care executive or a physician. But the benefits of these strategies accrue to both groups, and to patients too."

Demand Management: Putting Patients First

Demand Management: Putting Patients First : "Demand management is the process of empowering patients to make wiser health care decisions. It is not necessarily about reducing demand or keeping patients out of your practice. Rather, the goal is to engage patients in the quest for appropriate care. If you doubt the necessity of managing demand, think about all the patients who press you to prescribe antibiotics for their colds or demand other interventions you know to be unwarranted. Multiply the effect out across the country, and consider that the United States spends an estimated $200 billion a year on unnecessary and inappropriate care.2 To tackle this problem, demand management employs essentially two strategies: * First, it seeks to reduce the need for services by improving patients' health. The emphasis here is on wellness, health promotion, risk reduction, prevention and early detection. * Second, demand management attempts to improve patients' decisions. Patients may need to be taught, for example, when they need to see the doctor and when all they need is self-care. Tools such as patient education materials and telephone advice lines can aid the decision-making process."

Patient-Physician Partnership Agreement

Patient-Physician Partnership Agreement

This form can be downloaded as a PDF.

OBJECTIVE
To better manage your diabetes through a patient-physician partnership and goal setting.

REASON
Medical research and clinical experience have shown that optimal management of diabetes significantly reduces the known complications of this disease, including blindness, heart attack, kidney failure and loss of a limb.

EXPECTATIONS
You can expect your physician to provide the following services, which are an essential part of diabetes management.

• OFFICE VISITS - every three months for reviewing your progress.
• MONITORING - blood pressure, other vital signs, foot examination and hemoglobin A1c.
• ANNUAL SCREENING - lipids, microalbuminuria (test for kidney protein), eye examination and monofilament testing (sensory examination of feet).

PERSONAL GOALS

Weight/Body Mass Index:	Current:	________/______	Ideal:	_______
Hemoglobin A1c (<>	Current:	_______	Goal for 6 months:	_______
Blood pressure (<>	Current:	_______	Goal:	_______
Total cholesterol (<>	Current:	_______	Goal:	_______
LDL (<>	Current:	_______	Goal:	_______

YOUR RESPONSIBILITIES
• Schedule follow-up appointments every three months or as indicated by your doctor.

• Monitor blood sugars at home at the agreed testing frequency: _______.
• Work toward attaining the personal goals noted above.

PATIENT SIGNATURE	____________	Date:	_______
PHYSICIAN SIGNATURE	____________	Date:	_______

Simple tool to help doctors to help their patients make the most of their visit to the clinic

Today’s Visit

Main reason for today’s visit: _____________________________________________

_______________________________________________________________________

Other concerns I would like to discuss if there is time: _______________________

_______________________________________________________________________

Check all that apply:

o I have prescriptions that need to be refilled.

o I need a school or work excuse.

o I need a referral for my insurance company.

o I need the attached forms filled out.

o I would appreciate prayer today.

Patient’s name: __________________________________________________________

Date of birth: ___/___/___

Developed by Cornerstone Family Health, Williamsport, Pa. Copyright © 2003 American Academy of Family Physicians. Physicians may photocopy or adapt for use in their own practices; all other rights reserved. “Focusing on Today’s Visit.” Redka JW. Family Practice Management. June 2003:59-60, www.aafp.org/fpm/ 20030600/59focu.html.

End of box file

Improving Care With an Automated Patient History - July/August 2007 - Family Practice Management

Improving Care With an Automated Patient History - July/August 2007 - Family Practice Management: "One of the biggest challenges of using an electronic health record (EHR) system is how to fill it with patient data. What data should be entered, who should enter it, and when should it be done? I've seen many strategies tried, and in my experience the ideal solution is to have patients enter as much data as possible themselves before beginning a patient visit. This saves physicians time and can even lead to higher-quality data. After all, the patient is the person most interested in providing a thorough history."

Healthcare Scheduling - AppointmentQuest Online Scheduling Software

Healthcare Scheduling - AppointmentQuest Online Scheduling Software: "Patient scheduling is an integral part of daily work for healthcare professionals, from family practices to large clinics, from physician offices to hospitals. Medical office staff has to schedule patients for dentist, optometrist, ophthalmologist, surgeon, psychiatrist and other general care and specialist appointments. Scheduling quickly becomes complicated if the doctor is practicing in several clinics and travels between medical offices. Appointments need to be coordinated, medical support staff have to be constantly aware of all new patients and doctor’s schedule. Patient scheduling can be greatly simplified with capable online scheduling tools and appointment management software. With the help of online scheduling, medical office staff can easily manage doctor’s appointment schedules, patient records and individual appointments. Small medical practices can even allow patients to self-schedule their appointments online. Many doctors and small medical offices have already established their own web sites — online scheduling is a great addition to any such web site, an invaluable tool for communicating with patients."

Are Your Patients Ready for Electronic Communication? - October 2007 - Family Practice Management

Are Your Patients Ready for Electronic Communication? - October 2007 - Family Practice Management: "Overall, we were pleased to learn that 88 percent of our patients are able to access the Internet or e-mail either at home, through a public facility, or through family or friends. We had anticipated a much lower number. We were also impressed that 78 percent of patients with Internet access (either at home or elsewhere) expressed interest in using some form of electronic communication either to contact our office or to receive health-related information from our office. Acting on the numbers The results of our survey convinced us that patients are ready to begin using the Internet to communicate with our practice. The patients we surveyed were enthusiastic about receiving appointment reminders by e-mail, scheduling appointments online and receiving test results electronically, and we are planning to offer each of these services in the near future."

Virtual Office Visits: A Reachable and Reimbursable Innovation - October 2007 - Family Practice Management

Virtual Office Visits: A Reachable and Reimbursable Innovation - October 2007 - Family Practice Management: "Virtual visits satisfy patients' thirst for timely access to care and allow them to communicate with their doctor when it's convenient for them, whether from home or work, regardless of the time of day. With a virtual visit, patients don't have to wait on hold to schedule an appointment, they don't have to miss work and they don't have to waste time in a waiting room. This type of information exchange allows them to describe their problem and formulate their questions without feeling rushed, and because they have their physician's response in writing, they can reread the information as often as they like or need to understand the content. Virtual visits are generally paid for out-of-pocket by patients, although some insurers are beginning to reimburse for the service because they believe it is cost effective and increases patient satisfaction."

The Ideal Medical Practice Model: Improving Efficiency, Quality and the Doctor-Patient Relationship - September 2007 - Family Practice Management

The Ideal Medical Practice Model: Improving Efficiency, Quality and the Doctor-Patient Relationship - September 2007 - Family Practice Management: "What do you get when you mix low overhead with high technology and wrap it around an excellent physician-patient relationship? You get an ideal medical practice - a practice model designed to enhance doctor-patient relationships, increase face-to-face time between doctors and patients, reduce physician workloads, instill patients with a sense of responsibility for their health and cut wasted dollars from the entire system. The model encompasses the ideal micro practice model, which focuses on optimizing the smallest functional work unit capable of delivering excellent care: the solo doctor, even without any staff. The key principles ideal medical practices pursue are high-quality, patient-centered, collaborative care; unfettered access and continuity; and extreme efficiency."

Q: What Scares Doctors? A: Being the Patient -- Printout -- TIME

Q: What Scares Doctors? A: Being the Patient : "Even more insidious is the danger of overtreatment. With well-insured patients inclined toward hypervigilance, doctors afraid of missing something and a reimbursement system that rewards testing over talking, there is embedded in the system a dangerous impulse toward excess. Specialists are typically paid much more to do a procedure than the family doctor who takes the time to talk through the treatment options. A doctor who does a biopsy may be paid as much as $1,600 for 15 minutes' work, notes Dr. Jerome Groopman of Harvard Medical School. 'If you're an internist, you can easily spend an hour with a family where a member has been diagnosed with Alzheimer's or breast cancer, and be paid $100. So there's this disconnect between what's valued and reimbursement.' And yet sometimes, talking is the more important and certainly the safer treatment. Ten more minutes spent taking a family history can reveal clues that prevent a misdiagnosis or an unnecessary test; that childhood injury, that illness during a trip abroad, that family history of excessive bleeding. "

Good doctors, safer patients:

Good doctors, safer patients : "This report aims to create a new approach to promoting and assuring good medical practice and protecting patients from bad practice. The Chief Medical Officer was asked to undertake this broad review of medical regulation, following Dame Janet Smith's inquiry into the circumstances surrounding the murders committed by Hyde GP, Dr Harold Shipman. The CMO's report, Good doctors, safer patients, advises Ministers on measures to strengthen the arrangements in place for the protection of patients. The report contains 44 detailed recommendations. Proposed changes include devolving some of the powers of the GMC to a local level, changing its structure and function, and creating a new framework for revalidation."

Doctors can be harmful to your health !

We all want to remain healthy and well and we expect our doctors to help us to do so. However, this is a big mistake ! While doctors are very good for making you better when you fall sick, they are not good at keeping you healthy. After all, doctors are illness specialists, not wellness specialists ! In fact, most doctors have pretty unhealthy habits themselves ( even though you would expect them to know better !); and I sometimes feel that most doctors would not recognize a well person because they never see one ! ( For example, I am an infertility specialist, and see only infertile patients all day long. I never see fertile women, so though I help infertile women become fertile, I am not really an expert on optimising natural fertility !)

Things were different in the past. In China, doctors were paid as long as the family was healthy. If someone fell sick, payments were stopped until he recovered, because the fact that the person fell ill meant that the doctor was not doing a good job . This was a very sensible approach – and it’s one we should consider revisiting !

Unfortunately, today we seem to have lost our commonsense . We don’t trust our own bodies; and everything has become medicalised . We blindly do what doctors tells us to do – pop a pill; do a scan, run a test – the list is endless !

We need to regain control over our bodies – and the true experts are people like Mr Dalmia . He is great role model, and we can learn from his personal experience . Though he is apologetic that he is not a doctor , in fact I think this is his biggest advantage – he does not see the world through a doctor’s “illness” lens.

We have a rich and ancient heritage . Ayurveda is the Science of Life – not the science of just treating illness. I believe that people are the largest untapped healthcare resource – and if we want to remain in the pink of health, we’d be much better off learning from each other, rather than depending upon doctors.

An attitude of wisdom

"Be Confident enough to act on the best knowledge you have now;
Humble enough to doubt what you know; and
Wise enough to face the hard facts when better evidence comes along."

This is from the book, Hard Facts, by Jeffrey Pfeffer and Robert Sutton, which talks on Evidence-Based Management.

I guess this would be the businessman's version of the Serenity Prayer , which states -
God grant me the serenity to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.

The Healthy Way to Natural Living - Mr Dalmia

HELP recently organised a talk on - The Natural Way to Healthy Living. This was given by Mr Dalmia, one of India's leading industrialists. He is an excellent role model of how to live a healthy life !

Here's his talk - in full !

I am a businessman not a Doctor. My age is 66yrs. As per Reader's Digest test few years ago it was determined as 40 yrs. I took last medicine in 1967 and have not suffered from any illness since then. In last 40 yrs I have lost 4 working days due to catching cold in Cal monsoon. My experience confirms that disease-free living is possible without foregoing all pleasures of life. What is being shared, even I do not practise 100%, but I am conscious. Till 1975 my life style was not any different from others. It changed gradually. By the time I was 40 yrs old a lot of improvement had taken place. Looking after your BODY is like driving a car, when it deviates from its path, the driver corrects the course in time. If one is sensitive and responds, it is possible to correct before it is too late. Whatever is being shared is based on my own experience/analysis and interaction with Naturopath Doctors. If mothers want their children to lead a disease-free life they should inculcate right habits during childhood. Modern medicine is very good for emergency, particularly accidents, but not for every day life.

Every 'BODY' like every individual is different. All medical sciences works on averages. We must understand the limitation of average. Haven't you heard the sad story of a man, who drowned himself in a pond average 3 ft deep'.

A. Disease-free body is not muscular body of gym. Immunity gives disease-free body.

1. Causes of disease a. inheritance or b. own life style. Control life style before disease forces you to change. Disease is caused by accumulation of toxins in body ie elimination process not satisfactory. We allow toxins to accumulate upto the tolerance limit. Even after that by taking medicines we try to suppress it rather than eradicate.

2. Dr Swaminathan was a very strict naturopath. He was confident that if he was to drink a glass full of all types of bacteria nothing will go wrong with his body. How many Doctors can claim this? Immunity is affected by lifestyle. Western children have much lower level of immunity than Indian children, who live in more unhygienic conditions. Too clean homes are not good for children. US children now are developing allergy to simple things like groundnut. Instances of death by eating groundnut have also been reported.

3. Body's capacity to rejuvenate - Human BODY has immense capacity to rejuvenate, provided we help it and at least donot interfere. It is a masterpiece feat of Almighty and is impossible to match.

4. Toxins = waste from food + dead cells ++. Some food waste is more difficult to eliminate. Some practices/processes help waste elimination. We clean our house daily and some intense cleaning periodically. Are we careful re internal body cleaning? Do we do some intense cleaning of our internal body at all?

5. Ext vs int hygiene - Few people brush teeth at the back. Even fewer are aware of the internal cleanliness status of their body. Emphasis is on cleanliness of the visual parts. We need to learn how to improve internal hygiene. Mothers need to inculcate proper habits for good internal hygiene from childhood.

6. Obesity is a sign of ill health. Today people want to remain slim for looks. Classic joke "There is no such thing as an obese centenarian."

7. Body systems are very strong when young, as such one tends to develop wrong habits which one cannot cope with at a later age. Stop bad practices before they tend to become a habit. One gentleman weighed himself daily in say 10gm units. He will endeavour to eliminate any extra gm next day before it became permanent part of the body.

B. Toxins elimination

1. Accumulation of TOXINS is like Slow poisoning - realisation comes too late. If we put a frog in a bucket of hot water, the frog will try to jump out. If the frog is put in a bucket of water at room temperature, and heat is applied gradually, it stays there till it is too late. Unfortunately our knowledge re warning signs is poor, hence we donot pay heed to such signs. Fever or any other need to take medicine is already late. Even then we suppress the sign and ignore the cause. We seem to have got habituated to live with unhygienic conditions in our internal body.

2. Gaseous toxins removed through breathing - Lung volume for an average person is 5 litres, but most people inhale 1 lit +/-. As a result quality of air in the lungs is dirty. We clean our external body daily, house daily but make no efforts to clean our lungs. Pranayam helps cleaning of lungs. In Pranayam emphasis is on exhaling to get rid of accumulated toxins. There are 108 types of Pranayams. Some are meditational eg Anapan, Sukh Pranayam, Nadi Shodh, Anulom-Vilom etc. Kapal Bhati, Bhastrika emphasise on exhaling. Standard practice during pranayam is that time to exhale is twice the time to inhale. Laughing also helps cleaning of lungs. CORRECT WAY TO BREATHE IS TO LET STOMACH ALSO BLOAT DURING INHALING LIKE A NEW BORN CHILD DOES. I am told that Baba Ramdev was paralysed and regained normal body functions with the help of Pranayam and Yoga. I also understand that anyone practising Transcendental Meditation pays reduced premium on medical insurance in USA.

3. Liquid toxins removed through urination & sweat. We should drink 2-3 litres of water daily. Any liquid intake is not same as water intake. Air-conditioning prevents toxins elimination thru sweat - a contradiction for disease free life style.

4. Solid waste removed through stool. Have we ever experienced absolute clean intestines? Can we interpret inside happening by looking at our stool? Our knowledge re this very deficient. Ideal is 1motion for 1 meal. Effortless, smooth and quick elimination are some signs of clean intestine. Look at tongue. If intestine clean, no deposits on tongue - not necessary to clean tongue. Do we know what to do, if any problem with stool passing other that laxatives? Now a days there is a machine which washes the colon known as 'Colon Irrigation or Hydrotherapy'. There are yogic kriyas given below.

Case story - One patient was very sick - unable to stand/walk. Doctors were not sure if he will survive through the night. Heavy Enema eliminated the accumulated toxins. He passed comfortable night and was ready to run next morng even before eating any food.

5. Fasting helps detoxification - Fasting for health is not like modern days fasting by ladies for religious rituals. For detox one has to live for a few days on liquid food or only water. One naturopath lived for 23 days on water alone with full rest. At the end of the period higher energy that before fasting. An alt can be to have 4days cycle - 1st day only liquid, 2nd day fast, 3rd day liquid & 4th day solids. Cycle may be repeated. Naturally solid food has to be light food. Child's concept of light food is a piece of cake and that of balanced food a piece of cake in both the hands.

6. Yogic Kriyas a. Jalneti b. Sutra/Rubberneti c. Kunjal d. Vastra dhouti e. Laghu Shankh Prakshalan - drink warm salt water say 2 glasses and perform some Asans/excercises. Repeat the process 3-4 times. Most of the water gets diverted to intestines and washes the colon. Almost clear water comes in the end. Rishis did Maha Shankh Prakshalan before tapas. With total clean system, no food, few breaths, metabolism came to stand still. Ageing process stopped. To learn more about toxins elmination through yogic kriyas/yoga and nature cure - visit a good Nature Centre. Naturopathy is serious about teaching you how to remain disease-free and not treat you like a customer to be pleased. In commerce of health they hardly tell you to be disciplined. Disciplined life style only will help develop immunity. Pl remember that a Naturopath Doctor also gets a degree from the institute. Their courses on anatomy etc. are as detailed as for Allopaths. Treatment system taught is obviously different. There are also degrees for Yoga. One young girl practised Yoga during pregnancy under the guidance of an expert. As she narrated to me, her delivery was very smooth and almost painless.

7. Case histories:

a. One man from Dubai came regularly for say 15 days to a nature centre for detox. During his normal living, he indulged in everything not allowed by Naturopathy eg meat, smoking and alcohol. His approach was to overhaul the system like any machine, use it for one year and come back for overhaul every year. During the period of stay, he followed all the disciplines of the Centre and resorted to normal practices as soon as he stepped out.

b. One Mr J of Cal goes regularly for detox. He takes some medicines regularly for old illnesses. Whenever Doctors want to increase medicines or dose, he goes for detox instead of more medicines.

Learn to use the power of DETOX in your life... and you'll start to regain the health and energy that is your birthright.

C. Food

1. Hunger - Do we eat when really feel hungry or by watch. One senior industrialist asked me when I was about 12 years old whether I ever felt hungry. Looking to his seniority, I was taken aback by such a question. I did not want to be impolite by not responding. I mentioned that I felt hungry as everybody else. HE EXPLAINED THAT THIS WAS NOT HUNGER. HUNGER IS WHEN YOUR MOUTH STARTS TO WATER BY LOOKING AT THE MOST TASTELESS FOOD. All ladies know the remarks of family when food is not upto individual's taste. All because WE EAT EVEN WHEN NOT HUNGRY. Has anyone ever complained re nutrition? I can say I have never felt such hunger. Please analyse for yourself whether you eat when you are hungry or by watch.

2. Taste vs nutrition - Nutritious food must be pleasant but may not always be tasty eg Neem, Karela etc. When someone tries cheese, coca cola, he does not find it tasty. This applies even more to alcohol and smoking. But people adapt to taste of these things. We must adapt to the taste of healthy food. Ladies should see to this particularly for children.

One person went to a Swami ji and complained about his health and inability to take food. Swami ji requested to list out all the foods he liked and all the foods he did not like. After seeing the list, Swamiji said he should eat all the foods that he did not like and not eat all the foods that he liked. If this is how we adapt to taste, we can not have disease-free life.

3. Chewing is very important for proper absorption by the body. Chewing makes the bite finer and salivates it. Mother's concept is that the more the child eats, the better for him. In her pursuit

for this, she does not teach the child to chew. Mothers prepare next bite and bring it to the mouth as soon as previous one is in the mouth. As a result child learns to gulp. We have been taught to chew every bite 32 times. My perception is that the extent of chewing depends on the food eg boiled rice cannot be chewed even 32 times. Whereas certain hard/fibrous foods eg carrots or even sprouts can be chewed upto 200 times. Taste is also a reason for us to gulp. When food stays in the mouth for longer period, taste gets diluted. Hence, tendency to gulp and get the new bite for better taste.

4. Impact of Cooking/Heating

a. Roasted or boiled seed does not germinate. There is no change in chemistry of food by boiling/roasting.

b. We all consider CHHENNA to be healthy. It is considered light and full of nourishment. MAWA is considered to be heavy that is difficult to digest and not so healthy. We all know that both are milk solids. For making CHHENNA water is separated through chemical means whereas for MAWA water is removed through evaporation. Water leftover after recovering CHHENNA is considered to be very healthy as it has water soluble vitamins and minerals. As MAWA is prepared by water evaporation, these vitamins and minerals are supposed to be present in it. Chemically protein, carbohydrate and fat content of CHHENNA and MAWA are identical.

c. How long can you keep cooked food? May be for a few hours without freezing.

d. How long will raw fruits & vegetables last? May be few days.

e. What happens to sprouts everyday after germination. They are growing daily.

Conclusion

Roasting/boiling deprives the seed of life giving capacity. Heat has made MAWA unhealthy although its chemical nutrition is the same as CHHENA. It is obvious that although chemical nutrition may be similar, but there is difference depending on the source and how it is prepared. In my perception, cooked food is like dead body. It starts decaying soonafter being prepared. Fruits, vegetables and sprouts are live foods. For proper nourishment to sluggish or dead organs we need nutrition from living food and not dead food. On this basis, meat is even worse than the cooked vegetarian food as decay starts immediately

after slaughter. So it becomes like 24-hours old cooked food or dead body after 24hrs. Today American Institute of Cancer Research is recommending more and more use of fruits, vegetables, salads and limit meat taking to the minimum. It is my belief that in years to come they will recommend no meat at all. Possibly, if they do it today, its acceptablility in the society will be difficult. USA is very conscious when marketting a new product or idea re it's acceptability with the customer.

Case stories:

a. A lady had 3rd stage uterus cancer. Doctors wanted her to undergo standard treatment of radiation, chemotherapy etc. She refused any such advice and changed to 100% raw food. After 1 yr Doctors confirmed NO DETERIORATION!! It will require lot of guts on part of Doctors to confirm improvement merely by taking raw food.

b. One diabetic patient's wound was not healing after surgery, although sugar was kept under control with the help of medicines. A naturopath approached the family and suggested that his prescription be tried. When enough time was lost without sufficient progress, everybody agreed to try his prescription. His prescription was to have only raw food with even reasonable quantities of fruits such as banana, mangoes etc usually not allowed to diabetics. Sugar remained under control without medicine and the wound was healed. Sugar was under control in both the cases though by different means but healing rate improved considerably when the patient was only on raw food.

Recently there was an article 'Raw food slows down ageing'.

5. Acidic and alkaline foods - Cereals & dals are acidic foods, while fruits & veg are alkaline. In net food must be alkaline, therefore more fruits & veg. Some say max 20% Cereal+Dal, others accept upto 33%. It is a challenge for the ladies in the house how to give such a high proportion of fruits, vegetables to the family. You may mix veg in Khichri and even flour before making roti. Please remember fruits clean the body and vegetables build the body. Potato is a vegetable but not considered to be 100% vegetable, but is very healthy. It is a misconcept that Potato is fattening. It has 80% water and is too porous, hence can absorb a lot of fat without showing. It should always be taken with the skin. Fruits are predigested food, hence should be eaten separately from main meal or 30 to 45 minutes before meal. Although vegetables are not predigested, but it is also

recommended to take salads, etc. before the meal, as time reqd to digest is much lower. Nutrient density ie special nutrients/cal of intake is max in fruits & veg.

6. Milk - Most Naturopaths believe that nature has made milk only for the baby of the same species. However, everyone is unanimous that if external milk has to be taken, source has to be cow. Best is to have Dharoshna milk i.e, milk as it comes out without much delay. In any case, boiled milk is not recommended. It is better to have curd instead of milk. Alternative suggested is Soya milk.

7. Fat, salt and sugar

Fat - A perception has been developed to avoid fat for healthy diet. Fats are absolutely necessary and must form part of diet. Vit A & D are fat soluble. In absence of fat, body may become deficient in Vit A & D. Fat is very rich in calories hence its intake must be limited particularly for those who are not involved in physical labour. Fried food in any case is bad because of heat exposure. Frying temp is much higher than normal cooking temp. All ladies know that after some time, batch of frying medium needs to be changed otherwise the food may become poisonous. Obviously sustained high temperature changes the character of fat making it almost a poison.

White Sugar - taken only for taste. It has only calories. Due to lack of other nutrients, its nutrient density is nil. God has made Vit B composite with all sugar containing fruits. Vit B is required for digestion. In absence of Vit B, it takes Vit B from other parts and deprives the body of Vit B. It is also said to be Calcium thief. It deprives the body of Calcium. Net value of white sugar is negative. Sweetners like jaggery and honey are nutritious.

Common Salt: Rarely required for nutrition. Exceptional cases where salt may be required to replenish for people who sweat too much like working in hot conditions etc. Other than that its nutritional value is practically zero. Sodium deficiency is a very rare phenomenon. We all know that it tends to increase blood pressure and creates many other complications. As such it should be taken in very limited quantity for taste only.

Recent UK study showed high level of sickness among children. Their conclusion was that readymade foods contain excessive salt and sugar. Soon they intend to legislate restricting the amount of salt and sugar added to readymade foods. Choice will therefore be up to the individual to supplement salt & sugar as per his taste/wish. It will in any case not develop taste among children towards highly salty or sweet foods.

8. Sprouts - Sprouts can be prepared from different cereals and pulses. Most commonly used are Chana, Moong and Moth. However Wheat, Groundnut and Methi can also be sprouted. Methi sprout is a very good detoxifier and also helps control Cholesterol. Best is to have all varieties of sprouts. Generally, people tend to take sprouts with salt and lemon. There is nothing against lemon, but salt is not a desirable additive.

9. Micronutrients - We all know about major nutrient like carbohydrate, protein, fat etc. Ultimate difference in food value is because of micro nutrients. All cars have wheels, engine, steering, brake, etc. but not all cars are same. It is the minor additions which make all the difference between a good, better and best car. Micronutrients are like that. Lot of Micronutrients are still unknown. Hence, using maximum variety of foods is desirable. American Institute of Cancer Research emphasises that food plate should have all colours like rainbow. Green colour is due to Chlorophyl. Molecular structure of chlorophyll is identical to Haemoglobin except for Iron in the core. As such, it is the easiest raw material to produce haemoglobin. This is the main reason why emphasis on green vegetables. There are lot of micro-nutrients in Wheat Grass, Barley grass and even common grass. Haldi, Tulsi, Clove, Ginger & Lemon are natural antibiotics. We all know that mercury is a poison and cannot be consumed by the body. Tulsi is the only source of digestible mercury. This gives it the antibiotic property. Neem and Amla are very good blood purifiers. Karela is also rich in micronutrients and good for diabetics. There are lot of antioxidants in fruits and vegetables.

10. Genetically Modified food - There is a lot of talk about GM Food based diet. I understand GM food cannot generate own seed. What may be its impact over time on regeneration capacity of the people who use this regularly, needs to be understood.

11. CD/computer programme to educate children - I will suggest that someone develops a CD/computer programme to educate children re food choice. All types of food are lying on a table and children are given option to select the food from the buffet. Computer programme gives them marks based on food chosen. Children may have the option to take out some food and replace by alternative. This may develop a good concept among children regarding good and bad food as well as balanced diet. Good food chosen improves score and vice verse. PAVITRA's STORY, PK to narrate.

12. Chocolates, Icecream, Chips - A post mortem study of children 10-15yrs of age, who died prematurely was carried out in US. Blockage of artery was noticed in many cases. On checking the food habits of the children where blockage had started it showed common eating habits of potato chips, chocolate & Icecream. Today US schools are banning carbonated drinks. If we reward a child with junk food eg chocolate, the child will never understand that chocolate is bad for him.

13. Chilled water/Icecream - Digestion is a chemical process. All chemical reactions slow down at lower temp. Impact of chilled food or water in whatever form is to slowdown the digestion process.

14. Qty of food vs energy - Energy in the body depends on various factors. Quantity of food is definitely a factor but a less important factor. Among the type of audience here, lack of quantity of food cannot be a reason for lack of energy or nutrition. I strongly feel that after certain age one should reduce their food intake considerably. As per Ayurveda, one who survives on one meal a day is a Yogi; one who consumes two meals a day is a Bhogi and one who consumes more than two meals a day is a Rogi.

15. Blood Pressure - As a general belief that BP increases with age. When the arteries/pipelines are clean, heart can pump adequate quantity of blood with relatively low pressure. As the arteries get clogged, blood pressure tends to rise as any engineering student will know. This strains the heart. On the one hand our heart also has aged and has to work under higher pressure. Nothing can be worse than this for the heart. Constant care is required to prevent clogging of arteries.

16. How to murder yr Husband

There was a joke many years ago in Reader's Digest with the above title. It merely said feed your husband with very rich food and when he wants to go for exercise donot let him go on one plea or another, thereby showing how much you love him. Nobody will ever blame you for his premature death. Lot of us may be doing this ignorantly.

D. Life style

1. US Cancer statistics - One in four persons in US suffers from Cancer. This is totally due to their life style. This is also the reason why so much anti smoking consciousness has developed there. Besides tobacco, their beef eating is also possibly responsible for high incidence of cancer. I have not seen any country where steak is taken even for breakfast.

2. Indulge with responsibility - A School in Delhi, unlike most schools gives a lot of liberty to parents for letting their ward to be absent from school. They believe a child's education is incomplete without good family bonding. The Principal explains that if child's uncle/aunt have come with their kids and family is in a mood to go for a picnic, just go. As responsible parents how frequently this should be done is for the parents to decide. This is an absolute exception to what most schools allow. Similarly, as responsible individuals we have to decide regarding our indulgence. If we evaluate a doctor based on how much he allows us to indulge or a hospital based on its flooring we need to evaluate ourselves if we know enough to indulge.

3. Eating out - Eating out is so common these days. Eating out is always prone with poor nourishment and bad hygiene. Even if the establishment boils all the forks, spoons, etc. most bacteria may be destroyed but not most viruses. All establishments for eating out get business based on taste and not on nutrition. Naturally their emphasis is on taste ALONE. If our frequency of eating out is high, our nourishment goes down and risk of viral exposure goes up. One is not even sure of their cooking medium and how long it has been used before changing.

4. General

a. Sitting posture vs blood flow - In the olden days we used to work by sitting on the floor in a cross legged position. These days everybody from childhood sits on a chair. Just visualise the blood flow in the body in the two postures. All our active organs are above the abdomen. While sitting on the chair, lot of blood flows to the feet unnecessarily. To that extent, all active organs above abdomen right upto the brain receive reduced quantity of blood. Naturopaths recommend sitting in Vajrasana after meal to allow more blood and energy to organs involved in the process.

b. Stomach pumping and Nyoli Kriya are 2 activities which massage all active organs in the abdomen area.

c. Stay healthy without excercise - if we walk instead of using a car, go up the stairs instead of using the lifts, wipe the floors, stretch to access goods on the higher shelves, etc. we do not need to exercise specifically.

d. Standard of life vs standard of living - Now a days there is greater emphasis on standard of living ie indulgence, instead of standard of life.

5. Excercise - Syt GDBirla used to walk 25km daily. Instead of going on a horseback, he walked upto Kedarnath at age of 85yrs+. If he could find time, it is difficult to accept that we miss exercise due to lack of time.

E. Pollution & Environment

1. My father Syt Jai Dayal Dalmia told me in '70s

a. drinking water will be sold in bottles.

b. Air/O2 will follow

c. bio-degradabilty of certain materials in everyday use.

Please evaluate the impact of drinking water industry. How much pollution is created in transportation of so much water all over India. Disposing of the plastic bottles is a nuisance due to its non bio-degradability. Term biodegradability is somewhat understood now but in '70s it was an almost unknown term.

All these also contribute directly or indirectly in one form or the other to ill health.

There was a news article in Times of India dated 7 Oct07

London: The world moved into "ecological overdraft" on Saturday ie 6 Oct, the point at which human consumption exceeds the ability of the earth to sustain it in any year and goes into the red, the New Economics Foundation think-tank said.

Ecological Debt Day this year is three days earlier than in 2006 which itself was three days earlier than in 2005. NEF said the date had moved steadily backwards every year since humanity began living beyond its environmental means in the 1980s.

At this rate, Oxygen in the air will go on diminishing and will be substituted by Carbon Dioxide. On the one hand the forests are getting depleted due to limited consciousness regarding use of wood and paper. If it continues at this rate, my father's imagination that one day everybody carry air/oxygen cylinder for breathing will come true.

F. Medicine=Health?

If medicine is to help us live disease-free, how do Pharmaceutical cos forecast growth? It is only because if we take one medicine today, we will need MORE medicine tomorrow. General approach today is that you indulge we are there to look after. In any case not enough emphasis for diseasefree body. When someone suggested to Dr. SR Jindal in one of the open sessions at Jindal Institute, Bangalore, to open more such institutes all over India, and if there be constraint of funds, these may be operated on commerical basis. His response was that any institute which runs on commercial basis has to please the customer. Such institutes cannot impose discipline, which is a must for disease-free life. Now there is a Centre started in US to counsel on Life Style. Counselling Doctor's problems a. takes longer than prescribing medicine b. insurance does not pay for it

G. Misconceptions

a. Toothpaste cleans the teeth. This is not true. Function of tooth paste is only to lubricate. One person even suggested that it may be better to clean with soap. Salt will provide medium where bacteria cannot flourish. This was used for cleaning teeth mixed with few drop of oil. Rinsing the mouth with salt water last thing in the night possibly is better alternative than brushing the teeth.

b. Dettol etc have antiseptic properties. This is not true. Only publicity has given us this perception. These are just detergents as good or as bad as any other soap/detergent.

H. Impact on GDP

1. Many people believe that if we do not indulge, our economy will suffer. I believe, there is a good GDP and bad GDP, like productive employment and unproductive employment. GDP will fall if

a. Cancer is wiped out of USA

b. People stop smoking

2. Calamities like Earth Quake, Floods increase GDP, without increasing nation's wealth. Unfortunately nations do not keep record of Gross Domestic Wealth, like balance Sheet of a co. Even Wealth does not include education level, health level in the society. Bhutan carries out a survey regarding 'Happinesss Index' of their people.

I. Impact of change

1. Deterioration is like slow poisoning. Unless one is conscious it may not attract attention. Improvement is even slower, just as going uphill is slower than going downhill. Improvement is like adding 1 drop of colour in a bucket of water daily, nothing visible till a long time, so do not get disheartened if improvement takes time to be seen.